bluuebunny/crossref_metadata_2025 huggingface dataset:
A multicentre randomised trial of amniotomy in spontaneous first labour at term
Authors:   The UK Amniotomy Group
Published: August 2005

Objective
To measure the effect of a policy of routine amniotomy on nulliparous labour.

Design
A multicentre randomised controlled trial.

Subjects
One thousand four hundred and sixty‐three nulliparous women in spontaneous labour at term with intact membranes and a single cephalic fetus.

Interventions
To have the membranes ruptured routinely early in labour or left intact for as long as possible.

Main outcome measures
Duration of labour, operative and instrumental delivery rates, use of analgesia, perinatal death, neonatal convulsions and admission to special care.

Results
Median duration of labour was 8.4 h in the early rupture group and 9.4 h in the late group. There was no difference in caesarean section, typical odds ratio (OR) 1.1, 95% CI 0.65–1.8; operative vaginal delivery, OR 1.1, 95% CI 0.83–1.5; use of epidural/spinal, OR 0.92 95% CI 0.72–1.2; use of pethidine, OR 1.0, 95% CI 0.79–1.4; neither method of analgesia, OR 0.96, 95% CI 0.68–1.3; blood transfusion, OR 0.71, 95% CI 0.28–1.8. There was no effect on fetal intubation, OR 1.40 (95% CI 0.78–2.5); admission special care, OR 1.28 (95% CI 0.65–2.5). One fetus in the early amniotomy group had neonatal convulsions, but there were no perinatal deaths.

Conclusions
Beyond a modest shortening of labour, a policy of routine amniotomy has little effect on important outcomes and should not be recommended.
Is total abdominal hysterectomy with bilateral salpingo‐oophorectomy adequate for new FIGO Stage I endometrial carcinoma?
Authors: Lin Ho‐Hsiung , Chen Chin‐Der , Chen Chun‐Kai , Chen Chi‐Long , Chow Song‐Nan , Huang Su‐Cheng
Published: August 2005

Objective The new FIGO staging for endometrial cancer cases complies with other forms of surgical staging and correlates better with clinical outcomes because it includes prognostic factors. This study was done to investigate whether total abdominal hysterectomy with bilateral salpingo‐oophorectomy (TAH + BSO) is adequate for new FIGO Stage I endometrial carcinoma.

Subjects Sixty‐five cases of endometrial carcinoma defined according to the new FIGO Stage Ia (n= 26), Ib (n= 24) and Ic (n= 15) were analysed. They all received TAH + BSO only and were followed up for at least two years.

Methods The histologic type, grade, depth of myometrial invasion, lympho‐vascular tumour emboli and tumour size were analysed by t‐test to correlate the risk factors for treatment failure.

Results There were no recurrences after TAH + BSO in Ia and Ib cases. However, recurrences occurred in five cases (33 %) of Stage Ic with deep myometrial invasion, high histologic grade, large tumour size and tumour emboli.

Conclusions TAH + BSO is inadequate in some Ic cases with a high histologic grade, deep myometrial invasion and tumour emboli. Thus, thorough pre‐operative and intra‐operative staging, adequate operation method and prompt post‐operative adjuvant therapy are indispensable for successful treatment.
First trimester amnifiltration: technical, cytogenetic and pregnancy outcome of 104 consecutive procedures
Authors: Byrne Dominic L. , Penna Leonie , Marks Karen , Offley‐Shore Drbrigid
Published: August 2005

Objective To investigate the technical, cytogenetic and pregnancy complications of first trimester amnifiltration for the diagnosis of fetal karyotype.

Design Observational study.

Setting The fetal medicine unit, UMDS St Thomas' Campus, London.

Subjects One hundred and four women seeking prenatal diagnosis of fetal karyotype.

Main outcome measures Sampling success, culture rate, harvest time and karyotype, pregnancy outcome and complications.

Results Sampling was successful in all 104 cases, but equipment failure forced the procedure to be changed to early amniocentesis in eight (7%) cases. The karyotype was normal in 101 (97%) cases, abnormal in three. The mean harvest time was 14 days (range 9‐26 days; SD = 3.4), and three cultures failed (2.8 %). Pregnancies resulted in 99 (95%) live births, with a mean gestation of 277 days (range 182‐300 days; SD = 16). There was one termination for trisomy 21 and four spontaneous miscarriages (3.8%). Amniotic fluid leakage occurred in six cases (5%), all resulted in live births, five at term and one at 35 weeks.

Conclusions This study demonstrates that amnifiltration is technically possible in the first trimester of pregnancy, and that samples can be successfully karyotyped. The harvest time for culture is similar to early amniocentesis and chorion villus sampling. The rate of fetal loss, adjusted by the estimated natural loss, is 1.7%, whch compares favourably with both chorionic villus sampling and early amniocentesis.
The role of a single progesterone measurement in the diagnosis of early pregnancy failure and the prognosis of fetal viability
Authors: Al‐Sebai Mohamed Azmy Hassanein , Kingsland Charles Richard , Diver Michael , Hipkin Leslie , McFadyen Iain Ross
Published: August 2005

Objective
To assess the role of a single maternal serum progesterone measurement in the immediate diagnosis of early pregnancy failure and in the long term prognosis of fetal viability.

Design
A prospective comparative study of women presenting with vaginal bleeding and abdominal pain in early pregnancy. The comparison group was defined retrospectively as women who presented with abdominal pain without history of, or the subsequent occurrence of, vaginal bleeding and whose pregnancies continued to viability. The study groups were defined retrospectively as threatened‐continuing, non‐continuing (including blighted ovum, missed abortion, incomplete and complete abortion) and tubal pregnancy groups, according to the outcome of the pregnancies.

Setting
The emergency room at the gynaecology department of a teaching hospital.

Subjects
Four hundred and eighty‐nine women presenting with singleton pregnancy, vaginal bleeding and/or abdominal pain in the first 18 weeks of pregnancy. The comparison group comprised 131 women without vaginal bleeding whose pregnancies continued to viability. The study group comprised 358 women with 148 threatened‐continuing pregnancies, 175 non‐continuing and 35 tubal pregnancies.

Interventions
A 10 ml blood sample was taken and pelvic ultrasonography was performed at presentation. Otherwise, conventional management was used.

Main outcome measures
Progesterone levels were interpreted in accordance with the outcome of the pregnancy: comparison, threatened‐continuing, non‐continuing or tubal. Viability was defined as 28 weeks or more weeks of gestation.

Results
Progesterone levels were significantly lower in the non‐continuing and tubal pregnancy groups than in the comparison and threatened‐continuing groups (P < 0.001 in all cases). A cut‐off level at 45 nmol/l was found to differentiate between the viable (comparison and threatened‐continuing) pregnancies and the abnormal (non‐continuing and tubal) pregnancies with 87.6% sensitivity and 87.5% specificity.

Conclusions
A single serum progesterone measurement taken in early pregnancy is valuable in the immediate diagnosis of early pregnancy failure and the long term prognosis of viability.
Does colposcopically directed punch biopsy reduce the incidence of negative LLETZ?
Authors: Denny L. A. , Soeters R. , Dehaeck K. , Bloch B.
Published: August 2005

Objective
To evaluate the role of punch biopsy in reducing the occurrence of negative histology provided by large loop excision of the transformation zone in the management of cervical intraepithelial neoplasia.

Design
Retrospective review of computerised data base and clinic files.

Setting
Colposcopy Clinic, Groote Schuur Hospital, Cape Town, South Africa.

Subjects
Two hundred and ninety‐eight women considered suitable for the local outpatient management of cervical intraepithelial neoplasia.

Methods
Two groups of patients were identified: group A consisted of women who had cervical intraepithelial neoplasia confirmed colposcopically and who underwent directed punch biopsy; group B consisted of women who had cervical intraepithelial neoplasia confirmed colposcopically and were referred for large loop excision of the transformation zone without confirmatory punch biopsy.

Results
In Group A (n= 184) 123 women had cervical intraepithelial neoplasia diagnosed on punch biopsy. Large loop excision of the transformation zone was performed on 116 women and 7 were lost to follow up. The procedure confirmed cervical intraepithelial neoplasia in 95 cases (82%), but there was no cervical intraepithelial neoplasia in 21 cases (18%). Sixty‐one women had negative punch biopsies. Of these, 13 underwent large loop excision of the transformation zone, 31 had persistently negative follow up cytology, and 9 had positive cervical smears of which 7 were treated with large loop excision of the transformation zone, and 8 were lost to follow up. Overall, 25YO of all negative punch biopsies were falsely negative. In group B 114 were treated with large loop excision of the transformation zone and cervical intraepithelial neoplasia was confirmed in 97 cases (85%); one woman had unsuspected microinvasion (1%) and 16 women (14%) had no cervical intraepithelial neoplasia. Negative histology after large loop excision of the transformation zone was not statistically different in groups A and B.

Conclusion
Punch biopsy does not reduce the occurrence of negative histology after large loop excision of the transformation zone.
HLA‐G deletion polymorphism and pre‐eclampsia/eclampsia
Authors: Humphrey K. E. , Harrison G. A. , Cooper D. W. , Wilton A. N. , Brennecke S. P. , Trudinger B. J.
Published: August 2005

Objective
To investigate a HLA‐G deletion polymorphism in pre‐eclamptic pedigrees and the general population.

Design
A population association study of HLA‐G genotypes from pre‐eclamptic/eclamptic patients and control groups.

Setting
Analyses undertaken in the School of Biological Sciences, Macquarie University. Patients were from Royal Women's Hospital, Melbourne, and controls were from Westmead Hospital and Macquarie University, Sydney.

Subjects
One hundred and ninety‐six individuals, consisting of 29 pre‐eclamptic/eclamptic (PE/E) patients, 13 individuals born of a PE/E pregnancy, 46 blood relatives of PE/E patients, 21 husbands of PE/E patients, 25 women normotensive in first pregnancy, 15 husbands of women normotensive in first pregnancy and 47 staff and students of Macquarie University.

Results
Genotypic and gene frequencies were not significantly different in the seven groups examined.

Conclusion There is no detectable relationship between susceptibility to pre‐eclampsia or being born of a pre‐eclamptic pregnancy and HLA‐G genotype.
Serum parameters and nuchal translucency in first trimester screening for fetal chromosomal abnormalities
Authors: Zimmermann R. , Hucha A. , Savoldelli G. , Binkert F. , Achermann J. , Grudzinskas G.
Published: August 2005

Objective
To assess the relation between serum parameters and nuchal translucency in pregnancies affected by fetal aneuploidy in the first trimester.

Design
Retrospective study of different serum parameters collected prior to chorionic villus sampling and measurement of nuchal translucency in relation to fetal aneuploidy.

Setting
Switzerland (German and Italian sector) and Bregenz, Austria.

Population
One thousand one hundred and fifty‐one women aged 25 to 44 years at 10 to 13 weeks of gestation undergoing chorionic villus sampling, mostly for advanced maternal age. Fetal aneuploidy was found in 23 pregnancies including four cases of trisomy 21, five of trisomy 18 and one case of trisomy 13.

Main outcome measure
Fetal karyotype, serum levels of free β‐hCG, pregnancy‐associated plasma protein A (PAPP‐A) and alpha‐fetoprotein and the measurement of nuchal translucency.

Results
Serum PAPP‐A was decreased in all common chromosomal abnormalities. Free β‐hCG levels were increased in trisomy 21 but decreased in trisomy 18, whereas alpha‐fetoprotein was low in trisomy 21, 18 and other chromosomal abnormalities. Nine of twenty‐three abnormal embryos had evidence of an increased nuchal translucency. Nuchal translucency, however, did not seem to be associated with any alteration in the levels of the biochemical parameters in either chromosomally normal or abnormal embryos. A low serum PAPP‐A or an increased nuchal translucency was seen in two‐thirds of all pregnancies with chromosomal abnormalities.

Conclusion
A nuchal translucency 3 mm and depressed serum PAPP‐A levels have a good predictive value in the detection of fetal aneuploidy at 10 to 13 weeks of pregnancy. Serum free 0‐hCG and alpha‐fetoprotein levels may give additional information. An increased nuchal translucency was not‐associated with altered serum parameters. This would allow these different markers to be used in combination.
The suitability of DNA cytometry for the prediction of the histological diagnosis in women with abnormal cervical smears
Authors: van Leeuwen A. M. , Ploem‐Zaaijer J. J. , Pieters W. J. L. M. , Consultant H. Hollema , Burger M. P. M.
Published: August 2005

Objective
To analyse the suitability of DNA cytometry for predicting the histological diagnosis in women with cervical dyskaryosis.

Design
Survey with the use of diagnostic information to revise disease probability.

Setting
Colposcopy clinic of a university hospital.

Participants
One hundred and ten women with two mildly or moderately dyskaryotic cervical smears and 98 women with one severely dyskaryotic smear.

Interventions
DNA cytometric analysis using cytocentrifuge preparations of single cell suspensions from a cervical scrape. The main DNA cytometric parameter was N5C (i.e. the absolute number of cells with a DNA content of more than 5C on a given surface with a predefined cell density).

Main outcome measure
The probability of finding CIN II or worse. On arbitrary grounds, a positive test should point to a probability of 85% or higher.

Results
In the patients with cervical neoplasia, the value of N5C increased significantly with an increasing CIN grade (P < 0.001). In the patients with one severely dyskaryotic smear and in those with two mildly or moderately dyskaryotic smears, the prior probability of finding CIN II or worse was 94% and 53%, respectively. Therefore, DNA cytometric analysis might be particularly useful in women with mild or moderate dyskaryosis; further analysis was restricted to this group. All of the women in whom the N5C value was higher than 52 were diagnosed as having CIN II or worse. Only 16 (14.5%) of the 110 women had an N5C value of 52 or higher. When the N5C value was 27, the probability of finding CIN II or worse was estimated to be 85%. Only 28 (25%) patients had an N5C value of 27 or higher.

Conclusions
DNA cytometry produced significant diagnostic information, as was shown by the relation between N5C and the histological diagnosis. However, the N5C value could not discriminate sufficiently between women with CIN II or worse and CIN I or better. Therefore, the management of individual patients with cytological abnormalities cannot be based on the results of DNA cytometric analysis.
A comparative study of caesarean deliveries by assistant medical officers and obstetricians in Mozambique
Authors: Pereira Caetano , Bugalho Antonio , Bergström Staffan , Vaz Fernando , Cotiro Manuel
Published: August 2005

Objective
To evaluate the outcome of caesarean delivery performed by assistant medical officers and specialists in obstetrics and gynaecology with particular attention to post‐operative complications.

Design
We performed a nonrandomised analysis of 2071 consecutive caesarean deliveries at Maputo Central Hospital. Of these, 958 (46.3%) were performed by assistant medical officers (medical assistants trained for surgery) and the rest (53.7%) by specialists in obstetrics and gynaecology. The age and parity distributions of women in the two groups were almost identical.

Setting
University Hospital in Maputo, covering all emergency obstetrics with about 48,000 deliveries per year.

Population
Two thousand and seventy‐one consecutive caesarean deliveries.

Main outcome measures
Post‐operative complications and the duration of post‐operative hospital stay.

Results
There were no differences in the indications for caesarean delivery. The surgical interventions associated with caesarean delivery did not differ in the two groups. The only significant difference was in the group of superficial wound separation due to haematoma, which was slightly more common (0.35%vs 0.05%) in the group operated on by assistant medical officers (Odds Ratio 2.2; 95% Confidence Interval 1.3–3.9)

Conclusion
Training selected medical assistants to perform caesarean delivery, even on women in poor general condition, is justified in settings in which doctors are scarce.
Trends and variations in use of antenatal corticosteroids to prevent neonatal respiratory distress syndrome: recommendations for national and international comparative audit
Authors:   Scottish Neonatal Consultants, Collaborative Study Group, International Neonatal Network
Published: August 2005

Objective
In 1990 a meta‐analysis of randomised trials showed 70% lower mortality after antenatal corticosteroid therapy for 24 h or more for infants born before 31 weeks gestation. We investigated whether antenatal corticosteroid therapy has increased in these infants since 1990 and studied variations in use by hospital of birth.

Design
Retrospective cohort study in 1601 infants in nine neonatal units.

Subjects
Neonatal admissions before 31 weeks of gestation from January 1988 to October 1993.

Measure of outcome
Corticosteroids administered for 24 h or more before delivery.

Results
Data were obtained in 1579 (99 %) infants. The proportion (range) in each hospital whose mothers had antenatal corticosteroids for 24 h or more was 16 % (0–43) in 1988–89 and 29 % (0–36) in 1990–93 (P < 0.001). In post hoc analyses, 65/347 (20%) births in district hospitals had treatment for 24 h or more compared with 354/1254 (28%) in teaching hospitals (P= 0.001).

Conclusions
Antenatal corticosteroid therapy increased but varied by hospital of birth. This may reflect varying performance, or bias from reporting, selection or referral. Ideally, corticosteroid therapy should be compared in women at risk of preterm delivery, but standardising risk or indications for delivery between hospitals and accurate ascertainment presents major difficulties. To minimise selection or referral bias, hospitals should publish, for all mothers delivering between 24 and 33 weeks and 6 days gestation 48 h or more after admission, the proportions treated 1. for 24 h or more (target: > 70%), or 2. at all (target: > 90%).
A comparison of 600 and 200 mg mifepristone prior to second trimester abortion with the prostaglandin misoprostol
Authors: Webster Diana , Penney Gillian C. , Templeton Allan
Published: August 2005

Objective
To compare the use of 600 and 200 mg mifepristone prior to second trimester termination of pregnancy with the prostaglandin misoprostol.

Design
A randomised study. Setting A Scottish teaching hospital.

Participants
Seventy women undergoing legal induced abortion between 13 and 20 weeks of gestation.

Intervention
Administration of either 600 or 200 mg mifepristone 36 to 48 hours prior to prostaglandin.

Main outcome measure
Induction‐abortion interval.

Results
The geometric mean induction abortion interval was 6.9 (95 % CI 5.8–8.4) h and 6.9 (95 % CI 5.8–8.2) h in the 600 and 200 mg groups, respectively (no significant difference). The median dose of misoprostol was 1600 pg (three doses) in each group. Analgesic requirements and prostaglandin‐related side effects were similar between groups. Overall, 11‐4% of women required surgical evacuation of the uterus as a result of retained placenta.

Conclusions
The dose of mifepristone used in second trimester abortion can be reduced from 600 to 200 mg.
Coagulation and fibrinolysis in smoking and nonsmoking pregnant women
Authors: Mercelina‐Rournans Patricia E. A. M. , Ubachs Johannes M. H. , van Wersch Jan W. J.
Published: August 2005

Objective
To assess the effects of smoking during pregnancy on coagulation and fibrinolysis.

Design
A cross‐sectional study.

Setting
A teaching hospital in Heerlen, The Netherlands.

Results
Parameters of coagulation activation increased significantly with gestational age. The values presented are median values. Prothrombin fragment 1+2 increased from 0.8 to 25 nmol/l in the nonsmoking group of pregnant women and from 1.0 to 1.8 nmol/l in the smoking group. Thrombin‐antithrombin III (TAT) levels increased from 2.2 to 9.9 μg/l in the nonsmoking group and from 3.1 to 8.5 μg/1 in the smoking group. Parameters of fibrinolysis showed a different picture. Plasminogen levels in both groups rose significantly in the first half of gestation reaching a plateau in the second half. The α2‐antiplasmin levels remained constant in both groups, although the smokers started with significantly higher levels: 119 versus 105 % in the nonsmokers. The D‐dimer levels rose significantly in both groups: from 278 to 847 μg/ml in the nonsmokers and from 215 to 520 μg/ml in the smokers. They were significantly lower in the smoking group from the 11th up to the 40th weeks. The D‐dimer/TAT ratio was significantly higher in the nonsmokers.

Conclusions
In smoking pregnant women the activated coagulation process was not counterbalanced by an adequate increase of fibrinolysis which was the case in the nonsmokers.
Trial of labour after caesarean section in sub‐Saharan Africa: ameta‐analysis
Authors: Boulvain Michel , Fraser William D. , Brisson‐Carroll Gisèle , Faron Gilles , Wallast Elizabeth
Published: August 2005

Objective To evaluate the safety and effectiveness of apolicy of trial of labour for women with a previous caes are an section, delivering in hospitals in sub‐Saharan Africa.

Design Ameta‐analysis of 17 published reports. Setting Hospitals located in sub‐Saharan Africa.

Main outcome measures The probability of vaginal delivery, the risk of mortality and morbidity, and the risk difference for specific obstetrical condition swere computed using an approach equivalent to a random effects model.

Results The proportion of women who were allowed a trial of labour ranged from 37% to 97% across reports. The probability of a vaginal delivery among these women was 69% (95% CI63–75%). Maternal mortality among all women with aprevious caesarean section was 1.9/1000 (95%CI0–4.3). Uterine rupture and scar dehiscence occurred in 2.1% (95%CI1.0–3.2). Criteria used to select women foratrial of labour appeared to have a limited impact on the probability of vaginal delivery.

Conclusions In hospitals in sub‐Saharan Africa a selective policy of trial of labour after a previous caesarean section has a success rate comparable to that observed in developed countries. The policy appears to be relatively safe and applicable in this context.
Outcome of pregnancy in women with Marfan's syndrome
Authors: Lipscomb Karen J. , Clayton Smith Jill , Clarke Bernard , Donnai Paul , Harris Rodney
Published: August 2005

Objective
To improve life expectancy and prevent premature mortality in women with Marfan's syndrome.

Methods
During the development of a regional genetic register for Marfan's Syndrome the outcome of 91 pregnancies in 36 women with this condition was established retrospectively and the cardiovascular and obstetric complications documented.

Results
No patient had a significant cardiovascular abnormality limiting function before her pregnancy. Of 36 women, four had an aortic dissection relating to pregnancy and two others required aortic surgery following delivery. Thirty women had uncomplicated gestational histories. The incidence of obstetric complications did not exceed expectation.

Conclusions
Women with Marfan's syndrome are at significant risk of aortic dissection in pregnancy even in the absence of preconceptional cardiovascular abnormality. Aortic root dilatation may be a predictor of risk but dissection may occur without significant dilatation. Guidelines for obstetric care are suggested and preconceptional assessment recommended.
A randomised controlled trial of Doppler ultrasound velocimetry of the umbilical artery in low risk pregnancies
Authors:   Doppler French Study Group
Published: August 2005

Objective
To evaluate the effect on management and outcome of pregnancy of routine umbilical Doppler examination in low risk populations.

Design
Pragmatic randomised controlled trial.

Setting
Twenty centres caring for low risk pregnant women.

Participants
4187 women were randomly assigned to umbilical Doppler between 28 and 34 weeks of gestation or no routine umbilical Doppler. The women included were at low risk at 28 weeks of gestation denned by a normal ultrasonographic examination at the time of randomisation and no obstetric or medical complications during the first two trimesters of the pregnancy.

Results
The general characteristics at inclusion were comparable for the two groups. Performance of umbilical Doppler led to a significant increase in the number of ultrasonographic and Doppler examinations subsequently conducted; there were no other effects on the management of the pregnancy. There was no significant difference in fetal distress during labour (odds ratio [OR] 0.96; 95% confidence interval [CI] 0.70–1.33). There were three times fewer perinatal deaths in the Doppler group (three versus nine), but this difference was not significant (OR 0.33; 95% CI 0.06–1.33).

Conclusion
Based on this trial routine use of umbilical doppler for low risk pregnancy cannot be recommended. More data are needed to reach a definite conclusion of the value of routine Doppler.
The case for stopping cervical screening at age 50
Authors: Cruickshank Margaret E. , Angus Valerie , Kelly Margaret , McPhee Susan , Kitchener Henry C.
Published: August 2005

Objective
To determine the pattern of abnormal cervical cytology in women aged 50 to 60 years and to determine whether the development of cervical neoplasia in this age group is confined to women who have been inadequately screened.

Design
Retrospective case analysis study.

Population
An 11‐year birth cohort of women in Grampian Region born between 2/10/33 and 1/10/44, and those who had significant cytological abnormalities in the 5 year period 1/10/89 to 30/9/94.

Main outcome measures
Cytological and histological outcome for women with significant cytological abnormalities between 50 to 60 years of age and the interval between three consecutive smears taken up to 50 years of age for those women.

Results
Of 23,440 women aged 50 to 60 years ever screened in Grampian Region, 229 (1%) had significant cytological abnormalities. Seventy had CIN 3 and 15 had invasive disease of the cervix. Among approximately 9000 women with adequate smear histories prior to age 50, one case of CIN 3 and one case of invasion were detected. The prevalence of invasive disease in the whole cohort during this five year period was 59/100,000. Among the previously well screened women the prevalence was 11 /100,000.

Conclusion
The incidence of preinvasive disease of the cervix is low over the age of 50 and is seen almost exclusively in inadequately screened women. There would appear to be little benefit in continuing cervical screening over the age of 50 in women who have had regular negative smears. The release of this low risk group from the cervical screening programme could alleviate anxiety and could enable reallocation of resources to target better high risk women who default from regular screening and to reduce screening intervals where necessary to three years.
Serum concentrations of cancer antigen 125, placental alkaline phosphatase, cancer‐associated serum antigen and free beta human chorionic gonadotrophin as prognostic markers for epithelial ovarian cancer
Authors: Ind Thomas , Iles Ray , Shepherd John , Chard Tim
Published: August 2005

Objective
To investigate the prognostic significance of elevated levels of cancer antigen 125 (CA125), placental alkaline phosphatase (PLAP), free β human chorionic gonadotrophin (hCG) and cancer‐associated serum antigen (CASA) in women with primary epithelial ovarian carcinoma.

Design
A two year follow up study of survival.

Setting
A tertiary care gynaecological oncology unit.

Participants
One hundred and eleven women with histologically confirmed epithelial ovarian cancer.

Main outcome measures
Survival over a two year period.

Results
Stage corrected log‐rank χ2 tests demonstrated a significant effect on survival for all four tumour markers (CA125 P= 0.0142; PLAP P < 0.0001; CASA P= 0.0098; hCG P= 0.0002). This was confirmed when each variable was fitted together with disease stage in Cox proportional hazard models. When fitted as multiple variables in a Cox proportional hazard model, the addition of free β‐ hCG and CASA to disease stage, PLAP concentrations and CA125 levels did not demonstrate further prognostic value.

Conclusions
Levels of all four markers correlate with survival in patients with epithelial ovarian cancer. The combination of PLAP and CA125 concentrations together with disease stage may be used to predict survival but the addition of hCG and CASA levels do not give additional prognostic information.
Bladder visualisation as a prognostic sign in oligohydramnios‐polyhydramnios sequence in twin pregnancies treated using therapeutic amniocentesis
Authors: Kilby M. D. , Howe D. T. , McHugo J. M. , Whittle M. J.
Published: August 2005

Oligohydramnios‐polyhydramnios sequence in twin pregnancies may be managed by aggressive amniocentesis and is described in nine consecutive cases. In four of the nine pregnancies both twins survived, one pair died in the neonatal period, and the other four pairs all suffered intrauterine death. The median number of amnioreductions performed was five (range 2–7). In this series the reaccumulation of urine in the bladder of the ‘stuck twin’ was a predictive prognostic marker of survival in both twins, with a sensitivity and specificity of 100%.
A longitudinal study of umbilical artery Doppler waveforms in normal pregnancy: analysis using Laplace transform techniques
Authors: Brackley Karen J. , Ramsay Margaret M. , Pipkin Fiona Broughton , Rubin Peter C.
Published: August 2005

Objective
To analyse umbilical artery Doppler waveforms using the Laplace transform analysis technique, an alternative method of waveform shape analysis, and to determine the normal ranges for the variables of this technique throughout normal pregnancy.

Design
A prospective longitudinal study.

Setting
Department of Obstetrics and Gynaecology, Nottingham University Hospital.

Sample
A cohort of 17 healthy women investigated every four weeks from the end of the first trimester until term.

Methods
Umbilical artery Doppler signals were recorded and analysed using the Laplace transform analysis technique. The median and interquartile ranges for each variable were determined and serial changes during pregnancy described.

Results
Vessel wall tone decreases in the umbilical artery at the beginning of the second trimester. Alpha, the variable related to upstream flow conditions, also decreases at this stage of pregnancy but values are then comparatively stable from 24 weeks of gestation until term. A fall in downstream resistance within the fetoplacental circulation during pregnancy is detected using the C‐coefficient. Real pole appears to be of no value in the assessment of downstream resistance to flow in the fetus.

Conclusions
The normal ranges for the Laplace transform analysis variables have been established for the umbilical artery longitudinally through normal pregnancy. Changes in fetal blood flow during complicated pregnancy can now be investigated using this technique.
The significance of smooth muscle bundles in the endocervical submucosa
Authors: Tiltman Andrew J.
Published: August 2005

In approximately 25% of uterine cervices there are bundles of smooth muscle in the immediate submucosa of the endocervix usually in the region of the transformation zone. They are morphologically and immunohistochemically different from the inherent muscle deeper in the cervix in that they have more cytoplasm, are arranged in bundles not separated by collagen, and do not contain oestrogen or progesterone receptors. They are more commonly found during the reproductive years becoming less common after the menopause, but there is no association with parity, the use of exogenous steroids, uterine fibromyomas or uterine prolapse. At present it can only be concluded that their presence represents a morphological variation.
Glycosylated haemoglobin and hypertension arising in pregnancy
Authors: Roberts R. N. , Traub A. I. , Kennedy A. L. , Hadden D. R.
Published: August 2005

We analysed a database of glycosylated haemoglobin (HbA1) in nondiabetic pregnant women to investigate the relation between glucose metabolism in the first and second trimesters and hypertensive complications of pregnancy. From a total of 1334 women, 13 had pre‐existing hypertension, 225 developed gestational hypertension and 51 developed pre‐eclampsia. At 28 weeks of gestation, the women who susequently developed gestational hypertension had a significantly higher mean HbAl than those who remained normotensive (6.33 vs 6.17%, P < 0.02). This difference remained significant after correcting for the effects of age and body mass index (regression coefficient 0.11, SE 0.06, P = 0.05). In contrast, there were no significant differences in HbAl between the women with pre‐eclampsia and their normotensive counterparts. This provides indirect evidence to support our hypothesis that gestational hypertension is associated with insulin resistance but pre‐eclampsia is not.
Uterine thermal balloon therapy for the treatment of menorrhagia: the first 300 patients from a multi‐centre study
Authors: Amso Nazar N. , Stabinsky Seth A. , McFaul Peter , Blanc Bernard , Pendley Laura , Neuwirth Robert
Published: August 2005

Objective
To evaluate the safety and efficacy of thermal balloon therapy for menorrhagia.

Design
Prospective, observational study.

Setting
Fifteen centres in Canada and Europe.

Population
Two hundred and ninety‐six eligible women for whom follow up data were available for three months or more. Eligible women included those for whom further fertility was not a concern, were not postmenopausal, suffered from intractable menorrhagia, had a normal uterine cavity, and who were fully informed regarding the investigational nature of uterine thermal balloon therapy.

Methods
Three hundred and twenty‐one procedures of balloon endometrial ablation were performed using the same protocol between June 1994 and August 1996. Exclusion criteria included structural uterine abnormality or (pre) malignant lesions. Treatment entailed controlled heating of fluid in an intrauterine balloon. General anaesthesia was employed in the 61% of procedures while local anaesthesia with or without sedation was used in 39% of cases.

Analysis
Follow up data at 3 and/or 6, and/or 12 months were required for inclusion in the analysis. A paired t test, Wilcoxon signed‐ranks test, and multiple and logistic regression analyses were used to evaluate the changes in bleeding and dysmenorrhoea patterns, and possible confounding variables, respectively. Success was defined as the subjective reduction of menses to eumenorrhoea or less.

Results
No intra‐operative complications occurred, and post‐operative morbidity was minimal. Success of the procedure was constant over the year (range 88%–91%). Treatment led to a significant decrease in the duration of menstrual flow and severity of pain (P < 0.0001). Increasing age, higher balloon pressure, smaller uterine cavity, and a lesser degree of pre‐procedure menorrhagia were associated with significantly improved results. Pre‐treatment with gonadotrophin releasing hormone agonists increased amenorrhoea and spotting rates (P= 0.03), but was only used in 5% of cases.

Conclusion
Thermal balloon endometrial ablation appears to be safe, as well as effective in properly selected women with menorrhagia and is potentially an outpatient procedure.
Fetal cardiac function and septal thickness in diabetic pregnancy: a controlled observational and reproducibility study
Authors: Macklon Nicholas S. , Hop Wim C. J. , Wladimiroff Jurly W.
Published: August 2005

Objective
To determine the reproducibility of duplex Doppler waveform analysis and fetal cardiac interventricular septal thickness measurement and to compare these parameters in matched pregnancies with and without well‐controlled maternal Type 1 diabetes at 18–20 weeks of gestation.

Design
A prospective blind twin cohort study and a blinded inter‐observer and intra‐observer agreement study.

Setting
A tertiary referral prenatal diagnostic unit within a university hospital.

Results
Good inter‐ and intra‐observer agreement was found for the measurement of transvalvular peak flow velocities and the duration of ventricular ejection in the fetal heart. Inter‐observer agreement for aortic flow acceleration rate was poor. M‐mode measurement of interventricular septal thickness showed moderate reproducibility. The mean (SD) width of the interventricular septum in the fetuses of well controlled diabetic women was 2.1 mm (0.2 mm), and was significantly greater (P= 0.01) when compared with the corresponding value in matched controls [1.9 mm (0.2 mm)]. No cardiac functional differences were evident.

Conclusions
On‐screen video analysis of Doppler cardiac flow waveforms and M‐mode measurement of intraventricular septal thickness demonstrated good reproducibility. The fetuses of well controlled diabetic pregnancies demonstrated signs of altered cardiac morphology early in pregnancy, before any evident alterations in cardiac function.
Reduced fetal exposure to aspirin using a novel controlled‐release preparation in normotensive and hypertensive pregnancies
Authors: Regan Carmen L. , McAdam Brendan F. , McParland Peter , Boylan Peter C. , FitzGerald Garret A. , Fitzgerald Desmond J.
Published: August 2005

Objectives
To examine the fetal effects of a novel controlled‐release, low dose aspirin preparation in normal and hypertensive pregnancies.

Design
Random double‐blind study. Participants assigned to receive conventional formulation aspirin (75 mg), controlled‐release low dose aspirin (75 mg), or matching placebo.

Setting
National Maternity Hospital, Dublin.

Participants
Eighteen women with an uncomplicated pregnancy and 18 women with preeclampsia.

Main outcome measures
Urine was analysed for metabolites of thromboxane and prostacyclin by gas chromatography, mass spectrometry. Serum thromboxane B2, was determined in maternal and cord blood.

Results
Both aspirin preparations reduced maternal serum thromboxane B2, by 95% and induced similar reductions in the urinary 11‐dehydro‐thromboxane B2, a major metabolite of thromboxane A2in vivo. In contrast, neither preparation altered urinary 2,3–dinor‐6‐keto PGF1α, the major metabolite of prostacyclin. Despite their similar effects in the mothers, the two aspirin preparations differed in their effects on the fetus. While both suppressed cord fetal thromboxane B2, this was significantly (P < 0.005) less for the controlled‐release preparation (210 ± 42 ng/ml for placebo vs 109 ± 22 ng/ml for controlled‐release aspirin and 44 ± 9 ng/ml for regular oral aspirin).

Conclusions
At equivalent maternal suppression of serum thromboxane B2, a controlled aspirin release preparation results in lower fetal exposure than regular oral aspirin.
First trimester screening for Down's syndrome using maternal serum PAPP‐A and free β=hCG in combination with fetal nuchal translucency thickness
Authors: Biagiotti Roberto , Brizn Laura , Periti Enrico , D'Agata Albertino , VanZi Ermanno , Cariati Ettore
Published: August 2005

The aim of this study was to evaluate the potential effectiveness of maternal serum pregnancy‐associated plasma protein A (PAPP‐A) and free β‐hCG in combination with nuchal translucency thickness in first trimester screening for Down's syndrome. Maternal serum levels of PAPP‐A and free β‐hCG were assayed in stored sera from 32 Down's syndrome and 200 unaffected pregnancies. Fetal nuchal translucency was measured by ultrasound at the time of blood sampling. Screening of Down's syndrome using a combination of maternal age, PAPP‐A, free β‐hCG and nuchal translucency would achieve a detection rate of 75.8% for a false positive rate of 5%.
Two‐year follow up of women randomised to medical management or transcervical resection of the endometrium for heavy menstrual loss: clinical and quality of life outcomes
Authors: Cooper Kevin G. , Parkin David E. , Garratt Andrew M. , Grant Adrian M.
Published: August 2005

Objective
To assess clinical status and changes in health related quality of life after two years in women randomised to medical management or transcervical resection of the endometrium (TCRE) for treatment of heavy menstrual loss.

Design
Two‐year follow up using postal questionnaires and operative databank review.

Setting
Gynaecology department of a large UK teaching hospital.

Participants
Women who had joined a randomised comparison of medical treatment with TCRE for heavy menstrual loss two years previously.

Main outcome measures
Women's satisfaction with treatment, gynaecological symptoms, changes in health related quality of life, and additional treatments received at two years.

Results
Women allocated medical treatment were significantly less likely to be totally or generally satisfied (57%vs 79%, difference −22%, 95% CI −36, −9%), to find their management acceptable (77%vS 93%. difference −16%, 95% CI −26, A%), or to recommend their allocated treatment (24%vs 78%, difference −54%, 95% CI −61, −33%). In the medical cohort 59% of women had undergone TCRE, hysterectomy or both, whereas 17% in the TCRE cohort had undergone further surgery. Bleeding and pain scores were similar in the groups and highly significantly better than at recruitment. Short Form‐36 health survey scores were significantly improved from baseline for five of the eight health scores in the medical arm, and seven in the TCRE arm.

Conclusions
The results at two years consolidate the findings and conclusions based on the four‐month follow up data. A policy of early TCRE is effective and safe and does not result in an increase in hysterectomies. It should not be routinely withheld in an effort to try alternative medical therapies.
Hepatitis C virus infection is associated with a higher incidence of cholestasis of pregnancy
Authors: Locatelli Anna , Roncaglia Nadia , Arreghini Alessandra , Bellini Primula , Vergani Patrizia , Ghidini Alessandro
Published: August 2005

To investigate a possible relationship between hepatitis C virus infection and cholestasis of pregnancy, we identified all cases of cholestasis of pregnancy (145/16,271) and hepatitis C virus infection (63/16,27 1) between January 1992 and December 1997. Serologic screening was performed universally. The rate of cholestasis of pregnancy was greater in women whose hepatitis C virus antibodies were positive rather than negative [15.9% (10/63) vs 0.8% (135/16,208), P < 0.0011. Among women with cholestasis of pregnancy, mean (standard deviation) gestational age at onset of symptoms and at delivery was significantly lower among women whose hepatitis C virus antibodies were positive compared with negative women: 28.9 (3.2) vs 34.3 (3–5) weeks, P < 0.001 and 36–3 (0.9) vs 37.0 (1–6) weeks, P= 0.03, respectively. These findings suggest that early Occurrence of cholestasis of pregnancy may be an indication for serologic testing for hepatitis C virus.
Comparison of vaginal misoprostol and gemeprost as pretreatment in first trimester pregnancy interruption
Authors: Henry Aila‐Maija , Haukkamaa Maija
Published: August 2005

Objective
To compare the effectiveness of vaginal misoprostol pretreatment with standard gemeprost pre‐treatment in first trimester pregnancy termination.

Design
A prospective randomised study.

Population
One hundred and ninety‐nine women scheduled for day case termination of pregnancy during the first trimester.

Methods
Cervical priming with a vaginally applied 200 μg tablet of misoprostol for at least four hours, compared with a 1.0 mg vaginal suppository of gemeprost for at least three hours before vacuum aspiration.

Main outcome measures
The prostaglandin effect on baseline cervical dilatation was the main outcome. Others were occurrence of pre‐operative pain and need for analgesia, pre‐operative side effects such as nausea, vomiting and diarrhoea, presence of blood in the vagina and blood loss during the operation.

Results
There was no significant difference in the dilatation ability of misoprostol or gemeprost, nor in the preoperative use of analgesics. The frequency of nausea and diarrhoea was significantly less common in the misoprostol treated women.

Conclusions
Vaginally applied misoprostol is as effective as gemeprost in cervical priming prior to first trimester vacuum aspiration. Misoprostol was associated with fewer side effects than gemeprost.
Review and assessment of selection criteria used when booking pregnant women at different places of birth
Authors: Campbell R.
Published: August 2005

Objective
To describe and assess the selection criteria currently being used when booking women for different places of birth.

Design
A cross‐sectional survey.

Setting
The South and West region of England.

Sample
The 27 NHS Trusts who provide maternity care in the South and West region of England.

Main measures
Selection criteria used when booking pregnant women for different places of birth; length of time criteria in use; whether criteria applied individually or as part of a risk score; and method by which criteria developed.

Results
The response rate was 81%; 128 different, individual criteria, used as the basis to select women for different places of birth, were identified. No single criterion appeared on all the sets of criteria. None of the trusts who responded used the criteria in order to calculate a risk score. In all but one case the criteria were being used to select women who might be suitable for birth outside a consultant‐led maternity unit. Only two trusts used sets of criteria which identified, to any extent, 1. outcomes for which women could be at risk and 2. strategies that should be implemented to reduce that risk. Over half the trusts were able to identify a rationale for the particular set of criteria which they used but in only two cases was any reference made to an evidence base.

Conclusions
A large variety of criteria are being used as a basis on which to book women for different places of birth but they appear to be poorly focused on particular adverse outcomes. To be effective, selection criteria must identify quantifiable differences in the risk of particular preventable adverse outcomes for births booked at different locations. Furthermore, there must be evidence that the risk could be reduced by a selecting a particular location. A systematic review is required to determine which selection criteria, if any, should be employed at booking.