bluuebunny/crossref_metadata_2025 huggingface dataset:
Melanoma and pregnancy: a long‐term follow‐up
Authors: McMANAMNY D. S. , MOSS A. L. H. , BRIGGS J. C. , POCOCK P. V.
Published: August 2005

Treatment of the pregnant woman with melanoma is contentious. With the aid of a computerized melanoma register, in which pregnancy data can be recorded, 290 women with melanoma were reviewed (249 alive and 41 dead). Overall, 23 patients were pregnant at ithe time of diagnosis of melanoma, and another 23 became pregnant at some time after primary treatment of a melanoma. Pregnancy appears to have no significant influence on the survival of patients with melanoma J but it is recommended that pregnancy should be avoided for the first three years following excision of a melanoma.
Comparison of the Foley catheter and dinoprostone pessary for cervical preparation before second trimester abortion
Authors: HACKETT G. A. , REGINALD P. , PAINTIN D.
Published: August 2005

The Foley catheter and a 3 mg dinoprostone pessary (Prostin E2) were compared as methods for cervical preparation before second trimester dilatation and evacuation. The catheter was well tolerated and provided significantly greater change in cervical dilatation and improved cervical compliance. The Foley catheter would seem to provide a readily available and efficacious means of cervical preparation.
Diagnosis of deep venous thrombosis in pregnancy: a new role for diagnostic ultrasound
Authors: GREER I. A. , BARRY J. , MACKON N. , ALLAN P. L.
Published: August 2005

Summary. Ultrasound has recently become accepted as an accurate imaging technique in the diagnosis of deep vein thrombosis. Real‐time and duplex ultrasound findings in six pregnant women with clinically suspected deep venous thrombosis are described.
Laser laparoscopy in the treatment of endometriosis. A 5‐year study
Authors: SUTTON C. , HILL D.
Published: August 2005

Summary. The carbon‐dioxide laser used laparoscopically provides a precise and virtually bloodless technique for the vaporization of endometriotic implants in the pelvis. The technique has been used at St Luke's Hospital, Guildford, for the past 6 years and this report presents 228 consecutive patients with endometriosis treated during the 5 years between 1982 and 1987 and followed up for between 1 and 6 years. Pain was improved in 70% and 80% of the 56 infertile patients with endometriosis as the only identifiable abnormality conceived. Of the 54 pregnancies, only 37 (69%) had a successful outcome, reflecting the high pregnancy failure rate found in women with endometriosis. Hospital stay was relatively short and complications were few and usually minor and there was no injury or morbidity caused by laser energy. The main advantage of laser laparoscopy in endometriosis is that patients may be treated at the time of diagnosis with less need for medication and no delay before conception is attempted
Lack of correlation between a high caesarean section rate and improved prognosis for low‐birthweight twins (<2500 g)
Authors: RYDHSTRÖM HÅKAN , INGEMARSSON INGEMAR , OHRLANDER STEN
Published: August 2005

Summary. The impact of birth by caesarean section on perinatal mortality was estimated for 9368 low‐birthweight twins (<2500 g) born in Sweden between 1973 and 1985, by using national data from the Medical Birth Registry, National Board of Health and Welfare, Stockholm. During this period the caesarean section rate increased from 7–10% to 45–50% while concomitantly a sharp decrease in the perinatal mortality rate occurred. A causal relation between the increased rate of abdominal delivery and the improved prognosis for low birthweight twins might be expected. However, analysis of the results failed to show any correlation between these two variables. Factors other than route of delivery seem to have a greater impact on fetal outcome.
How accurate is a woman's diagnosis of threatened preterm delivery?
Authors: KRAGT HARRY , KEIRSE MARC J. N. C.
Published: August 2005

Summary. During a 1‐year period all women entering hospital with signs or symptoms that could herald preterm delivery were studied. The primary complaints of these 178 women were contractions in 70, watery discharge in 59, bloody discharge in 33, and abdominal pain in 16. These complaints were considered as confirmed threats of preterm delivery if the woman was delivered or received tocolysis within 48 h (n= 63; 35%); they were labelled as an unconfirmed threat if the woman was allowed to return home without further action within 48 h (n= 45; 25%). Overall, 75% of the women were correct in their estimation that something was wrong in that they either gave birth or were admitted for >48 h for diagnostic or therapeutic measures. Parity had only a small influence on women's predictive ability. It is concluded that efforts to increase women's awareness of the significance of various symptoms are not likely to contribute much to improvement in the early diagnosis of preterm labour. Greater effect can be anticipated from the development of methods to differentiate between contractions that will or will not lead to early delivery.
Anaesthesia for emergency caesarean section
Authors: MORGAN BARBARA M. , MAGNI VALERIE , GOROSZENUIK TEODORE
Published: August 2005

Summary. The Report on Confidential Enquiries into Maternal Deaths in England and Wales 1982–84 (Department of Health 1989) recommends early involvement of the anaesthetist in women having emergency caesarean sections and the use of epidural anaesthesia in preference to general anaesthesia. In an observational prospective study the need for emergency abdominal delivery could be anticipated in 87% of 360 consecutive emergency caesarean sections. Early establishment of epidural analgesia allowed extension, to an appropriate level for the surgery, in 70%. The duty anaesthetist accompanying the obstetric team on three wardrounds a day could be forewarned of anticipated problems in most women who are eventually delivered abdominally.
Large loop excision of the transformation zone (LLETZ) compared to carbon dioxide laser in the treatment of CIN: a superior mode of treatment
Authors: GUNASEKERA P. C. , PHIPPS J. H. , LEWIS B. V.
Published: August 2005

Summary. A series of 199 patients with histologically confirmed cervical intraepithelial neoplasia (CIN) grade II or III were allocated by hospital number to receive out‐patient treatment by carbon dioxide laser vaporization or large loop excision of the transformation zone (LLETZ). All patients received local anaesthesia. The women in the LLETZ group experienced less post operative haemorrhage, less discomfort, operative time was greatly reduced, and histological material was available for confirmation of the diagnosis. There was no significant difference in recurrence of CIN after treatment between the two groups. At 6 month follow‐up, recurrence rates of 8.2% (CIN II) and 7.5% (CIN III) were observed in the laser‐group and 5% (CIN II) and 5.3% (CIN III) in the LLETZ group. Further advantages of LLETZ are reduced capital expenditure and no hazard to the eyesight of the surgeon, but laser treatment is preferable in patients with widespread vaginal involvement.
Second trimester pregnancy termination using extraamniotic ethacridine lactate
Authors: BHATHENA R. K. , SHERIAR N. K. , WALVEKAR V. R. , GUILLEBAUD J.
Published: August 2005

Objective–To investigate the efficacy of ethacridine lactate by the extraamniotic route for second trimester pregnancy termination and its associated complications.

Design–Retrospective study of women undergoing second trimester termination, over 3½ years, with extra‐amniotic ethacridine alone, or extra‐amniotic ethacridine supplemented later by extra‐amniotic 15‐methyl prostaglandin F,α.

Setting–Teaching hospital in Bombay.

Patients–315 consecutive women undergoing late abortions with extraamniotic ethacridine. Demographic features were similar in the two groups.

Interventions–In group 1, 207 women had 150ml of 0.1% ethacridine lactate injected slowly into the extra‐amniotic space. In group 2, 108 women had the initial injection supplemented 6 h later by an extra‐amniotic injection of 250 μ.g (1 ml) of 15‐methyl prostaglandin F2α.

Main outcome measures–The occurrence of abortion following the induction procedure. The development of complications such as haemorrhage, infection, or injury to the uterus or cervix.

Results–The method was successful in 191 women (92%) in group 1 and in 106 (98%) in group 2. The median induction‐abortion intervals were 35 and 19 h, respectively (Mann‐Whitney U test, P<0.001). The corrected complication rate was <10% (30 women), with unplanned uterine evacuation in 6% (20), haemorrhage in 1% (4), and pelvic infection in 4% (14).

Conclusion–The use of extra‐amniotic ethacridine lactate provides an effective and safe treatment method for second trimester legal abortion. The inductionabortion interval can be appreciably reduced by supplementary prostaglandin.
The effect of caput succedaneum on oxygen saturation measurements
Authors: JOHNSON NICOLAS , JOHNSON VALERIE A. , BANNISTER JEFFREY , LILFORD RICHARD J.
Published: August 2005

Summary. Advances in oximetry have allowed the obstetrician to measure oxygen saturation in the fetus with non‐invasive transcutaneous techniques. The influence of caput succedaneum formation on the oxygen saturation results obtained with a pulse oximeter was studied in 30 newborn infants. Caput was associated with a reduced oxygen saturation reading (mean reduction of 15%; P<0.001). This effect is partly due to a true drop in local tissue oxygenation but is exacerbated by a systematic error intrinsic to the physics of spectrophotometry. If continuous intrapartum oximetry is ever to become a part of routine obstetric monitoring then probes that pass through the cervix beyond the caput of the presenting part will be required if erroneously low readings are to be avoided.
Early recurrent miscarriage: histology of conception products
Authors: JONG M. H. HOUWERT‐DE , BRUINSE H. W. , ESKES T. K. A. B. , MANTINGH A. , TERMIJTELEN A. , KOOYMAN C. D.
Published: August 2005

Summary. The histopathological appearance of conception products from 44 women with recurrent miscarriage was compared with those obtained from 105 women with sporadic miscarriage. Abnormal villi, suggesting fetal chromosomal abnormalities, were found in 62% of women with a recurrent miscarriage and in 58% of those with sporadic miscarriage. This difference is not statistically significant.
The results of tubal surgery in the treatment of infertility in two non‐specialist hospitals
Authors: WATSON A. J. S. , GUPTA J. K. , O'DONOVAN P. , DALTON M. E. , LILFORD R. J.
Published: August 2005

Summary. The results of surgery for tubal damage, other than reversal of sterilization, were studied in two large hospitals. This is the first recent study from centres claiming no special expertise in this surgery. An unusually high follow‐up rate was obtained. The term pregnancy rate for patients operated on for bilateral distal tubal occlusion was 4%. The success rate is lower than the lowest reported, overall success rates for each cycle of in vitro fertilization (IVF) and very much lower than cumulative term pregnancy rates for tubal surgery reported by most other authors. Patients with distal tubal occlusion but minimal adhesions had the best prognosis. Our results suggest that, provided in vitro fertilization is available, only those patients with good prognostic factors should undergo tubal surgery. These represent the minority of all patients with non‐iatrogenic tubal blockage.
Doppler echocardiographic assessment of time to peak velocity in the aorta and pulmonary artery of small for gestational age fetuses
Authors: RIZZO GIUSEPPE , ARDUINI DOMENICO , ROMANINI CARLO , MANCUSO SALVATORE
Published: August 2005

Summary. The time to peak velocity was measured at the level of the ascending aorta and pulmonary artery by Doppler echocardiography in 38 small‐for‐gestational age (SGA) fetuses before and during maternal hyperoxygenation. The values were compared to a reference range derived from the study of 142 appropriate‐for‐gestational age (AGA) fetuses. In the SGA fetuses the time to peak velocity at the level of pulmonary artery was significantly lower and at the level of the aorta significantly higher than in AGA fetuses. During maternal hyperoxygenation the aortic time to peak velocity decreased towards normal range but there was no significant change at the level of the pulmonary artery. These results may indicate variations of aortic and pulmonary pressures in SGA fetuses that can be partially modified by maternal hyperoxygenation and which may be associated with changes in the peripheral resistance of the cerebral circulation.
Malignant trophoblastic tumours in Norway. Fertility rate after chemotherapy
Authors: KJER J. J. , IVERSEN T.
Published: August 2005

Summary. During the period 1970–1986, 73 women with malignant trophoblastic tumours were reported in Norway. Forty‐six of these women were sent a questionnaire about the course of pregnancies subsequent to treatment with methotrexate and actinomycin D. Only 30 of these women had had the desire to get pregnant; 10 had had one, 13 had had two, and six had had three further children. It is concluded that treatment with combination of methotrexate and actinomycin D is safe in terms of preserving fertility.
Reliability of colposcopy and directed punch biopsy
Authors: SKEHAN M. , SOUTTER W. P. , LTM K. , KRAUSZ T. , PRYSE‐DAVIES J.
Published: August 2005

Summary. A group of 118 women underwent laser cone biopsy. Data were collected routinely on proforma case notes and entered into a computerized database. The histology of the cone biopsies was compared with that of previous, colposcopically directed punch biopsies, with the cytology of smears taken in the clinic and with the colposcopic diagnosis. The punch biopsy had a 54% false negative rate and neither of the two microinvasive carcinomas biopsied in this way were detected by the biopsy. Ten of 24 women with negative punch biopsies had CIN III in the cone. When the punch biopsy showed CIN II or worse, the cone biopsy confirmed the presence of CIN in 86%. There was some evidence of false negative cone biopsies. The data suggest that management should not be based solely upon the punch biopsy result but should include consideration of the cytology and colposcopy findings. Excisional methods of treatment are more likely to reveal early invasion and adenocarcinoma‐in‐situ.
External cephalic version at term. A randomized controlled trial using tocolysis
Authors: MAHOMED K. , SEERAS R. , COULSON R.
Published: August 2005

Objective— To assess the role of external cephalic version (ECV) at term, using tocolysis.

Design— A randomized controlled trial over a 12 month period.

Setting— Harare Maternity Hospital, Harare, Zimbabwe.

Subjects— 208 women with breech presentation at term were recruited after satisfying eligibility criteria. There were 103 women in the study group and 105 in the control group. At the end of the study a further 104 women were recruited for ECV.

Intervention— ECV attempted after intravenous injection of 10 μg of hexaprenaline, using either forward or backward somersault over a maximum period of 5 min.

Main outcome measures— Success rate in terms of presentation during labour, need for caesarean section, and various variables related to fetal outcome.

Results— ECV reduced the frequency of breech presentation during labour from 83% to 17% and that of caesarean section from 33% to 13%. There were no troublesome complications from the procedure.

Conclusion— In carefully selected women with breech presentation, ECV at term using tocolysis, safely reduced the rate of breech presentation in labour and also the caesarean section rate. Further research is needed to determine the role of ECV in early labour.
A randomized control trial of two cervical spatulas
Authors: WOODMAN C. J. B. , YATES M. , WILLIAMS D. R. , WARD K. , JORDAN J. , LUESLEY D.
Published: August 2005

Summary. The sampling efficacy of the Ayre and Rocket cervical spatulas was compared in a randomized controlled trial involving 533 women who were attending a colposcopy clinic either for investigation of cytological abnormality or for review after treatment of CIN. Smears were compared with respect to the presence of cytological abnormality and two types of normal cervical epithelial cells (endocervical and immature metaplastic cells) which are considered indicators of adequate cytological sampling. Smears taken with the Rocket spatula were significantly less likely to contain immature metaplastic cells (95% CI on difference in proportion; 5–30%), but more likely to contain endocervical cells (95% CI 16–36%). No significant difference was found in the proportion of smears containing one or other type of indicator cell or in the yield of abnormal smears. It is concluded that the Rocket spatula offered no advantage when used in these circumstances. This study illustrates how spurious conclusions of sampling efficacy can be drawn if only one type of indicator cell is used as an endpoint.
Fetal crown‐rump length values in the first trimester based upon ovulation timing using the luteinizing hormone surge
Authors: EVANS J.
Published: August 2005

Summary. Fetal crown rump length (CRL) was measured weekly in 33 singleton pregnancies that were established after in vitro fertilization, gamete intrafallopian transfer or natural intercourse in monitored infertility treatment cycles. The time of the luteinizing hormone surge or hCG administration was known for all of them. There was no difference in CRL between the different infertility treatment groups. CRL measurements from this and a similar study where gestational age had been based on the time of ovulation were compared with the CRL measurements from pregnancies where the gestational age had been calculated from the last menstrual period. The CRL was found to be generally smaller in the studies based on ovulation timing and the difference was statistically significant at one time point. This suggests that there is a need for a gold standard in obstetric ultrasound, measurements being based on the gestational age as calculated from the unequivocal date of conception, rather than the last menstrual period.
How obstetricians manage the problem of preterm delivery with special reference to the preterm breech
Authors: PENN ZOE J. , STEER PHILIP J.
Published: August 2005

Summary. A questionnaire regarding the route of birth for the preterm fetus with particular reference to the management of the preterm breech was sent to 180 consultants in England and Wales. Only 23% of respondents use electronic fetal monitoring below 26 weeks gestation and only 12% use caesarean section routinely for fetal indications at less than 26 weeks. Only 12% will use caesarean section for the preterm fetus presenting by the vertex in uncomplicated labour. Only 35% of all respondents consider that there is sufficient evidence to support the use of caesarean section for the uncomplicated preterm breech, but 76% will actually use caesarean section for this indication. Overall 71% reported that they are affected by medicolegal considerations in their management of the preterm breech. Overall, 83% said that they might change their practice regarding the mode of delivery of the preterm breech in the light of the findings of a randomized prospective controlled trial.
Trends in multiple births in Italy: 1955–1983
Authors: PARAZZINI FABIO , TOZZI LUCA , MEZZANOTTE GUERRINO , BOCCIOLONE LUCA , LA VECCHIA CARLO , FEDELE LUIGI , BENZI GUIDO
Published: August 2005

Summary. On the basis of the numbers of single and multiple births routinely collected by the Central Institute of Statistics, trends in multiple births in Italy over the period 1955–1983 were analyzed. Between 1955 and 1983 the frequency of multiple births declined by about 25% (from 12–6/1000 deliveries to 9‐6/1000 deliveries). The downward trend was constant until the early 1970s when rates tended to level off and increase slightly. This finding was largely attributable to trends in dizygotic rates, monozygotic births being approximately constant over the period considered. Multiple birth rates rose till age 35–39, being more than two times higher in this age group than in teenagers, but flattened off in the subsequent strata of age: this finding was constant over the period considered. Despite the general decreasing trend, the regional differences persisted largely unchanged, multiple birth rates being about 30% higher in Southern (and less developed areas) of the country than in the North of Italy. Geographic differences were limited to dizygotic pregnancies, monozygotic rates being constant (about 4/1000 pregnancies) in various areas.
The use of the GnRH analogue buserelin for IVF—does it improve fertility?
Authors: SHELTON KAREN , FISHEL SIMON , JACKSON PETER , WEBSTER JOHN , FARATIAN BAHMAN , JOHNSON JOANNE
Published: August 2005

Objective— To determine the effect of a short course of the GnRH analogue buserelin and human menopausal gonadotrophin (hMG), for ovarian stimulation in our IVF programme, on reproductive endocrinology and pregnancy rates compared with conventional clomiphene citrate and hMG treatment.

Design— Prospective randomized allocation to one of two ovulation stimulation regimens.

Setting— Fertility clinic.

Subjects— 373 infertile couples with various factors associated with their subfertility. All the women were <46 years of age and had normal menstrual cycles.

Intervention— The first group (n = 151) was given clomiphene citrate (CC) from days 2–6 of the menstrual cycle and hMG from day 5 onwards (CC/hMG). The second group (n = 222) was given buserelin from days 1–3 and hMG from day 2 (buserelin/hMG).

Main outcome measures— Concentration of plasma luteinizing hormone (LH), oestradiol (E2) and progesterone, number of ovulatory follicles induced and the occurrence of pregnancy.

Results— Plasma LH, E2 and progesterone concentrations were reduced in the late follicular phase after buserelin/hMG compared with CC/hMG. Buserelin/hMG promoted the development of more follicles than CC/hMG. The overall pregnancy rate after buserelin/hMG was not significantly different from that following CC/hMG treatment.

Conclusion— The chance of pregnancy is not improved by the short‐term use of buserelin with hMG, provided adequate follicular phase management is maintained.
Angiotensin II levels in hypertensive and normotensive pregnancies
Authors: HANSSENS MYRIAM , KEIRSE MARC J. N. C. , SPITZ BERNARD , VAN ASSCHE F. ANDRE
Published: August 2005

Summary. We measured circulating angiotension II by radioimmunoassay in women with pregnancy‐induced hypertension (n = 54), and compared these values with those obtained in women with normal pregnancy (n = 18) and in non pregnant women (n = 20). Pregnant women had statistically significantly higher plasma angiotensin II [mean (SD): 41.3 (12.6) pg/ml] than non‐pregnant women [29.2 (11.3) pg/ml; P < 0.004]. Angiotensin II concentrations in women with pregnancy‐ induced hypertension [mean (SD): 31.7 (16.2) pg/ml] were, on average, 25% lower than in normal pregnancy (P < 0.003) and resembled those obtained in non‐pregnant women. The lowest angiotensin II levels were found in women with more severe forms of pregnancy‐induced hypertension, such as proteinuric or superimposed pregnancy‐induced hypertension. Review of the published studies on angiotensin II and our data suggest that the conflict among studies on angiotensin II levels in pregnancy‐induced hypertension is largely due to the heterogeneity of the study populations in the various reports.
Peritoneal fluid volume and sex steroids in the preovulatory period in mild endometriosis
Authors: MAHMOOD TAHIR A. , TEMPLETON ALLAN
Published: August 2005

Summary. Twenty infertile women with laparoscopically confirmed mild endometriosis and ten women with tubal infertility underwent diagnostic laparoscopy 32 h after the onset of the endogenous luteinizing hormone (LH) surge during a spontaneous menstrual cycle. All visible peritoneal fluid was aspirated for assessment of volume and sex steroid content. There was no significant difference in peritoneal fluid volume or concentrations of oestradiol, progesterone and androstenedione between the two groups. Furthermore in the endometriosis group there was no significant difference in peritoneal fluid volume and concentrations of sex steroids between those women who had been treated previously with danazol and those who were left untreated.
Perceived risk not actual risk predicts uptake of amniocentesis
Authors: MARTEAU THERESA M. , KIDD JANE , COOK RACHEL , MICHIE SUSAN , JOHNSTON MARIE , SLACK JOAN , SHAW R. W.
Published: August 2005

Summary. A consecutive cohort of 71 women eligible for amniocentesis because they were over 38 years of age completed questionnaires during the first trimester of pregnancy. Sixty‐one women underwent amniocentesis, an uptake rate of 86%. Uptake was associated with a less negative attitude towards termination of an affected baby and a higher perceived risk of the fetus being abnormal. It was not associated with actual age‐related risks. There was no significant relation between actual risk and perceived risk. The results of this study suggests that it is important for doctors to understand the basis of women's decisions to have amniocentesis, and the difference between actual and perceived risk if they are to communicate effectively with women about the test and their options.
Effect of cervical traction with a tenaculum on the uterocervical angle
Authors: JOHNSON NICHOLAS , BROMHAM DAVID R.
Published: August 2005

Summary. The effect of cervical traction on the uterocervical angle was measured radiographically in 24 women undergoing diagnostic curettage. A radio‐opaque guidewire was inserted through the cervical canal into the uterine cavity and a lateral pelvic X‐ray taken before and after traction. The traction force was measured with a spring‐balance attached to the tenaculum. Cervical traction in a caudal direction (force 2 N) reduced the median uterocervical angle, from 75° to 10° (P= 0.001). Moderate cervical traction straightens the uterus and the routine use of a tenaculum theoretically makes insertion of an intrauterine device safer and the passage of an embryo transfer catheter less traumatic.
West Midlands perinatal mortality survey, 1987. An audit of 300 perinatal autopsies
Authors: RUSHTON D. I.
Published: August 2005

Summary. As part of the West Midlands regional perinatal mortality survey an audit of perinatal autopsies was performed in 10 of 20 districts in the region. Autopsy reports were available from 300 of the 426 deaths (70%) reported in these districts. These were coded for 8 aspects including the clinical summary, body measurements, descriptive content, organ weights, post mortem radiology and microbiology, histology and other relevant investigations e.g., biochemistry, cytogenetics. Overall 44% of the autopsies failed to attain an arbitrary minimum score of 300, the mean score being 299. Excluding those autopsies performed at the regional centre these figures were 50% and 268 respectively. These data indicate that a high autopsy rate does not necessarily reflect a high quality of service and further emphasise the concerns that have been expressed by obstetricians, paediatricians, geneticists, parents and parliamentarians about the perinatal pathology services in the United Kingdom.
Pretreatment of the primigravid uterine cervix with mifepristone 30 h prior to termination of pregnancy: a double blind study
Authors: COHN MIKE , STEWART PETER
Published: August 2005

Objective— To determine the effect of the antiprogestogen mifepristone (RU 486) on cervical resistance before first trimester termination of pregnancy.

Design— Prospective double blind randomized placebo controlled study.

Setting— Department of gynaecology in a university teaching hospital, Sheffield.

Subjects— 80 Primigravid women >18 years of age, undergoing termination of pregnancy at between 7 and 13 weeks gestation.

Interventions— A single dose of 600 mg of mifepristone or placebo given orally 30 h before termination of pregnancy under general anaesthesia.

Main outcome measures— Cervical resistance to dilatation.

Results— Pretreatment with mifepristone significantly reduced the amount of force required to dilate the cervix to 10 mm. In comparison with placebo, the mean sum of the peak forces obtained with dilators 4 to 10 mm was reduced from 84.3 N (SD 29.7) to 46.0 N (SD 26.7). Two women in the treated group had a cervical resistance of >100 N compared with nine women in the placebo group (RR 0.18, 95% Cl 0.04–0.89). The 8 mm dilator could be passed with less than 5 N force in 16 women (43%) in the treated group compared with none in the placebo group. Women in the active treatment group had more preoperative pelvic pain and vaginal bleeding but less postoperative pain.

Conclusion— Mifepristone significantly reduces cervical resistance in the first trimester of pregnancy and produces minimal side effects.
Follicular development in spontaneous and stimulated cycles in women with minimal‐mild endometriosis
Authors: MAHMOOD TAHIR A. , MESSINIS IOANNIS E. , TEMPLETON ALLAN
Published: August 2005

Objective— To study follicle development in women with minimal‐mild endometriosis.

Design— In women with endometriosis a spontaneous ovulatory cycle was compared with two subsequent cycles in which either clomiphene or clomiphene and FSH were given to stimulate folliculogenisis. Spontaneous cycles in women with tubal infertility provided a comparison group.

Setting— Infertility clinic, Aberdeen Maternity Hospital.

Subjects— 17 women with minimal‐mild endometriosis and 10 women with tubal infertility.

Interventions— The women with endometriosis were treated with 150 mg clomiphene citrate from days 2 to 6 in one cycle and in a subsequent cycle with 150 mg clomiphene citrate on days 2 to 6 plus 75 iu FSH daily thereafter.

Main outcome measures— Follicular size measured daily using ultrasound. Serum FSH estimated on days 5 and 7 and then daily.

Results— Spontaneous follicular growth in the women with endometriosis was similar to that in the women with tubal infertility. Follicular development began earlier in cycles with clomiphene/FSH and the leading follicle reached 16 mm 2 days sooner but the rate of growth was similar whether or not either regimen of stimulation was used.

Conclusion— Follicular growth is not impaired by minimal‐mild endometriosis. Infertility with this condition cannot be explained by altered follicular growth or responsiveness.
Computerization of a colposcopy clinic
Authors: SOUTTER W. P.
Published: August 2005

Summary. The first phase of a paperless computer record has been developed at Hammersmith Hospital. The system was designed around the work practices of the clinic staff. In this phase the data are collected on forms which replace the normal case notes. This information is entered onto an IBM compatible computer by the secretary using a quick, user‐friendly program written in a dBASE dialect and compiled with Quicksilver. The program produces letters to patients and their doctors and a printed record of the clinic findings for the case sheet to replace the handwritten form. When funding for hardware becomes available the data will be entered directly into the system by the medical staff in the clinic. Clinic appointment lists are maintained and patients ‘lost to follow‐up’ can be identified. Ad hoc enquiries can be made using dBASE III Plus or any similar program. This approach has integrated the computerized recording of data in a colposcopy clinic with the normal work of the staffinvolved so that no extra effort is required from medical or secretarial staff. The immediate accessibility of patient data and the ability to audit the work of the clinic have been particularly useful.
Cotinine‐assisted intervention in pregnancy to reduce smoking and low birthweight delivery
Authors: HADDOW JAMES E. , KNIGHT GEORGE J. , KLOZA EDWARD M. , PALOMAKI GLENN E. , WALD NICHOLAS J.
Published: August 2005

Objective— To investigate the feasibility and impact of integrating a cotinine‐assisted smoking intervention programme with an existing antenatal maternal serum alpha‐fetoprotcin (AFP) screening service for open neural tube defects.

Design— A multisite randomized controlled trial.

Setting— 139 physician offices and clinic sites in Maine providing antenatal care.

Subjects— 2848 pregnant women who smoked 10 or more cigarettes daily, enrolled at between 15 and 20 weeks gestation, from a population base of approximately 18 000 pregnancies.

Interventions— The women were individually allocated at random to intervention or control groups within each centre at the time the serum sample was received for AFP measurement. The intervention group received an interpreted measurement of the serum cotinine, reported through the physician to the woman, along with a self‐help smoking cessation booklet and a repeat serum cotinine measurement one month later, again interpreted and reported through the physician to the woman. Women in the control group received the usual anti‐smoking advice provided by the antenatal care site and were not told of the study.

Main outcome measures— Birthweight, physician cooperation with study protocol (as measured by effectiveness in obtaining repeat serum samples for cotinine measurements).

Results— Pregnancy outcome data were available for 97% of the study population, including birthweight for 2700 singleton viable pregnancies. The smoking intervention programme led to a significant 66 g increase in mean birthweight (P = 0.03; 95% CI+9 to +123 g) and to a 30% reduction in the rate of low birthweight in pregnancies managed by the 70 physicians who secured the highest rate of obtaining repeat serum samples for cotinine measurements in their intervention group. Among the remaining 69 physicians, intervention had no detectable effect on birthweight.

Conclusion— A cotinine‐assisted smoking intervention programme managed from a central location as an adjunct to a maternal serum AFP screening service can, with the cooperation of physicians responsible for antenatal care, lead to a significant and cost‐effective reduction in the number of low birthweight babies. This programme is inexpensive, requires little extra effort, and does not need specially trained personnel.
Fetal blood sampling and pregnancy loss in relation to indication
Authors: MAXWELL DARRYL J. , JOHNSON PAM , HURLEY PAULINE , NEALES KATE , ALLAN LINDSEY , KNOTT PETER
Published: August 2005

Objective— To assess the relation between the indication for fetal blood sampling and pregnancy loss following the procedure.

Design— Retrospective study.

Setting— The tertiary referral Fetal Medicine Units at Guy's and University College Hospitals, London.

Subjects— Women undergoing diagnostic fetal blood sampling in four groups: (1) 94 having prenatal diagnosis with normal ultrasound findings; (2) 94 with a structural fetal abnormality; (3) 30 having fetal assessment and (4) 35 with non‐immune hydrops.

Interventions— Freehand ultrasound guided fetal blood sampling from umbilical cord, intrahepatic vein or fetal heart.

Main outcome measures— Pregnancy losses were divided into those within 2 weeks and those 2 weeks after the procedure, obstetric accidents and neonatal deaths.

Results— The 253 patients had fetal blood sampled on 268 occasions. Fifty‐one pregnancies were terminated. Overall, 51 of the remaining 202 desired continuing pregnancies were lost, of which 19 (9%) were lost within 2 weeks of the procedure. After exclusion of the pregnancies that were terminated, the procedure‐related losses within 2 weeks of sampling were 1 in 76 (1%), 5 in 76 (7%), 4 in 29 (14%) and 9 in 36 (25%) in groups 1, 2, 3 and 4 respectively.

Conclusions— The risk of fetal blood sampling is increased in abnormal pregnancies, reflecting the underlying pathology and this must be taken into account when counselling patients before the procedure.
Magnesium intake and status and pregnancy outcome in a Danish population
Authors: SKAJAA KRISTJAR , DØRUP INGE , SANDSTROM BRITT‐MARIE
Published: August 2005

Objective— To investigate the relation between pregnancy outcome and magnesium intake and status.

Design— A prospective observational study in which the estimate of nutrient intake and serum samples were obtained before the final outcome of pregnancy was known. A second part of the investigation was a cross‐sectional comparison of magncsium status of normal pregnant women and women with certain pathological pregnancies.

Setting— Antenatal clinic associated to the University Clinic of Obstetrics and Gynaecology, University of Aarhus, Denmark.

Subjects— 1203 consecutive women in the 30th week gestation were invited to participate in the study, 991 (82.4%) accepted and records for 965 (80.2%) were available for analysis.

Data— Food intake data were collected by a combination of a self administered questionnaire and a structured interview of a dietary history type. Serum samples were obtained from blood withdrawn in the 30th and 37th week gestation. Obstetric data were collected from the midwifery and hospital records. For a second part of the investigation, biopsies from the uterus and the abdominal rectus musclc were obtained from women delivered by caesarean section.

Results— In the women with normal pregnancies and in the three groups of pathological pregnancies (pre‐eclampsia, SGA‐infants and preterm labour) the average magnesium intake was with in the range of 200 to 208 mg per 1000 kcal perday (SD 32)and there were no differences between the groups. Neither were differences in serum magnesium observed. Birthweight for gestational age was not influenced by determinationm intake. No differences in magnesium status as assessed by determination of magnesium content in muscle biopsies were found between the normal pregnancies and women with pre‐eclampsia, SGA‐infants or preterm labour.

Conclusion— The intake of magnesium seemed adequate, and pre‐eclampsia, SGA‐infants, or preterm labour did not seem associated with a low dietary intake of magnesium or magnesium deficiency. Routine magnesium supplementation during pregnancy is not recommended for populations of relative good socio‐economic status.
Respiratory function in severe gestational proteinuric hypertension: the effects of rapid volume expansion and subsequent vasodilatation with verapamil
Authors: BELFORT M. A. , ANTHONY J. , KIRSHON B.
Published: August 2005

Objectives— (1) To define the baseline respiratory function in untreated severe gestational proteinuric hypertension (GPH) and (2) to assess the effects of volume expansion with dextran (MW = 70 000 Dalton) and subsequent vasodilatation with the calcium antagonist verapamil on the baseline respiratory function in severe GPH.

Design— Prospective descriptive study.

Setting— Reproductive Research Unit, Groote Schuur Hospital, Cape Town, South Africa.

Subjects— Six women with severe GPH undergoing stabilization and delivery.

Interventions— Baseline haemodynamic and respiratory function was assessed using invasive monitoring. Patients then underwent volume expansion to a pulmonary capillary wedge pressure of 16 mmHg with dextran‐70, followed by vasodilatation with the calcium antagonist verapamil. Haemodynamic and respiratory variables were measured, before and after both the fluid load and the reduction (20%) in the mean arterial pressure.

Main outcome measures— Mean arterial pressure, heart rate, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, central venous pressure, cardiac index, systemic vascular resistance, pulmonary vascular resistance, respiratory rate, blood gases, alveolar arterial oxygen difference, oxygen availability, oxygen consumption, pulmonary shunt fraction.

Results— Baseline oxygen availability/delivery and oxygen consumption indices were consistent with severe tissue ischaemia. Volume loading with 400 ± 114 ml dextran‐70 normalized these variables, and subsequent vasodilatation with verapamil did not reduce these indices below the normal limits for pregnancy.

Conclusions— These data support the theory that some of the complications of severe GPH may follow organ damage due to prolonged tissue ischaemia. They also support the appropriateness of controlled volume expansion in the management of this condition. We suggest, from these data, that the combination of volume expansion and verapamil vasodilatation lowers the blood pressure without compromising the maternal respiratory function.
Randomized controlled trial of antenatal social support to prevent preterm birth
Authors: BRYCE ROBERT L. , STANLEY FIONA J. , GARNER J. BARRY
Published: August 2005

Objective— To test the effect of a programme of additional antenatal social support on the occurrence of preterm birth (a birth from 20 to 36 weeks gestation) in women at risk of preterm birth.

Design— A prospective randomized controlled trial. The design was one of randomization before consent for a new treatment.

Setting— Three public hospital antenatal clinics in Perth and the offices of 87 obstetricians and general practitioners in Western Australia.

Subjects— 1970 pregnant women with poor obstetric histories entered the trial; 983 of these were randomly allocated to the programme group and 987 to the control group.

Interventions— Normal antenatal care was provided for both groups. In addition, members of the programme group were offered an intervention aimed at providing expressive (emotional) social support, consisting of antenatal home visits and telephone calls by midwives. Of the women allocated to the programme group, 24 refused consent and 69 were not traced before completion of their pregnancies, the remaining 890 women (90.5%) agreed to enter the programme, and each received at least one intervention.

Main outcome measures— Gestational age at completion of the pregnancy. A pregnancy ending before 20 weeks was labelled a miscarriage.

Results— There were 126/981 (12.8%) preterm births in the programme group and 147/986 (14.9%) in the control group. The outcome data for two women in the programme group and one in the control group could not be found. The unadjusted odds ratio for preterm birth in the programme was 0.84 (95% CI 0.65–1.09). The observed relative reduction in preterm births associated with the programme was 13.8% (95% CI −8.2% to +31.5%) and the trial had a 60% power to exclude a true relative reduction of 25%.

Conclusions— The results of this trial and those of other controlled clinical trials provide little evidence for the effectiveness of social support interventions in the prevention of preterm birth in women with poor obstetric histories.
Pre‐operative cervical preparation before first trimester vacuum aspiration: a randomized controlled comparison between gemeprost and mifepristone (RU 486)
Authors: HENSHAW R. C. , TEMPLETON A. A.
Published: August 2005

Objective— To compare the effectiveness of 200 mg mifepristone with 1 mg gcmeprost vaginal pessary in achieving cervical dilatation and softening (‘priming’) before late first trimester pregnancy vacuum aspiration.

Design— A randomized, operator blind, placebo controlled trial.

Setting— UK teaching hospital.

Subjects— 90 primigravid women with 63–91 days amenorrhoea and ultrasonically confirmed single living fetus of correct size for gestational age.

Interventions— The women were allocated to receive 200 mg mifepristone orally or an identical oral placebo 36 h before operation or 1 mg gemeprost vaginal pessary 3–4 h preoperatively.

Main outcome measures— Onset of new symptoms following drug administration, a proven objective measure of the force required to dilate the cervix, and estimated intraoperative blood loss.

Results— There were no significant diffcrences in the baseline cervical dilatation, the force required to dilate the cervix or the volume of intraoperative blood loss between the active treatment groups. Both drugs were significantly more effective than placebo. Significantly fewer women in the mifepristone group had adverse side effects than in the gemeprost group.

Conclusions— Mifepristone is a highly effective cervical priming agent, and has the advantages of being an oral prcparation associated with few side effects.
A clinical comparison of sonographic hydrotubation and hysterosalpingography
Authors: MITRI F. F. , ANDRONIKOU A. D. , PERPINYAL S. , HOFMEYR G. J. , SONNENDECKER E. W. W.
Published: August 2005

Objective— To assess the value of vaginal sonographic hydrotubation as a pre‐liminary test of uterine configuration and tubal patency in infertility inves‐tigation, and to compare this new test with hysterosalpingography.

Design— A prospective blind comparison of the two tests in an unselected group of infertile women.

Setting— Hillbrow Hospital, Johannesburg, South Africa.

Subjects— Sixty women undergoing routine infertility investigations agreed to participate in the study. There were no refusals.

Interventions— Within 4 weeks before or after hysterosalpingography sonographic hydrotubation was performed as follows: The uterus and tubes were identified using a 5 MHz vaginal ultrasound probe and between 10 and 20 ml of normal saline were injected into the uterine cavity through an endocervical catheter.

Main outcome measures— The shape of the uterus and its cavity, the flow of saline through the tubes, the presence of hydrosalpinges before and after injection of saline and the presence of free fluid in the pouch of Douglas.

Results— The sonographic and hystersalpingographic findings were similar in 82% of the women with respect to uterine assessment and in 72% with respect of tubal findings. In seven women (12%) found to have bipolar tubal disease on sonography and cornual block on hysterosalpingography, the sonographic diagnosis was confirmed at laparoscopy. Septate uterus in three women was diagnosed with greater certainty with sonographic hydrotubation.

Conclusions— Sonographic hydrotubation is a simple office procedure which should be used in the preliminary assessment of the uterine cavity and fallopian tubes. Its use will reduce the need for hysterosalpingography and in some cases laparoscopy.
Is genetic susceptibility to pre‐eclampsia conferred by homozygosity for the same single recessive gene in mother and fetus?
Authors: LISTON WILLIAM A. , KILPATRICK DAVID C.
Published: August 2005

Objective— To determine whether any simple, purely genetic mechanism can account for susceptibility to pre‐eclampsia.

Design— Six simple Mendelian models of inheritance were considered, and pre‐dictions concerning the incidence of pre‐eclampsia in various family members of index cases were calculated for each genetic model. Data were then extracted from published family studies in which a suitable disease definition had been used, and compared to our theoretical expectations.

Results— Only one of the genetic models considered, in which both mother and fetus must express the same recessive gene to confer susceptibility, was consistent with the observed incidence values for relatives of index cases. This model was also consistent with the putative association with HLA‐DR4, but could not account for the comparative rarity of pre‐eclampsia in parous women.

Conclusion— Homozygosity for a single recessive gene shared by mother and fetus, unlike five other genetic mechanisms tested, is consistent with published family studies in pre‐eclampsia, and should be considered the best working hypothesis at present.