bluuebunny/crossref_metadata_2025 huggingface dataset:
Undergraduate obstetrics and gynaecology in the United Kingdom and the Republic of Ireland, 1989
Authors: BIGGS J. S. G. , HARDEN R. M. , HOWIE P.
Published: August 2005

Summary. Undergraduate obstetrics and gynaecology has given rise to concern at a time when the community has become increasingly sensitive about genital structure and function and human reproduction. A survey of clinical schools in the United Kingdom and the Republic of Ireland shows that an average of 11 weeks is available for undergraduate learning in the discipline. Nearly all schools provide written aims and objectives for clinical students. Pelvic examination is taught in what is concluded to be a sensible and responsible manner; students are expected to conduct an average minimum of eight deliveries. Family planning instruction is seen as generally inadequate. Comparison of clinical courses with those in Australia and New Zealand shows striking similarities. Undergraduate courses need to be under constant review and revision so that the best students are encouraged to see obstetrics and gynaecology as a desirable career path.
Women who gain more fat during pregnancy may not have bigger babies: implications for recommended weight gain during pregnancy
Authors: LAWRENCE M. , MCKILLOP F. M. , DURNIN J. V. G. A.
Published: August 2005

Summary. The correlation between infant birthweight and the amount of fat gained during pregnancy (estimated as the change in maternal weight between 10 weeks gestation and 2–3 weeks postpartum) was studied in 115 healthy, parous, urban Scottish housewives. There was very little correlation between these variables (r = 0.13, falling to r = 0.07 after birthweight was adjusted for initial maternal weight and length of gestation), i.e., women who gained more fat during their pregnancies did not give birth to heavier babies. This suggests that for most women one of the principal effects of increasing food intake during pregnancy may be to increase maternal fat gain rather than promote fetal growth, and that efforts to increase birthweight by encouraging greater weight gain during pregnancy may be unsuccessful
Polycystic ovaries: do these represent a specific endocrinopathy?
Authors: GADIR AHMED ABDEL , KHATIM MOHAMED S. , MOWAFI RAOUF S. , ALNASER HUDA M. I. , ALZAID HUSSEIN G. N. , SHAW ROBERT W.
Published: August 2005

Summary. Serum pituitary gonadotrophins, oestradiol, testosterone and insulin pulse patterns were examined at 15‐min intervals for 6 h in 40 women with a previous diagnosis of polycystic ovarian disease (PCO) based on clinical, endocrinological and ultrasound data. Age, duration of symptoms, body mass index (BMI) and ovarian volume showed no correlation with the 6‐h mean value of any hormone and testosterone blood levels did not correlate with those of insulin. Some patients had high and others low LH pulse pattern components, and few had an inverted LH:FSH ratio. Morphological polycystic ovarian changes may be a reflection of various rather than a single pattern of gonadotrophin secretion.
Attitudes towards gamete donation among couples undergoing in vitro fertilization
Authors: OSKARSSON THORDUR , DIMITRY ESSAM S. , MILLS MARTIN S. , HUNT JENNIFER , WINSTON ROBERT M. L.
Published: August 2005

Summary. The attitudes of 234 anonymous couples undergoing in vitro fertilization toward sperm and oocyte donation were explored by questionnaire. All the questionnaires were returned of which 222 (95%) were complete and analysed. A high proportion of couples found the use of donor sperm acceptable for therapeutic, diagnostic and treatment purposes (77%, 90% and 97% respectively) and 72%, 84% and 90% respectively were willing to donate oocytes for these purposes. Of potential oocyte donors 41% would agree to nonanonymous donation, 12% would wish to meet the recipient couple and although only 4% wanted to choose the recipient, a quarter of the couples would prefer a relative or friend as the recipient. Provision of nonidentifying information about the donor to the recipient couple was acceptable to almost 70% whereas 40% found giving the same information to the child acceptable.
Prediction of lethal pulmonary hypoplasia and chorioamnionitis by assessment of fetal breathing
Authors: OHLSSON ARNE , FONG KATHERINE , HANNAH MARY , HEYMAN ZAHAVA , GONEN RON , ROSE TOBY , BABOOLAL RANJIT
Published: August 2005

Summary. Twenty‐three pregnancies with fetuses at risk for pulmonary hypoplasia were studied weekly until delivery. The amount of time spent in fetal breathing activity was recorded under controlled conditions during 1 h using real‐time ultrasound. An amniotic fluid index was determined. The clinicians and the pathologist were unaware of the ultrasound findings. Eight of 23 fetuses did not breathe at the last ultrasound examination. Three babies died of pulmonary hypoplasia and two of these showed fetal breathing before birth. The three deaths were associated with rupture of the membranes at <20 weeks gestation and of ≥44 days duration. One infant developed bronchopulmonary dysplasia. The amniotic fluid index in these four pregnancies was low and the newborn infants had limb contractures. Chorioamnionitis/funisitis was noted in 13 placentas. Eight fetuses were assessed for fetal breathing within 2 days of birth. The lack of fetal breathing had sensitivity, specificity, positive and negative predictive values of 0.75 for chorioamnionitis/funisitis. In this pilot study the absence of fetal breathing was of no value in predicting lethal pulmonary hypoplasia, but was related to chorioamnionitis/funisitis. We recommend further studies of fetal breathing in relation to fetal/neonatal infections.
Prospective comparison of videopelviscopy with laparotomy for ectopic pregnancy
Authors: BAUMANN RALF , MAGOS ADAM L. , TURNBULL ALEXANDER
Published: August 2005

Objective— To compare operativc laparoscopy with laparotomy for the management of ectopic pregnancy in haemodynamically stable women.

Design— Non‐randomized prospective cohort study, treatment allocation depending on the surgical preference and experience of the on‐call medical team.

Setting— Provincial undergraduate teaching hospital.

Subjects— 87 consecutive and unselected haemodynamically stable women treated for ectopic pregnancy bctween 1 March 1988 and 31 August 1989.

Interventions— Salpingotomy, salpingectomy, salpingo‐oophorectomy or simple extraction of the ectopic pregnancy depending on its site, size and nature performed under laparoscopic control or laparotomy.

Main outcome measures— Operative outcome, duration of surgery, intra‐ and post‐operative complications, post‐operative hospital stay, return to normal domestic activities. return to work, changes in plasma β‐hCG concentrations, health and social service costs.

Results— 60 women were treated by videopelviscopy on 65 occasions and the othcr 27 were treated by laparotomy. The two groups were similar for age, parity and gestation at presentation. Of the 65 operative laparoscopies 61 (94%) were successful and all 27 laparotomies were completed uneventfully. Whereas the operating time was similar in the two groups, 55.3 and 51.1 min for videopelviscopy and laparotomy respectively, operative laparoscopy was associated with significantly shorter post‐operative hospital stay (1.7 vs 5.2 days), faster return to domestic activitics (1.5 vs 3.3 weeks) and work (2.5 vs 5.7 weeks) (P<0.001 for all). In economic terms, successful vidcopelviscopy was associated with a reduction in hospital accommodation costs by 69% (£248 vs£808), drug costs by 52% (£8.38 vs£17.57) and statutory sickness payment by 51% (£130.25 vs£266.51), that is an overall saving to the health and social services of £701.47 or 50% per ectopic pregnancy (P<0.001).

Conclusions— Operative laparoscopy can be used to successfully treat most cases of extrauterine pregnancy with advantages over laparoscopy in terms of reduced hospitalization, faster recovery and lower health service costs.
Direct antenatal fetal electrocardiographic waveform analysis
Authors: ARULKUMARAN S. , NICOLINI U. , FISK N. M. , TANNIRANDORN Y. , ROSEN K. G. , RODECK C. H.
Published: August 2005

Objective— To establish a technique for continuous recording of fetal electrocardiograms (ECG) for waveform analysis in the antenatal period.

Design— Prospective descriptive study.

Setting— Fetal Medicine Unit, Queen Charlotte's and Chelsea Hospital, London, UK.

Subjects— 35 women undergoing antenatal fetal blood sampling.

Interventions— One end of an insulated Cooner wire was attached to the sampling needle and the other to an automatic ECG‐ST waveform analyser.

Main outcome measures— ECG signals were obtained with the needle in the fetal abdomen during intrahepatic umbilical vein sampling or aspiration of fetal urine but not when it was in the placental cord insertion.

Results— Continuous recording of the T/QRS ratio was obtained for a total of 166 min (mean 8 min per fetus) from 20 fetuses (16–38 weeks). The T/QRS ratio had no correlation with gestational age and fetal heart rate and was similar to values described in term fetuses in labour.

Conclusions— The technique described can identify ST waveform changes and may be useful in the investigation of fetal cardiac arrhythmias, intrauterine growth retardation and in monitoring fetal transfusions.
United Kingdom Colposcopy Survey, British Society for Colposcopy and Cervical Pathology
Authors: KITCHENER H. C.
Published: August 2005

Objective— To audit various aspects of colposcopy practice throughout the United Kingdom on behalf of BSCCP.

Design— A postal questionnaire was circulated to those responsible for colposcopy services in all districts in the United Kingdom in 1988, followed by a smaller survey of 40 clinics in 1990 to detect any trends.

Main outcome measures— Information was sought on colposcopy workload, referral criteria, treatment method and follow‐up, waiting times, staffing and training.

Results— There was a 71% response to the national survey of 1988 practice which alone accounted for 80 000 new referrals for colposcopy. Cytological criteria for colposcopy referral were generally liberal. In 1988 laser ablation was the single most popular method, and waiting times for colposcopy varied, with 79% of patients being seen within 8 weeks of referral. Colposcopy clinies run by non‐gynaecologists, mainly genito‐urinary physicians, were reported by 32% of districts. Half the respondents did not have accurate statistics, only 17% being computerized, and dissatisfaction with clerical support was widespread. Resources are required to improve administration and data collection. The principal findings from the 1990 data subset were a 10% reduction for new patient referrals compared with 1988 and the use of diathermy loop excision by one‐third as their preferred treatment.

Conclusions— This audit of colposcopy has provided useful information as well as a means of monitoring trends in colposcopy activity in the future.
Fast‐scan magnetic resonance imaging of fetal anomalies
Authors: GARDEN ANNE S. , WEINDLING A. M. , GRIFFITHS R. D. , MARTIN P. A.
Published: August 2005

Objective— To identify those congenital fetal anomalies, previously identified by ultrasound scanning, in which fast‐scan magnetic resonance imaging (F‐SMRI) would give additional information for the perinatal management of the infants.

Design— Observational clinical study.

Setting— Hospital Department of Obstetrics and Gynaecology/Resonance Research Centre.

Subjects— Seven women carrying eight fetuses in whom congenital abnormal‐ities had been identified using ultrasound scans. The duration of the pregnancies was 28 to 39 weeks gestation.

Interventions— Fast‐scan magnetic resonance imaging at between 28 and 39 weeks gestation.

Main outcome measures— Identification of fetal abnormalities.

Results and conclusions— F‐SMRI was of limited value in the diagnosis of further assessment of fetuses with abnormalities of accumulation of tissue fluid. Renal anomalies were poorly identified unless associated with cystic formation of the kidney. Further study is required in the imaging of fetal central nervous system anomalies. Until echoplanar imaging is more widely available, MRI does not contribute to the diagnosis of cardiac anomalies. F‐SMRI appears to be most useful in the diagnosis and management of soft tissue gastro intestinal abnormalities.
Fetal heart rate and intrauterine growth
Authors: ROBINSON SIAN M. , WHEELER TIMOTHY , HAYES MATTHEW C. , BARKER DAVID J. P. , OSMOND CLIVE
Published: August 2005

Objective— To assess whether fetal heart rate in early and late pregnancy relates to size at birth.

Design— Prospective study of fetal heart rates in early and late pregnancy.

Setting— Princess Anne Hospital, Southampton.

Subjects— 63 primigravid women.

Main outcome measures— Anthropometric measurements made on the newborn infant.

Results— There were no differences in heart rate between the sexes at 18 weeks gestation but by 36 weeks the boys had rates which were 4.4 beats lower than those of the girls. Higher fetal heart rate at 18 weeks was associated with lower ponderal index, smaller head circumference and smaller mid‐arm circumference. There were no trends in fetal heart rate at 36 weeks with any birth measurements.

Conclusion— Babies born at term who have a pattern of neonatal measurements which reflect growth retardation have raised heart rates in early pregnancy. Influences which impair fetal growth appear to take effect early in gestation.
Chromosome abnormalities detected in chorionic villus biopsies of failing pregnancies in a subfertile population
Authors: LOWER ADRIAN M. , MULCAHY MARIE T. , YOVICH JOHN L.
Published: August 2005

Objective— To determine the range and prevalence of chromosomal abnormal‐ities occurring in failing pregnancies in subfertile women.

Design— Prospective biochemical and ultrasound monitoring of all pregnancies conceived between 1988 and 1990 in a subfertile population.

Setting— A single‐centre specialist fertility clinic in Perth, Western Australia.

Subjects— Tissue from 50 early pregnancy losses was successfully cultured for chromosomal analysis from 46 pregnancies comprising 29 anembryonic preg‐nancies, 9 miscarriages and 8 ectopic pregnancies.

Main outcome measures— Impending pregnancy loss was identified at an early stage. Chromosomal analysis was performed on chorionic villi obtained before the diagnosis became clinically evident.

Results— Significant chromosomal abnormalities were identified in 54% (14/26) of early pregnancy losses where gamete manipulation was involved and 45% (9/20) of those following spontaneous conception. The most common abnormal‐ities were trisomies (12 pregnancies, mainly trisomy 16), triploidies (3 preg‐nancies) and monosomy X (3 pregnancies). An excess of female fetuses was noted with only 24% of conceptuses (11/46) bearing a Y chromosome.

Conclusions— The data indicate a similar rate of chromosomal abnormalities underlying pregnancy losses at earlier stages of pregnancy and after infertility treatments as that reported from the general population. Gamete manipulation does not appear to confer a higher rate of chromosomal abnormalities in ensuing pregnancies.
The relation between bone mineral density and early pregnancy loss
Authors: HAMED HAMED M. , PURDIE DAVID W. , STEEL SUE A. , HOWEY SYD
Published: August 2005

Objective
To determine if women who suffer from early pregnancy loss are at increased risk of osteoporosis later in life.

Design
Part of a Community screening project for bone mineral density (BMD).

Subjects
392 women aged 50–54 who had had from 0 to 6 miscarriages out of 0 to 8 term pregnancies.

Technique
BMD measured using dual energy X‐ray absorptiometry at both the lumbar spine and the proximal femur.

Results
The mean BMD in nulligravid women was not significantly different from those whose only pregnancies ended in early loss. There was no significant correlation between the BMD at either the lumbar spine or the proximal femur and the number of miscarriages (r= 0.03 and 0.01, respectively). The BMD of the lumbar spine and femoral neck were not affected by parity (P= 0.08 and P= 0.87, respectively).

Conclusion
The risk of osteoporosis was not influenced by parity or the number of previous miscarriages.
The usage of pregnancy tests in one health district
Authors: VOSS SIMON
Published: August 2005

Objective
To investigate the total number of pregnancy tests performed and the proportion that are repeated in one health district. To relate these results to the number of conceptions.

Design
Collection of data related to the numbers of pregnancy tests performed from all sources. Surveys of women booking for antenatal care or undergoing non‐routine obstetric ultrasound examination.

Setting
One health district in the south of England.

Results
About five pregnancy tests were performed for each proven pregnancy. Nearly two‐thirds of tests were purchased over the counter, the remainder being carried out by hospital laboratories and pregnancy advisory services. Very few women had their pregnancy diagnosed on clinical grounds alone and a small number of ultrasound examinations were apparently performed in lieu of chemical tests. Repeated testing was more likely in primiparous women (P<0.005).

Conclusions
Chemical pregnancy tests appear to be trusted more than clinical examination for the diagnosis of pregnancy by women and doctors. When there is no medical urgency, women who want formal confirmation of pregnancy should be advised that home testing kits will provide the quickest results.
Endometrial phospholipases A2, polycystic ovaries and pelvic pain
Authors: BONNEY R. C. , WATSON H. , BEESLEY J. S. , HIGHAM J. M. , ROGERS V. , FRANKS S.
Published: August 2005

Objective
To compare the activity of calcium independent phospholipase A2 in the endometrium of women with polycystic ovaries and in women with normal ovaries, and to investigate the influence of chronic pelvic pain on phospholipase A2 activity.

Design
A prospective descriptive study.

Setting
The Samaritan Hospital for Women and the Unit of Metabolic Medicine, St Mary's Hospital Medical School, London.

Subjects
73 women attending the Samaritan Hospital for Women for clip sterilization, infertility, early recurrent miscarriage or pelvic venous congestion. 45 of these women had no pelvic pain, 22 had normal ovaries and 23 had polycystic ovaries diagnosed by ultrasound. The other 28 women had chronic pelvic pain, 14 of them had normal ovaries and 14 polycystic ovaries.

Interventions
Endometrial tissue was obtained at curettage or from the excised uterus in the proliferative or secretory phase of the menstrual cycle. The activities of calcium dependent (type 1) and calcium independent (type 2) phospholipase A2 isoenzymes were measured in all endometrial samples.

Results
In all the women phospholipase A2 type 1 activity, was significantly higher in the secretory phase than in the proliferative phase (P > 0.001). There was no difference between women with normal ovaries and those with polycystic ovaries at either stage of the cycle irrespective of whether or not chronic pelvic venous congestion was present. In women with normal ovaries, both with and without chronic pelvic pain, phospholipase A2 type 2 activity was significantly higher in the secretory phase than in the proliferative phase (P > 0.02 and P > 0.05 respectively) but in women with polycystic ovaries, with and without chronic pelvic pain, there was no significant differene in activity between the two phases of the cycle. Women with polycystic ovaries had markedly higher proliferative phase type 2 activity than women with normal ovaries (P > 0.001). Secretory phase type 2 activity was similar in all the women investigated.

Conclusion
These data suggest that phospholipase A, type 2 activity is increased in proliferative phase endometrium of women with polycystic ovaries but that the increase is not associated with chronic pelvic venous congestion.
Cord insulin and C‐peptide—distribution in an unselected population
Authors: STANLEY K. P. , FRASER R. B. , MILNER M. , BRUCE C.
Published: August 2005

Objective
To assess the distribution of cord blood insulin in an unselected population, and examine its relation to birthweight centiles.

Setting
District General Hospital in Nottinghamshire.

Subjects
209 unselected singleton births.

Mean Outcome Measure
Cord blood insulin; cord blood C‐peptide; birthweight centiles.

Results
Hyperinsulinaemic babies (> 97th centile for cord insulin) were found at all birthweight centiles. 15% of high birthweight babies were hyperinsulinaemic. For low birthweight babies, the distribution of cord insulin/C‐peptide was skewed indicating a high number of low values. Hypoinsulinaemic babies were present up to the 50th centile for birthweight.

Conclusions
Abnormalities of fetal insulinisation may be found in babies of all birthweights.
The role of abnormal fetal heart rate in scheduling chorionic villus sampling
Authors: YAGEL SIMCHA , ANTEBY EYAL , RON MOSHE , HOCHNER‐CELNIKIER DRORITH , ACHIRON REUVEN
Published: August 2005

Objective
To assess the value of fetal heart rate (FHR) measurements in predicting spontaneous fetal loss in pregnancies scheduled for chorionic villus sampling (CVS).

Design
A prospective descriptive study.

Setting
Two hospital departments of obstetrics and gynaecology in Israel.

Subjects
114 women between 9 and 11 weeks gestation scheduled for chorionic villus sampling (CVS).

Interventions
Fetal heart rate was measured by transvaginal Doppler ultrasound and compared with a monogram established from 75 fetuses. Whenever a normal FHR was recorded, CVS was performed immediately.

Results
106 women had a normal FHR and underwent CVS; two of these pregnancies ended in miscarriage. In five pregnancies no fetal heart beats could be identified and fetal death was diagnosed. In three pregnancies an abnormal FHR was recorded and CVS was postponed; all three pregnancies ended in miscarriage within 2 weeks.

Conclusion
Determination of FHR correlated with crown‐rump length could be useful in predicting spontaneous miscarriage before performing any invasive procedure late in the first trimester.
Plasma endothelin, atrial natriuretic peptide (ANP) and uterine and umbilical artery flow velocity waveforms in hypertensive pregnancies
Authors: LUMME RIITTA , LAATIKAINEN TIMO , VUOLTEENAHO OLLI , LEPPÄLUOTO JUHANI
Published: August 2005

Objective
To investigate the relation between concentrations of endothelin and atrial natriuretic peptide (ANP) in maternal plasma and vasospasm in the uterine and umbilical arteries as detected by duplex pulsed colour Doppler ultrasonography in hypertensive pregnancies.

Design
An observational study.

Subjects
32 women admitted consecutively to hospital with pregnancy induced hypertension (seven without proteinuria and 25 with proteinuria) and 78 healthy pregnant women examined at 28–0 weeks gestation.

Main outcome measures
Systolic/diastolic (S/D) ratio in flow velocity waveforms (FVWs) and plasma concentrations of endothelin and ANP in the 32 women with pregnancy induced hypertension; plasma concentrations of endothelin and ANP in 78 healthy pregnant women (controls).

Results
Pathological FVWs suggesting vasospasm in the uterine or umbilical artery, or both arteries, were found in 12 women with hypertension. Plasma ANP was significantly higher (P= 0.03) in the women with hypertension and pathological FVWs (median 23.0, range 10.1–52.8 pmol/1) than in those with hypertension and normal FVWs, (median 13.8, range 5.3–42.3 pmol/1) but corresponding plasma endothelin levels did not show any significant difference (median 1.63, range 0.51–3.33 pmol/1 and median 1.38, range 0.51–3.51 pmol/1, respectively).

Conclusion
Local release of endothelin from the vascular endothelium is thought to cause vasospasm in pregnancy induced hypertension but this does not seem to increase the concentration of endothelin in the maternal peripheral plasma, probably because of its rapid disappearance from the blood circulation. As ANP dilates the blood vessels, the increase of its release in hypertensive pregnancies may be a compensatory mechanism against vasospasm.
Intergenerational studies of human birthweight from the 1958 birth cohort.
Authors: EMANUEL IRVIN , FILAKTI HAROULLA , ALBERMAN EVA , EVANS STEPHEN J. W.
Published: August 2005

Objective
To ascertain whether maternal twinning influences the previously described association between the birthweight of singleton mothers and their infants.

Design and subjects
The association between the birthweight of singleton parents and their offspring and that between twin parents and their offspring was compared using data from the 23‐year‐old sample of the 1958 British national birth cohort. The numbers available for full comparison were 1027 female and 611 male singleton cohort members, and 26 female and 17 male twin cohort members and their first singleton livebirths.

Results
Of the mothers who had been twins, half had been of low birthweight, and overall their mean weight was 700 g less than that of their singleton counterparts. Nevertheless, the mean birthweight of babies of twin mothers was 133 g, and of twin fathers 94 g, greater than of babies of corresponding singletons. For female, but not male, parents this difference persisted after adjustment for confounding variables.

Conclusions
We suggest two possible reasons for the difference between the weight of babies of twin and singleton mothers. Firstly, the growth of twins becomes retarded late in pregnancy, possibly after a period critical in determining long‐term reproductive effects. Secondly, the twin survivors were of higher birthweight than the original twin cohort, whilst the singleton survivors were more representative of all singleton births, thus introducing a possible bias.
Prepregnancy counselling: experience from 1 075 cases
Authors: COX M. , WHITTLE M. J. , BYRNE A. , KINGDOM J. C. P. , RYAN G.
Published: August 2005

Objective To assess the activity of a prepregnancy counselling clinic in terms of investigations, counselling, treatment and subsequent pregnancy outcome.

Design
Review of 1 075 couples attending over a nine year period.

Setting
University Hospital offering a tertiary referral service for fetal medicine.

Subjects
Couples referred to the clinic from a variety of sources.

Main outcome measures
Categories of referral, value of diagnostic tests, and subsequent pregnancy outcome.

Results
The main categories of referral were: previous miscarriage (44.4%); previous fetal abnormality (19.6%); chronic maternal disease (22.3%); and others (13.7%). Routine investigations produced a low yield of abnoramality (1 %), in contrast to investigations selected for specific reasons (12%). Subsequent pregnancy outcome, which was unaltered in either the previous miscarriage or fetal abnormality groups, did improve in the chronic maternal disease group.

Conclusions
This study does not prove the value of prepregnancy counselling. However, it does illustrate the importance of making an accurate assessment of previous problems and current health as a means of determining both maternal and fetal risks in a subsequent pregnancy, a process which seems to lead to an improved outcome within selected groups. The importance of continuity of care in all couples, especially when there has been a previous adverse pregnancy outcome is emphasized.
The importance of serial biophysical assessment of fetal wellbeing in gastroschisis
Authors: CRAWFORD R. A. F. , RYAN G. , WRIGHT V. M. , RODECK C. H.
Published: August 2005

Objective
To review antenatal and intrapartum assessment of pregnancies complicated by gastroschisis.

Design
Retrospective descriptive study.

Setting
University College Hospital, London.

Subjects
24 consecutive cases of gastroschisis between 1986 and 1991.

Results
The gestational age at sonographic diagnosis was 20.3 weeks (SD 6.77) and at birth was 36.5 weeks (SD 2.06). There were 21 live births, all with good surgical outcome. There were 16 vaginal deliveries and eight caesarean sections. The elective sections were for oligohydramnios and dilated bowel (1) and clinically suspected growth retardation (1); the intrapartum caesarean sections were for fetal distress (4) and premature breech presentation (2). There were six with dilated gut on ultrasound; one of these ended in a stillbirth. There was a significant association between gut dilatation and caesarean section for fetal distress (P= 0.004). There was also a significant association between meconium staining and fetal distress (P= 0.021). Of these babies, 46% were ≤ third centile for corrected birth weight.

Conclusions
While half of the babies with gastroschisis were small for gestational age at birth, reliable antenatal prediction of birth weight is difficult. Gut dilatation may be an indicator of either antenatal or intrapartum fetal distress, but does not correlate with poor neonatal surgical outcome. We suggest close antenatal surveillance of fetal wellbeing in all cases of gastroschisis because, in addition to growth retardation, many show some evidence of fetal distress and 12.5% end in stillbirth, even when appropriately grown.
Transcervical resection of the endometrium: a review of 400 consecutive patients
Authors: RANKIN L. , STEINBERG L. H.
Published: August 2005

Objective
To assess the efficacy of transcervical resection of the endometrium (TCRE) in women presenting with menstrual disorders.

Design
A retrospective audit of 400 patients.

Setting
The Department of Gynaecology, St John's Hospital, Chelmsford, Essex.

Subjects
400 consecutive referrals with various bleeding disorders which were suitable for treatment with TCRE.

Interventions
TCRE, either partially or completely.

Main outcome measures
Patient satisfaction with procedure at 4 months. The procedure was initially recorded as a failure if any further therapy was required but satisfaction after a second procedure was assessed.

Results
432 procedures were performed in 400 women. Major operative complications were rare with two (0.46%) uterine perforations, four (0.93%) primary haemorrhages requiring Tamponade to control bleeding and one (0.23%) secondary haemorrhage requiring hysterectomy to control it. Glycine toxicity was not clinically apparent. 85% were satisfied after the initial TCRE and 92% were satisfied if the procedure was repeated.

Conclusion
TCRE is an advance in the management of menstrual disorders. Extensive training is required to minimise complications. The lack of long term follow‐up is its major deficiency but this will be rectified in the future.
Serum and intracellular magnesium during normal pregnancy and in patients with pre‐eclampsia
Authors: SEYDOUX JACQUES , GIRARDIN ERIC , PAUNIER LUC , BÉGUIN FRANÇOIS
Published: August 2005

Objective
To determine the serum and lymphocyte magnesium concentrations during normal pregnancy and to compare the magnesium status in the third trimester of pregnancy between women with normal pregnancy and those with gestational hypertension (GH) or pre‐eclampsia (PE).

Design
A prospective cross‐sectional study followed by a prospective comparative study.

Setting
Department of Obstetrics and Gynecology, Department of Pediatrics and Genetics, Hôpital Cantonal Universitaire Genève, Switzerland.

Subjects
Seventy‐one healthy pregnant women, with normal pregnancies between 6 and 38 weeks gestation. The second part included 43 women in the third trimester of pregnancy, 11 had GH, 11 had PE and 21 formed the comparison group of healthy normotensive women.

Main outcome measures
Total serum and intralymphocytic Mg concentrations and urinary Mg excretion.

Results
There was a progressive reduction in total serum magnesium concentrations during normal pregnancy, thought to be partly due to haemodilution, because the decline in concentration of serum proteins paralleled that of Mg (P<0.001), In the three groups studied in the third trimester the serum Mg concentration was very similar in the GH and the comparison groups, but it was significantly higher in the PE group (P<0.01). The intralymphocytic Mg concentrations and the urinary Mg excretion were similar in all three groups. In five patients treated with MgSO4 there was a large increase in the serum Mg concentration and in the urinary Mg excretion. The intralyphocytic Mg concentration remained remarkably stable.

Conclusions
Our data does not support the conclusion that Mg deficiency is the primary cause of pre‐eclampsia.
A tale of two prior probabilities—avoiding the false positive antenatal diagnosis of autosomal recessive polycystic kidney disease
Authors: LILFORD R. J. , IRVING H. C. , ALLIBONE E. B.
Published: August 2005

We describe a case in which the typical ultrasound diagnosis of infantile polycystic kidney in a woman with no family history of renal disease was not confirmed by histology following termination of the pregnancy. This is contrasted with the situation in another couple who were known carriers of autosomal recessive polycystic kidney disease and where the prenatal ultrasound diagnosis was confirmed histologically. When prior genetic risk is low, the possibility of a normal or less severe outcome must be discussed with parents when fetal ultrasound shows large, echogenic kidneys but normal amniotic fluid volume.
The role of trophoblast dysfunction in the aetiology of miscarriage
Authors: Johnson M. R. , Riddle A. F. , Grudzinskas J. G. , Sharma V. , Collins W. P. , Nicolaides K. H.
Published: August 2005

Objective
To investigate the endocrine changes associated with spontaneous miscarriage after fetal heart activity has been demonstrated.

Design
Prospective study during the first trimester of pregnancy comparing the circulating levels of human chorionic gonadotrophin (hCG), Schwangerschaft protein 1 (SP‐1), pregnancy‐associated plasma protein A (PAPP‐A), oestradiol (E2), and progesterone (P), and fetal growth (crown‐rump length [CRL] and gestational sac volume [GSV]) in women who miscarried after the identification of fetal heart activity with those of normal singleton and twin pregnancies achieved following in vitro fertilisation (IVF) and embryo transfer (ET).

Setting
The Assisted Conception Unit of King's College Hospital, London.

Subjects
Nine women who miscarried after demonstration of fetal heart activity, 52 normal singleton and 22 normal twin pregnancies.

Interventions
Weekly blood tests and ultrasound assessments of CRL and GSV.

Results
Four fetuses (all singleton) died between 9 and 12 weeks gestation (Group 1), and seven (three singleton and two twin) died between 16 and 20 weeks gestation (Group 2). In Group 1, both fetal growth and placental function, as assessed by serial measurements of CRL and GSV, and of serum levels of PAPP‐A, SP‐1 and hCG respectively, were reduced before fetal death. In Group 2, while fetal growth was maintained in all but one case, placental function was reduced in 4 of 5 women.

Conclusion
These findings suggest that there may be a relationship between trophoblast dysfunction and some forms of miscarriage. Furthermore, the pattern of the reduction in the circulating levels of the placental proteins in later miscarriages suggests that the function of specific cell types may be impaired.
Alphafetoprotein levels in amniotic fluid from 8 to 18 weeks of pregnancy
Authors: Wathen N. C. , Campbell D. J. , Kitau M. J. , Chard T.
Published: August 2005

Oabjective
The aim of this study was to ascertain the normal range of amniotic fluid alphafetoprotein (AFP) levels from 8 to 18 weeks of pregnancy.

Design
Amniotic fluid samples obtained by amniocentesis were analysed by radioimmunoassay for AFP. From 8 to 12 weeks, fluid was obtained by transvaginal amniocentesis prior to termination of pregnancy. Samples from 13 to 18 weeks were obtained from amniotic fluid specimens submitted for cytogenetic analysis.

Setting
A tertiary referral prenatal diagnostic service.

Subjects
Two hundred thirty‐seven women between 8 and 18 weeks gestation.

Results
High levels of AFP were present in amniotic fluid at 8 weeks (median 83.0 kU/ml), falling rapidly to 11 weeks (median 19.9 kU/ml) (P<0.01). Levels then rose to a peak at 13 weeks (median 30.7 kU/ml), thereafter falling to 18 weeks.

Conclusions
A single coherent view of the levels of AFP from 8 to 18 weeks of pregnancy is presented for the first time. The rapid changes and complex pattern of AFP levels in early pregnancy suggest that interpretation of amniotic fluid AFP levels in the diagnosis of neural tube defects may be more difficult between 8 and 13 weeks of pregnancy than in the second trimester.
Phenytoin prophylaxis in severe pre‐eclampsia and eclampsia
Authors: Robson S. C. , Redfern N. , Seviour J. , Campbell M. , Walkinshaw S. , Rodeck C. , de Swiet M.
Published: August 2005

Objective
To determine plasma phenytoin levels and seizure outcome in women given phenytoin for seizure prophylaxis in severe pre‐eclampsia and eclampsia.

Design
Prospective observational study comparing two phenytoin loading regimens.

Setting
Two UK teaching hospitals.

Subjects
Sixty‐seven consecutive women with severe pre‐eclampsia and five with eclampsia.

Interventions
The first 29 women were given a 15 mg/kg intravenous loading dose of phenytoin. The next 43 received 17.5 mg/kg. All were given 500 mg phenytoin 12 h after completion of the loading dose and then 250 mg every 12 h for four doses.

Main outcome measures
Total plasma phenytoin levels at 30 min, 6 h and 12 h after loading dose, 6 h after first maintenance dose and on days 2 and 3 of maintenance therapy; eclamptic seizures after starting phenytoin.

Results
Mean plasma phenytoin levels were higher at 30 min and 6 h after the 17.5 mg/kg loading dose. Nine of 29 (31%) phenytoin levels 30 min after the loading dose were above the therapeutic range in the 15 mg/kg group compared with 26/38 (68%) in the 17.5 mg/kg group (P<0.01). Six of 27 (22%) phenytoin levels 12 h after the loading dose were subtherapeutic in the 15 mg/kg group compared with 2/38 (5%) in the 17.5 mg/kg group (P<0.05). Three women, two in the 17.5 mg/kg group, developed seizures after starting phenytoin. All three had plasma levels within the therapeutic range.

Conclusions
Compared with a loading dose of 17.5 mg/kg, loading with 15 mg/kg phenytoin was associated with a lower incidence of high plasma levels at 30 min but a higher incidence of subtherapeutic levels at 12 h. Seizures occur in 2 to 3% of pre‐eclamptics despite apparently therapeutic phenytoin levels.
The coelomic cavity: an important site of materno‐fetal nutrient exchange in the first trimester of pregnancy
Authors: Campbell James , Wathen Neville , Perry Gillian , Soneji Suryakant , Sourial Nefertiti , Chard Tim
Published: August 2005

Objective
To measure levels of folate and vitamin B12 in matched samples of amniotic fluid and extraembryonic coelomic fluid from 9 to 12 weeks' gestation.

Design
Prospective observational study.

Setting
Homerton Hospital, London.

Subjects
Twenty‐two women with ultrasonographically normal pregnancies before surgical termination.

Methods
Transvaginal ultrasound‐guided needle aspiration of amniotic fluid and extra‐embryonic coelomic fluid was performed. Pure samples of amniotic fluid and extra‐embyronic coelomic fluid were obtained from each pregnancy, and folate and vitamin B12 were measured using microbiological assays.

Results
Levels of folate and vitamin B12 were higher in extra‐embyronic coelomic fluid than in amniotic fluid and maternal serum. Amniotic fluid folate levels were lower than in maternal serum whereas vitamin B12 levels in amniotic fluid were higher than in maternal serum. All differences in concentration were significant (P<0.0005; paired t‐Test). Positive correlations were found between the concentrations of folate and vitamin B12 in each fluid. There was a linear correlation between gestational age and amniotic fluid folate levels (r= 0.648; P= 0.001).

Conclusions
High concentrations of folate and vitamin B12 in coelomic fluid suggest that the coelomic cavity plays an important role in the materno‐fetal exchange of these nutrients.
Infertility treatment: from cookery to science. The epidemiology of randomised controlled trials
Authors: Vandekerckhove P. , O'Donovan P. A. , Lilford R. J. , Harada T. W.
Published: August 2005

Objectives
To review the epidemiology of published randomised controlled trials in infertility treatment over the last 25 years, with special emphasis on the number and quality of trials.

Design
Computer literature review by MEDLINE backed up by a manual search of 41 journals. Each trial was classified according to the methodology described and quality criteria. The results were recorded in a computer database. Odds ratios (OR) and confidence intervals (CI) were calculated where the data were sufficient.

Subjects
Couples suffering from primary or secondary infertility. The trials studied 33 761 patients overall.

Setting
Institute of Epidemiology and Health Services Research, Leeds.

Results
Five hundred and one randomised trials in male and female infertility treatment were identified between 1966 and 1990. Pregnancy was an outcome in 291 (58%) and these were the subject of detailed analysis. Two hundred and twenty‐four (77%) and 67 (23%) ‘pregnancy trials’ were concerned, respectively, with female and male infertility. Four per cent of the trials were preceded by a sample size calculation, and the average sample size was 96 patients (range 5–933); 700 patients per group would be required to demonstrate plausible success rates for most treatments. The method of randomisation was unstated or pseudo‐randomised in 206 (71%) of trials where pregnancy was an outcome. Only 29 (5.8%) of studies were multicentre. The method of confirmation of pregnancy was omitted for 70% of papers. Cross‐over design was used in 103 (21%) of cases. Meta‐analysis is possible for selected topics such as the use of anti‐oestrogens in idiopathic oligospermia and unexplained female infertility. Eight cases of double reporting were identified.

Conclusions
Trials using randomised methodology were relatively few in comparison with other branches of medicine, although their use is important in the evaluation of treatment for infertility as treatment‐independent pregnancy is common. It was encouraging to note that an exponential increase in the use of this methodology occurred during the last three years, especially in association with assisted conception techniques, and meta‐analysis has become possible for selected topics. However, many trials suffer from an unrealistically small sample size, inappropriate use of cross‐over design or pseudo‐randomisation. The trend towards properly controlled studies should be encouraged but these studies should be of improved quality and organised on a multicentre or even international basis.
Distribution of mast cells and the effect of their mediators on contractility in human myometrium
Authors: Rudolph M. Isolde , Reinicke Karin , Cruz M. Antonieta , Gallardo Victoria , Gonzalez Clemente , Bardisa Luis
Published: August 2005

Objective
To examine the distribution of mast cells in human uterine tissue and to study the interactions between mast cell mediators (histamine and serotonin) and PGF2α in human myometrium contractile activity.

Design
Distribution of mast cells were analysed in cryostat sections of myometrium samples stained with Toluidine blue. Contractile activity was evaluated in an isolated organ bath preparation on myometrial strips obtained from women whose pregnancies ended in elective caesarean section.

Setting
Biological Science Laboratories at the University of Concepción.

Subjects
Twenty women undergoing elective caesarean and 10 women undergoing hysterectomy at the G. Grant Hospital.

Main outcome measurements
Cumulative concentration‐response curves for histamine and serotonin before and after the addition of subumbral concentrations of the PGF2α or serotonin were performed.

Results
Serotonin was more active than histamine to evoke contractions (EC50:0.20 (SE 0.02) μmol/l vs 1.5 (SE 0.2) μmol/l, respectively). Furthermore, threshold concentrations of serotonin (0.05 μmol/l) potentiated the contractile effect of histamine (EC50:0.3 (SE 0.06) μmol/l and 50% increase in Emax). PGF2α had a poor contractile effect, but threshold concentrations (0.05 and 0.10 μmol/l) enhanced the contractile effect of both serotonin and histamine. A population of mast cells was found in close apposition to smooth muscle fibres.

Conclusions
It is postulated that the simultaneous release of mast cell mediators (histamine and serotonin) in myometrium could be an important stimulus for evoking strong contractions in the human uterus. PGF2α may have indirect effects in myometrium by amplifying the effects of histamine and serotonin.
Intra‐observer and inter‐observer reliability of the pulsatility index calculated from pulsed Doppler flow velocity waveforms in three fetal vessels
Authors: Scherjon Sicco A. , Kok Joke H. , Oosting Hans , Zondervan Hans A.
Published: August 2005

Objective
Study of the intra observer and inter observer reliability of the pulsatility index, calculated from pulsed Doppler recordings of three fetal vessels.

Design
Flow velocity waveforms (FVW) were recorded from the umbilical artery, the fetal descending aorta and the fetal internal carotid artery. Intra‐observer reliability was assessed in six fetuses; ten repeated measurements were performed by one observer. Inter‐observer reliability was studied in 14 fetuses; two observers performed two repeated measurements in each fetus.

Setting
A tertiary referral hospital.

Subjects
High risk pregnancies with a gestational age ranging from 29 to 42 weeks.

Main outcome measures
Analysis of variance with repeated measurements and a graphical method were used for data analysis. Intra‐observer repeatability was expressed as Intraclass Correlation Coefficient (IntraCC). Inter‐observer agreement was expressed as Interclass Correlation Coefficient (InterCC).

Results
IntraCC for umbilical artery, descending aorta and internal carotid artery were 0.91, 0.78, and 0.54, respectively. InterCC values for these vessels were 0.39, 0.45 and 0.34, respectively. No systematic differences between the two observers except for the fetal descending aorta, were apparent. IntraCC decreased remarkable when fetuses with absent end diastolic velocities were excluded from the analysis.

Conclusion
The pulsatility index (PI) used for fetal measurements has a poor reliability. This is of serious concern when clinical use of FVW measurements is considered as a diagnostic tool.
Type III collagen content in the skin of postmenopausal women receiving oestradiol and testosterone implants
Authors: Savvas M. , Bishop J. , Laurent G. , Watson N. , Studd J.
Published: August 2005

Objective
To investigate the effect of subcutaneous oestradiol and testosterone on the proportion of type III collagen in the skin of postmenopausal women.

Design
A cross sectional comparison.

Setting
Dulwich Hospital menopause clinic.

Subjects
Fourteen untreated women and 11 women who had received subcutaneous oestradiol and testosterone for a median 8.0 years (range 3–14). Ten of the untreated women received subcutaneous hormone implants and the effect on skin collagen was studied prospectively.

Measurements
The proportion of type III collagen in skin biopsies taken from the lateral aspect of the thigh.

Results
The median type III collagen content in the skin of the women who had received hormone replacement therapy (25.4%, range 21.4–30.2) was significantly higher (P<0.01) than in the untreated women (19.6%, range 18.2–28.8). The proportion of type III collagen in the skin of 10 untreated women increased significantly (P<0.01) from a median of 19.9% (range 18.2–23.9) to 22.4% (range 20.5–31.5) following 6 months of treatment with hormone implants.

Conclusion
This study indicates an increase in the proportion of type III collagen in women receiving hormone replacement therapy.