bluuebunny/crossref_metadata_2025 huggingface dataset:
The epidemiology of hysterectomy: findings in a large cohort study
Authors: VESSEY MARTIN P. , VILLARD‐MACKINTOSH LAURENCE , MCPHERSON KLIM , COULTER ANGELA , YEATES DAVID
Published: August 2005

Objective
To examine patterns of hysterectomy in the Oxford‐Family Planning Association (Oxford‐FPA) study in relation to age, parity, social class and calendar period (–1974, 1975–79. 1980–84, 1985–89).

Design
The Oxford‐FPA study is a large scale prospective study of 17 032 women recruited from 1968–74 and still under observation.

Setting
Seventeen family planning centres throughout England and Scotland.

Subjects
At recruitment the 17 032 women were all white, British, married, aged 25–39 and willing to co‐operate. In addition, they were using the pill or an intrauterine device or a diaphragm as their method of contraception.

Main outcome measure Hysterectomy rates per 1000 woman‐years of observation in various subclasses of the data.

Results
Up to the end of 1989, 1885 (11.1%) of the 17 032 women in the study were known to have undergone hysterectomy. Fibroids were the most common cause followed closely by menstrual disturbances in the absence of fibroids (hereafter referred to as ‘menstrual disturbances’). Social class had a modest influence on hysterectomy rates. Hysterectomy for fibroids, prolapse, endometriosis and ‘other reasons’ showed little trend with calendar period while hysterectomy for menstrual disturbances and for cancer showed a sharp increase with calendar time especially at ages 30–39. Hysterectomy generally tended to increase with age and showed a strong relation to parity; in particular, hysterectomy for fibroids fell with parity and hysterectomy for menstrual disturbances rose sharply with parity. Using lifetable methods, it was estimated that almost 20% of the women in the study would have had a hysterectomy by age 55.

Conclusions
The results give insights into factors affecting hysterectomy rates. Of particular interest is the modest influence of social class, the strong influence of parity and the rise in rates with calendar time at ages 30–39 for those undergoing hysterectomy for menstrual disturbances or cancer, but since the cohort is not directly representative of the population, some caution is required in extrapolating these findings. The estimated hysterectomy rate of about 20% by age 55 is in line with other similar estimates for the United Kingdom.
Secondary amenorrhoea: prevalence and medical contact—a cross–sectional study from a Danish county
Authors: MÜNSTER KIRSTINE , HELM PETER , SCHMIDT LONE
Published: August 2005

Objective
To examine the prevalence of secondary amenorrhoea and the patterns of seeking medical advice for secondary amenorrhoea in an unselected population.

Design
Cross‐sectional postal questionnaire study.

Setting
County of Copenhagen, Denmark.

Subjects
3743 women, aged 15–44, selected at random from a Danish county who were asked to provide information on menstrual patterns for the preceding year, 1988. The response rate was 78%. Information from non‐responders was obtained via telephone interviews.

Results
One‐year period prevalence of secondary amenorrhoea of more than 3 months duration was 4.6% and was 7.6%, 3.0%, and 3.7% in women aged 15–24, 25–34, and 35–44 respectively. The duration of secondary amenorrhoea was 6 months or less in 75% aged 15–34 years, but longer than 6 months in 55% of those aged 35–44 years. A social gradient was found of the prevalence of secondary amenorrhoea (odds ratio 3.3, 95% CI 1.5–8.3) in the lowest social group compared with the highest social group; controlled by age. Only 39% of women with secondary amenorrhoea had contacted a doctor. Educational level or social status did not seem to influence the frequency of medical contact in women with amenorrhoea.

Conclusion
Spontaneous return of the menstrual cycle occurs within 6 months in many amenorrheic women below the age of 35. The detailed investigation of secondary amenorrhoea in this age group can be postponed until it is of 6 months duration, unless there is clinical suspicion of disease. The relative infrequency with which women with secondary amenorrhoea seek medical advice constitutes an important source of selection bias in hospital‐based clinical research on this topic.
Detection of small‐for‐gestational‐age fetuses by ultrasound screening in a high risk population: a randomized controlled study
Authors: LARSEN TORBEN , LARSEN JØRGEN FALCK , PETERSEN STEN , GREISEN GORM
Published: August 2005

Objective
To assess the value of fetal weight estimation during routine third trimester ultrasound examinations for the identification of small‐for‐gestational‐age (SGA) fetuses, to promote active pregnancy management and so reduce perinatal morbidity.

Design
A prospective controlled randomized study.

Setting
Outpatient clinic at the Department of Obstetrics, Herlev University Hospital, Denmark.

Subjects
One thousand pregnant women considered at risk were selected consecutively from April 1985 to September 1987 and randomized to either a revealed‐results group or a withheld‐results group.

Intervention
All the women had an early ultrasound examination for estimation of gestational age. Both groups had routine ultrasound estimates of fetal weight after 28 weeks and then every third week until delivery. The results were available for clinical use only in the revealed group.

Main outcome measures
Number of interventions during pregnancy (admission to hospital, elective delivery), emergency intervention during labour, and fetal outcome.

Results
Revealing the results of ultrasound estimates of fetal weight for gestational age during the third trimester resulted in statistically significantly increased diagnosis of SGA fetuses, of elective deliveries based on this diagnosis, and of healthy preterm babies admitted to the neonatal care unit, but no detectable overall improvement in weight for gestational age at birth, or in neonatal morbidity or mortality.

Conclusion
This method of screening improved the diagnosis of SGA fetuses, but this was not followed by improved fetal outcome.
Prevalence of hepatitis B and C viruses and human immunodeficiency virus infections in women of reproductive age
Authors: PURO V. , GIRARDI E. , IPPOLITO G. , LO PRESTI E. , BENEDETTO A. , ZANIRATTI S. , GIANNINI V. , GIOIA C. , NATILI S. , TOSSINI G. , POMINI P. , RIZZI N. , TELLINI P.
Published: August 2005

Objective: To determine the prevalence of hepatitis B and C viruses, and human immunodeficiency virus infections in women of reproductive age attending a health care System.

Design: Prospective cross‐sectional study.

Setting: Public Obstetric Clinic and Service for Pre‐ and Perinatal Prevention of Infectious Diseases, Rome, Latium Region, Italy.

Subjects: 1142 women attending our centres consecutively for delivery, miscarriage, voluntary Interruption of pregnancy or screening for pre‐ and perinatal prevention of infectious diseases.

Interventions: Serum samples, collected after informed consent over a period of 2 months, were tested for hepatitis B virus markers (anti‐HBc and HBsAg) by enzyme linked immunosorbent assay (ELISA), for antibodies against hepatitis C virus (by ELISA and, if positive, by RIBA) and for human immunodeficiency virus antibodies (by ELISA and, if positive by Western blot).

Results: The seroprevalence of hepatitis B virus was 144% (95% CI Poisson distribution 12.2–16.5) for anti‐HBc and 1.6% (95% CI, 0.9–2.5) for HBsAg. Antibodies against hepatitis C virus were detected by ELISA in 2.4% (CI 1.6–3.5) and by first generation RIB A in 0.9% (CI 0.4–1.6). Human immunodeficiency virus seroprevalence was 1.0% (CI 0.5–1.7). No significant differences were observed by age or by reason for attending.

Conclusions: Women attending our centres have a higher prevalence of hepatitis B virus, hepatitis C virus and human immunodeficiency virus infection than those observed in our country in larger national surveys of newborn babies, in reproductive‐aged women or in other selected low‐risk groups such as blood donors. This could be due to the attendance of women at increased risk such as drug addicts. The Information has the additional value of emphasizing the need for adherence by health care personnel, to the recommendations issued for the prevention of occupational infections.
Experience with the Cardial inferior vena cava filter as prophylaxis against pulmonary embolism in pregnant women with extensive deep venous thrombosis
Authors: NARAYAN HARINI , CULLIMORE JOHN , KRARUP K. , THURSTON H. , MACVICAR JOHN , BOLIA A.
Published: August 2005

Objective
To report the use of the Cardial inferior vena caval filter as prophylaxis against pulmonary embolism in pregnant women with extensive iliofemoral thrombosis.

Setting
Leicester Royal Infirmary.

Subjects
Four pregnant women with extensive iliofemoral thrombosis, deemed to be at high risk of pulmonary embolism, managed over a period of one year.

Technique
In addition to standard full anticoagulation with heparin, the Cardial inferior vena cava filter was introduced percutaneously under local anaesthesia through the unaffected contralateral femoral vein and positioned in the inferior cava below the renal veins.

Results
The procedure was uncomplicated and did not compromise feto‐maternal condition. There was no evidence of pulmonary embolism after filter insertion.

Conclusion
The use of inferior vena cava filters should be considered as an adjunct to intravenous anticoagulation in pregnant women with extensive deep vein thrombosis of the lower limbs.
A case‐control study of unexplained antepartum stillbirths
Authors: ALESSANDRI LOUISA M. , STANLEY FIONA J. , GARNER J. BARRY , NEWNHAM JOHN , WALTERS BARRY N. J.
Published: August 2005

Objective
To ascertain factors that will identify women who are at increased risk of unexplained antepartum stillbirth.

Design
Matched case‐control study. The cases and controls were initially analysed as a whole group and again after dichotomizing into those of low birthweight (<2500 g) and those of normal birthweight (<=2500 g).

Setting
Western Australia 1980–1983.

Subjects
Unexplained antepartum stillbirths of ≥ 1000 g birthweight (cases) and liveborn infants individually matched for year of birth, plurality, sex and birthweight of infant and race of mother (controls).

Results
The case pregnancies had more polyhydramnios (OR 10.83, 95% CI 2.41–48.69) and cord problems (OR 6.57 95% CI 1.36–31.75) than the controls but, paradoxically, other obstetric and medical complications were less common in the cases. The association with polyhydramnios persisted when the analysis was confined to those with low birthweight. With normal birthweight fetal distress was more frequent in the cases (OR 3.65 95% CI 1.36–9.80) but there were few other differences.

Conclusions
The clinical and diagnostic systems currently in use are unable to identify many fetuses at risk of death. Decreases in the rate of unexplained antepartum stillbirths await the discovery of new preventable causes, or of innovations in clinical or laboratory aspects of obstetric care.
Do fetal pulse oximetry readings at delivery correlate with cord blood oxygenation and acidaemia?
Authors: McNAMARA HELEN , CHUNG D. CHRISTOPER , LILFORD RICHARD , JOHNSON NICHOLAS
Published: August 2005

Objective
To assess the accuracy of a pulse oximeter in the fetus.

Design
A prospective descriptive study, comparing oxygenation and acidaemia of cord blood with oxygen saturation in the arteries of the fetal scalp measured by a pulse oximeter just before delivery. The data were collected using an experimental pulse oximeter and a sensor specifically adapted to cope with the problems of fetal pulse oximetry.

Setting
The labour ward in a teaching hospital.

Subjects
Thirty seven Caucasian fetuses presenting by the vertex in normal uncomplicated labour.

Main outcome measure
Fetal pulse oximetry reading shortly before birth, umbilical cord oxygenation and pH, and Apgar scores.

Results
Data of sufficient quality were obtained from 28 fetuses. There was a highly significant correlation between pulse oximetry reading and umbilical vein oxygen saturation r= 0.59, P= <0.001). There was also a significant correlation between the pulse oximeter reading and cord blood pH (vein: r= 0.57, P= 0.002, artery: r= 0.63, P= 0.001). Apgar scores were not related to the oximetry results.

Conclusion
Pulse oximetry readings reflect fetal oxygenation at birth.
Does admission to hospital for bed rest prevent disease progression or improve fetal outcome in pregnancy complicated by non‐proteinuric hypertension?
Authors: CROWTHER C. A. , BOUWMEESTER A. M. , ASHURST H. M.
Published: August 2005

Objective
To test whether a policy of admission to hospital for rest is of value in the management of women with non‐proteinuric hypertension during pregnancy.

Design
A randomized controlled trial. Setting Harare Maternity Hospital, Zimbabwe.

Subjects
218 (28 first pregnancies) women with non‐proteinuric hypertension and a singleton pregnancy at between 28 and 38 weeks gestation allocated to rest in hospital or routine outpatient care.

Intervention
Admission to hospital for rest. Encouraged to rest in bed although voluntary ambulation around the ward was allowed. The women in the control group were encouraged to continue normal activity at home, to check urine each day for proteinuria. All the women were reviewed weekly.

Main outcome measures
Disease progression was assessed by the development of severe hypertension (≥160/110 mmHg), development of proteinuria, need for induction of labour and number of infants born preterm (≤37 weeks). Fetal outcome was assessed by birthweight, number of infants small‐for‐gestational age (SGA), and the number of infants requiring admission to the neonatal unit and their length of stay.

Results
The hospital rest group had a decreased risk of developing severe hypertension (blood pressure ≥160/110 mmHg [odds ratio 0.47, 95% CI 0.26–0.83]). No differences were found in fetal growth or neonatal morbidity. The mean antenatal stay in hospital was 22.2 (SD 16.5), and 6.5 (SD 7.9) days in the rest and control groups, respectively.

Conclusions
Hospital admission for bed rest decreased the risk of developing severe hypertension but no improvement in fetal growth or neonatal morbidity was observed. Fetal monitoring at home and continued outpatient antenatal care provided a safe, alternative policy to hospital admission.
Transvaginal sonography for fetal measurement in early pregnancy
Authors: KUSTERMANN ALESSANDRA , ZORZOLI ALESSANDRO , SPAGNOLO DANIELE , NICOLINI UMBERTO
Published: August 2005

Objective
To establish reference ranges for fetal size by gestation in the first trimester as indicated by cephalic, abdominal and limb measurements using trans‐vaginal sonography.

Design
A prospective descriptive study.

Setting
Two antenatal clinics in Milan, Italy.

Subjects
270 women with normal singleton pregnancies at 42–108 days gestation. All had regular cycles and certain dates.

Interventions
Vaginal ultrasound examination including inspection of fetal structures and lasting 5–15 min.

Main outcome measures
As many of the following fetal measurements as possible according to gestational age and ease: crown‐rump length (CRL), biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur and foot lengths.

Results
CRL was measured in 183 fetuses, BPD in 201, HC in 162, AC in 160, femur length in 133 and foot length in 62. The best description of the relation of CRL to gestational age was achieved by a quadratic function (y =−3.98 − 0.308×+ 0.0117×2). Mean values thus derived were virtually identical to those obtained by Robinson & Fleming in 1975 with transabdominal static scanning. Fetal BPD, HC, AC and femur length correlated more closely with CRL than gestational age. Reference ranges (mean and 95% data intervals) were constructed for each biometrical measurement in relation to gestational age and CRL. The HC/AC and femur/foot length ratios did not show any significant variation with gestational age or CRL.

Conclusions
These data may be useful in the early detection of genetic disorders affecting the growth of fetal head, trunk and limbs. Genetic and/or environmental variables play an appreciable role in the modulation of early fetal growth.
Diagnosis of bacterial vaginosis in a gynaecology clinic
Authors: HAY P. E. , TAYLOR‐ROBINSON D. , LAMONT R. F.
Published: August 2005

Objective
To estimate the prevalence of bacterial vaginosis in women referred to a gynaecology clinic, and to compare two methods of diagnosing bacterial vaginosis.

Setting
Gynaecology Clinic at Northwick Park Hospital

Subjects
114 women aged 16 to 65 referred consecutively to the gynaecology clinic of one consultant.

Main outcome measures
Detection of bacterial vaginosis by standard compound criteria and by examination of a Gram stained smear of fluid from the posterior vaginal fornix.

Results
Bacterial vaginosis was detected by both the Gram stain and the compound criteria in 13 women. There was no correlation between the symptom of vaginal discharge and the diagnosis of bacterial vaginosis in this population, but the presence of discharge noted by the clinician was associated with bacterial vaginosis.

Conclusions
The prevalence of bacterial vaginosis was 11%. The Gram stain provides a simple and inexpensive method for laboratory confirmation of bacterial vaginosis where facilities for using the compound criteria are not available.
Outpatient falloposcopy; intra‐luminal imaging of the fallopian tube by trans‐uterine fibre‐optic endoscopy as an outpatient procedure
Authors: SCUDAMORE IAN W. , DUNPHY BRUCE C. , COOKE IAN D.
Published: August 2005

Objective
To develop trans‐uterine falloposcopy using the linear eversion tech‐nique in outpatients.

Design
A prospective, descriptive study of the introduction and application of this new technique.

Setting
A tertiary referral University Research Clinic independent of operating theatres and inpatient admission.

Subjects
Twenty‐one infertile women with previous evidence of fallopian tube disease.

Main outcome measures
Rate of successful tubal cannulation and procedure completion, tubal section visualized, condition of the tubal epithelium, subsequent treatment plan.

Results
A bilateral examination was attempted in 19/21 patients and completed in 18. Two early falloposcopies with inadequate analgesia were aborted due to pain after only one tube had been examined without an attempt to identify or cannulate the contralateral tubal ostium. In one patient, neither ostium was identified or can‐nulated. After ostial localization, 37/37 tubes were cannulated. If the ostium was not localized but ‘blind’ cannulation attempted, 1/3 were cannulated successfully. Epithelium characteristic of the ampulla was seen in 31/38 (82%) tubes, and of the proximal tube only in 3/38 (8%). Successful bilateral assessment noted complete bilateral proximal obstruction in 2/18 patients, non‐obstructive bilateral endotubal damage in 7/18, unilateral damage in 3/18 and bilateral healthy tubes in 6/18. Unilateral examination in two patients found minimal evidence of damage in one and severe intra‐tubal adhesions in the other. After falloposcopy, 11/21 patients elected for 1VF, 9/21 tubal surgery and 1/21 for IVF whilst awaiting surgery.

Conclusion
Falloposcopy is a technique which can be performed in an outpatient clinic. It is well tolerated, and high rates of luminal cannulation and visualization are possible. Atraumatic access to the tube and visualization of its lumen offer excit‐ing opportunities for diagnosis and treatment of tubal conditions.
Breech delivery and epidural analgesia
Authors: CHADHA YOGESH C. , MAHMOOD TAHIR A. , DICK MICHAEL J. , SMITH NORMAN C. , CAMPBELL DORIS M. , TEMPLETON ALLAN
Published: August 2005

Objective
To examine the effect of epidural analgesia on the progress and outcome of spontaneous labour in women with a singleton breech presentation at term (3=37 weeks).

Design
A retrospective study.

Setting
Data Bank, Aberdeen Maternity Hospital.

Subjects
643 women (273 primiparae and 370 multiparae) with a singleton breech presentation and spontaneous onset of labour at term.

Outcome measures
Duration of labour; augmentation of labour with oxytocin infusion; caesarean section rates.

Results
Epidural analgesia was associated with a significantly increased need for augmentation of labour with oxytocin infusion (P<0.001) and longer duration of labour (P<0.001), irrespective of parity. Comparing women who had epidural analgesia with those who did not, there was no significant difference in caesarean section rates in the first stage of labour in primiparae (odds ratio 1.79; 95% CI0.88–3.63) or multiparae (odds ratio 0.97; 95% CI 0.48–1.96). Epidural analgesia was associated with a significantly increased likelihood of caesarean section in the second stage of labour, both in primiparae (odds ratio 5.43; 95% CI 2.46–11.95) and multiparae (odds ratio 5.37; 95% CI 2.07–13.87). The increased likelihood of caesarean section in the second stage in primiparae with epidurals was independent of the extent of cervical dilatation (<3 cm or ≥3 cm) on admission. However, in multiparae with epidurals, the difference in second stage caesarean section rate was significant only when initial cervical dilatation was <3 cm (odds ratio 3.65; 95% CI 1.14–11.65).

Conclusion
Epidural analgesia was associated with longer duration of labour, increased need for augmentation of labour with oxytocin infusion and a significantly higher caesarean section rate in the second stage of labour.
Survey of colposcopy service provided by genito‐urinary medicine in England and Wales
Authors: WILLIAMS OLWEN , BODHA MARGARET , HICKS D. , ALAWATTEGAMA A. B.
Published: August 2005

Objective
To investigate the expansion of colposcopy services within genitourinary medicine (GUM) in England and Wales since 1985.

Design
Data collected by postal and verbal communication from 189 genitourinary medicine clinics in England and Wales in January 1990.

Subjects
Consultant and junior genito‐urinary physicians practising colposcopy.

Main outcome measures
Number of clinics providing colposcopy service; indication for colposcopy, treatment facilities available, waiting lists and training opportunities, compared with that in 1985.

Results
Of the 189 genito‐urinary medicine clinics contacted, 60 provided a colposcopy service and 55 of these returned completed questionnaires. There has been a 67% increase in the number of colposcopes in use and over 50% of clinics have the facilities to treat cervical pathology. Waiting lists were minimal for both examination and treatment. Both men and women are examined with the colposcope for a variety of indications. At present, 52% of career grade GUM physicians practise colposcopy compared to 24% in 1985 and 94% of senior registrars compared with 42% in 198.5 were in training or trained in colposcopy.
Gynaecologists' abortion practice
Authors: FRANCOME COLIN , SAVAGE WENDY D.
Published: August 2005

Objective
To ascertain the relation between gynaecologists' opinions on the provision of abortion and the service provided by the Health Service in their district and to investigate the methods used for second trimester abortion.

Design and Setting
A postal questionnaire sent three times to a 50% random sample of gynaecologists practising in the National Health Service (NHS) in 1989 in Great Britain.

Subjects
343 of 396 practising gynaecologists, 87% of those selected.

Main outcome measures
Proportion of gynaecologists holding views or reporting practice.

Results
Although only 11% actually performed abortions beyond 20 weeks, 57% approved later operations in cases of rape and 85% for a threat to the woman's health; only 47% approved late abortion for schoolgirls under 16 years. Dilatation and evacuation was used by only 1% of NHS gynaecologists even though from 13 to 16 weeks it is a safe and efficient method. Although Government statistics report that vacuum aspiration is used in over one third of second trimester abortions, this is technically unlikely and was not confirmed by this study. Less than 50% of abortions in England and Wales are performed in the NHS yet fewer than 40% of gynaecologists reported problems in providing an abortion service. Overall 21% thought they were providing abortions for over 90% of the women resident in their districts, whereas only 2% of districts achieve this proportion in their home regional health authority. Overall 60% supported separating abortion work from general gynaecology, and 45% would like regional abortion units. Only 27% supported fertility control acquiring the status of a subspecialty.

Conclusions
Accepting these suggestions would improve the service, reduce regional variations in provision, provide opportunities for research and could have an important effect in helping slow the world population increase.
Which hormone tests for the diagnosis of polycystic ovary syndrome?
Authors: ROBINSON S. , RODIN D. A. , DEACON A. , WHEELER M. J. , CLAYTON R. N.
Published: August 2005

Objective
To assess the frequency of abnormal values for hormone measurements commonly used in the biochemical diagnosis of polycystic ovary syndrome (PCOS).

Design
Hormone measurements in 63 unselecled women with clinical and ultrasound diagnosis of PCOS attending gynaecological and general endocrine clinics in a District General Hospital were compared with those from a group of 20 normal ovula‐tory controls in the early follicular phase of their cycles.

Measurements
Serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), LH/FSH ratio, total testosterone, derived free testosterone, sex hormone binding globulin, androstenedione, and dehydroepiandrosterone (DHEA) were measured by radioimmunoassays. LH and FSH measured by two different assays.

Results
The mean serum LH and LH/FSH ratio were significantly (P<0.01) higher in the women with PCOS compared with the normal group, but these two measurements were in the abnormal range for only 35% and 41–44%, respectively. Absolute gonadotrophin values were significantly different using the two assay methods, which employed the same reference preparation as standard. Mean serum total testosterone concentration was significantly higher in the PCOS group and was the most frequently (70%) abnormal biochemical marker for PCOS. Sex hormone binding globulin (SHBG) did not differ significantly between the two groups but showed a negative correlation with body mass index in women with PCOS. The combination of SHBG and testosterone to derive a free testosterone value did not further aid the biochemical diagnosis of PCOS. Androstenedione was significantly higher in the PCOS group than in the control group, with a frequency of 53%. There was no significant difference in DHEA‐S between the two groups.

Conclusion
When typical ovarian ultrasound appearances plus the clinical features of oligomenorrhoea and/or hirsuitism were used to define PCOS total testosterone was the best single hormonal marker of the condition. Testosterone, androstenedione or LH, either alone or in combination, were raised in 86% of women with PCOS and these should be the definitive hormonal tests. Using LH/FSH ratio as a biochemical criterion for diagnosis of PCOS should be abandoned because of its low sensitivity. To be of value the normal range for all hormones should be precisely defined in a group of regularly ovulating women in the early follicular phase of the cycle for the assay used in each laboratory.
Contact factor mediated fibrinolysis is increased by the combined oral contraceptive pill
Authors: Campbell S. J. , Mackie I. J. , Robinson G. E. , Machin S. J.
Published: August 2005

Objective
To study the fibrinolytic pathways and their relationship with the contact system in women using combined oral contraceptives (COCs).

Design
Serial plasma samples were collected from 18 women before treatment with COCs containing 30 μg oestrogen during treatment cycles 3 and 6, and 2 weeks after stopping treatment. Fibrinolysis was measured before and after dextran sulphate mediated contact activation using fibrin plates.

Results
Fibrinolysis increased significantly during cycles 3 and 6 (from 77% to 100% and 113%, respectively, P<0.01) and showed a further increase after dextran sulphate activation (from 134% to 158% and 167%, respectively, P<0.01). Tissue‐plasminogen activator, urokinase‐plasminogen activator and plasminogen activator inhibitor did not change significantly. There were significant elevations of Factor XII (from 0.92 μ/ml to 1.43 u/ml, P<0.01) and prekallikrein (0.94 u/ml to 1.10 u/ml, P<0.05) in cycle 3, which both remained high at cycle 6 (P<0.01) and decreased after stopping the COC. Alpha‐2‐macroglobulin and C1‐esterase inhibitor showed no significant change, but alpha‐1‐antitrypsin increased from 0.85 u/ml to 1.11 u/ml by cycle 3 (P<0.01), and returned to near normal levels after stopping the COC.

Conclusions
The increase in fibrinolysis may be due to increased levels of Factor XII and prekallikrein without a corresponding increase in their natural inhibitors (C1‐esterase inhibitor and alpha‐2‐macroglobulin). A parallel increase in the intrinsic pathway of coagulation may be limited by elevated alpha‐1‐antitrypsin at the level of activated Factor XI. The increase in fibrinolysis caused by oral contraceptives may balance any potential thrombotic risk due to increased fibrinogen or vitamin K dependent coagulation factors.
Fractured clavicle of the newborn in a population with a high prevalence of grand‐multiparity: analysis of 78 consecutive cases
Authors: Turnpenny P. D. , Nimmo A.
Published: August 2005

Objective
To perform a clinical analysis of newborn babies with a fractured clavicle and investigate the possible role of relative calcium deficiency in the aetiology.

Design
Prospective descriptive study (clinical aspects); case controlled study (calcium, phosphate, alkaline phosphatase).

Setting
The Nazareth Hospital, Israel.

Subjects
All babies with a fractured clavicle detected in the newborn period and their mothers delivered between 23 August 1987 and 22 June 1989. The majority of the population were Arab.

Interventions
Serum calcium, phosphate and alkaline phosphatase were measured on the third postpartum day in 42 affected babies (with uncomplicated deliveries), their mothers, and a matched group of babies and mothers as controls.

Main outcome measures
Clinical associations of fractured clavicle of the newborn; statistical comparison of affected group with controls (calcium study).

Results
The incidence of fractured clavicle was 18.7 per 1000 singleton vaginal births; 38 in the posterior clavicle at delivery, 27 in the anterior, position unascertained in nine. Four (5.2%) occurred in instrumental deliveries, three (3.9%) in assisted breech delivery; shoulder dystocia was noted in 13. The male to female ratio of 51:26 was significantly different but not due to birth weight. Affected babies were significantly heavier than the unaffected population. The incidence was higher in parous mothers older than 25 years of age but there was no evidence of increased incidence with increasing parity. No significant results were obtained in the calcium study between affected babies and their mothers, when compared with controls.

Conclusions
Fractured clavicle of the newborn is a benign form of birth trauma from which heavier babies are at greater risk. It occurs in 1 to 2% of deliveries, most of these being uncomplicated vaginal births, and is often undetected. There is no evidence for relative calcium deficiency.
Whole blood platelet aggregation in moderate and severe pre‐eclampsia
Authors: Norris Lucy A. , Gleeson Noreen , Sheppard Brian L. , Bonnar John
Published: August 2005

Objective
To compare whole blood platelet aggregation in moderate and severe pre‐eclampsia with normal pregnancy.

Design
Whole blood platelet aggregation in response to collagen, ADP, PAF, adrenalin and arachidonic acid was measured in the pre‐eclampsia group at 36 weeks gestation and at 1, 24 and 48 h and at five days and six weeks post delivery. The normal pregnancy group were studied serially at 12, 20, 28, 32, and 36 weeks gestation and at 1, 24, 48 h and six weeks post delivery.

Setting
Trinity College Medical School, St James's Hospital, Dublin.

Subjects
Thirty women with diagnosed pre‐eclampsia were recruited for the study. Fifteen of these women had severe pre‐eclampsia and the remaining 15 had moderate disease. The pre‐eclampsia group were compared with 20 healthy primigravid women with uncomplicated pregnancies and deliveries.

Results
In women with severe pre‐eclampsia, platelet aggregation in response to collagen, ADP, adrenalin and arachidonic acid was significantly lower at 36 weeks gestation compared with normal pregnancy. Lower levels of collagen induced aggregation were also found at 1 h post delivery when compared with normal pregnancy. Women with moderate pre‐eclampsia showed a decreased response to aggregating agents at 36 weeks gestation but this was not significant. ADP, collagen and PAF induced aggregation was higher in women with moderate pre‐eclampsia at 36 weeks gestation and during the early puerperium compared with severe pre‐eclampsia.

Conclusions
The clinical signs of pre‐eclampsia are accompanied by a reduction in platelet responsiveness, the extent of which is related to the severity of the disease. This suggests that an abnormal platelet activation occurs early in pregnancies destined to be complicated by pre‐eclampsia. This activation may be involved in the pathogenesis of pre‐eclampsia since its inhibition using low dose aspirin has been shown to modify the disease in high risk pregnancies.
Prediction of morbidity in small and normally grown fetuses by fetal heart rate variability, biophysical profile score and umbilical artery Doppler studies
Authors: Soothill P. W. , Ajayi R. A. , Campbell S. , Nicolaides K. H.
Published: August 2005

Objective
To assess the ability of noninvasive tests of fetal wellbeing to predict hypoxic morbidity independent of fetal size.

Design
A prospectively planned, longitudinal, observational study.

Setting
Fetal Surveillance Unit, King's College Hospital, London.

Subjects
One hundred and ninety‐one pregnant women with singleton pregnancies who were delivered after 32 weeks' gestation who were seen in the Fetal Surveillance Unit within seven days of delivery.

Interventions
Fetal surveillance by fetal abdominal circumference, heart rate variability (mean range), biophysical profile score and umbilical artery pulsatility index measurements.

Main outcome measures
Birthweight was classified as < or ≤2.5th centile (AGA or SGA) for gestational age and sex. Morbidity was defined as at least one of the following at birth: delivery by emergency caesarean section for fetal distress, umbilical venous blood pH less than 7.15, 5 min Apgar score less than 7 or admission to the Special Care Baby Unit (SCBU).

Results
Fetal abdominal circumference was the best indicator of which fetuses (n = 30) would be SGA. Fourteen of the 30 (47%) SGA fetuses had morbidity at birth and abnormal umbilical Doppler studies significantly predicted this (χ2= 2.93, P= 0.003). By contrast, fetal heart rate variability and the biophysical profile score did not. Twenty‐seven of the 161 (17%) AGA fetuses had morbidity at birth, but this was not significantly predicted by heart rate variability, biophysical profile score or umbilical Doppler studies.

Conclusions
None of the antenatal testing techniques studied predicted morbidity in normally grown fetuses but Doppler studies indicated whether a small fetus was ‘sick small’ or ‘normal small’.
Denervation and re‐innervation of the urethral sphincter in the aetiology of genuine stress incontinence: an electromyographic study
Authors: Barnick C. G. W. , Cardozo L. D.
Published: August 2005

Objective
To investigate the role of altered innervation of the urethral sphincter in the genesis of genuine stress incontinence.

Design
Prospective observational study.

Setting
Tertiary referral centre urodynamics unit.

Subjects
Sixty‐eight women, 33 with urodynamically proven pure genuine stress incontinence and 35 controls without urinary symptoms.

Interventions
Concentric needle electromyography of the urethral striated sphincter.

Main outcome measures
The means of motor unit potential duration, number of changes in polarity and the amplitude of individual motor unit potentials were compared between the two groups.

Results
There was no statistically significant difference in motor unit potential duration (P= 0.87) or in the number of changes in polarity (P= 0.85). There was a trend towards a higher amplitude of motor unit potentials in the control group (P= 0.07).

Conclusions
Our findings suggest that denervation and re‐innervation of the striated urethral sphincter following trauma to the pelvic floor, such as that occurring during childbirth, is not a major aetiological factor in the development of genuine stress incontinence.
Reagent strip testing of antenatal urine specimens for infection
Authors: Etherington I. J. , James D. K.
Published: August 2005

Objective
To compare reagent strip testing (RST) with microscopy and culture in identifying significant bacteriuria, and secondly, to consider potential cost savings if RST screening proved to be reliable.

Design
Prospective descriptive study.

Setting
Antenatal Clinic, Bristol Maternity Hospital.

Subjects
Eight hundred and ninety‐eight women having urine testing in pregnancy for microscopy and culture either routinely or because of a clinical indication.

Interventions
The midstream specimens of urine had RST examination using Ames Multistix 8SG prior to being sent to the laboratory.

Main outcome measure
Significant culture (>105 colonies/ml) of a single organism in culture.

Results
The highest predictive value for a negative result of the urine culture (99.7%) was obtained when using four RSTs in combination. The RST for nitrite had a high predictive value for a positive urine culture (90%). The samples which gave a false negative result with RST screening were mainly infected with low grade urinary pathogens or genital tract contaminants.

Conclusion
RST screening for bacteriuria provides a reliable and cheap alternative to culture of all urine specimens.
Plasma protein levels in normal human fetuses: 13 to 41 weeks' gestation
Authors: Fryer A. A. , Jones P. , Strange R. , Hume R. , Bell J. E.
Published: August 2005

Objective
To establish reference ranges for the levels of alpha‐fetoprotein, albumin, prealbumin (transthyretin) alpha‐1‐antitrypsin, transferrin, ceruloplasmin and total protein in the plasma of normal human fetuses and newborn babies.

Design
Prospective study of individual normal cases to fulfil objectives.

Setting
Pathology laboratories of the University of Edinburgh and the biochemistry laboratories of the University of Keele.

Subjects
Twenty‐two normal fetuses 13 to 22 weeks of gestation and 66 babies born between 24 and 41 weeks gestation.

Results
Albumin is the predominant plasma protein throughout gestation. The levels of alpha‐fetoprotein and prealbumin fell significantly with increasing gestation, whereas the concentrations of the other proteins studied increased. The ratios of individual proteins to total protein demonstrated similar trends.

Conclusions
This study provides developmental profiles of normal human fetal plasma proteins to serve as possible reference data for abnormal fetuses. Declining levels of prealbumin (transthyretin) were unexpected and suggest a functional role for this protein in early pregnancy.
Second trimester ambulatory blood pressure in nulliparous pregnancy: a useful screening test for pre‐eclampsia?
Authors: Kyle P. M. , Clark S. J. , Buckley D. , Kissane J. , Coats A. J. S. , de Swiet M. , Redman C. W. G.
Published: August 2005

Objective
To assess the effectiveness of second trimester 24‐hour ambulatory blood pressure measurement as a screening test for pre‐eclampsia.

Design
Prospective interventional study.

Setting
John Radcliffe Maternity Hospital, Oxford, and Queen Charlotte's and Chelsea Hospital, London.

Subjects
One hundred and sixty‐two normotensive nulliparous women recruited at hospital booking clinics.

Intervention
Ambulatory blood pressure was measured at 18 and 28 weeks gestation using the TM2420 monitor.

Main outcome measure
The development of pre‐eclampsia.

Results
Awake systolic and mean arterial pressures were significantly increased (P<0.02) at 18 weeks in those who later developed pre‐eclampsia. Those differences were more apparent at 28 weeks at which time the diastolic pressure was also increased (P<0.01). At both stages of gestation the higher readings were sustained during sleep so that the awake‐sleep differences were similar in relation to each outcome. The group with incipient pre‐eclampsia had a significantly faster heart rate at both 18 and 28 weeks (P<0.002) The sensitivity in predicting pre‐eclampsia for a mean arterial pressure of 85 mmHg or greater at 28 weeks was 65%, with a positive predictive value of 31 %. The sensitivity and positive predictive value for a test combining a mean arterial pressure of 85 mmHg or greater and a heart rate of 90 bpm or greater were 53% and 45%, respectively.

Conclusion
Although second trimester ambulatory blood pressure is significantly increased in women who later develop pre‐eclampsia, the predictive values for blood pressure alone are low. The efficiency of the test is increased by combining the awake ambulatory heart rate and blood pressure measurement together. If an effective method for preventing pre‐eclampsia becomes available (commencing at 28 weeks gestation), then awake ambulatory blood pressure and heart rate may have some clinical value as a screening test.
Can laparoscopic assisted hysterectomy safely replace abdominal hysterectomy?
Authors: Hunter R. W. , McCartney A. J.
Published: August 2005

Objective
To evaluate the feasibility, safety and advantages of laparoscopic hysterectomy.

Design
Retrospective review.

Setting
St. John of God Hospital, Perth, Australia.

Subjects
Fifty‐four women scheduled to undergo laparoscopic hysterectomy for a variety of benign gynaecological conditions.

Main outcome measures
Failure to complete the operation laparoscopically, time taken in theatre, incidence of febrile morbidity, incidence of major complications, duration of post‐operative stay in hospital, interval from operation to full activity and return to work.

Results
Laparoscopic hysterectomy was attempted in 54 women. A total of 53 operations were completed laparoscopically with one conversion to laparotomy because of haemorrhage. Major complications occurred in two women, both of whom required further surgery. There were four cases of febrile morbidity. The average duration of post‐operative stay was four days (range 2–9), with return to normal activity in two and a half weeks and to work in three weeks.

Conclusions
Laparoscopic hysterectomy can be successfully achieved in most women selected for the procedure. Serious complications are inherent to some of the techniques used, but these can be overcome by modifications. Proper training and supervision in laparoscopic surgery is essential during the learning phase of the technique. There are considerable advantages to eligible women in terms of a rapid return to normal activities and work.
A study of endometrial morphology in women who failed to conceive in a donor insemination programme
Authors: Li T. C. , Klentzeris L. , Barratt C. , Warren M. A. , Cooke S. , Cooke I. D.
Published: August 2005

Objective
To examine the morphology of endometrium in women who failed to conceive after nine or more cycles of donor insemination treatment.

Design
Prospective study.

Setting
Jessop Hospital for Women, Sheffield.

Subjects
Two groups: twenty‐six infertile women and a control group of eight fertile women.

Intervention
Endometrial biopsy specimens were obtained in the mid‐luteal phase, timed precisely by the luteinising hormone surge.

Main outcome measure
Morphological study of endometrial biopsy specimens by the use of traditional dating criteria and established morphometric techniques.

Results
Twelve biopsy specimens (42%) were found to be retarded. In addition, morphometric analysis revealed significant differences in the glandular component of the endometrium between the infertile and fertile groups.

Conclusion
Endometrial defect leading to implantation failure may be an important underlying cause of failure to conceive after repeated attempts at donor insemination. The endometrium should be investigated in this group of women, and further attempts at donor insemination treatment should be offered only in conjunction with attempts to restore the normality of the endometrium.
Changes in amniotic arachidonic acid metabolism associated with increased cyclo‐oxygenase gene expression
Authors: Bennett Phillip R. , Slater Donna , Sullivan Mark , Elder Murdoch G. , Moore Gudrun E.
Published: August 2005

Objectives
To study the differences in the metabolism of arachidonic acid, to prostaglandins and other eicosanoids, between amnion cells before and after labour. To study the changes in the expression of the type 1 cyclo‐oxygenase gene associated with the changes in arachidonic acid metabolism.

Design
Amnion cells collected before labour, at elective caesarean section, and following spontaneous labour and delivery were established in mono‐layer culture. Intracellular arachidonic acid pools were radio‐labelled and the metabolic fate of endogenous archidonic acid was then studied using high performance liquid chromatography. RNA was extracted from the cell cultures and expression of the cyclooxygenase gene was studied using northern hybridisation to a sheep cyclo‐oxygenase cDNA.

Results
Metabolism of endogenous arachidonic acid in amnion cells established in culture prior to labour is principally via lipoxygenase and epoxygenase enzyme pathways to di‐ and mono‐HETEs and EET with little cyclo‐oxygenase metabolism to prostaglandins. Following labour there is a large increase in arachidonic acid metabolism with a change in the cyclo‐oxygenase: lipoxygenase enzyme pathway ratio in favour synthesis of prostaglandin E2. Whilst synthesis of lipoxygenase metabolites doubles, the increase in prostaglandin E2 synthesis is ten fold. Expression of the cyclo‐oxygenase gene is significantly greater in cell cultures established following spontaneous labour and delivery than in those established following elective caesarean section prior to labour.

Conclusions
In association with labour there is an increase in arachidonic acid metabolism in amnion cells and a change in the ratio of metabolism via cyclo‐oxygenase and lipoxygenase enzyme pathways to increase synthesis of prostaglandin E2. This change is associated with increased expression of the cyclooxygenase gene.
Changes in the concentration of alpha‐fetoprotein and placental hormones following two methods of medical abortion in early pregnancy
Authors: Thong K. Joo , Norman Jane E. , Baird David T.
Published: August 2005

Objective
Measurement of alpha‐fetoprotein (AFP) was used to investigate the occurrence of feto‐maternal haemorrhage in women undergoing medical abortion.

Design
Three groups of women with amenorrhoea of 56 or less days were studied. A control and a mifepristone group had two blood samples taken 48 h apart. Women undergoing medical abortion with gemeprost had two blood samples taken 24 h apart.

Setting
Medical Termination Unit, Simpson Memorial Maternity Pavilion, Edinburgh.

Subjects
Three hundred and thirty‐five women requesting abortion.

Interventions
Blood samples taken at 24 h or 48 h apart.

Measurements and main results
The rise in concentration of AFP in plasma was much higher (P= 0.01) in the two groups of women in whom abortion was induced by gemeprost or mifepristone than in control women. Whereas only 5% of women in the control group had a significant rise in AFP, 27% and 33% of women in the mifepristone and gemeprost groups, respectively, had a rise in AFP level which exceeded the 95th centile (≥38%). The concentration of hCG rose by 48 h in both control and mifepristone groups. Progesterone remained unchanged, and oestradiol decreased (P<0.02) in the mifepristone group. By 24 h, there was a significant fall in the concentrations of hCG, progesterone and oestradiol in the group who had aborted after being given gemeprost.

Conclusions
Anti‐D prophylaxis must be administered to rhesus negative women to avoid rhesus iso‐immunisation.