bluuebunny/crossref_metadata_2025 huggingface dataset:
Platelet angiotensin II binding sites in normotensive and hypertensive women
Authors: BAKER PHILIP N. , PIPKIN FIONA BROUGHTON , SYMONDS E. MALCOLM
Published: August 2005

Summary. Specific binding of angiotensin II (AII) to platelets was measured in 89 women, 25 nulliparous non‐pregnant women and 64 primigravida in the third trimester of pregnancy. There was significantly lower binding in the 25 pregnant women who were normotensive (2.3 fmol/109 cells) when compared with the non‐pregnant women (9.0 fmol/109 cells P<0.001). Significantly higher platelet AII binding levels were found in the 39 women who had pregnancy induced hypertension (PIH) (5.5 fmol/109 cells) when compared with the 25 normotensive pregnant women (P<0.001). Of the 39 women with PIH, platelet AII binding was higher in the 23 women who had pre‐eclampsia (7.0 fmol/109 cells), when compared with the 16 who had non‐proteinuric PIH, (4.6 fmol/109 cells) although the difference was not statistically significant (P<0.04). The pressor response to AII is also diminished in pregnancy, yet less so if pregnancy induced hypertension develops. Platelets may provide a readily accessible tissue with which to study AII responsiveness in pregnancy.
Maternal and fetal haemodynamics in hypertensive pregnancies during maternal treatment with intravenous hydralazine or labetalol
Authors: HARPER ANN , MURNAGHAN G. A.
Published: August 2005

Summary. Intravenous treatment with 10 mg of hydralazine or 100 mg of labetalol was randomly allocated to 30 hypertensive pregnant women. Umbilical artery flow velocity waveforms were recorded using a pulsed Doppler duplex scanner (ATL Mk V) and umbilical artery pulsatility index (PI) and fetal heart rate (FHR) were derived from these recordings. Maternal blood pressure decreased significantly after both drugs. Maternal pulse rate increased after hydralazine but did not change significantly after labetalol. FHR did not change significantly after hydralazine but decreased after labetalol. PI decreased after hydralazine and increased after labetalol‐most fetuses showed little change but a few in each group showed large changes in PI, as did two of five additional patients studied. We attributed the decrease in PI in some fetuses after hydralazine to vasodilation, and the increase in PI in some fetuses after labetalol to vasoconstriction in the fetoplacental circulation, suggesting that fetal beta‐blockade may occur after maternal treatment with labetalol.
Head circumference/abdominal circumference ratio, ponderal index and fetal malnutrition. Should head circumference/abdominal circumference ratio be abandoned?
Authors: COLLEY N. V. , TREMBLE J. M. , HENSON G. L. , COLE T. J.
Published: August 2005

Summary. Head circumference/abdominal circumference (HC/AC) ratios of the fetus are accepted as a means of distinguishing different patterns of growth retardation with a high ratio implying malnutrition of the fetus. Ponderal index (birthweight/length3) is used by paediatricians as a measure of neonatal wasting and would therefore be expected to correlate with HC/AC ratios at delivery. Anthropometric data on 999 newborn infants have been collected and analyzed by multiple regression. The results show a poor correlation between ponderal index and HC/AC ratio, worse than that between ponderal index and AC alone. The use of HC/AC ratios antenatally to identify subgroups of intrauterine malnutrition should be abandoned. The prediction of intrauterine malnutrition by weight/length ratios should be investigated further.
Atrial natriuretic peptide and atrial size during normal pregnancy
Authors: STEEGERS E. A. P. , VAN LAKWIJK H. P. J. M. , FAST J. H. , GODSCHALX A. W. H. J. , JONGSMA H. W. , ESKES T. K. A. B. , SYMONDS E. M. , HEIN P. R.
Published: August 2005

Summary. Plasma atrial natriuretic peptide (ANP), right and left atrial areas and the diameter of the left atrium were studied serially during normal pregnancy and at 6 weeks post partum in 21 nulliparous women. Concentrations of ANP in plasma were significantly elevated during mid‐pregnancy. Thereafter ANP levels were not significantly different from those at 6 weeks after delivery. All atrial measurements were significantly increased in the third trimester of pregnancy, but none was significantly correlated with the plasma ANP concentrations. This might point at an altered mechanism of ANP secretion, which may be part of a physiological adaptive process to sustain the hypervolaemia of pregnancy.
The prevention of the materal manifestationsofreclampsia by intensive antihypertensive treatment
Authors: BLAKE S. , MACDONAL D.
Published: August 2005

Summary. The purpose of the study was to determine if reduction of pregnancy hypertension to normal prevented the clinical maternal manifestations of pre‐eclampsia. Thirty‐six women with hypertension, but without proteinuria, were alloted at random to a test group of 17 who received intensive treatment, and a control group of 19 who were managed according to routine mehtods by hospital staff unconnected with the study. The development of proteinuria was chosen as an indicator of pre‐eclampsia. proteinuria developed significantly more often in the control group (in six of the 19 women) than in the test group (in one of the 17 women).
Risk of recurrence after myomectomy
Authors: CANDIANI G. B. , FEDELE L. , PARAZZINI F. , VILLA L.
Published: August 2005

Summary.The risk of recurrence of uterine myomas was analyzed in 622 patients who underwent myomectomy between 1970 and 1984 at the First Department of Obstetrics and Gynecology of the University of Milan. The cumulative 10‐year recurrence rate was 27%, and this increased steadily up to the end of the observation period. Differences were not observed in frequency of recurrence by age at diagnoses or by the site of the myomas at surgery. Patients with a single myoma tended to experience a lower rate, but this finding was not statistically significant. Women who gave birth to a child after myomectomy had a 10‐year recurrence rate of 15%, against 30% for those who did not; this difference was statistically significant.
Is GIFT (gamete intrafallopian transfer) the best treatment for unexplained infertility?
Authors: MURDOCH A. P. , HARRIS M. , MAHROO M. , WILLIAMS M. , DUNLOP W.
Published: August 2005

Objective— To compare the cumulative pregnancy rates after gamete intrafallopian transfer (GIFT) with the cumulative spontaneous pregnancy rates in couples with unexplained infertility.

Design— A contemporaneous study in a single group of patients.

Setting— Northern Regional Fertility Centre.

Subjects— 76 couples with unexplained infertility of more than 3 years duration

Interventions— Successful pregnancies were recorded during at least 3 months before GIFT and up to 21 months after a maximum of three cycles of GIFT treatment.

Main outcome measures— Pregnancy resulting in a live birth.

Results— Average monthly fecundability without treatment was 0.021 and after GIFT was 0.14 (P<0.001). This was reflected as a cumulative pregnancy rate of 52% after three cycles of GIFT and 30% after 24 months without treatment

Conclusions— The chance of having a baby after one cycle of GIFT is significantly greater than the chance in a spontaneous cycle. However, considering the cumulative pregnancy rates, we suggest that if GIFT is to be a realistic treatment option, it should be offered for more than one cycle.
Companionship to modify the clinical birth environment: effects on progress and perceptions of labour, and breastfeeding
Authors: HOFMEYR G. JUSTUS , NIKODEM V. CHERYL , WOLMAN WENDY‐LYNNE , CHALMERS BEVERLEY E. , KRAMER TAMI
Published: August 2005

Objective— To measure the effects of supportive companionship on labour and various aspects of adaptation to parenthood, and thus by inference the adverse effects of a clinically orientated labour environment on these processes.

Design— Randomized controlled trial.

Setting— A community hospital familiar to most of the participants, with a conventional, clinically‐orientated labour ward.

Subjects— Nulliparous women in uncomplicated labour.

Intervention— Supportive companionship from volunteers from the community with no medical nor nursing experience, concentrating on comfort, reassurance and praise.

Main outcome measures— Duration of labour, use of analgesia, perceptions of labour and breastfeeding success.

Results— Companionship had no measurable effect on the progress of labour. Diastolic blood pressure and use of analgesia were modestly but significantly reduced. The support group were more likely to report that they felt that they had coped well during labour (60 vs 24%, P<0.00001). Their mean labour pain scores (26.4 vs 44.2, P<0.00001) and state anxiety scores (28.2 vs 37.8, P<0.00001) were lower than those of the control group. Compared with the control group (n= 75), at 6 weeks women in the support group (n= 74) were more likely to be breastfeeding exclusively (51 vs 29%. P<0.01); and to be feeding at flexible intervals (81 vs 47%, P < 0.0001).

Conclusions— Labour in a clinical environment may undermine women's feelings of competence, perceptions of labour, confidence in adapting to parenthood and initiation of successful breastfeeding. These effects may be reduced by the provision of additional companionship during labour aimed to promote self‐esteem.
The effect of induced abortion on subsequent pregnancy outcome
Authors: FRANK PETER I. , McNAMEE ROSANNE , HANNAFORD PHILIP C. , KAY CLIFFORD R. , HIRSCH SYBIL
Published: August 2005

Objective—To investigate the effect of induced abortion on the outcome of the next pregnancy.

Design—Long‐term prospective controlled cohort study.

Setting—Joint Royal College of General Practitioners/Royal College of Obste‐ tricians and Gynaecologists study based in general practice in England, Scotland and Wales.

Subjects—1311 women whose recruitment pregnancy had ended in induced abortion (the abortion group) and 2131 women whose recruitment pregnancy had a natural conclusion (the non‐abortion group).

Main outcome measures—Non‐viable outcome (spontaneous or missed miscar‐ riage, ectopic pregnancy or stillbirth), birthweight, length of gestation.

Results—Induced abortion was not materially associated with any of the three measures of adverse outcome. Compared with the non‐abortion group the rela‐ tive risk of a non‐viable outcome in the abortion group was 1.01 (95% CI 0.81 to 1.27). In the abortion group birthweight was an average 23 g lighter (95% CI −76 g to + 30 g) and length of gestation an average 0.9 days shorter (95% CI −2–2 days to + 0.4 days) than in the non‐abortion group. Women who had their abortions in NHS premises had an increased risk of a non‐viable outcome (RR 2.55, 95% CI 1–31 to 4.94) and had babies with significantly lower mean birth‐ weight (− 119 g, 95% CI −233 g to +5 g) compared with those who obtained their operations in the private sector. Women whose abortion had been carried out by a consultant had the lowest risk of non‐viable outcome. Although these differences remained after adjustment for a number of important variables, it is possible that factors not measured in the present study, such as economic status and occupation, played a contributory role.

Conclusion—Overall, induced abortion was not associated with any important effect on the three measures of adverse outcome in the subsequent pregnancy.
The role of Chlamydia trachomatis and Neisseria gonorrhoeae in the aetiology of ectopic pregnancy in Gabon
Authors: VILLE Y. , LERUEZ M. , GLOWACZOWER E. , ROBERTSON J. N. , WARD M. E.
Published: August 2005

Objective— To study the association between ectopic pregnancy and Chlamydia trachomatis and Neisseria gonorrhoeae.

Design— A prospective observational study with two comparison groups.

Setting— A general hospital in Franceville, Gabon.

Subjects— Forty‐five women with ectopic pregnancies and two comparison groups each of 45 women, one at 5 to 12 and the other at 32 to 41 weeks gestation.

Main outcome measures— Serum levels of IgG and IgA antibodies to C. trachomatis (L1 and rMOMP) and N. gonorrhoeae (pili) in all the women. In the women with ectopic pregnancy peritoneal adhesions were scored and in 40 women samples of tube were cultured for organisms being studied.

Results— IgG and IgA antibodies to C. trachomatis (L1) were detected in 84% of the ectopic group and 53 and 39% of the comparison groups (P<0.0001). IgG and IgA antibodies to N. gonorrhoeae occurred in 49, 28 and 18% and 49, 28 and 26% of the groups but the differences were not statistically significant. Adhesions were positively associated with the antibodies. C. trachomatis was cultured from the tubes of 71% of the women with ectopic pregnancy.

Conclusions— Infection with chlamydia, and probably with N. gonorrhoeae, is an important factor in the causation of ectopic pregnancy in Gabon.
A comparison of perinatal outcome, antenatal and intrapartum care between England and Wales, and France
Authors: MASCARENHAS L. , ELIOT B. W. , MACKENZIE I. Z.
Published: August 2005

Objective
To compare the national statistics of England and Wales with the national statistics of France, and see if there are significant differences in obstetric care resulting in a significantly different perinatal outcome.

Design
Retrospective analysis of national statistics 1970–1989 (latest available figures) relating to perinatal outcome, antenatal and intrapartum care.

Setting
HIPE and DoH statistics (England and Wales); INSERM statistics (France).

Subjects
Pregnant women residents of England and Wales, and of France.

Interventions
Different aspects of obstetric care for which comparable data were available from national statistics.

Main outcome measures
Perinatal mortality rate, incidence of low birth weight and preterm delivery; type of antenatal care, number of antenatal visits and in‐patient admission rate; induction of labour rate, incidence of acceleration of labour with oxytocin, incidence of spontaneous and operative deliveries and person undertaking delivery; episiotomy rate and postnatal in‐patient stay.

Results
More antenatal intervention and marginally less intrapartum intervention in England and Wales as compared with France. No significant difference in the perinatal mortality rate, in the incidence of low birth weight or preterm delivery, with similar trends being observed over the two decades.

Conclusion
Significant differences in obstetric practices between the two countries without a major difference in perinatal outcome.
A prospective study of conization of the cervix in the management of cervical intraepithelial glandular neoplasia (CIGN)—a preliminary report
Authors: CULLIMORE J. E. , LUESLEY D. M. , ROLLASON T. P. , BYRNE P. , BUCKLEY C. H. , ANDERSON M. , WILLIAMS D. R. , WADDELL C. , HUDSON E. , SHAFI M. I.
Published: August 2005

Objective
To assess the efficacy of cervical conization as primary management of cervical intraepithelial glandular neoplasia (CIGN).

Design
A multicentre prospective cohort study.

Setting
CRC Clinical Trials Unit, Birmingham.

Subjects
84 women registered with the Unit between May 1986 and January 1989. After excluding 33 women, 51 who had been managed in accordance with the described protocol and had the presence of CIGN confirmed by central review of diagnostic histopathological material were included in the study.

Intervention/Protocol
Women with CIGN diagnosed on a cervical cone specimen were managed in accordance with a specific protocol: (a) women with negative cone margins were managed conservatively and followed up with regular cervical cytological and colposcopic examinations; (b) women with involved cone margins were managed by hysterectomy.

Main outcome measures
Presence or absence of CIGN at cone margins, results of cervical cytological examinations following conization, results of histopathological assessment of any surgical specimens taken after initial cone biopsy.

Results
Of the 51 women with confirmed CIGN, managed by conization, 14 (27%) were aged 30 or less and 15 (29%) were nulliparous. Thirty five women who had a cone biopsy showing margins free of CIGN have been managed by conization alone. After a median follow‐up period of 12 months there is no apparent residual CIGN or invasive disease in this group. Thirteen women have had further surgical procedures (according to protocol) and two have had a hysterectomy for benign gynaecological disorders. Eight further procedures were carried out because the original cone biopsy had margins involved with CIGN, and only one of them was found to have residual CIGN. The other five procedures were carried out solely because of abnormal cytology, only one of them had a diagnosis of CIN 1. A total of 10 women had cytological abnormality following cone biopsy, one had CIGN, one had CIN 1 and a third had CIN 3.

Conclusions
Our preliminary data suggests that when a diagnosis of CIGN is made upon a cone biopsy, further surgery is unnecessary in those women in whom the margins of the cone specimen are free of disease. Cytological and colposcopic follow up, including cytological sampling of the endocervical canal, is recommended for these women.
A randomized prospective study comparing delivery with metal and silicone rubber vacuum extractor cups
Authors: CHENOY RASHNA , JOHANSON R.
Published: August 2005

Objective
To determine the relative benefits and complications of assisted vaginal delivery with metal and silicone rubber vacuum extractor cups.

Design
Prospective randomized controlled study.

Setting
A busy referral maternity hospital in Kathmandu, Nepal.

Subjects
101 women were assigned to delivery with the Silc‐cup and 98 to delivery with the metal cup.

Main outcome measures
Success rate at achieving delivery with the assigned Instrument and incidence of neonatal trauma. Analysis was by ‘intention to deliver’ with women remaining in their original group regardless of the eventual mode of delivery.

Results
Randomization resulted in two groups of women similar in respect of age, parity, gestation and indication for delivery. The overall success rate was similar for the two instruments (Silc‐cup 85% and metal cup 87%). The Silc‐cup was more likely to fail if there was excessive caput (seven failures compared with one in the metal cup group). The frequency of clinically significant maternal trauma was low in both groups. There were fewer babies with clinically significant scalp trauma in the Silc‐cup group (22%), compared with the metal cup group (37%).

Conclusions
The data indicate a greater tendency for the Silc‐cup to fail when excessive caput is present but that metal cups are associated with increased scalp injuries.
An economic evaluation of daycare in the management of hypertension in pregnancy
Authors: TWADDLE SARA , HARPER VALERIE
Published: August 2005

Objective
To evaluate the efficiency of daycare in the management of hypertension in pregnancy compared with inpatient management with prior domiciliary visits.

Design
Comparative study.

Setting
Two maternity teaching hospitals, Glasgow Royal Maternity Hospital which has an established daycare unit and Aberdeen Maternity Hospital with no day‐care unit.

Main outcome measures
Pregnancy outcomes in terms of maternal hypertensive complications, gestation at delivery, mode of delivery, birthweight, Apgar scores, admission rates and length of admission to special care baby unit.

Results
There was no significant difference in any of the measured pregnancy outcomes between the two hospitals. The average cost of treating a woman with mild hypertension was £154.91 in Glasgow and £136.59 in Aberdeen. The average cost of treating women with a single episode of hypertension and women with a past history of hypertension was £88.65 and £214.12 in Glasgow and £31.18 and £28.28 in Aberdeen, respectively. If these two groups are excluded, the average cost of treating women with mild hypertension was £172.32 in Glasgow and £201.13 in Aberdeen. The majority of women were willing to attend daycare five times per week to avoid admission.

Conclusion
Daycare management of hypertension in pregnancy is more efficient than inpatient care with prior domiciliary visits for most women, but less efficient for women with transient or previous hypertension. It is very acceptable to women. Domiciliary checking of women with hypertension found at outpatient clinics would reduce resource use.
Sonographic estimation of fetal weight in diabetic pregnancy
Authors: PEDERSEN J. F. , MØLSTED‐PEDERSEN L.
Published: August 2005

Objective
To investigate whether fetal weight estimation by ultrasound in diabetic pregnancy might be based upon fetal abdominal circumference (AC) alone.

Design
A retrospective study.

Setting
Diabetes Center, Rigshospitalet and Ultrasound Laboratory, Glostrup Hospital, Copenhagen.

Subjects
Eighty‐six diabetic pregnant women who had an ultrasound study within 2 days before delivery.

Results
We assessed in 73 fetuses various formulas based upon biparietal diameter and AC against formulas based upon AC alone, and these were only marginally less effective than the more complex ones. In 86 fetuses an AC was available. These fetuses were divided into a study population and a test population. The linear model was customized for the study population. Evaluation on the test population showed that the relative error (error as a percentage of birthweight) in predicting birthweight had a Standard deviation of 7–8%. The efficacy of AC in detecting fetuses >4000 g was examined in the test population; If AC>36–0 cm was chosen as riterion for macrosomia the positive and negative predictive values were 80% (8/10) and 91% (30/33), respectively.

Conclusion
Formulas for estimating fetal weight in diabetic pregnancy based on AC alone are almost as effective as more complex ones. We recommend a simple linear formula of fetal weight as a function of AC.
Detection of hydatidiform mole in maternal serum screening programmes for Down's syndrome
Authors: CUCKLE H. S. , DENSEM J. W. , WALD N. J.
Published: August 2005

Objective
To determine how frequently hydatidiform mole will be detected in a maternal serum Down's syndrome screening programme.

Design
Affected pregnancies were identified using a national register. Unconjugated oestriol (μE3) and human chorionic gonadotrophin (hCG) were measured in stored serum samples and alphafetoprotein (AFP) levels were available from previous neural tube defect screening at 15–20 weeks gestation.

Subjects
Ten pregnancies with a complete mole (i.e., hydropic placenta without a fetus), nine with stored serum samples and one with an AFP level only.

Results
The median values were 0.08, 0.13 and 1–83 multiples of the normal median for AFP, uE3 and hCG respectively. Six out of nine (67%) tested for all three markers had a high risk of Down's syndrome given maternal age and the marker levels.

Conclusion
Many molar pregnancies that have not presented clinically before 15 weeks will be detected through Down's syndrome screening.
Erythrocyte membrane composition in pregnancy‐induced hypertension: evidence for an altered lipid profile
Authors: ANCESCHI M. M. , COATA G. , COSMI E. V. , GAITI A. , TROVARELLI G. F. , DI RENZO G. C.
Published: August 2005

Objective
To investigate whether the increased membrane fluidity postulated as a possible contributing factor to the hypertensive states of pregnancy is related to the lipid composition of the erythrocyte membrane.

Design
An observational case control study.

Subjects
30 women with pregnancy induced hypertension, 26 normotensive pregnant women matched for gestational age, and 10 normotensive non pregnant nulliparous women.

Interventions
Erythrocyte membranes were prepared from venous blood samples obtained from all the women.

Main outcomes measures
Lipid analysis, including cholesterol to phospholipids ratio, distribution of phospholipid classes and fatty acid composition of total phospholipids in erythrocyte ghosts.

Results
The cholesterol/phospholipid ratio was significantly higher in the women with pregnancy induced hypertension compared with the normotensive pregnant women (mean 1.24, SD 0.31, 95% CI 1.12 to 1.35 vs mean 0.90, SD 0.09, 95% CI 0.86 to 0.94; P <0.01). Normotensive non‐pregnant erythrocyte membrane cholesterol/ phospholipid ratio was 0.88 (SD 0.11, 95% CI 0.79 to 0.96). The percentage distribution of different phospholipid classes and fatty acid composition was similar in all the four groups.

Conclusions
The increased cholesterol/phospholipid ratio of the erythrocyte membrane found in pregnancy‐induced hypertension represents one factor involved in the pathophysiology of this condition and a possible biochemical marker of the disease.
Distribution of renin‐containing cells in the developing human kidney: an immunocytochemical study
Authors: GRAHAM P. C. , KINGDOM J. C. P. , RAWEILY E. A. , GIBSON A. A. M. , LINDOP G. B. M.
Published: August 2005

Objective
To characterize the pattern of renin containing cells (RCC) within the human kidney between 20 weeks of gestation and 6 months of postnatal life.

Design
Descriptive study using paraffin‐embedded blocks of kidney stored following postmortem examination.

Methods
Sections of kidney were stained immunocytochemically using an antibody to human renin; the proportion of RCC within each of three zones (superficial, middle and deep) of the cortex, and their anatomical relation to individual glomeruli were determined. The cases were divided into five groups for analysis to gestational or postnatal age.

Results
Fetal RCC were usually at the vascular pole of the most mature glomeruli within the deeper areas of the cortex and were occasionally located within glomeruli. This distribution persisted until birth, even when the kidney was histologically mature. By contrast there were fewer RCC in neonatal and infant kidneys and, as in adult kidneys, these were located predominantly in the superficial cortex.

Conclusion
The change in RCC distribution around the time of normal birth may relate to the transition to independent renal function. The location and density of RCC during fetal life may influence renal perfusion and amniotic fluid production.
Clinical assessment of fetal electrocardiogram monitoring in labour
Authors: MURPHY KARL W. , RUSSELL VIRGINIA , JOHNSON PAUL , VALENTE JANE
Published: August 2005

Objective
To assess the potential clinical value of fetal electrocardiographic (ECG) monitoring in labour.

Design
Descriptive study of the use of ECG waveform analysis during labour and its correlation with other indices of fetal and neonatal well‐being.

Setting
Teaching hospital in Oxford.

Subjects
86 high risk pregnancies.

Main outcome measures
Suitability of ST Segment Analyser (Cinventa, Sweden) for clinical use; relation between the T/QRS ratio during labour (an index of ST segment and T wave elevation) and intrapartum cardiotocography, umbilical artery pH at birth and Apgar scores; T/QRS ratio trends in labour.

Results
The system was robust and user‐friendly. No statistically significant relation was found between T/QRS ratios in labour and FHR abnormalities in the cardiotocograph. There was a weak relation between T/QRS ratios and umbilical artery acidosis: at a cervical dilatation of 4 cm, the Spearman rank correlation of the mean T/QRS ratio with umbilical artery actual base deficit was r =−0.31, 0.05<P<0.01. The correlation of T/QRS with the umbilical artery pH was not statistically significant, although a trend was present (Spearman rank: r=−0.26, P<0.05). Correlation of the T/QRS ratio with Apgar scores at 1 and at 5 min was not statistically significant. Only 3 of 16 infants with an Apgar score of <7at 1 min had a mean T/QRS ratio above 0.25 at any time during labour.

Conclusions
Further research is necessary before a decision can be made whether this new method of fetal monitoring should be introduced into clinical practice.
In‐utero sound levels when vibroacoustic stimulation is applied to the maternal abdomen: an assessment of the possibility of cochlea damage in the fetus
Authors: ARULKUMARAN S. , TALBERT D. , HSU T. S. , CHUA S. , ANANDAKUMAR C. , RATNAM S. S.
Published: August 2005

Objective
To measure sound pressure level in utero while a vibro acoustic stimulator is applied to maternal abdomen and to calculate whether the estimated effect on fetal cochlea cilia vibration would be hazardous.

Design
Prospective descriptive study.

Setting
Labour ward, National University Hospital, Singapore.

Subjects
Eight women undergoing induction of labour.

Intervention
A hydrophone was introduced via the cervix into the uterus and placed under ultrasound guidance near the fetal ear. Sound pressure was recorded when a vibroacoustic stimulator was applied directly to the maternal abdomen and also when separated by 2 cm of air.

Main outcome measures
Sound pressure levels in utero.

Results
The sound level recorded from the vibrator diaphragm in air was 107 dB at 2 cm and 74 dB at 1 m. The mean sound pressure level in utero was 90.7 dB (range 75–96 dB) when the vibrator was in contact with the abdominal wall and 80.1 dB (range 70–88 dB) when separated by 2 cm of air.

Conclusions
Analysis of factors affecting displacement of cochlear sensing cilia in utero show that, for equal sound pressures, sound intensity and sound vibration are about 4000 times less in amniotic fluid, compared to that produced in air. Further protection is provided by viscous and hydrodynamic features of the ear. The estimated effect on cilia vibration by the mean sound pressure registered in utero, about 90 dB, corresponds to that produced postnatally by an airborne sound registering about 40 dB, which would not be hazardous.
Evidence against a pathogenetic role for endothelin in pre‐eclampsia
Authors: BENIGNI ARIELA , ORISIO SILVIA , GASPARI FLAVIO , FRUSCA TIZIANA , AMUSO GIUSEPPE , REMUZZI GIUSEPPE
Published: August 2005

Objective
To assess whether increased placental or systemic endothelin synthesis has a pathogenic role in pre‐eclampsia (gestational proteinuric hypertension).

Design
Prospective observations study.

Subjects
19 women with pre‐eclampsia and 10 healthy pregnant women were studied. All were in the last trimester.

Main outcome measures
Preproendothelin‐1 gene expression by Northern blot analysis and generation of endothelin‐1 precursor, big‐endothelin‐1, and endothelin isoforms, namely endothelin‐1, 2 and 3, were assessed by specific radioimmunoassays, in placental tissue. Plasma endothelin‐1 levels and urinary excretion of big‐endothelin‐1 and endothelin‐1 were measured.

Results
Placental preproendothelin‐1 gene expression and immunoreactive bigendothelin‐1 and endothelin‐1, 2 and 3, were comparable in placental tissue from pre‐eclamptic and normal pregnant women. Plasma levels of endothelin‐1 did not differ between pre‐eclamptic and normal pregnancies. In contrast, urinary excretion of endothelin‐1, which is likely to reflect the renal synthesis of the peptide, was significantly decreased in pre‐eclamptic, as compared with normal pregnant women. This was not due to a decreased renal generation of endothelin‐1 precursor, since urinary excretion of big‐endothelin‐1 did not differ between pre‐eclamptic and normal pregnancies. These data suggest an increased renal endothelin‐1 breakdown in pre‐eclampsia.

Conclusions
Endothelin is unlikely to play a role in the pathogenesis of pre‐eclampsia. Instead, an increased renal breakdown may have a role in limiting the negative effects of other vasoactive factors on the renal circulation.
Pregnancy induced hypertension and sodium pump function in erythrocytes
Authors: MACPHAIL S. , THOMAS T. H. , WILKINSON R. , DAVISON J. M. , DUNLOP W.
Published: August 2005

Objective
To determine if erythrocyte sodium pump function is altered with the onset of pregnancy induced hypertension.

Design
A prospective descriptive study.

Subjects
Thirty‐two primigravid women with pregnancy‐induced hypertension (17 had proteinuria) and 32 gestation‐matched normotensive primigravid pregnant women were studied and measurements repeated 20 weeks after delivery.

Intervention
Erythrocyte sodium, ouabain‐sensitive sodium flux and the sodium pump rate constant were measured in whole blood and the maximum velocity and sodium affinity of the sodium pump were measured in vitro.

Results
Blood pressure remained higher after delivery in the women who had been hypertensive during pregnancy. In normal pregnancy erythrocyte sodium was decreased, and ouabain‐sensitive sodium flux, the sodium pump rate constant and maximum velocity (Vmax) were increased compared with 20 weeks after delivery. In pregnancy‐induced hypertension erythrocyte sodium and sodium pump changes were the same as in normal pregnancy. The possibility of a positive association between changes in erythrocyte sodium and in blood pressure was excluded. The rate constant of the sodium pump in blood was related to its Vmax measured in vitro but the relation had greater variance in the hypertensives with 7 of the 32 women having rate constants greater than expected from their Vmax.

Conclusion
There was no evidence of sodium pump inhibition or a rise in intracellular sodium associated with increased blood pressure in pregnancy. There may have been stimulation of the sodium pump by a plasma factor in some hypertensive woman.
Role of prostaglandin in the management of prelabour rupture of the membranes at term
Authors: MAHMOOD T. A. , DICK M. J. W. , Smith N. C. , TEMPLETON A. A.
Published: August 2005

ObjectiveTo compare conservativeversusprostaglandin management of prelabour rupture of the membranes (PROM) in healthy primigravid women at term.

DesignA prospective randomized study.

SettingLabour Ward, Aberdeen Maternity Hospital.

Subjects230 primigravidae at term with PROM, 115 allocated to be treated conservatively and 115 to be managed with prostaglandin treatment.

InterventionsIn the conservatively managed group the women were observed for up to 24 h after hospital admission with PROM. The actively managed group had PGE2gel (2 mg) instilled into the posterior fornix and if contractions had not commenced, a further dose of PGE2gel (1 mg) was instilled 6 h later. In both groups, if labour had not established 24 h after admission, intravenous oxytocin was given in escalating doses.

Main outcome measuresPROM to delivery interval, oxytocin augmentation, mode of delivery, maternal and neonatal infective morbidity.

ResultsThere was a significant reduction in the PROM to delivery interval in the women managed actively with PGE2gel and fewer women in the PGE2group required oxytocin augmentation (31%vs51%). The two managements groups were comparable for intrapartum analgesia, antibiotic treatment, babies requiring admission to the special care nursery unit and delivery by caesarean section.

ConclusionThe early use of prostaglandin is associated with a significant reduction in PROM to delivery interval without a significant increase in infective morbidity or caesarean section rate. However, the advantages of the conservative approach should not be overlooked. More work is still needed in the management of those women where uterine activity fails to establish within 24 h after PROM.
Determinants of caesarean section rates in Italy
Authors: PARAZZINI FABIO , PIROTTA NICOLETTA , LA VECCHIA CARLO , FEDELE LUIGI
Published: August 2005

Objective
To analyse the determinants of caesarean section rates in Italy.

Design
Analysis of information using a standard form on all the deliveries after the 28th week of gestation routinely collected by the Italian Central Institute of Statistics.

Setting
National data of all Italian deliveries in the periods 1980–1983.

Subjects
A total of more than 2 400 000 deliveries occurred in Italy in the period and are considered in this analysis.

Results
The frequency of caesarean section rose from 11.2/100 deliveries in 1980 to 14.5/100 in 1983. Caesarean section rates were lower in the Southern (less rich) areas, and rose steadily with maternal age, being about three times higher in women aged ≥40 years than in teenagers. Maternal education was directly associated with caesarean section rates: compared with women with only primary school education, those with a college education reported an about 40% higher rate of caesarean section, but this difference dropped markedly after allowance for maternal age and birth‐weight. The section rate was 13.3/100 deliveries in public hospitals and 11.8/100 in private ones, but this reflected the different utilization of public and private services in various geographical areas. Birthweight and gestational age at delivery were important determinants of caesarean section rates; lowest values were observed for very‐low‐birthweight and very preterm deliveries and babies weighing 3000–3999 g and term deliveries. Caesarean section rates were about 20% higher in nulliparous than in parous women and the rates increased with number of stillbirths or miscarriages; further, the rate ratio was about double in multiple than in single births.

Conclusion
Caesarean section rates in Italy in the early 1980s were still lower than in North America, but their determinants share several similarities with those reported in other areas.
Labour induction policy in hospitals of different levels of specialisation
Authors: Järvelin Marjo Riitta , Hartikainen‐Sorri Anna‐Liisa , Rantakallio Paula
Published: August 2005

Objective
To examine indications for the induction of labour and variations in the current policy of induction at different levels of obstetric specialisation and to compare the outcome of induced and spontaneous labour.

Design
A prospective 1 year birth cohort.

Setting
Maternity hospitals in the two northernmost administrative provinces of Finland, including one university hospital and three central hospitals, three local hospitals and five health centres.

Subjects
Eight thousand six hundred and six singleton pregnancies, including 1679 with induced labour.

Main outcome measure
Data collection on age, parity, social factors and education at antenatal clinic. Data on labour collected from the hospital records after delivery.

Results
Labour was induced significantly more often at units of the lowest level of specialisation, the health centres (29.4%) than at the local hospitals (23.6%, P<0.003) or in the most specialised central hospitals (17.7%, P<0.0001). Cases of induced labour accumulated on working days. Indicative reasons, such as maternal or fetal conditions, comprised 45.0% of the indications for induction, the most common causes being elective reasons, e.g. timing of labour (51.3%). The risk of elective induction was 2.6 times greater at the primary care level than at the central hospitals (95% confidence limit, CL 2.0.3.2). The corresponding risk ratio for local hospitals was 1.8 (CL 1.5–2.1). The risk of caesarean section was 1.5 times greater in the elective induction group than in the spontaneous group (CL 1.1–1.9) and 2.9 times greater in the indicative induction group. The most common indication for caesarean section was dysfunctional, arrested labour; causes such as fetal asphyxia or antenatal haemorrhage were not seen in excess.

Conclusion
The practice of induction of labour are not consistent in different hospitals. The opinions of individual practitioners and staff routines influence the induction policy nearly as much as do medical reasons. Despite the safety of induction, a liberal induction policy leads to an increase in operative deliveries creating potential risks for the mother and child and greater expense.
An alternative to hysterectomy? GnRH analogue combined with hormone replacement therapy
Authors: Gangar Kevin F. , Stones R. William , Saunders Dawn , Rogers Vera , Rae Toni , Cooper Susan , Beard Richard W.
Published: August 2005

Objective
To assess whether GnRH analogues are effective in relieving pelvic pain and congestion and whether menopausal symptoms caused by GnRH analogues can be minimised by supplementation with low dose continuous combined hormone replacement therapy (HRT).

Design
Open prospective study.

Setting
Tertiary referral clinic at a teaching hospital.

Patients
Twenty‐one women with chronic pelvic pain.

Intervention
Four months’ therapy with goserelin 3.6 mg/month combined with continuous oestradiol valerate 1 mg daily and medroxyprogesterone acetate 5 mg daily.

Main outcome measures
Visual analogue scale for pain, menopausal symptoms, bleeding patterns, uterine area, endometrial status, oestradiol concentrations and venogram scores.

Results
Amenorrhoea was maintained in all but two women. Endometrial atrophy was maintained despite HRT supplementation. Two women had moderate menopausal symptoms but none had severe symptoms. Significant reduction of uterine cross sectional area was maintained throughout the study. There was no significant relief of pain.

Conclusions
HRT supplementation of GnRH analogues abolishes menopausal symptoms and thus may improve patient acceptability. Potentially beneficial effects such as endometrial atrophy, reduction of uterine volume and amenorrhoea were not negated by HRT. This combination is not effective in the treatment of chronic pelvic pain and congestion.
Plasminogen activator inhibitors (PAI‐1 and PAI‐2) in normal pregnancies, pre‐eclampsia and hydatidiform mole
Authors: Reith A. , Booth N. A. , Moore N. R. , Cruickshank D. J. , Bennett B.
Published: August 2005

Objective
To examine the behaviour of the major inhibitors of fibrinolysis (PAI‐1 and PAI‐2) in normal pregnancy and pregnancy complicated by either pre‐eclampsia or hydatidiform mole.

Design
Prospective study.

Setting
Antenatal Clinic and Maternity Hospital.

Subjects
Eleven women with established pre‐eclampsia and eleven women, matched by age, parity, and duration of pregnancy who were undergoing uncomplicated pregnancy. Two women having surgery for hydatidiform mole.

Main outcome measure
Plasma levels of PAI‐1 and PAI‐2 antigens determined by sensitive specific ELISA. Functional identification of PAI‐2 by nondenaturing gel electrophoresis with overlay zymography.

Results
In pre‐eclampsia PAI‐2 antigen was significantly lower than in normal pregnancy (105.3 ± 34.9 versues 187.1 ± 67.9 ng/ml; P<0.001). In contrast PAI‐1 antigen was significantly higher in pre‐eclampsia than in normal pregnancy (170.7 ± 71.2 versus 113.8 ± 35.6 ng/ml; P<0.05). In consequence the ratio of PAI‐1/PAI‐2 increased markedly in pre‐eclampsia (2.5 versus 0.6). No PAI‐2 was detected in plasma of women with hydatidiform moles.

Conclusions
PAI‐2 levels fell significantly in pre‐eclampsia probably as a result of decreased placental mass or function. The raised PAI‐1 level in pre‐eclampsia may reflect a response to hypertension or renal damage that is not specific to pregnancy or may reflect altered placental function. The use of the ratio of PAI‐1/PAI‐2 assists in separating normal from abnormal pregnancies.
Alterations in erythrocyte chloride content accompanying the changes in erythrocyte hydration and potassium content in normal human pregnancy: a comparison with pregnancy induced hypertension
Authors: Bolton L. M. , Thomas T. H. , Macphail S. , Taylor A. , Davison J. M. , Dunlop W.
Published: August 2005

Objectives
To determine whether the change in erythrocyte potassium content in normal human pregnancy is accompanied by a similar change in erythrocyte chloride content. To assess erythrocyte hydration and potassium and chloride content in pregnancies complicated by proteinuric pregnancy induced hypertension.

Design
A serial study during and after normal pregnancy. A comparative study during and after pregnancies complicated by proteinuric pregnancy induced hypertension (PIH). Erythrocyte hydration, total osmoles, potassium and chloride and plasma osmolality were determined.

Setting
University teaching hospital, UK.

Subjects
Twenty‐eight women studied at 14, 28 and 36 weeks of normal pregnancy and ten women with PIH studied during the third trimester of pregnancy. All women were reinvestigated 20 weeks after delivery.

Results
The fall of erythrocyte potassium early in normal pregnancy (277.4 vs 265.2 mmol/kg; P<0.02) and its rise between 28 and 36 weeks (272.3 vs 288.0 mmol/kg; P<0.005) were accompanied by similar changes in erythrocyte chloride content (151.9 vs 131.1 mmol/kg; P<0.001 and 129.4 vs 141.3 mmol/kg; P<0.001, respectively). Plasma osmolality in PIH was raised above that normal in pregnancy (287.2 vs 283.0 mosm/kg; P<0.005). In PIH, compared to normal pregnancy, erythrocyte hydration (2.00 vs 1.89 l/kg dry weight cells), total osmoles (573.0 vs 534.2 mosm/kg), potassium (303.0 vs 288.0 mmol/kg) and chloride (154.9 vs 141.3 mmol/kg) were greater.

Conclusions
These findings further support the hypothesis that changes in plasma osmolality in pregnancy are secondary to alterations in cell osmoles and serve to limit changes in cell hydration. Erythrocyte composition and plasma osmolality are altered in PIH.
Neural tube defects and serum zinc
Authors: Hambidge Michael , Hackshaw Allan , WALD Nicholas
Published: August 2005

Objective
To investigate the relationship of zinc in the causation of neural tube defects and so explore the possible role as a cause of these defects.

Design
Stored serum samples collected as part of the Medical Research Council's multicentre randomised trial§ of vitamin supplementation in the prevention of neural tube defects were retrieved in respect of women who had had an affected pregnancy together with four matched unaffected controls per case. One control was selected from each of the four randomisation groups: 1. no extra vitamins; 2. folic acid supplementation alone; 3. folic acid and other vitamin supplementation; and 4. other vitamin supplementation, such that it was matched with an NTD case by study centre, maternal age (the year of birth differed at most by one year) and duration of storage of the serum sample (in most instances to within the same year).

Setting
A prospective case‐control study using serum samples stored at ‐40°C. The serum samples were collected from women at entry to the trial, immediately before the women became pregnant and at about 12 weeks of pregnancy.

Subjects
Twenty‐seven women with a pregnancy associated with a neural tube defect and 108 matched controls with unaffected pregnancies.

Results
There was no association between serum zinc levels and neural tube defects; the mean values in μg/dl were: 82 and 85 in cases and controls, respectively, at entry to the study; 86 and 87 μg/dl just before pregnancy; and 76 and 80 μg/dl in the first trimester of pregnancy. Folic acid supplementation did not have an effect on serum zinc levels.

Conclusion
Within the range of serum zinc levels observed among women in our study, serum zinc is not a cause of neural tube defects, and periconceptional folic acid supplements do not compromise the zinc status of the mother or the embryo with respect to zinc intake.
Sweeping the membranes: a valid procedure in stimulating the onset of labour?
Authors: Allott Helen A. , Palmer Christopher R.
Published: August 2005

Objective
To determine whether sweeping the membranes in pregnancies of longer than 40 weeks gestation results in an accelerated onset of labour and a reduction in the incidence of induction of labour.

Design
A prospective randomised controlled study.

Setting
The antenatal clinic of a district general hospital.

Subjects
One hundred and ninety‐five antenatal women with pregnancies proceeding beyond 40 weeks gestation.

Interventions
A Bishop score assessment of the cervix alone or combined with a membrane sweep, on a randomised basis.

Outcome measures
Subsequent duration of pregnancy to the onset of spontaneous labour. The incidence of induction of labour for post‐maturity.

Results
Sweeping the membranes significantly reduces the subsequent duration of pregnancy, from an average of five days to two days following the procedure. The proportion of inductions of labour was 8.1 % in the swept group and 18.8% in the control group. No harmful side effects to the procedure were noted.

Conclusions
Sweeping the membranes is a safe and useful procedure which results in a reduced incidence of post‐mature pregnancies, and a subsequent reduction in the labour induction rate.