bluuebunny/crossref_metadata_2025 huggingface dataset:
Monozygotic twin pregnancy: diagnostic and Doppler ultrasound studies
Authors: NEILSON J. P. , DANSKIN F. , HASTIE S. J.
Published: August 2005

Of 178 consecutive twin pregnancies, 63 were both monozygotic and also studied prenatally by real‐time B‐scan (and usually Doppler) ultrasound. The 48 pregnancies with monochorionic placentas (in which vascular anastomoses are almost universal) were compared with the 15 monozygotic pregnancies having dichorionic placentas. The type of placenta found at delivery was predicted with substantial accuracy by ultrasound examination in mid‐pregnancy. We were unable to identify any inter‐group difference in fetal growth rate, discordance of fetal growth between twins or pattern of umbilical artery flow velocity waveform. In the absence of the rare florid twin transfusion syndrome, the vascular anastomoses that have been shown to be common in monochorionic placentas do not exert a strong influence on fetal growth or fetoplacental blood flow.
Large intrauterine haematomata in threatened miscarriage. Frequency and clinical consequences
Authors: PEDERSEN JAN FOG , MANTONI MARGIT
Published: August 2005

Summary. Previously we described intrauterine haematomata seen with ultrasound in patients with threatened miscarriage and we suggested that a haematoma of ≥50 ml might represent a risk to the pregnancy. We have now investigated 566 patients with vaginal bleeding in the first half of pregnancy and followed up 23 (4%) who had a haematoma of ≥50ml (mean 71 ml, range 50–150) at between 12 and 20 weeks gestation. One patient had a miscarriage and two had a preterm delivery, so that, contrary to our original suggestion, these large haematomata do not seem to represent any serious threat to the pregnancy.
Effectiveness of ultrasound determination of fetal abdominal circumference and fetal ponderal index in the diagnosis of asymmetrical growth retardation
Authors: SARMANDAL P. , GRANT J. M.
Published: August 2005

Summary. A total of 310 unselected women attending an antenatal clinic was screened for growth retardation by ultrasound between 34 and 36 weeks gestation, by measuring the fetal abdominal circumference (AC) and femoral length (FL), from which the ‘fetal ponderal index’ (AC/FL) was calculated. Asymmetrical growth retardation in the newborn was assessed by Rohrer's ponderal index and the mid‐arm/ occipito‐frontal circumference (MAC/OFC) ratio within 72 h of birth, a neonatal ponderal index or MAC/OFC ratio below the 10th centile being considered abnormal. The sensitivities of an AC below the 25th centile in identifying a birthweight, neonatal ponderal index or MAC/ OFC ratio below the 10th centile were 86, 62 and 67% respectively, the specificities being 80, 78 and 76%. The sensitivities of a fetal ponderal index below the 25th centile in identifying a neonatal ponderal index or MAC/OFC ratio below the 10th centile were 52 and 47% respectively, the specificities being 77 and 77%. A possible reason for the poor performance of the fetal ponderal index is discussed.
Prevention of post‐cone biopsy cervical stenosis using a temporary cervical stent
Authors: LUESLEY D. M. , REDMAN C. W. E. , BUXTON E. J. , LAWTON F. G. , WILLIAMS D. R.
Published: August 2005

Summary. Stenosis of the residual cervix is not an infrequent complication of cone biopsy which may result in subfertility, problems with adequate follow‐up and dysmenorrhoea. In an attempt to minimize this complication a temporary indwelling cervical support stent has been developed. This is sutured into the exposed cone bed immediately after cutting the cone specimen and removed 2 weeks later. A pilot study using this device in 33 cold knife conizations has been performed. There were no primary or secondary haemorrhages and no post‐conization pelvic infections. At follow‐up, 6 months after cone biopsy two patients (6%) had clinical cervical stenosis, and one patient (3%) complained of dysmenorrhoea (although the cervix was not stenosed). The cervical transformation zone was fully visible in 21/33 patients (64%) (95% CI48 to 80) and follow‐up smears contained endocervical cells in 20/33 patients (61%) (95% CI 44 to 78). These results compare very favourably with historical controls from the same unit and suggest that cone biopsy support stents should now be assessed in a prospective randomized trial.
Intravenous treosulfan versus intravenous treosulfan plus cisplatinum in advanced ovarian carcinoma
Authors: MASDING J. , SARKAR T. K. , WHITE W. F. , BARLEY V. L. , CHAWLA S. L. , BOESEN E. , ROSTOM A. Y. , MENDAY A. P.
Published: August 2005

Summary. In a prospective, multicentre, randomized trial, the efficacy and tolerance of treosulfan alone was compared with that of treosulfan plus cisplatinum in 135 women with advanced ovarian carcinoma. No statistically significant difference was found between the two treatments in terms of median survival. Combined treatment was associated with significantly greater side‐effects and haematological toxicity. Optimal survival with minimal toxicity can be achieved by using treosulfan alone in patients (mainly stages Ic or II) with minimal postoperative residual disease. Patients (likely to be stage III or IV) with greater residual disease should receive treosulfan plus cisplatinum.
Treatment with GnRH agonists before myomectomy and the risk of short‐term myoma recurrence
Authors: FEDELE LUIGI , VERCELLINI PAOLO , BIANCHI STEFANO , BRIOSCHI DIANA , DORTA MILENA
Published: August 2005

Summary. Twenty‐four women with symptomatic multiple uterine myomas were allocated randomly to treatment with buserelin, 1200μg/day intranasally, for 3 months followed by myomectomy (n = 8) or to immediate myomectomy (n = 16). Pre‐operative treatment with buserelin reduced the mean uterine volume from 432 (SD 165) to 242 (SD 82) ml (P < 0.01) but intra‐operative blood loss and postoperative morbidity were not significantly less in this group. Six months after operation, pelvic examination was normal in all the patients. However, ultrasonography with transvaginal probe demonstrated the presence of myomas of < 1.5 cm in five women (63%) treated pre‐operatively with the analogue and in two women (13%) who underwent immediate surgery (P < 0.05). Induction of a period of hypo‐oestrogenism before myomectomy seems to favour short‐term recurrence of uterine myomas, limiting the efficacy of surgery.
A pilot study of chemo‐radiotherapy in advanced carcinoma of the vulva
Authors: WHITAKER S. J. , KIRKBRIDE P. , ARNOTT S. J. , HUDSON C. N. , SHEPHERD J. H.
Published: August 2005

Summary. Advanced squamous cell carcinoma of the vulva (FIGO stages III and IV) has a poor cure rate even with exenterative surgery. We report a pilot study of combined pre‐operative chemo‐radiotherapy (CHT/RT) in all patients with advanced vulval carcinoma presenting to St Bartholomew's Hospital between July 1987 and March 1989. Twelve patients have been treated, of whom nine had primary lesions (four FIGO stage III and five stage IV) and three had recurrent disease after simple or radical vulvectomy. Seven patients were treated with an initial split course of CHT/RT: there was one treatment‐related death and the others have all died following recurrence with a median disease‐free survival of 5 months (range 3–12) and a median survival of 7 months (range 3‐16). Five patients have received a continuous course of CHT/RT: one died before operation with pulmonary metastases, three patients are disease free at 6 to 9 months, and another patient has been treated with only palliative intent. Toxicity was acceptable in the continuous regimen and this treatment seems to have a promising role in the management of advanced carcinoma of the vulva. A review of the literature on combined therapy is presented.
The effect of abdominal surgery on the serum concentration of the tumour‐associated antigen CA 125
Authors: VAN DER ZEE ATE G. J. , DUK JITZE M. , AALDERS JAN G. , BOONTJE AB H. , TEN HOOR KLASKE A. , DE BRUIJN HENK W. A.
Published: August 2005

Summary. The CA 125 assay is used to monitor the course of disease in women with adenocarcinoma of the genital tract. We measured serum CA 125 levels longitudinally in three different groups of patients who had normal scrum CA 125 levels (16 U/ml) before extensive intraperitoneal abdominal surgery (group 1, second‐look laparotomy in 28 women with ovarian cancer; group 2, radical hysterectomy in 42 patients with cervical cancer; group 3,13 men and one woman who had aortic surgery for atherosclerotic occlusive disease or aneurysm formation). Following surgery, rising serum CA 125 levels were observed in 69 out of the 84 patients (82%), irrespective of the primary diagnosis, type of operation or sex. The highest levels were found during the second week after the operation (range 3–336 U/ml) and decreased gradually thereafter, to become normal at 8 weeks after surgery. It was concluded that abdominal surgery interferes with the specificity of CA 125 as a tumour marker during the early postoperative period.
Embryonic heart activity: appearance and development in early human pregnancy
Authors: SCHATS R. , JANSEN C. A. M. , WLADIMIROFF J. W.
Published: August 2005

Summary. The appearance and development of embryonic cardiac activity was studied in early human pregnancies established by in‐vitro fertilization (IVF) using transvaginal sonography. Embryonic cardiac activity could be detected as early as 25 days after follicle aspiration. The range in appearance of embryonic cardiac activity in normal continuing pregnancies was 5 days. There was no correlation with maternal age, day of embryo transfer, or cell stage at embryo transfer. As the differcnce in appearance of embryonic cardiac activity was associated with a difference in crown‐rump length whilst the subsequent growth curve was normal we ascribe these findings to different duration of the implantation stage. The later cardiac activity was detected the greater the risk of miscarriage. Reference curves were created relating embryonic heart rate to the number of days after follicle aspiration, the number of days that cardiac activity is present and the crown‐rump length. In pregnancies ending in miscarriage heart rate patterns fell away from the reference curve. Embryonic factors seem to play an essential role in these observations.
Anti TSH‐receptor antibodies in pregnant patients with autoimmune thyroid disorder
Authors: CLAVEL SYLVAINE , MADEC ANNE‐MARIE , BORNET HUBERT , DEVILLER PHILIPPE , STEFANUTTI ANNE , ORGIAZZI J.
Published: August 2005

Summary. The study was designed to test further the usefulness of the radioreceptor assay of thyroid stimulating hormone (TSH) binding inhibitory immunoglobulins (TBH) and the bioassay of thyroid stimulating antibodies (TSAb) or TSH stimulated cAMP response inhibitory antibodies (TBkAb) in the prediction of neonatal thyroid dysfunction. Of 63 pregnant women with a current or past history of autoimmune thyroid disorder, 11 (one with active and six with a past history of Graves'disease and four with autoimmune thyroiditis) gave birth to a baby with transient hyper or hypo‐thyroidism. Only high maternal titres (which could persist after partial thyroidectomy) of anti TSH‐receptor antibodies (TRAb) led to neonatal hyperthyroidism. Both types of assay were able to detect the antibodies responsible for transitory neonatal autoimmune thyroid disease. TBH values reflectcd TSAb titres so that there was a significant correlation between the results of both assays in women with Graves' disease and in neonatal sera. Positive TBII and TBkAb activities were present in 5 of the 28 women with autoimmune thyroiditis. Therefore, when TBII is positive, the functional characterization of the antibodies warrants the use of the bioassay.
Birth asphyxia and the intrapartum cardiotocograph
Authors: MURPHY KARL WILLIAM , JOHNSON PAUL , MOORCRAFT JAMES , PATTINSON ROBERT , RUSSELL VIRGINIA , TURNBULL ALEXANDER
Published: August 2005

Summary. The intrapartum cardiotocographs (CTGs) of 38 severely asphyxiated, term infants, born during a 17‐month period, and those of 120 healthy term infants acting as controls were independently reviewed by three investigators who were unaware of the clinical outcome. Interobserver agreement was good (Kappa statistic = 0.74, P<0.0001). The investigators found that cardiotocographic abnormalities were present in 33 of the asphyxiated infants (87%) and in 35 of the controls (29%) and predicted that the abnormalities were severe enough to lead to significant fetal metabolic acidosis at delivery in 23 asphyxiated infants (61%) and in 11 controls (9%). The differences between the two groups were highly significant (P<0.001). Using the traditional diagnostic criteria for fetal distress, the investigators found that fetal blood sampling was indicated in 58% of cases in the asphyxia group and in 20% of controls but was only performed in 16% of asphyxiated infants and in 8% of controls. Furthermore, the median response times of delivery suite staff for abnormal fetal heart rate patterns were similar whether the FHR changes, classified using Krcbs' CTG scoring system, were moderate or severe: 80 min and 90 min, respectively. These findings suggest that interpretation of the intrapartum CTG continues to pose major problems for practising obstetricians.
Cyclic changes in composition and volume of the breast during the menstrual cycle, measured by magnetic resonance imaging
Authors: FOWLER P. A. , CASEY C. E. , CAMERON G. G. , FOSTER M. A. , KNIGHT C. H.
Published: August 2005

Summary. The volumes and spin‐lattice (T1) relaxation times of breast tissues and parenchymal water content were measured non‐invasively by magnetic resonance imaging (MRI) in eight healthy women during four to eight consecutive menstrual cycles. Total breast volume, and parenchymal volume, T1 relaxation time and water content were lowest between days 6 and 15. Between days 16 and 28, parenchymal volume, T1 relaxation time and water content rose sharply by 38·9%, 15·1% and 24·5%, respectively, and peaked after day 25. Within 5 days of the onset of menses, parenchymal volume fell sharply by 30·3%, while water content declined by 17·5%. Rising parenchymal volume in the second half of the menstrual cycle is not solely due to increased tissue water content and provides in vivo evidence for both growth and increased tissue fluid at this time.
Effective destruction of cervical intraepithelial neoplasia (CIN) 3 at 100°C using the Semm cold coagulator: 14 years experience
Authors: GORDON HELEN K. , DUNCAN IAN D.
Published: August 2005

Summary. A total of 1628 women with CIN 3 treated with the Semm cold coagulator between 1975 and 1989 was followed primarily by cytology. The standard suitability criteria for ablation were adhered to except that patients were treated at their first visit when the colposcopist expected that the diagnosis would be no worse than CIN 3. Overall 97% of the women were treated at their first visit. In 30 women (2%) the histology was glandular or worse than expected, but 22 of these showed no persistent cervical disease subsequently. Follow‐up was achieved for 87% at 10 years. In actuarial terms the primary success rate was 95% at 1 year and 92% at 5 years, it was similar for all age groups. Repeat coldcoagulation for persistent/recurrent CIN 3 was less successful and is not advised. The outcome for 226 pregnancies established after treatment is known. The rates for miscarriage, preterm or operative delivery were not increased. Cold‐coagulation of CIN 3 at 100°C as performed by us is as effective as any other treatment and calls into question the need for more expensive practices.
Babies born before arrival at hospital
Authors: BHOOPALAM PRAKASH S. , WATKINSON M.
Published: August 2005

Objective— To establish the prevalence of babies born before arrival at two local hospitals. To identify women at risk of giving birth before arrival, and the morbidity and mortality associated with such births.

Design— A. case control study. Each baby born before arrival and its mother were compared with the next born in the hospital (random control), and one matched for gestation and birthweight, together with their mothers.

Setting— Two maternity units serving East Birmingham and Solihull.

Subjects— All babies (and their mothers) born before arrival at these hospitals from January 1983 to December 1987.

Main outcome measures— Perinatal mortality rates, patterns of perinatal morbidity, demographic, social and obstetric features of the mothers.

Results— 137 (0.44%) of 31 140 consecutive births were before arrival at hospital (BBA group). The perinatal mortality rate in the BBA group was 58.4/1000 (8 deaths) compared with 10.1/1000 for all inborn babies (relative risk 5.8, 95% confidence interval 2.9–11.4). In the BBA group the mean birthweight of 3008 g was 212 g (95% CI 50–374 g) less than that in the random control group; the mean gestation of 266 days was 10 days less (95% CI 5.9–14.1 days) than in the random control group. Hypothermia was the commonest morbidity. Women delivered before arrival tended to be either multigravid inner city Asians living a long way from the hospital or unmarried unbooked younger white Europeans.

Conclusions— The high perinatal mortality was related to immaturity and low birthweight, rather than to birth before arrival itself. Although groups of mothers at risk of delivery before arrival can be identified more information is needed to establish whether additional antenatal care would be beneficial for these women and their babies.
Distal urethral electrical conductance (DUEC)—a preliminary assessment of its role as a quick screening test for incontinent women
Authors: CREIGHTON SARAH M. , PLEVNIK STANISLAV , STANTON STUART L.
Published: August 2005

Summary. Measurement of distal urethral electrical conductance (DUEC) has been used to detect the movement of urine along the distal urethra. DUEC was used as a screening test in 100 women attending the urodynamic clinic with incontinence and in the 33 women who voided over 250 ml, the findings correlated well with subsequent urodynamic diagnosis of urethral sphincter incompetence and detrusor instability.
The immunoperoxidase localization of tumour markers in ovarian cancer: the value of CEA, EMA, cytokeratin and DD9
Authors: HAMMOND R. H. , BATES THELMA D. , CLARKE D. G. , GRANT ANNE G. , HAINES A. M. R. , EUSTACE D. L. S. , HEYDERMAN EADIE
Published: August 2005

Summary. Primary tumours from 40 patients with epithelial ovarian cancer, treated at St Thomas's Hospital over a 10‐year period, were studied for the immunocytochemical expression of the following tumour markers in formalin‐fixed paraffin embedded material: carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA), cytokeratin (CAM 5.2), and DD9. An indirect immunoperoxidase staining technique was used. All of the tumours were positive for EMA and CAM 5.2, and 30% of them were positive for both CEA and DD9. The absence of CEA and DD9 may be of value in differentiating between metastatic abdominal adenocarcinomas of ovarian origin and those of gastrointestinal origin, but no indication of prognosis was obtained using these epithelial markers. The strong and widespread staining of all of the tumours for EMA suggests that this may be a useful marker for detecting metastatic or recurrent disease by immunoscintigraphy.
A randomized controlled trial of early amniotomy
Authors: FRASER WILLIAM D. , SAUVE REG , PARBOOSINGH I. JOHN , FUNG TAK , SOKOL ROBERT , PERSAUD DAVID
Published: August 2005

Objective— To determine if a policy of early amniotomy resulted in a reduction in mean labour duration when compared to a policy of conservation of the membranes.

Design— A single‐centre randomized controlled trial.

Setting— A tertiary care teaching hospital in Alberta, Canada.

Subjects— Ninety‐seven term nulliparae in spontaneous labour, baby in cephalic presentation.

Intervention— Early amniotomy versus intent to keep membranes intact.

Main outcome measures— Interval from randomization to delivery, rate of abnormalities of fetal heart rate tracings, cord artery blood pH, Apgar scores.

Results— The mean interval from randomization to delivery was 390.9 (SE 29.1) min in the amniotomy group and 442.9 (SE 34.1) min in the control group (P= 0.251). There were no differences between groups in the occurrence of fetal heart rate tracing abnormalities, nor was there a difference in the proportion of babies with abnormal Apgar scores, or abnormal cord pH (< 7.20).

Conclusion— The results of the study fail to support the long held belief that early amniotomy is an effective method for reducing labour duration.
Vaginal infection and preterm labour
Authors: McDONALD H. M. , O'LOUGHLIN J. A. , JOLLEY P. , VIGNESWARAN R. , McDONALD P. J.
Published: August 2005

Objective— To study the vaginal flora of women in preterm labour (PTL) and determine whether the presence of specific vaginal microflora is significantly associated with onset of PTL.

Design— A comprehensive prospective study of the vaginal microflora of women in early labour comparing women in PTL with term controls. Microbiological assessment included cultures for aerobic and anaerobic bacteria, yeasts, genital mycoplasmas and Trichomonas vaginalis. Multiple logistic regression analysis was used to adjust for confounding obstetric and demographic variables.

Setting— The Queen Victoria Hospital, Adelaide.

Patients— 428 Women in PTL compared to 568 women in labour at term.

Main outcome measure— PTL and preterm prelabour rupture of membranes (PPROM) in relation to specific vaginal microflora.

Results— After multiple logistic regression analysis, two distinct bacteriological groupings were associated with PTL <37 weeks gestation, namely, the bacterial vaginosis group of organisms, Gardnerella vaginalis and Bacteroides spp., and a group of enteropharyngeal organisms, E. coli, Klebsiella spp., Haemophilus spp. and S. aureus. G. vaginalis was found in 12% of women in PTL compared to 6% at term [regression odds ratio (ROR) 1.8, 95% confidence intervals (CI) 1.1–3.1] whereas Bacteroides spp. were detected in 45% of women in PTL compared with 35% at term (ROR 1.6, CI 1.2–2.1). The prevalence of G. vaginalis (17%) and Bacteroides spp. (50%) was even higher in women in PTL <34 weeks gestation. The enteropharyngeal group of organisms were more commonly present in women in PTL <37 weeks (E. coli 10% vs 6%, ROR 1.4, CI 0.8–2.4; Klebsiella spp. 3% vs <1%, ROR 5.4, CI 1.1–26.7; Haemophilus spp. 2% vs <1%, ROR 5.5, CI 1.1–28.6; aureus 6% vs 4%, ROR 1.8, CI 0.9–3.3) and were isolated even more frequently in women in PTL <34 weeks (E. coli 15%; Klebsiella spp. 4%; S. aureus 7%). Bacteroides spp., Klebsiella spp., and Haemophilus spp. were all found to be associated with PPROM.

Conclusion— There are two distinct bacteriological groupings commonly found in women in PTL, especially in PTL <34 weeks gestation. These bacteriological groups are women with bacterial vaginosis in pregnancy and women who demonstrate enteropharyngeal bacteria in the vagina.
Congenital and maternal cytomegalovirus infections in a London population
Authors: GRIFFITHS P. D. , BABOONIAN C. , RUTTER D. , PECKHAM C.
Published: August 2005

Objective— To determine if women at risk of having babies infected with cytomegalovirus (CMV) can be identified antenatally.

Design— Prospective serological and demographic study of pregnant women and virological study of their newborn infants.

Setting— Teaching hospital in London.

Subjects— 3315 pregnant women and 2737 of their babies.

Main outcome measures— Quantitative detection of CMV IgG antibodies; qualitative detection of CMV IgM antibodies; demographic characteristics of mothers; qualitative and quantitative titration of CMV viruria in newborn.

Results— Congenital CMV infection was found in nine newborn babies (0.33%) two of whom had symptoms. Serological testing of the nine mothers showed four primary and five recurrent infections; both of the symptomatic children were born in the latter group. Testing for CMV specific IgM antibodies or quantitation of IgG antibodies in early pregnancy sera could not differentiate those women at risk of giving birth to babies infected or damaged by CMV from the rest of the population. Quantitation of viruria confirmed that those babies most at risk of CMV disease have the highest titres of CMV.

Conclusions— (i) Since laboratory tests in pregnant women cannot reliably identify fetuses at risk of disease, screening for asymptomatic maternal infection coupled with termination of pregnancy cannot be recommended. (ii) Since ‘immune’ women can still give birth to babies affected by CMV, we propose that future CMV vaccines should be used to immunize children with the aim of eradicating CMV infection in preference to selective immunization of sero‐susceptible females.
Induced abortions, contraceptive practices, and tobacco smoking as risk factors for ectopic pregnancy in Athens, Greece
Authors: KALANDIDI ANNA , DOULGERAKIS MANOLIS , TZONOU ANASTASIA , HSIEH CHUNG‐CHENG , ARAVANDINOS DIONISIOS , TRICHOPOULOS DIMITRIOS
Published: August 2005

Summary. A case‐control study of the role of induced abortion and other factors on the subsequent occurrence of ectopic pregnancy was undertaken in 1986–1987 in Athens, Greece, where a similar study 20 years ago found a tenfold risk of ectopic pregnancy among women with one or more illegal induced abortions. Seventy women residents of Athens, consecutively admitted to the major state maternity hospital with a diagnosis of ectopic pregnancy, were individually matched with women with a newly diagnosed pregnancy of the same order as the ectopic index pregnancy. Two control women were found for each of 63 cases, but only one control for each of the remaining seven cases. All cases and controls were interviewed by the same qualified obstetrician. Statistical analysis was undertaken with stratification of individual matched triplets and pairs, as well as through conditional multiple regression procedures. The relative risk of recurrence of an ectopic pregnancy was 6.39 with 95% confidence interval (CI) 1.96–21.04. Miscarriages did not increase the risk of ectopic pregnancy. The relative risk for subsequent ectopic pregnancy among women with one or more induced abortion, compared to women without such abortions, was 1.87 (CI 0.84–4.16) controlling only for the matching factors, and 1.71 (CI 0.69–4.27) when marital status (a possible selection factor) was also accounted for in the conditional logistic regression. There was no evidence for increasing risk with increasing number of induced abortions. Past use of an intrauterine device (IUCD) was associated with a relative risk of 3.89 (0.72–21.02); the relative risk increased with the duration of use of the IUCD. Tobacco smoking significantly increased the risk of an ectopic pregnancy, the relative risk being 2.35 (CI 1.19–4.67). Legalized induced abortions, as currently practised in Greece, do not appear to increase the relative risk of ectopic pregnancy to a substantial degree.
Psychiatric morbidity and acceptability following medical and surgical methods of induced abortion
Authors: URQUHART D. R. , TEMPLETON A. A.
Published: August 2005

Summary. Ninety‐one women were asked to complete a standardized multiple choice questionnaire (modified from the Edinburgh Postnatal Depression Scale) to screen for anxiety and depression before and after legal abortion in early pregnancy achieved either by using mifepristone in combination with a prostaglandin (n= 54) or by vacuum aspiration under general anaesthesia (n= 37). Before abortion over 60% in both groups had high scores (compatible with psychiatric morbidity), but after the abortion there was a significant and equal fall in scores so that by 1 month <10% of either group had high scores. There was no difference between the two groups. Both methods of abortion were acceptable to the majority of women, although only 75% of the medical group indicated they would have the same method if a future termination was ever required, compared with 94% in the surgical group. However, in 13 women who had experience of both methods, the medical approach was preferred by 10 (77%). Thus, medical abortion is acceptable to the majority of women and is associated with the same low rate of short term psychiatric morbidity as has been recorded with surgical methods of termination, despite greater patient involvement and awareness of the abortion process.
‘Nuns, virgins, and spinsters’. Rigoni‐Stern and cervical cancer revisited
Authors: GRIFFITHS MALCOLM
Published: August 2005

Summary. The view that nuns have a very low risk of cervical cancer is questioned. The historical evidence for this view is reviewed, from the beginning of the eighteenth century to the present. An estimate of the actual mortality rate from cervical cancer suggests that risk of death from this neoplasm among nuns is little different from that among the general female population. It is recommended that nuns should not be excluded from cervical cytology screening. When symptoms which might suggest cervical cancer arise in such women, full gynaecological assessment is necessary.
The effect of maternal anaemia and iron deficiency on the ratio of fetal weight to placental weight
Authors: GODFREY K. M. , REDMAN C. W. G. , BARKER D. J. P. , OSMOND C.
Published: August 2005

Objective— To examine the maternal influences which determine large placental weight and a high ratio of placental weight to birthweight. These are known predictors of adult blood pressure.

Design— Retrospective analysis of routine obstetric and haematology department records for a large cohort of pregnant women.

Setting— John Radeliffe Hospital, Oxford.

Subjects— 8684 pregnant women who were delivered between January 1987 and January 1989 and whose records could be linked to the results of two or more pregnancy blood counts.

Main outcome measures— Placental weight and the ratio of placental weight to birthweight.

Results— Large placental weight was associated with a low maternal haemoglobin and a fall in maternal mean cell volume during pregnancy. The highest ratio of placental weight to birthweight occurred in the most anaemic women with the largest falls in mean cell volume. Large placental weight and a high ratio of placental weight to birthweight were also independently associated with a high maternal body mass index. Maternal smoking reduced placental weight, but increased the ratio of placental weight to birthweight.

Conclusions— Anaemia and iron deficiency during pregnancy are associated with large placental weight and a high ratio of placental weight to birthweight. This points to maternal nutritional deficiency as a cause for discordance between placental and fetal growth. This may have important implications for the prevention of adult hypertension, which appears to have its origin in fetal life.
Trophoblast deportation in pre‐eclamptic pregnancy
Authors: CHUA SELINA , WILKINS THURL , SARGENT IAN , REDMAN CHRISTOPHER
Published: August 2005

Objectives— To examine the deportation of trophoblast cells into the maternal blood in pre‐eclamptic (gestational proteinuric hypertension) and normal pregnancy.

Design— The monoclonal anti‐cytokeratin antibody JMB2 was used in the APAAP technique to label trophoblast cells in cell smears of uterine vein blood obtained at caesarean section.

Subjects— 10 women with proteinuric pre‐eclampsia requiring caesarean section, 10 pregnant women requiring elective caesarean section for reasons other than pre‐eclampsia and five control women who had never been pregnant.

Results— Three populations of trophoblast cells were identified; two mononuclear cytotrophoblast types with diameters varying from 11–14 μm and 19–25 μm respectively, and multinucleated syncytiotrophoblast cells varying in size from 23–88 μm. Women with pre‐eclampsia had more trophoblast cells in uterine vein blood than were found in pregnant women without pre‐eclampsia. There was no correlation between the numbers of trophoblast cells and the stage of gestation or severity of the pre‐eclampsia, although an acute maternal or fetal event necessitating delivery was associated with increased deportation of trophoblast. Mononuclear cytotrophoblast cells were detected in the peripheral blood of only 1 of 5 pre‐eclamptic patients, despite their presence in the uterine vein blood of all 5 women.

Conclusions— Trophoblast deportation is increased in pre‐eclamptic pregnancy, with both cytotrophoblast and syncytiotrophoblast present in the uterine vein blood, but there is no correlation with the severity of the disease. In some cases cytotrophoblast may also enter the peripheral circulation.
Prospective serial study of viral change in the cervix and correlation with human papillomavirus genome status
Authors: KITCHENER H. C. , NEILSON L. , BURNETT R. A. , YOUNG L. , MACNAB J. C. M.
Published: August 2005

Objective— To observe in serial fashion the histological changes of human papilloma virus (HPV) infection of the cervix and to correlate these with the detection of HPV genomes.

Design— A prospective longitudinal study to perform colposcopy and at 0,9 and 18 months to obtain a smear, a biopsy for histology and HPV‐16 genome detection by DNA/DNA hybridization.

Setting— Glasgow Family Planning Centre.

Subjects— Eighty‐two women recruited on the basis of a routine smear showing viral change without dyskaryosis.

Interventions— Women found to have CIN 3 were treated with laser.

Main outcome measures— Cytology and cervical biopsy results and HPV‐16 DNA detection by Southern blotting obtained serially from individual subjects.

Results— Of 82 women recruited, 10% were positive for HPV‐16 detection by Southern blotting. Detection of HPV‐16 genomes did not correlate with either CIN or viral infection assessed histologically and serial hybridizations in a given individual showed fluctuation in HPV‐16 detection. Polymerase chain reaction in a subset of samples revealed 46% positive for HPV DNA.

Conclusion— No clear correlation exists between HPV genome detection and the histological appearance. HPV‐16 genome detection alone may not be a useful predictor of precancerous progression.
Gamete intrafallopian transfer (GIFT) compared with intrauterine insemination in the treatment of unexplained infertility
Authors: MURDOCH A. P. , HARRIS M. , MAHROO M. , WILLIAMS M. , DUNLOP W.
Published: August 2005

Objective— To compare GIFT, intrauterine insemination (IUI) with, and without, ovarian hyperstimulation in the treatment of unexplained infertility.

Design— Women randomly allocated to one of three treatment protocols.

Setting— Northern Regional Fertility Centre.

Subjects— 59 couples with unexplained infertility of more than 3 years duration.

Interventions— Three cycles of either GIFT, IUI after ovarian hyperstimulation or IUI in a spontaneous cycle.

Main outcome measures— Pregnancy resulting in a live birth.

Results— Fecundabilities were 0.12 after GIFT, 0.018 after ovarian hyperstimulation and IUI, and 0.018 after IUI in a spontaneous cycle. The fecundability after IUI was no different from that which would be expected without treatment in these couples but fecundability was significantly better (P>0.02) after GIFT.

Conclusions— This trial does not support the use of IUI in the treatment of unexplained infertility but confirms the value of GIFT.
Ureteric obstruction in pregnancy—diagnosis and management
Authors: ECKFORD S. D. , GINGELL J. C.
Published: August 2005

Objective— To discuss the aetiology, diagnosis and management of ureteric obstruction in pregnancy and to describe the use of double‐pigtail ureteric stents in a series of 10 patients.

Design— Retrospective study of women presenting to a maternity unit in whom the diagnosis of ureteric obstruction is reached.

Setting— Southmead Hospital in Bristol; a large district general hospital with a throughput of around 6OOO maternity patients per year.

Subjects— 10 women (8 in their first pregnancy, 1 in her second and 1 in her third; mean age 29.2 years (range 18–31 years).

Interventions— Double‐pigtail ureteric stents were electively passed after a diagnosis of ureteric obstruction. Stents remained in situ for a mean 15.5 weeks (range 8–25 weeks) and were electively removed 4–6 weeks post partum.

Results— Nine women progressed uneventfully through the remainder of their pregnancy. One developed strangury, haematuria and discomfort after stent insertion. Seven women had normal vaginal deliveries, two assisted vaginal deliveries and one was delivered by caesarean section. None required to have external urinary drainage.

Conclusions— Double‐pigtail ureteric stents are easy to place and remove and are well tolerated. They provide a simple, safe and effective method of internal upper urinary tract drainage in ureteric obstruction in pregnancy.
Insufficient remodelling of the uterine connective tissue in women with protracted labour
Authors: GRANSTRÖM L. , EKMAN G. , MALMSTRÖM A.
Published: August 2005

Objective— To investigate the association between a slow progress of labour and insufficient remodelling of the uterine connective tissue.

Design— An open comparative study.

Setting— Danderyd Hospital, Department of Obstetrics and Gynaecology, referral centre.

Subjects— Eleven women (study group) in oxytocin augmented labour but with an unripe cervix in whom vaginal delivery could not be accomplished and 12 women (normal labour group) in normally progressing spontaneous labour and a favourable cervix but who needed to be delivered by caesarean section due to signs of fetal distress.

Interventions— At caesarean section tissue specimens were obtained from the fundus, the isthmus and the cervix uteri.

Main outcome measures— Collagen concentration and extractability, collagenolytic activity expressed as DNP‐peptide hydrolytic activity and the concentrations of sulphated glycosaminoglycans (S‐GAG) and hyaluronic acid (HA) in the tissue specimens.

Results— Statistically significantly higher concentrations and lower extractability of collagen in the isthmus and the cervix uteri was found in women with slow progress of labour compared with those with normal labour.

Conclusions— An insufficient remodelling of the connective tissue in the cervix and isthmus uteri may contribute to slow progress of labour.
Emergency cervical cerclage
Authors: MacDOUGALL JANE , SIDDLE NICHOLAS
Published: August 2005

Objective— To assess the efficacy of emergency cervical cerclage.

Design— Retrospective review of patients who underwent emergency cervical cerclage between August 1986 and August 1989.

Setting— University College and the Middlesex Hospitals obstetric unit, a neonatal referral centre.

Subjects— 19 women between 16 and 28 weeks gestation with a cervical dilatation between 3 and 10 cm. There were two twin pregnancies.

Interventions— Amniocentesis and bacteriological assessments were performed prior to cerclage and prophylactic antibiotics were given. Insertion of sutures was aided by a combination of techniques described previously.

Main outcome measures— Prolongation of gestation and pregnancy outcome. Bacteriological findings at delivery and maternal and fetal morbidity were also recorded.

Results— Membranes remained intact in all the women after cerclage. Fifteen live babies were born and 13 of them survived (survival rate 63%). Gestation was prolonged from between 1 and 19 weeks in these patients and the gestational age at delivery ranged from 25 to 41 weeks. All eight intrauterine or neonatal deaths were associated with infection. Infecting organisms included Escherichia coli, Gardnerella vaginalis, Mycoplasma hominis, Trichomonas vaginalis and Fusobacterium spp. Pregnancy was prolonged for <5 weeks in these infected pregnancies. A cervical laceration occurred in a patient who had the suture inserted at full dilatation and subsequently laboured, but there were no other maternal complications.

Conclusions— Emergency cervical cerclage can prolong pregnancy and influence the outcome favourably.
Conservative laparoscopic treatment of ectopic pregnancies using the CO2‐laser
Authors: KONINCKX P. R. , WITTERS K. , BROSENS J. , STEMERS N. , OOSTERLYNCK D. , MEULEMAN C.
Published: August 2005

Objective—To assess the feasibility of CO2‐laser‐endoscopic surgical treatment for large and/or ruptured ectopic pregnancies, and to compare the results with those of microsurgical salpingotomy.

Design—A retrospective review of all women treated for an ectopic pregnancy during a 6‐year period, 1984–1989. During 1988 and 1989 treatment was randomized by the day of admission, depending only upon the surgeon in charge, some performing a linear salpingotomy (n=42) and some a CO2laser laparooscopy (n=34) in all women haemodynamically stable.

Setting—Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Leuven.

Subjects—135 women with ectopic pregnancies of whom 76 were included in the randomized series between 1988 and 1989. Overall 11 were treated by pelvic lavage, 78 by laparotomy and 46 by laparoscopic procedures.

Main outcome measures—Postoperative complications, duration of hospital stay. Cumulative pregnancy rates after the procedures.

Results—The two groups of women analysed in the randomized series were comparable for duration of amenorrhoea, diameter of the ectopic pregnancy and prevalence of ‘ruptured’ ectopics, but the duration of stay in hospital was much shorter (mean 2–9, SD 1.8 days) for the 34 women treated by laparoscopy than for the 42 women treated by laparotomy (mean 6.8, SD 1.6 days). The postoperative cumulative pregnancy rate was higher in nulliparous women with a history of infertility or pelvic inflammatory disease (PID), when treated with CO2‐laser‐laparoscopy (P=0.009). The recurrency rate was low (<5% in both groups). Overall in the women treated by laparotomy, postoperative cumulative pregnancy rates were lower following excision or adnexectomy than after a microsurgical linear salpingotomy (P=0.01). Four women treated by laparoscopy required a second procedure.

Conclusion—Endoscopic treatment of large and/or ruptured ectopic pregnancies is feasible and resulted in a shorter hospital stay and, in nulliparous women with a history of PID or infertility, in higher cumulative pregnancy rates, than after microsurgical salpingotomies.
An audit of the management of ectopic pregnancy
Authors: NORMAN S. G.
Published: August 2005

Objective— To estimate the local incidence of ectopic pregnancy and to review the management of ectopic pregnancy with reference to those misdiagnosed at presentation. To establish management guidelines to be applied to all possible ectopic pregnancies.

Design— A review of all ectopic pregnancies presenting over a 2‐year period, and of emergency gynaecological admissions during 4 months.

Setting— A teaching hospital

Results— The local rate of ectopic pregnancy was similar to that seen in other UK studies. Nineteen (13%) women with ectopic pregnancies were sent home with an incorrect diagnosis. Eight were recalled but eight required emergency admission and one died at home. Undue confidence in ultrasound reports and failure to follow up inconclusive histology results were a feature in cases where patients were not recalled. A set of simple management guidelines has been drawn up. Amongst general gynaecological admissions 1 in 12 of all first trimester complications was an ectopic pregnancy. Amongst apparently true uterine miscarriages 20% of histological examinations were inconclusive and histology and ultrasound examinations failed to confirm a uterine miscarriage in 14% of apparently true missed miscarriages.

Conclusions— Ectopic pregnancy is common amongst first trimester complications. Adherence to simple management guidelines would minimize the number of patients requiring emergency admission, though up to 20% of patients with apparently true uterine miscarriages would also require further investigation.
Colposcopically directed punch biopsy: a potentially misleading investigation
Authors: BUXTON E. J. , LUESLEY D. M. , SHAFI M. I. , ROLLASON M.
Published: August 2005

Objective— To determine the relation between the histology of an initial colposcopically directed punch biopsy and a subsequent diathermy loop excision biopsy of the transformation zone, and the effect of lesion size on this relation.

Design— Prospective observational study of loop diathermy excision biopsies of the cervical transformation zone.

Setting— Academic unit colposcopy clinics at The Birmingham and Midland Hospital for Women and Dudley Road Hospital, Birmingham.

Subjects— 243 women managed by colposcopy and directed punch biopsy followed by loop diathermy excision.

Outcome measures— The histology of the punch biopsy and the excised transformation zone and the size of the abnormal lesion.

Results— In 132 (54%) of the 243 women the histology of the punch biopsy and loop excision specimen did not agree. In 62 (47%) of these 132 women a more severe lesion was found in the excised transformation zone, including three unsuspected adenocarcinoma in situ and one stage Ia1 cancer. In 39 (41%) of the 96 women in whom a lesion of CIN 3, or greater severity, was found in the loop excision specimen, the paired punch biopsy had suggested a lesion of lesser severity. In small area lesions, the punch biopsy was more likely to show more severe disease than the loop excision specimen (P= 0.0014).

Conclusions— The results suggest that directed punch biopsy is an inadequate endpoint by which to judge the severity of an epithelial lesion. The findings have important implications for patient management and the design of trials and cast doubt on the results of studies using punch biopsy as an endpoint.
Passive maternal smoking and birthweight in a South Indian population
Authors: MATHAI MATTHEWS , VIJAYASRI R. , BABU SANDHYA , JEYASEELAN L.
Published: August 2005

Objective
To determine the effects of passive maternal smoking on birthweight.

Design
Cohort of consecutive singleton live births.

Setting
Teaching hospital in South India.

Subjects
994 infants and their mothers.

Main outcome measure Birthweight.

Results
All the women were themselves non‐smokers; 520 (52%) were passive smokers while the remainder were not exposed to tobacco smoke. Infants born to passive smokers were on the average 55 g lighter than those born to non‐smokers. Passive smoking was associated with a decrease in birthweight of 63 g (95% CI 12–114 g) even after adjusting for other variables known to affect birthweight.