bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparison of oral and vaginal misoprostol tablets in induction of labour at term
Authors: Shetty Ashalatha , Danielian Peter , Templeton Allan
Published: December 2003

Objective
To compare the efficacy of equivalent doses of orally administered with vaginally administered misoprostol in induction of labour at term.

Design
A non‐blinded randomised controlled trial.

Setting
Induction and labour wards of a UK teaching hospital.

Participants
Two hundred and forty‐five pregnant women at term, with medical or obstetric indications for labour induction and unfavourable cervices.

Methods
The women were randomly assigned to receive 50μgm of misoprostol orally or vaginally four hourly to a maximum of five doses.

Main
outcome measures Interval from induction to vaginal delivery, mode of delivery, oxytocic and analgesic requirements in labour, neonatal outcome, patient satisfaction and acceptability.

Results
The mean induction to vaginal delivery interval was significantly shorter in the vaginal group compared with the oral group (17.8h vs 27.9h: mean difference 10.1hrs, 95% CI 5.8–14.4). More women were delivered within 24 hours (80%vs 46.3%; RR 1.7, 95% CI 1.3–2.1) and fewer women needed oxytocin augmentation (39%vs 58.2%; RR 0.67, 95% CI 0.5‐0.9) in the vaginal group. There was no difference in the mode of delivery, analgesic requirements or neonatal outcomes in the two groups. There was a higher incidence of uterine hyperstimulation in the vaginal group (4.9%vs 0.8%, RR 6, 95% CI 0.07–48.7) and more caesarean sections were performed for fetal distress in this group (13%Vs 2.4%, RR 5.3, 95% CI 1.6–17.7), although the overall operative delivery rate was similar in the two groups.

Conclusion
Misoprostol effectively induces labour, with the vaginal route of administration having a faster action than the oral route in equivalent doses. However, the more frequent occurrence of hyperstimulation and the higher intervention rate for fetal distress in the vaginal group could mean that the preferred route might be oral. More trials are needed to find the right oral dosage that combines efficacy with safety.
The effect of stopping smoking on cervical Langerhans'cells and lymphocytes
Authors: Szarewski Anne , Maddox Peter , Royston Patrick , Jarvis Martin , Anderson Malcolm , Guillebaud John , Cuzick Jack
Published: December 2003

Objective
To investigate the effects of stopping smoking on cervical Langerhans’ cells and lymphocytes.

Design
Prospective intervention study.

Setting
A large family planning clinic in central London.

Population
Women volunteers prepared to attempt to give up smoking for six months. Their most recent cervical smear showed no abnormality greater than mild dyskaryosis.

Methods
The women were seen at three‐month intervals for six months. Reduction in smoking was assessed by self‐reporting and validated by salivary cotinine concentrations. Colposcopy and a biopsy of a normal area were performed at the first and last visits. Any area of abnormality was also biopsied at the final visit. Langerhans’ cells and lymphocytes were counted.

Main
outcome measures Proportional changes in counts of Langerhans’ cells and lymphocytes with reduction in smoking.

Results
Reduction in smoking by 20 to 40 cigarettes per day was significantly associated with a reduction of between 6% and 16% in counts of Langerhans cells, CD8 and total lymphocytes. Heavy smoking was significantly associated (P= 0.02) with an increased chance of persistent human papillomavirus infection. The presence of candida was associated with significantly higher counts of between 41% and 47% in total lymphocytes and CD8 lymphocytes. In contrast, the presence of anaerobic vaginosis was associated with significantly lower counts of between 16% and 30% in Langerhans cells, CD4 and CD8 lymphocytes.

Conclusions
This large intervention study has demonstrated a clear relationship between reduction in smoking and changes in cervical immune cell counts. Future studies need to take into account cytokine interactions, which recent studies suggest may be significant in the immune response to both human papillomavirus and cervical intraepithelial neoplasia and the ever‐increasing complexity of the cell‐mediated immune system of the cervix.
Antibiotic prophylaxis to prevent post‐abortal upper genital tract infection in women with bacterial vaginosis: randomised controlled trial
Authors: Crowley Tessa , Low Nicola , Turner Andrew , Harvey Ian , Bidgood Ken , Horner Patrick
Published: December 2003

Objective
To determine the prevalence of bacterial vaginosis in women undergoing first trimester suction termination of pregnancy and to evaluate the efficacy of metronidazole in reducing the risk of post abortal pelvic infection in women with bacterial vaginosis.

Design
Randomised double‐blind placebo‐controlled trial.

Setting
Two teaching hospitals and one district general hospital.

Sample
Two hundred and seventy‐three women with bacterial vaginosis undergoing termination of pregnancy.

Methods
Women with bacterial vaginosis, diagnosed using modified Spiegel's criteria, were individually randomised to receive either a 2 g metronidazole suppository or identical placebo per‐operatively. Participants, doctors and investigators were blinded to treatment allocation. Participants were asked to complete a questionnaire about post‐operative symptoms, visits to the general practitioner, antibiotic treatment, readmission to hospital, contraception and emotional response after one month.

Results
The prevalence of bacterial vaginosis was 29.3% (326/1111). Intention‐to‐treat analysis showed that post‐operative upper genital tract infection developed in 12/142 (8.5%) women allocated to metronidazole and 21/131 (16.0%) women randomised to placebo, a difference of 7.6% (95% confidence intervals –15.4 to +0.2%; relative risk 0.53, 0.27 to 1.03, P= 0.055). The effect of prophylaxis was similar when the analysis was restricted to women receiving the allocated treatment and with complete follow up. There was no difference in the risk of readmission to hospital and the frequencies of self reported symptoms in the two groups were similar.

Conclusion
This randomised placebo‐controlled trial among women with bacterial vaginosis provides weak evidence that metronidazole decreases the risk of upper genital tract infection after first trimester suction termination of pregnancy but a chance finding could not confidently be excluded. Large well‐conducted randomised trials with long term outcome measures are now needed to determine the most effective antibiotic combinations and strategy for prevention of post‐abortal pelvic infection.
Circulatory responses to maternal hyperoxaemia and hypoxaemia assessed non‐invasively in fetal sheep at 0.3–0.5 gestation in acute experiments
Authors: Kiserud Torvid , Jauniaux Eric , West Daniel , Ozturk Ozkan , Hanson Mark A.
Published: December 2003

Objectives
To determine fetal haemodynamic responses to hyperoxaemia and hypoxaemia in early pregnancy.

Design
Repeated measurements in acute experiments.

Setting
Experimental physiology laboratory.

Methods
Non‐invasive Doppler ultrasound of the umbilical vein, ductus venosus, umbilical and common carotid arteries of 12 fetal lambs (0.27–0.56 gestation) during maternal hyperoxaemia and hypoxaemia under ketamine anaesthesia. The effect of gestational age, hyperoxaemia, and hypoxaemia were assessed based on analysis of variance for dependent measurements and P≤ 0.05 was considered significant. Differences between groups were considered significant if the 95% confidence interval did not include zero.

Results
Gestational age had a significant effect on the blood velocity in the umbilical vein and ductus venosus. There were no circulatory changes during hyperoxaemia, but a simultaneous increase of pCO2 was an important confounder. However, hypoxaemia caused significantly reduced heart rate, reduced maximum and weighted mean blood velocity, and augmented pulsation in the umbilical vein. Hypoxaemia also caused reduced velocities in the ductus venosus (peak velocity during systole and minimum during diastole, and time‐averaged velocity) and augmented pulsation of the flow velocity. Additionally, the pulsatility of blood flow increased in the umbilical artery and was reduced in the common carotid artery.

Conclusions
Maternal hypoxaemia in early pregnancy causes similar fetal circulatory responses to those in late pregnancy: bradycardia, reduced venous flow velocities, augmented pulsatility in veins and a redistributional flow velocity pattern of the umbilical and common carotid arteries.
Epidural compared with general anaesthesia for caesarean delivery in conscious women with eclampsia
Authors: Moodley J. , Jjuuko G. , Rout C.
Published: December 2003

Objective
To compare retrospectively the outcome of caesarean section under epidural anaesthesia with that of general anaesthesia in “stable” women with eclampsia.

Design
Retrospective review.

Method
Over the five–year study period, there were 533 women with eclampsia and of these 66 women (12.4%), fulfilled the criteria of being ‘stable’. Of the 66 women, 37 received epidural, 27 general, and 2 spinal anaesthesia.

Results
There were no major complications with either general or epidural anaesthesia. Epidural anaesthesia was associated with higher one–minute Apgar scores.

Conclusion
This study indicates that both maternal and neonatal outcomes are not affected adversely by the use of epidural anaesthesia in selected cases of eclampsia.
Effects of gynaecological education on interpersonal communication skills
Authors: van Dulmen A.M. , van Weert J.C.M.
Published: December 2003

Objective
To investigate the effects of an experimental communication course on how gynaecologists handle psychosocial issues in gynaecological consultation.

Design
Pre‐post testing. Multilevel analysis was used to take into account the similarity among encounters with the same gynaecologist.

Sample
Eighteen gynaecologists (13 consultants and 5 junior doctors) from five different hospitals participated. All gynaecologists videotaped consecutive outpatient encounters before and after attending an intensive training course.

Main
outcome measures The communicative performance of the gynaecologists at pre‐and post measurement.

Results
The gynaecologists recorded a total of 526 outpatient encounters, 272 before and 254 after the training. As a result of the training, gynaecologists’ sensitivity to psychosocial aspects of their patients increased. At post measurement, the gynaecologists gave more signs of agreement, became less directive, asked fewer medical questions and more psychosocial questions. No difference was found in the duration of the outpatient visits. With the trained gynaecologists, patients asked more questions and provided more psychosocial information.

Conclusions
Junior doctors and clinically experienced gynaecologists can be taught to handle psychosocial issues without lengthening the visit.
Induced myeloperoxidase activity and related superoxide inhibition during hormone replacement therapy
Authors: Békési Gabor , Kakucs Reka , Varbiro Szabolcs , Feher Janos , Pazmany Tamas , Magyar Zoltan , Sprintz Detlef , Szekacs Bela
Published: December 2003

Objective
To test whether the menopause entails any changes in the myeloperoxidase activity of neutrophil granulocytes. The effects of hormone replacement therapy on myeloperoxidase activity and related changes in free radical production were also investigated.

Design
Laboratory investigation of the effect of oestrogen on intracellular myeloperoxidase activity and release from human neutrophil granulocytes. Analysis of related changes in superoxide anion generation.

Setting
2nd Department of Medicine and 1st Department of Obstetrics and Gynaecology, Semmelweis University, Budapest.

Samples
Intracellular myeloperoxidase activity (mean peroxidase index) was measured automatically in blood samples obtained for general laboratory work‐up from 135 randomly selected patients in our department. Blood samples from 11 postmenopausal women were analysed before and during hormone replacement therapy. Blood samples from 20 healthy volunteers were obtained and neutrophil granulocytes separated for in vitro measurement of superoxide anion production after adding myeloperoxidase to the incubation media.

Methods
The mean peroxidase index was measured using a Technicon H‐3 instrument. myeloperoxidase release from neutrophils was quantified by ELISA technique. Superoxide production of isolated neutrophil granulocytes was measured by photometry.

Main
outcome measures Intracellular activity of myeloperoxidase, concentration of myeloperoxidase‐protein in supernatant of neutrophils, release of superoxide anion from neutrophil granulocytes.

Results
1. Intracellular myeloperoxidase activity in neutrophils was lower in postmenopausal women, than in females with regular cycles (‐1.84 ±3.06 versus 1.59 ±3.55, P<0,001). 2. In postmenopausal women intracellular myeloperoxidase activity and myeloperoxidase release increased during hormone replacement therapy (‐5.54 ±6.63 versus ‐0.2 ±6.05; P<0.001 and 52.74 mU/ml ±25.73 versus 251.4 ±234.1 mU/ml; P<0.05). 3. Adding myeloperoxidase to neutrophil granulocyte suspensions, the production of superoxide anion fell (e.g. adding 280 ng/ml myeloperoxidase: 77.9 ±14.04 % of control production, P<0.001).

Conclusion
Hormone replacement restores the reduced myeloperoxidase activity in menopausal women. Adding myeloperoxidase to neutrophil granulocytes, the production of free radicals decreases.
Contribution of cervical smooth muscle activity to the duration of latent and active phases of labour
Authors: Pajntar Marjan , Leskošek Branimir , Rudel Drago , Verdenik Ivan
Published: December 2003

Objective
To identify the effect of cervical muscle activity as an additional factor influencing the duration of the latent and active phase of labour.

Design
Prospective observational study.

Setting
The Ljubljana Maternity Hospital.

Participants
Fifty healthy nulliparous women requiring induction of labour having relatively unripe cervices.

Methods
At the onset of labour an open‐ended catheter was inserted to measure intrauterine pressure during the latent and active phase of labour. Electromyographic activity of the cervix was registered by two bipolar spiral needle electrodes placed in the transverse direction on the proximal part of the cervix in the vagina. The mean intensity of distinctive peaks in an electromyographic spectrogram were calculated in the time/frequency domain. Multiple linear regression was used to find factors affecting the duration of the latent and active phase of labour.

Main outcome measures
Duration of the latent and active phase of labour.

Results
Eleven independent variables explained 64% of the variance of the latent phase duration, the most important being the effacement and consistency of the cervix, and intensity of electromyographic signals. For the duration of the active phase the same variables explained 36% of the variance; the most important variables were mean duration of uterine contractions, mean maximum intensity of uterine contractions and the newborn's head circumference.

Conclusions
The cervical smooth muscle activity, expressed as an electromyographic signal, contributes to the duration of the latent phase but not to the duration of the active phase. However, frequent cervical contractions are not associated with a longer latent phase.
Rate of rise in maternal plasma corticotrophin‐releasing hormone and its relation to gestational length
Authors: Leung T.N. , Chung T.K.H. , Madsen Gemma , Lam Peggo K.W. , Sahota Daljit , Smith Roger
Published: December 2003

Objective
To assess the relationship between rate of increase in maternal plasma corticotrophin‐releasing hormone and gestational length.

Design
A prospective observational study.

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

Methods
Serial venous samples taken at four to six week intervals from 81 pregnant Chinese subjects were assayed for corticotrophin‐releasing hormone concentrations. The investigators responsible for the laboratory assay were blinded to the obstetric outcome.

Results
A total of 380 blood samples were taken. Each subject provided three to seven samples (median =5). Seven of the 81 subjects had preterm delivery. Maternal corticotrophin‐releasing hormone levels increased exponentially as gestation advanced. A negative correlation between the rate of rise of logarithmic equivalence of corticotrophin‐releasing hormone concentrations (Ln‐corticotrophin releasing hormone) per week and the gestational age at delivery was demonstrated (r =−0.45, P<0.001). The rate of increase of Ln‐corticotrophin releasing hormone concentrations per week was also significantly greater for those who delivered preterm before 37 weeks compared with those with uncomplicated term deliveries (0.27 Vs 0.22, P= 0.018).

Conclusions
The rate of increase in maternal plasma corticotrophin‐releasing hormone is inversely proportional to gestational length. Results in a Chinese population confirm and extend results from previous caucasian populations. This study provides another piece of evidence on the close link between maternal plasma corticotrophin‐releasing hormone and the timing of human parturition. As the hormone is synthesized by the placenta, it supports the suggestion that the human placenta has an important role in determining gestational length.
Vaginal microbiological flora, and behavioural and clinical findings in women with vulvar pain
Authors: Tchoudomirova Krasimira , Mårdh Per‐Anders , Hellberg Dan
Published: December 2003

Objective
To study genital symptoms and signs in women with vulvar pain, and the association with potential risk factors such as microbiological agents, sexual behaviour and genital hygiene.

Design
Prospective cohort study of apparently healthy women attending for contraceptive advice.

Setting
Two family planning clinics and one youth clinic in Sweden.

Population
Out of 996 women recruited, 79 women (7.9%) had, on request, complaints of current burning and smarting vulvar pain and/or superficial dyspareunia (our definition of vulvar pain) while 917 women without such symptoms served as controls.

Results
Complaints of dysmenorrhoea, vaginal discharge, genito‐anal pruritus, dysuria, and abdominal pain were more frequent in the study group, than in the control group. In the women with vulvar pain, erythemas, superficial ulcerations, and fissures were found significantly more frequently. Vaginal candidosis was the only current genital infection that occurred more often in the study group, than among the controls. There were no differences in the history of gonorrhoea, genital chlamydial infection, genital herpes, genital warts, and candidosis between the two groups. The sexual debut of the women with vulvar pain occurred later in life, compared with the control group. Control subjects were more likely to use tampons for menstrual sanitation, than the women with vulvar pain.

Conclusions
Neither infectious conditions caused by current known agents, with the exception of candidosis in some cases, nor behavioural factors, such as sexual behaviour and genital hygiene habits could in this study explain vulvar pain.
Screening with a uterine Doppler in low risk pregnant women followed by low dose aspirin in women with abnormal results: a multicenter randomised controlled trial
Authors: Goffinet François , Aboulker Danielle , Paris‐Llado Josefa , Bucourt Martine , Uzan Michèle , Papiernik Emile , Bréart Gérard ,   Collaborators and participating centres of the French Doppler study group are listed on page 517.
Published: December 2003

Objectives
To assess whether systematic screening with an uterine artery Doppler in low risk pregnant women followed by the prescription of low dose aspirin in cases with abnormal results reduced the incidence of intrauterine growth restriction and pre‐eclampsia.

Design
A multicentre randomised trial.

Population
3317 low risk pregnant women. In the Doppler group, the uterine artery Doppler was performed between 20 and 24 weeks. Women with abnormal results received 100 mg of aspirin daily until the 35th week.

Main
outcome measures Intrauterine growth restriction was defined as birthweight below the tenth and the third centile according to gestational age. Pre‐eclampsia was defined as hypertension associated with proteinuria > 0.5g/L.

Results
Intrauterine growth restriction, whether defined by the third or tenth centile, did not differ significantly between the two groups (RR = 1.22 [0.73 ‐ 2.04] and 1.18 [0.93 ‐ 1.51] respectively). Screening with uterine artery Doppler did not affect birthweight or any of the criteria of perinatal morbidity. There was no effect on the incidence of pre‐eclampsia (RR = 1.99 [0.97 ‐ 4.09]) or hypertensive disorders. These results were the same for nulliparae and multiparae.

Conclusions
There is no justification for screening with uterine artery Doppler in a low risk population, even if abnormal results are followed by aspirin treatment and increased prenatal surveillance. Future studies must assess predictive tests that can be performed early in pregnancy and can identify populations at very high risk of pre‐eclampsia and intrauterine growth restriction. Only when all of these conditions are fulfilled, aspirin or other treatments may prove its efficacy.
Efficacy of mifepristone followed on the same day by misoprostol for early termination of pregnancy: report of a randomised trial
Authors: Creinin Mitchell D. , Schwartz Jill L. , Pymar Helen C. , Fink Wendy
Published: December 2003

Objective
To examine the clinical efficacy of mifepristone 600 mg followed on the same day or two days later by misoprostol 400μg orally in women undergoing medical termination of pregnancy whose pregnancies have a gestational age up to 49 days.

Design
Prospective, randomised trial.

Setting
Clinical research office.

Participants
Eighty‐six women, requesting elective termination of a pregnancy which has a gestational age of ≤ 49 days.

Methods
After administration of mifepristone 600 mg, participants were randomised to take misoprostol six to eight hours later (Group 1) or 48 hours later (Group 2). Women returned for a follow up evaluation 24±1 hours after taking the misoprostol. Participants in Group 1 who had not aborted received a second dose of misoprostol to take 48 hours after the mifepristone. All women returned approximately two weeks after receiving mifepristone. If termination of pregnancy had still not occurred and the pregnancy was non‐viable, the woman returned again in three weeks.

Main
outcome measures Rate of complete abortion 24 hours after administration of misoprostol.

Results
At 24 hours after receiving misoprostol, 21/42 (50%, 95% CI 35%, 65%) women in Group 1 and 40/44 (91%, 95% CI 82%, 99%) women in Group 2 had complete abortions. By follow up two weeks later after the administration of mifepristone, 40/42 (95%, 95% CI 89%, 100%) women in Group 1 and 43/44 (98%, 95% CI 93%, 99%) women in Group 2 were known to have complete abortions. Nausea, vomiting or diarrhoea in women using the standard regimen (Group 2) occurred in 68%, 36%, and 20%, respectively.

Conclusions
After treatment with mifepristone 600 mg, administration of misoprostol 400 μg orally on the same day is not as effective at causing abortion within the first 24 hours compared with the standard time interval of 48 hours between medications.
Wide scope prenatal diagnosis at Kuopio University Hospital 1997‐1998: integration of gene tests and fetal karyotyping
Authors: Kallinen Juuso , Marin Katja , Heinonen Seppo , Mannermaa Arto , Palotie Aarno , Ryynänen Markku
Published: December 2003

Objective
To investigate the applicability of carrier screening in women undergoing invasive prenatal diagnosis.

Design
Prospective study.

Setting
University‐based clinic.

Participants
Two hundred and fifty‐six pregnant women.

Methods
Gene tests were offered for fragile X syndrome, aspartylglycosaminuria and infantile neuronal ceroid lipofuscinosis at the time of invasive prenatal testing.

Results
The overall uptake of the tests was 92%. Previously unrecognised carriership was found in 10 women: aspartylglycosaminuria (7); infantile neuronal ceroid lipofuscinosis (2) and fragile X (1). Fetal genotyping was carried out in one carrier of aspartylglycosaminuria whose partner was also a carrier, and in one woman who was found to have fragile X premutation. Both fetuses were unaffected.

Conclusion
Carrier screening for single‐gene disorders is feasible and well accepted among pregnant women undergoing invasive prenatal testing. The major benefit is that there is no need to consider extra invasive tests when carriership is detected. Incorporation of genetic testing into fetal karyotyping gives more security to future parents.
Anxiety levels in women attending colposcopy clinics for treatment for cervical intraepithelial neoplasia: a randomised trial of written and video information
Authors: Freeman‐Wang Theresa , Walker Patrick , Linehan John , Coffey Claire , Glasser Brian , Sherr Lorraine
Published: December 2003

Objective
To assess the effectiveness of video information in reducing the level of anxiety in women attending Colposcopy clinics.

Design
An observational study followed by a randomised trial.

Setting
Colposcopy Clinic, Royal Free Hospital, London.

Participants
Between April and December 1999, all new referrals to the clinic with a cervical smear showing moderate or severe dyskaryosis.

Main outcome measure
The level of anxiety measured by the Spielberger State Anxiety Inventory.

Conclusion
Women attending colposcopy clinics for either diagnosis or treatment, experience a high level of anxiety. The highest levels occur in women attending a one‐stop see and treat clinic. The introduction of visual information in the form of an explanatory video prior to attendance significantly reduced anxiety.
A novel in vitro co‐culture system for the study of maternal decidual endothelial cell–trophoblast interactions in human pregnancy
Authors: Gallery Eileen D.M. , Campbell Suzanne , Ilkovski Biljana , Sinosich Michael J. , Jackson Christopher
Published: December 2003

Investigation of the pathophysiology of pre‐eclampsia (characterised by insufficient invasion of the intrauterine vasculature by cytotrophoblasts) has been hampered by the absence of a suitable animal model, and ethical constraints in clinical studies. We have developed a novel in vitro human cell co‐culture system allowing direct assessment of cytotrophoblast invasion of a decidual endothelial cell monolayer from the abluminal side, as occurs in vivo. This model will facilitate detection, at the cellular level, of abnormal endothelial cell–trophoblast functional interactions in pre‐eclampsia and other pregnancy disorders with abnormal placentation.
Impact of pneumoperitoneum on visceral metastasis rate and survival. Results in two ovarian cancer models in rats
Authors: Lécuru Fabrice , Agostini Aubert , Camatte Sophie , Robin François , Aggerbeck Martine , Jaïs Jean‐Philippe , Vildé Françoise , Taurelle Roland
Published: December 2003

Objective
To compare the impact of CO2 laparoscopy, gasless laparoscopy, and midline laparotomy on the development of distant metastases and on survival in two ovarian carcinoma models.

Design
A prospective randomised study in rats.

Material
and methods Two ovarian cancer xenografts were obtained by intraperitoneal injection of IGR–OV1 or NIH–OVCAR‐3 cells. Experimental surgical procedures were performed on day 7 (IGR–OV1 model) or day 14 (NIH: OVCAR‐3 model) after intraperitoneal injection: CO2 laparoscopy (pneumoperitoneum (PNP) with unheated CO2 at a pressure of 8 mmHg for 1 hour); gasless laparoscopy (consisting in abdominal wall expansion by a balloon for 1 hour); midline laparoscopy (consisting in bowel exteriorisation on a mesh for one hour following xyphopubic laparotomy). The control group underwent general anaesthesia alone. The animals were killed by CO2 inhalation as soon as they became moribund.

Main
outcome measures Pathological examination was carried out on the liver, lungs and pleura as well as the retroperitoneal nodes. Survival was determined from the time of surgery to the sacrifice of the animal. Statistical analysis used ANOVA, Fisher exact test, Bonferonni method and the log‐rank test.

Results
In the IGR–OV1 model, distant metastases were rare, and were not promoted by CO2 laparoscopy. With the NIH: OVCAR‐3 model, pleural, pulmonary and para‐aortic metastases were not enhanced by CO2 PNP when compared with other approaches. Conversely, midline laparotomy and laparoscopy significantly increased liver involvement when compared with gasless laparoscopy (P= 0.04 and P= 0.008). Survival was comparable no matter what kind of surgery had been performed in the IGR–OV1 model (P= 0.7) or in the NIH: OVCAR‐3 model (P= 0.5).

Conclusions
CO2 laparoscopy had a minor impact on distant and nodal metastases in the two models. Similarly, survival was similar for all surgical groups.
False positive serum biochemical screening and subsequent fetal loss in women less than 35 years of age
Authors: Antsaklis Aris J. , Papantoniou Nikolaos E. , Daskalakis George J. , Mesogitis Spyros A. , Kitmirides Stylianos J. , Michalas Stylianos S.
Published: December 2003

Objective
To examine the fetal loss rate in women younger than 35 years of age following a false positive serum biochemical screening.

Design
Retrospective analysis of case records between 1991 and 1998.

Setting
Fetal medicine unit of a large teaching hospital.

Population
Four hundred and fifty‐six women with singleton pregnancies and false positive serum biochemical screening for Down's Syndrome (study group). Nine hundred and twelve matched controls with true negative serum biochemical screening (control group).

Methods
Women of both groups had a second trimester serum screening for Down's Syndrome using alpha fetoprotein, human chorionic gonadotrophin (hCG) and unconjugated oestriol (uE3); and they also underwent genetic amniocentesis.

Results
The overall fetal loss rate in the study group was 5.3% (24/456), compared with 1.65% (15/912) in the control group RR 3.2, 95% CI 1.7‐5.99; P<0.001). The majority of fetal losses in the study group occurred after 28 weeks, while in the controls this happened between 24 and 28 weeks of gestation.

Conclusions
A false positive serum biochemical screening in women under 35 years of age is associated with a threefold increased risk of subsequent fetal loss. However, most of fetal losses in this group occurred after 28 weeks, indicating that intensive antepartum fetal surveillance could improve the perinatal outcome.
The accuracy of lamellar body count and lecithin/sphingomyelin ratio in the prediction of neonatal respiratory distress syndrome: a meta‐analysis
Authors: Wijnberger L.D.E. , Huisjes A.J.M. , Voorbij H.A.M. , Franx A. , Bruinse H.W. , Mol B.W.J.
Published: December 2003

Objective
To compare the performance of the lecithin/sphingomyelin ratio and the lamellar body count in the prediction of neonatal respiratory distress syndrome.

Design
Meta‐analysis.

Sample
Six studies reporting on the performance of both the lecithin/sphingomyelin ratio and the lamellar body count published between January 1966 and August 1999.

Methods
We performed a computerised MEDLINE search to identify articles published on the subject. For the six selected studies, prevalence of respiratory distress syndrome and sensitivity and specificity of the tests in the prediction of respiratory distress syndrome were calculated, and overall performance was assessed by constructing summary receiver–operating characteristic curves.

Results
The constructed summary receiver–operating characteristic curves showed the lamellar body count to perform slightly better than the lecithin/sphingomyelin ratio in the prediction of respiratory distress syndrome (P= 0.13).

Conclusions
Since the lamellar body count can be performed quickly and since it is less expensive than the lecithin/sphingomyelin ratio, we recommend the former as the test of first choice in the assessment of fetal lung maturity.
Premenopausal women affected by sexual arousal disorder treated with sildenafil: a double‐blind, cross‐over, placebo‐controlled study
Authors: Caruso Salvatore , Intelisano Giorgia , Lupo Lorenzo , Agnello Carmela
Published: December 2003

Objective
To verify whether sildenafil is effective in young premenopausal women affected by arousal disorder.

Design
A double‐blind cross‐over study.

Setting
Centre for Sexological Research, Department of Microbiological and Gynaecological Science, University of Catania, Italy.

Sample
Fifty‐three volunteer women aged 22–28 years affected by arousal disorders.

Methods
The study consisted of three 4‐week periods: sildenafil, washout, placebo, by six possible sequences. sildenafil was used at 25 mg or 50 mg.

Main
outcome measures Efficacy was assessed at baseline and once monthly by the Personal Experiences Questionnaire based on the 5‐point Likert scale. The questionnaire quantified subjective arousal (primary endpoint), and orgasm, enjoyment, sexual frequency, and the number of sexual fantasies.

Results
Fifty‐one women completed the study. Mean (SD) usage of sildenafil 25mg and 50mg was, respectively, 2.8 (0.8) and 2.7 (1.3) times weekly, while mean usage of placebo was 2.8 (1.6) times weekly. During both sildenafil dosages, arousal and orgasm improved with respect to placebo (P<0.001). Therapeutically significant differences were not noted during the treatment with both 50 mg and 25 mg of sildenafil for arousal and orgasm. The frequency of sexual fantasies and of sexual intercourse, and enjoyment, improved in the women treated with sildenafil (P<0.05).

Conclusions
Our study suggests that sildenafil may improve sexual performance of women affected by sexual difficulties such as arousal disorder, and may indirectly improve other aspects of sexual life. Moreover, further studies need to define the use of PDE type 5 inhibitors in this sexual pathophysiology.
Fever in labour and neonatal encephalopathy: a prospective cohort study
Authors: Impey Lawrence , Greenwood Catherine , MacQuillan Kathryn , Reynolds Margaret , Sheil Orla
Published: December 2003

Objective
To determine whether the reported association of maternal fever with neonatal encephalopathy is independent of other associated intrapartum risk factors.

Design
Prospective cohort study.

Setting
Dublin teaching hospital delivery ward.

Population
4915 low risk women in labour at 36‐41 weeks of gestation.

Methods
Using logistic regression with odds ratios and 95% confidence intervals, the incidence of neonatal encephalopathy and other neonatal outcomes of women who had an intrapartum fever >37.5° C was compared with those who did not.

Results
The cohort comprised 33% of all deliveries during the study period. Neonatal encephalopathy was diagnosed in 3.25/1000 births. The incidence of intrapartum fever was 6.8%. Maternal fever was strongly associated with neonatal encephalopathy (crude OR 10.8, 95% CI 4.0‐29.3). Univariate analysis showed maternal fever was associated with epidural analgesia, nulliparity, induction, longer labour, oxytocin administration, greater fetal birthweight and gestational age and instrumental vaginal delivery, but not with prolonged (>24hours) prelabour rupture of the membranes. The association of fever with neonatal encephalopathy persisted having adjusting for these covariates (adjusted OR 4.72, 95% CI 1.28‐17.4).

Conclusions
The relationship between maternal intrapartum fever and neonatal encephalopathy is independent of other known intrapartum risk factors. This provides further evidence for the role of inflammatory processes in the aetiology of neonatal neurological morbidity.
Beta‐3 versus beta‐2 adrenergic agonists and preterm labour: in vitro uterine relaxation effects
Authors: Dennedy Michael C. , Friel Anne M. , Gardeil Francois , Morrison John J.
Published: December 2003

Objective
1. To investigate the effects of the selective beta‐3 adrenoreceptor agonist, BRL 37344, on human pregnant myometrial contractility in vitro. 2. to compare these effects with those of the beta‐2 adrenoreceptor agonist, ritodrine.

Methods
Isometric tension recording was performed under physiological conditions in isolated myometrial strips from biopsies obtained at elective caesarean section. Following pre‐incubation with oxytocin (10‐9 M), the effects of cumulative additions of BRL 37344 or ritodrine (10‐8–10‐3.5 M) on myometrial contractility were investigated. Results were expressed as ‐log EC50 (pD2) and mean maximal inhibition achieved for both drug compounds.

Results
BRL 37344 exerted a concentration dependant relaxant effect on myometrial contractions in all strips exposed [pD2, 7.26 (0.48) (SEM); mean maximal inhibition 61.98 (4.89%); n= 6]. Similarly, ritodrine exerted a concentration dependant inhibition of myometrial contractility in all strips exposed [pD2= 7.40 (0.28); mean maximal inhibition 59.49 (3.97%); n= 6]. There was no significant difference between calculated pD2 values (P= 0.65) or mean maximal inhibition achieved (P= 0.79).

Conclusions
The beta‐3 adrenoreceptor agonist BRL 37344 induced relaxation of human myometrial contractions with similar potency to that of the most commonly used tocolytic agent ritodrine. This raises the possibility that the novel beta‐3 adrenoreceptor agonists may have potential as therapeutic agents for human preterm labour. In view of their reported reduced cardiovascular side effects their potential clinical use requires further evaluation.
Lay persons’ understanding of the risk of Down's Syndrome in genetic counselling
Authors: van Vliet Hubertus A.A.M. , Grimes David A. , Popkin Benjamin , Smith Ursula
Published: December 2003

Genetic counselling traditionally expresses risk in proportions (e.g. 1 in 112) rather than as rates (e.g., 8.9 per 1000). The justification for this practice is unclear. To assess the understanding of lay persons of the risk of Down's Syndrome, whether expressed as rates or as proportions, we analysed 589 self‐administered questionnaires. Overall, respondents understood rates significantly better than proportions (76.2%vs 72.3% correct, respectively; P=0.03) Evidence from two studies in disparate populations suggests that rates are better understood and thus are the preferred way to explain genetic risk to lay persons.
Plasma P‐selectin is elevated in the first trimester in women who subsequently develop pre‐eclampsia
Authors: Bosio P.M. , Cannon S. , McKenna P.J. , O'Herlihy C. , Conroy R. , Brady H.
Published: December 2003

Objective To report plasma concentrations of the adhesion cell molecule P‐selectin during pregnancy to determine the effect of subsequent development of hypertension and pre‐eclampsia.

Design A longitudinal study.

Methods A longitudinal study involving 70 women followed up from early pregnancy; 20 who subsequently developed pre‐eclampsia were compared with 24 who developed gestational hypertension and 26 normotensive women with normal obstetric outcome. The determination of citrate plasma soluble P‐selectin levels throughout pregnancy was performed using a commercial quantitative sandwich immunoassay kit. The temporal course of plasma P‐selectin in the three groups of subjects was analysed.

Results There was no significant difference in mean plasma P‐selectin concentration between normotensive and gestational hypertensive subjects at any stage of pregnancy. Using a cutoff level of 60 ng/mL, P‐selectin concentration at 10–14 weeks had a negative predictive value for pre‐eclampsia of almost 99%. Mean plasma P‐selectin concentrations were significantly elevated by 10–14 weeks in women who later developed pre‐eclampsia (P<0.001).

Conclusions Our data support an inflammatory model for pre‐eclampsia whereby endothelial cell activation may be secondary to a primary inflammatory response. Plasma P‐selectin has significant potential as a first trimester clinical marker of pre‐eclampsia.
The predictive value of serum 1,5‐anhydro‐D‐glucitol in pregnancies at increased risk of gestational diabetes mellitus and gestational impaired glucose tolerance
Authors: Tam Wing‐Hung , Rogers Michael Scott , Lau Tze‐Kin , Arumanayagam Mano
Published: December 2003

The objective of the study was to determine the efficacy of 1,5‐anhydro‐D‐glucitol (1,5 AG) for the prediction of gestational diabetes and gestational impaired glucose tolerance (GIGT). One hundred and eighty‐five pregnant women with epidemiological risk factors of gestational diabetes or GIGT underwent 75 g oral glucose tolerance test and plasma 1,5 AG assay at 26 to 28 weeks of gestation. There was no significant difference in plasma 1,5 AG either before or after an oral glucose load. The area under the receiver operator characteristic curve for 1,5 AG was only 0.485 which implies that 1,5 AG is a poor predictor of GIGT or gestational diabetes.
Endometrial laser intrauterine thermotherapy for the treatment of dysfunctional uterine bleeding: the first British experience
Authors: Jones Kevin , Abbott Jason , Hawe Jeremy , Sutton Christopher , Garry Ray
Published: December 2003

Forty patients due to undergo endometrial ablation as a treatment for dysfunctional uterine bleeding were recruited to assess the efficacy and safety of endometrial laser intrauterine thermo‐therapy using the gynelase. At 12 months the average menstrual score reduction was 88%, the amenorrhoea rate was 70%, and the hypomenorrhoea rate 16%. Four women (10%) have had a hysterectomy for persistent menorrhagia, and one (3%) for pelvic pain. One patient (3%) has had a further endometrial laser ablation. There were no major complications, and 34 patients (85%) were most satisfied with the treatment. The system is easy to use and has a short learning curve.
Human chorionic gonadotrophin inhibition of pregnant human myometrial contractility
Authors: Slattery Michael M. , Brennan Cara , O'Leary Michael J. , Morrison John J.
Published: December 2003

Objective To evaluate the effect of human chorionic gonadotrophin (hCG) on pregnant human myometrial contractility in vitro and to determine whether the hCG‐elicited effect was oestrogen dependant.

Methods Isometric tension recording was performed under physiological conditions in isolated myometrial strips from biopsies obtained at elective caesarean section. The effect of cumulative additions of hCG (0.001, 0.01, 0.1, 1.0 and 10 iu/mL) on myometrial contractility was evaluated. Secondarily, the contractile activity of pregnant myometrium following hCG exposure was investigated in tissue pre‐treated with beta‐oestradiol.

Results hCG exerted a statistically significant relaxant effect on pregnant human myometrial tissue. The relaxant effect increased with increasing concentrations of hCG from 8.96% (SEM 2.06) (0.001 iu/mL hCG; P<0.01) to a net cumulative total of 58.50% (SEM 3.74) (10 iu/mL hCG; P<0.01). The relaxant effect was also time‐dependant, increasing in magnitude throughout the duration of experiments. Beta‐oestradiol did not significantly affect the response of myometrial tissue to hCG.

Conclusions These results clearly demonstrate that hCG exerts a significant concentration‐dependant relaxant effect on human myometrial tissue obtained rate in pregnancy. These findings outline an inhibitory physiological role of hCG on human myometrial contractility and raise the possibility of its potential use as a tocolytic.
Prevalence and features of pancreatic islet cell autoimmunity in women with gestational diabetes from different ethnic groups
Authors: Kousta E. , Lawrence N.J. , Anyaoku V. , Johnston D.G. , McCarthy M.I.
Published: December 2003

Objective To assess the prevalence and characteristics of islet cell autoimmunity amongst women with gestational diabetes selected from South Asian and Afro‐Caribbean as well as European populations.

Design Cross‐sectional retrospective survey of subject cohort.

Population Three hundred and twenty‐one women with a recent history of gestational diabetes (173 European, 86 South Asian and 62 Afro‐Caribbean), a median (range) of 22 (1‐150) months postpartum.

Results Antibodies to Glutamic acid decarboxylase were found in 13 (4%) of these women. There was no difference in the prevalence of anti‐glutamic acid decarboxylase positivity between the three ethnic groups (European 4.6%, South Asian 3.5%, Afro‐Caribbean 3.2%). Anti‐glutamic acid decarboxylase positive women were leaner than anti‐glutamic acid decarboxylase negative women (body mass index, median (upper‐lower quartile) 23.9 (22.5–26.7) vs 26.6 (23.4‐30.5)kg/m2, P=0.03, P=0.049 allowing for ethnicity). There was no difference between glutamic acid decarboxylase‐positive and glutamic acid decarboxylase‐negative women for age, family history of diabetes, waist/hip ratio, prevalence of insulin treatment during pregnancy, postpartum glucose status, lipid profile and indices of insulin action and beta‐cell function.

Conclusions Markers of islet cell autoimmunity are found as frequently in gestational diabetes women of South Asian and Afro‐Caribbean origin, as they are in European subjects. Identification of future risk of type 1 diabetes is relevant to the planning of clinical management and intervention strategies in women with gestational diabetes of all major ethnic groups.
Maternal height and newborn size relative to risk of intrapartum caesarean delivery and perinatal distress
Authors: Merchant Kathleen M. , Villar José , Kestler Edgar
Published: December 2003

Objective To estimate the changes in risk of intrapartum caesarean delivery and perinatal distress that may be introduced through increased birth size, resulting from interventions such as improving nutrition of the mother; and to characterise delivery risk relative to maternal stature by birth size.

Design Model these risks using data from the Guatemalan Perinatal Study.

Setting The antenatal clinic of the Gynaecology and Obstetrics Hospital of the Guatemalan Social Security Institute in Guatemala City serving predominantly working class women.

Population Women who had their first prenatal visit between April 1984 and January 1986.

Methods Multivariate logistic regression models were developed to estimate incidence of intrapartum caesarean delivery and perinatal distress and used to calculate changes in risk associated with changes in size.

Main outcome measures Incidences of intrapartum caesarean delivery and perinatal distress.

Results A woman of 146cm height (‐1 SD) relative to another of 160cm (+1 SD) has a 2.5 times higher risk of intrapartum caesarean delivery. An increase in newborn head circumference and weight (from ‐1 SD to +1 SD) are each independently associated with an increase in risk of intrapartum caesarean delivery (2.0 times and 1.5 times, respectively). An increase in birthweight from 2,450 g to 2,550 g is associated with a decrease in risk of perinatal distress of 34/1000 cases and an increase in risk of intrapartum caesarean delivery of 8/1000 cases.

Conclusions Increases in fetal growth comparable to those attributable to improved nutrition during pregnancy are associated with a larger decrease in risk of perinatal distress relative to the increase in risk of intrapartum caesarean delivery for the mother. Greater maternal stature is associated with lower risk of intrapartum caesarean delivery.