bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal morbidity and pregnancy outcome in a cohort of mothers transferred out of perinatal centres during a national census
Authors: Bennett Charlotte C. , Lal Mithilesh K. , Field David J. , Wilkinson Andrew R.
Published: December 2003

Objective
To record the maternal morbidity and pregnancy outcome in this cohort.

Design
Retrospective data collection from a prospectively defined cohort.

Setting
The 37 largest perinatal centres in the UK.

Population
258 in utero transfers recorded during a three‐month census (1/4/99–30/6/99).

Methods
A questionnaire regarding the outcome of each mother was sent to the perinatal centre and receiving hospital.

Results
Data were returned on 242/258 (94%) mothers. Fifty‐eight percent were transferred out of their perinatal centre in preterm labour and 38% had coexisting disease necessitating early delivery. The median gestational age at transfer was 32 weeks (range 23–41). Sixty‐one percent delivered at the receiving hospital; 12% were transferred on to a third hospital and 29% ultimately returned to deliver at the original perinatal centre. Fifty‐two percent of mothers received postnatal care in hospitals other than those defined as a major perinatal centre. One mother delivered during transfer and a further nine within one hour of arrival. One mother received intensive care after delivery and later died, a further 7% required high dependency care postnatally. Data were available on 273/333 (82%) babies. The median gestational age at delivery was 34 weeks (range 24–41). Six infants were stillborn and 187/264 (71%) infants were admitted to a neonatal unit.

Conclusions
This study has documented the maternal morbidity, potential risks and pregnancy outcome of a cohort of mothers transferred out of the largest perinatal centres in the UK because of a shortage of neonatal cots. A national standard for the delivery of high risk perinatal services is needed to uphold good clinical practice guidelines in the care of high risk mothers and their infants.
Is outpatient diagnostic hysteroscopy more useful than endometrial biopsy alone for the investigation of abnormal uterine bleeding in unselected premenopausal women?
Authors: Bain Christine , Parkin David E. , Cooper Kevin G.
Published: December 2003

Objective
To formally evaluate the clinical benefit of additional outpatient hysteroscopy over traditional vaginal examination and endometrial biopsy.

Design
A prospective randomised controlled trial.

Setting
A large teaching hospital in the northeast of Scotland.

Sample
Premenopausal women with abnormal uterine bleeding referred to the general gynaecologic clinic and requiring endometrial biopsy.

Methods
Women were randomised to either outpatient hysteroscopy and endometrial biopsy or endometrial biopsy alone.

Main outcome measures
Primary outcome: initial surgical intervention rates. Secondary outcomes: procedural success and acceptability, intrauterine pathology identified and changes in management.

Results
Three hundred and seventy women were recruited to the study. Initial trends in clinical management were comparable in both groups. No woman was advised to have removal of a localised lesion found at outpatient hysteroscopy and a normal uterine cavity at hysteroscopy did not influence the hysterectomy rate, which was similar in both groups. Outpatient hysteroscopy was found to be as acceptable as an outpatient endometrial biopsy and successfully completed in 85% compared with 91% of women who underwent endometrial biopsy alone. No cases of endometrial malignancy were identified.

Conclusions
Outpatient diagnostic hysteroscopy is an acceptable procedure and may give more reassurance. It did not influence clinical management, especially with respect to hysterectomy rate. Outpatient hysteroscopy may be useful in selected cases, but when performed in a non‐selective manner, it has little influence on clinical management and increases costs.
Transplacental transfer of citalopram, fluoxetine and their primary demethylated metabolites in isolated perfused human placenta
Authors: Heikkinen Tuija , Ekblad Ulla , Laine Kari
Published: December 2003

Objective
To investigate the transplacental transfer and the effects of protein binding on the transfer of citalopram, desmethylcitalopram, fluoxetine and desmethylfluoxetine in the isolated perfused human placenta model.

Design
Prospective observational study.

Methods
Fifteen term human placentas were obtained immediately after delivery with maternal consent and a 2‐hour non‐recirculating perfusion cycle of a single placental cotyledon was set up. Citalopram (1230 nmol/L) and desmethylcitalopram (600 nmol/L) or fluoxetine (1455 nmol/L) and desmethylfluoxetine (1525 nmol/L) were added to the maternal reservoir and their appearance to the fetal circulation was followed by repeated measurements. To investigate the effect of protein binding on the transfer of citalopram and fluoxetine, nine additional perfusions were performed without albumin in the perfusion medium. Citalopram and desmethylcitalopram concentrations were measured by reversed‐phase high performance liquid chromatography. Fluoxetine and desmethylfluoxetine concentrations was measured by gas chromatography and antipyrine (used as a reference compound) concentrations spectrophotometrically.

Results
The mean (SD) steady‐state transplacental transfer (TPTSS%) for citalopram, desmethylcitalopram, fluoxetine and desmethylfluoxetine was 9.1%, 5.6% (P= 0.017 compared with citalopram), 8.7% and 9.1%, respectively, calculated as the ratio between the steady‐state concentrations in fetal venous and maternal arterial sides. The TPTSS%s of citalopram, desmethylcitalopram, fluoxetine and desmethylfluoxetine were 86%, 50%, 88% and 91% of that of freely diffusable antipyrine. The absence of albumin significantly reduced the transfer of citalopram and fluoxetine (TPTSS% 1.1% and 4.8%, respectively) but not the transfer of antipyrine.

Conclusion
Citalopram, fluoxetine and desmethylfluoxetine all cross the human placenta, and may, therefore, affect the perinatal outcome of infants exposed to these drugs during pregnancy. The transfer of desmethylcitalopram was significantly lower, which in the clinical setting may suggest lower fetal exposure of serotonin re‐uptake inhibition by citalopram compared with fluoxetine. The presence of albumin was necessary for the transplacental transfer of both citalopram and fluoxetine.
Inflationary oscillometry provides accurate measurement of blood pressure in pre‐eclampsia
Authors: Golara Moneli , Benedict Amanda , Jones Clare , Randhawa Manjit , Poston Lucilla , Shennan Andrew H.
Published: December 2003

Objective
To evaluate the accuracy of the OMRON‐MIT inflationary oscillometric device for blood pressure measurement in pregnancy and pre‐eclampsia.

Design
Prospective observational study, using validation methods recommended by the British Hypertension Society (BHS) and the Association for the Advancement of Medical Instrumentation (AAMI).

Settings
Antenatal clinics and ward, Guy's Hospital, London.

Population
Normotensive pregnant women and those diagnosed with pre‐eclampsia according to the definition of the International Society for the Study of Hypertension in Pregnancy.

Methods
Validation according to BHS protocol.

Main outcome measures
Proportion of readings within 5, 10 and 15 mmHg (absolute differences) between the automated device and two trained, blinded observers, according to the BHS and AAMI criteria.

Results
The OMRON‐MIT achieved an overall BHS grade B for systolic and grade A for diastolic blood pressure measurement in both pregnancy and pre‐eclampsia. The mean (SD) differences between the standard and the test device were −5 (7) mmHg for systolic and 2 (6) mmHg for diastolic blood pressure in pregnancy and −4 (6) mmHg for systolic and 2 (7) mmHg for diastolic blood pressure in pre‐eclampsia. This device therefore fulfils the AAMI criteria.

Conclusion
The OMRON‐MIT is the only automated oscillometric device that has proven to be accurate for blood pressure measurement in pre‐eclampsia according to the BHS protocol in pregnancy. Inflationary oscillometry may correct the error associated with oscillometric devices in pre‐eclampsia.
Active labour is associated with increased oxidisibility of serum lipids ex vivo
Authors: Fainaru Ofer , Almog Benny , Pinchuk Ilya , Kupferminc Michael J. , Lichtenberg Dov , Many Ariel
Published: December 2003

Objective
As a first step towards evaluating the role of oxidative stress in the process of labour, we tested whether term labour is associated with increased oxidisibility of maternal serum lipids.

Design
A controlled prospective study.

Setting
Tertiary care centre.

Population
Twenty healthy women in active labour and 20 healthy pregnant women not in labour (controls) matched for maternal and gestational age.

Methods
Venous blood was drawn from women in both groups. Serum levels of lipid peroxidation products and the kinetics of copper‐induced oxidation ex vivo were monitored spectroscopically at 37°C by continuous recording of absorbance at 245 nm.

Main outcome measures
Oxidative stress parameters.

Results
The initial optical density (OD) at 245 nm, attributed to preformed dienic hydroperoxides and 7‐keto‐cholesterol (main products of lipid peroxidation), was higher in the labouring group than in the controls (1.30 ± 0.11 vs 1.18 ± 0.09, OD 245 nm, respectively, P < 0.001). The lag phase, reflecting resistance of serum lipids to oxidation, was significantly shorter in the labouring group than in the controls (43.2 ± 1.4 vs 56.2 ± 4.7 min, respectively, P= 0.01).

Conclusion
High levels of serum hydroperoxides and decreased resistance of serum lipids to copper‐induced peroxidation ex vivo suggest labour to be associated with high oxidative stress. Whether oxidative stress is involved in initiating the labour process or is consequent awaits further studies.
Cystic fibrosis and pregnancy. Report from French data (1980–1999)
Authors: Gillet Dominique , de Braekeleer Marc , Bellis Gil , Durieu Isabelle ,   The participating centres to the French Cystic Fibrosis Registry
Published: December 2003

Objective
To study the consequences of pregnancy on women affected by cystic fibrosis and to clarify the impact of the disease on maternal and newborn health.

Design
Retrospective study.

Setting
Pregnancy survey from the French Cystic Fibrosis Registry.

Population
Women with cystic fibrosis having a pregnancy between 1980 and 1999.

Methods
During the 1980–1999 period, 90 pregnancies in 80 French female patients were registered in the pregnancy survey of the French Cystic Fibrosis Registry. General and clinical data before pregnancy were noted. Outcome of the pregnancy was described. Variations of pulmonary function and body weight during pregnancy were evaluated. Comparison between a group of pregnant women and a group of non‐pregnant cystic fibrotic women of same age and genotype, followed in the same care centre network, was made.

Main outcome measures
Spirometric and nutritional parameters, vital status and perinatal health indicators.

Results
The outcome was identified for 75 cases: 64 delivered babies (45 at term and 10 prematurely, prematurity rate: 18%), 10 abortions (five spontaneous and five therapeutic or medical), and one maternal death during pregnancy. The proportion of newborns with low weight was 29.8%. Mean maternal weight gain during pregnancy was 5.5 kg. Four affected children were diagnosed after birth. A decline in the forced expiratory volume in one second (FEV1) and forced vital capacity was observed between the beginning of pregnancy and the year following the delivery. However, no significant difference was found when comparing the variation in the pulmonary function during pregnancy between cases and controls. Moreover, the pulmonary status before pregnancy was better than the status of non‐pregnant women. Among 12 deaths recorded after pregnancy, only three happened in the year following the pregnancy. All three women had an FEV1 <50% before pregnancy.

Conclusion
Pregnancy only has a slight adverse effect on maternal health if the women are in good general condition before starting pregnancy. Women with a better health status are more inclined to initiate and successfully complete a pregnancy. Complete collaboration between cystic fibrosis practitioners and obstetricians should be observed to allow women to deliver children in the best conditions.
High incidence of obstetric interventions after successful external cephalic version
Authors: Chan Louis Yik‐Si , Leung Tak Yeung , Fok Wing Yee , Chan Lin Wai , Lau Tze Kin
Published: December 2003

Objective
To investigate the delivery outcome after successful external cephalic version (ECV).

Design
Case–control study.

Setting
University teaching hospital.

Population
The study group consisted of 279 consecutive singleton deliveries at term over a six‐year period, all of which had had successful ECV performed. The control group included 28,447 singleton term deliveries during the same six‐year period.

Methods
Between group differences were compared with the Mann–Whitney U test or Student's t test where appropriate. Odds ratio and 95% confidence interval (CI) were calculated for categorical variables.

Main outcome measures
Incidence of and indications for obstetric interventions.

Results
The risk of instrumental delivery and emergency caesarean section was higher in the ECV group (14.3%vs 12.8%; OR 1.4; 95% CI 1.0–2.0, and 23.3%vs 9.4%; OR 3.1; 95% CI 2.3–4.1, respectively). The higher caesarean rate was due to an increase in all major indications, namely, suspected fetal distress, failure to progress in labour and failed induction. The higher incidence of instrumental delivery was mainly due to an increase in prolonged second stage. The odds ratio for operative delivery remained significant after controlling for potential confounding variables. There were also significantly greater frequencies of labour induction (24.0%vs 13.4%; OR 2.0; 95% CI 1.5–2.7) and use of epidural analgesia (20.4%vs 12.4%; OR 1.8; 95% CI 1.4–2.4) by women in the ECV group. The higher induction rate is mainly due to induction for post term, abnormal cardiotocography (CTG) and antepartum haemorrhage (APH) of unknown origin.

Conclusion
The incidence of operative delivery and other obstetric interventions are higher in pregnancies after successful ECV. Women undergoing ECV should be informed about this higher risk of interventions.
Respiratory function in singleton and twin pregnancy
Authors: McAuliffe Fionnuala , Kametas Nikos , Costello John , Rafferty Gerrard F. , Greenough Anne , Nicolaides Kypros
Published: December 2003

Objective
Singleton pregnancy causes important changes in respiratory function. The incidence of twin pregnancies is increasing, but it is not known whether affected women suffer greater respiratory compromise. The aim of this study was to determine if changes in respiratory function during pregnancy in healthy women were greater in those with a twin pregnancy compared with those with a singleton pregnancy.

Design
Cross sectional study.

Setting
London teaching hospital.

Population
Healthy pregnant women attending the antenatal clinic and ultrasound department.

Methods
A cross sectional study of respiratory function was performed in 68 women with twin pregnancies (17 examined in the first trimester, 35 second trimester, 16 third trimester) and 140 women with singleton pregnancies (28, 80, 40, respectively) and 22 non‐pregnant women. Women were examined once between 7 and 40 weeks of gestation. Forced vital capacity, relaxed vital capacity, forced expiratory volume in 1 second (FEV1), peak flow, inspiratory capacity, functional residual capacity (FRC), expiratory reserve volume, pulmonary diffusing capacity and minute ventilation were measured.

Results
Both in twin and singleton pregnancies, the mean FRC and expiratory reserve volume of women studied in the third trimester and minute ventilation of women studied in each trimester differed significantly from that of the non‐pregnant women. There were, however, no significant differences demonstrated in respiratory function between healthy women with twin as compared with singleton pregnancies.

Conclusion
In healthy women, the extra demands of a twin compared with a singleton pregnancy do not compromise further the respiratory system.
Polymorphisms in various coagulation genes in black South African women with placental abruption
Authors: Hira B. , Pegoraro R.J. , Rom L. , Govender T. , Moodley J.
Published: December 2003

This pilot study examined Factor V Leiden (R506Q), prothrombin (20210G → A), thrombomodulin (A455V) and MTHFR (677C →T) in 100 Zulu‐speaking black South African women with placental abruption and 217 controls. The Factor V Leiden and prothrombin variant gene alleles were not detected in either patient or control groups. The thrombomodulin polymorphic variant was not seen in the patient group but three heterozygotes (1%) were found in the controls. No homozygotes for the MTHFR T677 variant were detected in the patients but two (1%) were noted in the controls; the normal and heterozygote genotype and allele frequencies for this polymorphism were similar in the two groups.
The impact of continuing illegal drug use on teenage pregnancy outcomes—a prospective cohort study
Authors: Quinlivan Julie A. , Evans Sharon F.
Published: December 2003

Objective
To evaluate the impact of continuing illegal drug use on teenage pregnancy outcomes.

Design
Prospective cohort study.

Setting
Three Australian obstetric hospitals.

Sample
Four hundred and fifty‐six teenage antenatal patients.

Methods
Teenage antenatal patients were interviewed and completed questionnaires to establish their pattern of non‐prescription drug use before and during pregnancy. Illegal drug use data provided by the participants were validated in a subgroup of 180 who were interviewed six months postpartum. Antenatal, intrapartum and postnatal outcomes were collated independently. Data were analysed using SAS.

Main outcome measures
Antenatal co‐morbidity, delivery and newborn outcomes.

Results
In the cohort, 20.3% used marijuana throughout their pregnancy. However, 33.5% of these were multidrug users. The remaining 79.6% did not use illegal drugs throughout pregnancy (non‐users). However, half the ‘non‐users’ were ‘ex‐users’ who ceased drug use immediately before or during early pregnancy. Illegal drug use was associated with an increased incidence of concurrent cigarette and alcohol use (both OR > 4.1 and P < 0.0001) and social and psychiatric morbidity (all OR > 1.95 and P < 0.001). Multidrug use was associated with a significant increase in the incidence of chlamydial and other endocervical infections (chlamydia: OR = 4.2, 95% CI = 1.6–10.9; endocervical infections: OR = 2.6, 95% CI = 1.1–5.7). After controlling for significant covariates, and in the setting of good antenatal care, the only difference in outcome was a significant linear trend towards an increased incidence of threatened preterm labour across the three groups (P= 0.02). Of note, there were no effects on birthweight, birthweight ratio or preterm birth.

Conclusion
Good antenatal care may be able to ameliorate many adverse pregnancy outcomes in teenagers who use illegal drugs throughout pregnancy. The high levels of coexisting psychosocial morbidity are a concern for future mothercrafting.
Randomised clinical trial of suture compared with adhesive strip for skin closure after HRT implant
Authors: Selo‐Ojeme Daniel O. , Lim K.B.
Published: December 2003

To determine which method of skin closure was associated with less bleeding, 250 women were randomly allocated to have either a suture closure (3‐0 Dexon II) or an adhesive strip closure (Steri‐Strip) following subcutaneous insertion of hormone (HRT) implants. Data were collected via a tested questionnaire and analysed. Significantly, more women in the adhesive strip group recorded postprocedure bleeding (RR = 2.26; 95% CI 1.42–3.60) and considered the bleeding excessive (RR = 4.17; 95% CI 1.18–14.76) and unacceptable (RR = 12.52; 95% CI 1.63–96.19). Pain scores and symptoms of local infection were similar in both groups. Routine use of adhesive strips for implant skin incision closure is not recommended.
The ‘sacral hand wedge’: a cause of arrest of descent of the fetal head during vacuum assisted delivery
Authors: Vacca Aldo
Published: December 2003

During a study of 108 vacuum assisted deliveries, a fetal hand was detected in the pelvic space between the head and maternal sacrum in seven of the procedures. The larger presenting diameters resulting from the compound fetal presentations were reflected in a greater number of pulls and higher traction forces recorded during the deliveries. In all cases, extraction of the hand facilitated the completion of birth without causing serious injury to the fetus or maternal perineum. It is recommended that a digital examination to detect the presence of a fetal hand in the sacral space should become a part of standard vacuum delivery practice.
The impact of an assisted conception unit on the workload of a general gynaecology unit
Authors: McManus Joanne , Traub Anthony I.
Published: December 2003

The burden placed on a hospital by the presence of an assisted conception unit has been emphasised only in terms of its impact on neonatal services. This paper examines the previously neglected subject of the gynaecological workload generated by a tertiary fertility centre that provides treatments by assisted conception. As many IVF units operate independently this additional workload may not be appreciated. It has, however, significant practical and financial implications for neighbouring hospitals and trusts. This is of particular relevance in view of the move towards more uniform health service funding of assisted conception throughout the United Kingdom.
High transduction efficiency of circulating first trimester fetal mesenchymal stem cells: potential targets for in utero ex vivo gene therapy
Authors: Campagnoli Cesare , Bellantuono Ilaria , Kumar Sailesh , Fairbairn Leslie J. , Roberts Irene , Fisk Nicholas M.
Published: December 2003

We recently reported the existence of fetal mesenchymal stem cells in first trimester fetal blood. Here we demonstrate that fetal mesenchymal stem cells from as early as eight weeks of gestation can be retrovirally transduced with 99% efficiency without selection. Circulating fetal mesenchymal stem cells are known to readily expand and differentiate into multiple tissue types both in vitro and in vivo, and might be suitable vehicles for prenatal gene delivery. With advances in early fetal blood sampling techniques, we suggest that genetic disorders causing irreversible damage before birth could be treated in utero in the late first/early second trimester by genetically manipulated autologous fetal stem cells.
Total alpha‐fetoprotein and Lens culinaris agglutinin‐reactive alpha‐fetoprotein in fetal chromosomal abnormalities
Authors: Yamamoto Ritsu , Azuma Masaki , Kishida Tatsuro , Yamada Hideto , Satomura Shinji , Fujimoto Seiichiro
Published: December 2003

Objective To examine the differences in multiples of the median (MoM) of total alpha‐fetoprotein, and the proportion of Lens culinaris agglutinin reactive alpha‐fetoprotein (% alpha‐fetoprotein‐L2+L3) in the maternal serum and amniotic fluid of pregnant women whose fetuses were diagnosed with autosomal or sex chromosomal abnormalities.

Design Prospective consecutive series.

Setting University hospital.

Sample Maternal sera and amniotic fluids from 46 pregnant women with trisomy 21 fetuses, 10 pregnant women with trisomy 18 fetuses, one pregnant woman with a trisomy 13 fetus, six pregnant women with fetal sex chromosomal abnormalities, and 100 pregnant women for whom the fetal karyotype was diagnosed as normal following a genetic amniocentesis.

Results The proportion of alpha‐fetoprotein‐L2+L3 in maternal serum for trisomy 21 (40.3%, P<0.0001) and trisomy 18 (39.8%, P<0.05) showed a significantly higher value compared with normal (32.6%). The proportion of alpha‐fetoprotein‐L2+L3 in amniotic fluid was significantly higher (P<0.0001) for trisomy 21 (46.6%) than for a normal karyotype (41.5%). Only for the trisomy 21 group was there a strong correlation in the % alpha‐fetoprotein‐L2+L3 between maternal serum and amniotic fluid (r=0.840, P<0.0001). For all groups, there was no correlation between alpha‐fetoprotein MoM and % alpha‐fetoprotein‐L2+L3 in maternal serum and amniotic fluid.

Conclusion The proportion of alpha‐fetoprotein‐L2+L3 in maternal serum is an appropriate choice for a trisomy 21 biochemical marker, and it is possible that combining alpha‐fetoprotein‐L2+L3 analysis with assays of alpha‐fetoprotein in maternal serum could further improve the sensitivity and specificity of multiple marker screening.
Venous thromboembolism during pregnancy: a retrospective study of enoxaparin safety in 624 pregnancies
Authors: Lepercq Jacques , Conard Jacqueline , Borel‐Derlon Annie , Darmon Jean‐Yves , Boudignat Odile , Francoual Christine , Priollet Pascal , Cohen Corinne , Yvelin Nicole , Schved Jean‐François , Tournaire Michel , Borg Jeanne‐Yvonne
Published: December 2003

Objective To assess the maternal, fetal and neonatal safety of enoxaparin in pregnant women who require antithrombotic therapy.

Design Retrospective analysis of case notes of women who received enoxaparin during pregnancy, irrespective of dose, duration and reason for treatment.

Setting Fifty‐five French perinatal centres.

Sample Data from 624 pregnancies in 604 women between 1988 and 1997. The incidence of previous thromboembolism was 29.8%, known thrombophilia 15.2%.

Methods Indication, regimen of enoxaparin and outcome measures were reported for each pregnancy. Information was obtained from case records, validated by research staff and analysed by an independent scientific committee.

Main outcome measures Incidence, seriousness and causality of maternal, fetal and neonatal adverse events, pregnancy outcome, and incidence of venous thromboembolism.

Results Enoxaparin was administered for treatment of an acute episode in 49 cases and for thromboprophylaxis in 574 cases. Serious maternal haemorrhage occurred in 11 cases during pregnancy (1.8%), one being reasonably related to enoxaparin, and in nine cases at delivery (1.4%), all unrelated to enoxaparin. Maternal thrombocytopenia was reported in 10 cases (1.6%), two being serious but unrelated to enoxaparin. Eight pregnancies ended in stillbirth (1.1%). Among the 693 live births, 17 major congenital abnormalities (2.5%) and 10 serious neonatal haemorrhages (1.4%) were reported. None of the fetal or neonatal adverse events was related to enoxaparin. Eight venous thromboembolic events (1.3%) were reported.

Conclusions The incidence of adverse events reported could be explained by the high risk profile of the study population. Overall, this retrospective study suggests enoxaparin is well tolerated during pregnancy.
Pregnant women with chronic hypertension and superimposed pre‐eclampsia have high cerebral perfusion pressure
Authors: Belfort Michael A. , Tooke‐Miller Cathy , Allen John C. , Varner Michael A. , Grunewald Charlotta , Nisell Henry , Herd J. Alan
Published: December 2003

Objective To determine any differences in cerebral perfusion pressure in patients with chronic hypertension compared with those with chronic hypertension and superimposed pre‐eclampsia.

Design A prospective observational study.

Setting University hospital clinic and labour and delivery suite.

Participants Fifteen women with chronic hypertension and 15 with superimposed pre‐eclampsia.

Methods Transcranial Doppler ultrasound was used to measure blood velocity in the middle cerebral arteries of the patients. Systemic blood pressure in the brachial artery was measured simultaneously. Middle cerebral artery, resistance index, pulsatility index, and cerebral perfusion pressure were calculated and plotted on the same axes as data from normal pregnant women. Cerebral perfusion pressure values outside of the 5th and 95th centiles were regarded as abnormal. Cerebral perfusion pressure data from the chronic hypertension and superimposed pre‐eclampsia groups were also expressed in terms of the number of normative standard deviations from the mean value for normal pregnancy (Multiples of the Standard Deviation: MOS). All studies were conducted before labour, under similar conditions, and before volume expansion or treatment. Statistical analysis was by Student's t test and Fisher's exact test as appropriate with significance set at a two‐tailed P<0.05.

Results Patient demographics and blood pressure were not significantly different between the two groups. The resistance index and pulsatility index were not significantly different (neither absolute nor multiples of the standard deviation values). The absolute cerebral perfusion pressure was significantly higher in the patients with superimposed pre‐eclampsia. The group of women with superimposed pre‐eclampsia had a significantly higher mean value of cerebral perfusion pressure measured as multiples of the standard deviation from the mean value for normal pregnancy, despite there being no blood pressure difference.

Conclusions Superimposed pre‐eclampsia is associated with significantly higher cerebral perfusion pressure measurements compared with women with uncomplicated chronic hypertension. This is not directly related to a higher blood pressure. The difference in cerebral perfusion pressure may be used to speculate upon the pathophysiology of the increased risk for eclampsia seen in patients with superimposed pre‐eclampsia.
Is conservative treatment for adenocarcinoma in situ of the cervix safe?
Authors: Soutter W.P. , Haidopoulos D. , Gornall R.J. , McIndoe G.A. , Fox J. , Mason W.P. , Flanagan Adrienne , Nicholas N. , Barker F. , Abrahams J. , Lampert I. , Sarhanis P.
Published: December 2003

Objective To determine the long term results of treatment of adenocarcinoma in situ by conisation of the cervix using survival analysis.

Design A retrospective study in six teaching hospitals in North West Thames.

Population Eighty‐five women with a histological diagnosis of adenocarcinoma in situ of the cervix in punch or cone biopsy were identified from pathology and clinical databases.

Results In one patient a small focus of adenocarcinoma in situ was found in a cervical polyp. Subsequent cytology was normal and no further treatment was undertaken. The 84 remaining women underwent diathermy loop, cold knife cone biopsy, laser cone biopsy, or needle excision of the transformation zone. A hysterectomy or second conisation was performed in 31/84 women (36.9%) as part of the initial treatment. In all, nine (10.6%) had early invasive lesions of which four were squamous. Fifty‐nine patients were treated conservatively following one or two conisations (median follow up 78 weeks, range 0–543 weeks). One had a subsequent hysterectomy for menorrhagia. Five women have undergone treatment for suspected recurrence, a 21.5% cumulative rate of further treatment by four years. The cumulative rate of histologically proven recurrence after conservative management was 4.3% at one year and 15% at four years.

Conclusions In those cases with clear margins in the cone biopsy, there is a place for conservative management of a selected group of patients who wish to preserve fertility. However, 16.7% of these will require further treatment after four years because of recurrent cytological abnormalities. Women who opt for conservative management should undergo regular, long term surveillance in a colposcopy clinic. Among those women with involved margins in the initial cone biopsy, there is a high incidence of residual disease. A second cone biopsy may be appropriate ‘definitive treatment’ for young women who wish to preserve their fertility if the margins of the second biopsy are clear and there is no evidence of invasion. Even among those for whom a hysterectomy is the proposed ‘definitive treatment’, a second cone biopsy may be required before hysterectomy to avoid inappropriate treatment of an occult invasive lesion.
Does the fetus lose weight in utero following fetal death: a study in preterm infants
Authors: Chard Tim
Published: December 2003

Objective To evaluate whether the fetus loses weight in utero following fetal death, looking specifically at weight differences according to whether the death occurred during labour or before labour.

Design Record linkage of maternity data and perinatal mortality data.

Setting Scotland, UK.

Population A group of 8069 singleton live and stillbirths without obvious congenital abnormalities delivered at 24–32 weeks.

Main outcome measure Birthweight.

Results Stillborn infants weighed less than liveborns of equivalent gestational age at delivery. Stillborn infants in whom the death occurred during labour weighed more than those in whom the death occurred before labour; this applied to both vaginal deliveries and those by caesarean section.

Conclusions These findings could be attributed to the hypothesis that the low birthweight of stillborn infants is due to weight loss following the death, in addition to any process of growth restriction before the death. The analysis described here contains no data which would negate this hypothesis.
The impact of the menstrual cycle on urinary symptoms and the results of urodynamic investigation
Authors: Hextall Andrew , Bidmead John , Cardozo Linda , Hooper Richard
Published: December 2003

Four hundred and eighty‐three consecutive women referred for videocystourethrography completed a structured questionnaire about their menstrual status and urinary symptoms. Women were included in the study if they were premenopausal, had a regular menstrual cycle and were not taking hormonal therapy. One hundred and thirty‐three women satisfied the inclusion criteria of whom 55 (41%) complained that their urinary symptoms were cyclical. The times at which symptoms were said to be at their worst were reported by the women as follows: during a period (n=20; 36%); just after a period (n=4; 7%); middle of the month (n=8; 15%); just before a period (n=23; 42%). The prevalence of abnormal detrusor activity on videocystourethrography increased significantly with time from the last menstrual period (χ2 for trend=6.56, P=0.01) and might reflect increases in the circulating level of progesterone following ovulation. This study provides further indirect evidence that progesterone could have an adverse effect on female lower urinary tract function. In addition, it might be necessary to consider the stage within the menstrual cycle when interpreting the results of urodynamic investigation.
The development of a national database of the results of surgery for urinary incontinence in women
Authors: Kulseng‐Hanssen Sigurd
Published: December 2003

Objective
To describe the development of a national network, database and reporting of data from a short‐form questionnaire recording the severity of symptoms, quality of life and objective outcome values pre‐ and post‐operatively, in women with stress and mixed incontinence.

Design
A prospective descriptive study.

Setting
Twenty‐three Norwegian departments of gynaecology.

Participants
Eight hundred and eighty‐three women with stress and mixed incontinence.

Methods
A short‐form questionnaire was used to record the severity of symptoms, quality of life and objective outcome values pre‐ and post‐operatively, in women with stress and mixed incontinence. Type of operation, the performance of a combined vaginal prolapse operation and an incontinence procedure and complications were recorded. The questionnaires were scanned and data were transferred to a national database. Twice a year the participating departments received a report where their own data were compared with the national average.

Main outcome measures
Pre‐ and post‐operative Stress, Urge and Quality of Life Indices, Satisfactioin with the operation. Post‐operative mean Stress, Urge and Quality of Life Indices, leakage during stress test, and satisfaction with the operation, related to number of operations performed by each surgeon.

Results
Eighty‐four percent of the operations performed were with the tension‐free vaginal tape operation and 13% were abdominal Burch colposuspensions. The post‐operative Stress and Urge Incontinence Indices and Quality of Life Index and all the objective outcome values except for the mean voiding volume were significantly lower than they were pre‐operatively. Eighty‐four percent of the women were very satisfied, 8% were moderately satisfied, 2% were neither satisfied nor dissatisfied, 3% were moderately dissatisfied and 2% were very dissatisfied with the operation. Women who had a tension‐free vaginal tape operation performed were significantly more satisfied, were leaking significantly less, had significantly lower stress incontinence and quality of life indices and had significantly less superficial infections post‐operatively than women who had had a Burch colposuspension. Surgeons performing fewer than 25 operations had a large variation in their results.

Conclusion
A large number of Norwegian gynaecological departments are reporting to the database. The questionnaire and the objective outcome values are well suited to record the effect of incontinence operations and to make comparisons between surgical procedures, surgeons and departments.
The development of a questionnaire to measure the severity of symptoms and the quality of life before and after surgery for stress incontinence
Authors: Kulseng‐Hanssen Sigurd , Borstad Ellen
Published: December 2003

Objectives
To develop and validate a short questionnaire recording the severity of symptoms and the quality of life, pre‐ and post‐operatively, in women undergoing surgery for stress incontinence.

Design
The questionnaire was designed from previously designed questionnaires and pilot studies. In this study, it was tested for validity and reliability using standard psychometric techniques. Data from the questionnaire are reported to a national database, which generates reports for comparison of surgical procedures, departments and surgeons.

Setting
Tertiary referral urogynaecology units at Bærum and Aker Hospitals, Norway, and 22 Norwegian departments of gynaecology.

Population
Fifty and 65 women with stress incontinence from Bærum and Aker hospitals, respectively, and 628 women with stress incontinence from 22 Norwegian departments of gynaecology.

Methods
Stress Incontinence, Urge Incontinence and Quality of Life Indices were constructed. Internal consistency of the indices was measured by Cronbach's alpha and test–retest reliability by Bland–Altman plots. Stress Incontinence Index was tested against stress test and Urge Incontinence Index and Stress Incontinence Index were tested against the 24‐hour pad test. Quality of Life Index was tested against a part of the King's College Hospital Quality of Life Questionnaire.

Main outcome measure
Face and content validity. Missing velues of the questionnaire. Reliability and internal consistency. Criterion validity.

Results
The 628 women completed a mean of 98.2% of all the questions. The content validity was good. The reliability was good in terms of test–retest reliability and internal consistency. The criterion validity of stress and urge incontinence was tested against the stress and 24 hour pad tests. The correlation between the indices and the objective tests was moderate. The correlation between the Quality of Life Index and the physical and social part of the previously validated King's College Hospital questionnaire was good.

Conclusions
The questionnaire is easy to understand and complete and is a valid and reliable instrument for assessment of the symptoms of incontinence and the quality of life. Pre‐ and post‐operative evaluation of women with stress incontinence was performed in a standardised setting in 22 of the 37 Norwegian departments and the reporting to a national database was successful. Comparison of surgical procedures, departments and surgeons is possible.
Colonisation of extragenital sites by Candida in women with recurrent vulvovaginal candiosis
Authors: Mårdh Per‐Anders , Novikova Natalia , Stukalova Elena
Published: December 2003

Objectives
To study colonisation of extragenital sites by Candida in women with a history of recurrent vulvovaginal candidosis and to determine the association of such colonisation with clothing and sexual practice.

Design
A prospective case–control (current genital colonisation by candida organisms vs non‐colonisation) study.

Setting
Outpatient clinic, University hospital, Kiev, Ukraine and Department of Obstetrics and Gynaecology, University Hospital, Lund, Sweden.

Sample
Women with a history of recurrent vulvovaginal candidosis and an assumed new attack of the condition.

Methods
Eighty‐six women with a history of recurrent vulvovaginal candidosis and an assumed current attack of this condition underwent culture for Candida from the genital tract, the perianal skin, the rectum, the mouth and from voided urine samples, using Sabouraud and chromogenic agar. The women were interviewed about some factors that have been considered to trigger colonisation with Candida spp.

Main outcome measures
Colonisation of extragenital sites of women with recurrent vulvovaginal candidosis by different species of Candida. Correlation with oral and anal sex, and with clothing.

Results
Candida spp. was isolated from the mouth, the rectum, the perianal skin and from voided urine in 11(13%), 24(28%), 35(41%) and 16(19%) of women, respectively. Candida was recovered from one or more of these sites in 44(51%) of the women. The rate of culture of Candida from the extragenital sites was significantly higher (P < 0.05) in women who had a positive culture from the introitus or the vagina. The recovery rates of Candida in the 46 vaginal culture‐positive women were 8 (17%), 24 (52%), 34 (74%) and 16 (35%) from the extragenital sites in the order mentioned. Species of Candida other than Candida albicans occurred more often at the extragenital than the genital sites. Neither oral nor anal sex was associated with colonisation of the mouth and the rectum with Candida spp. Neither tight‐fitting trousers nor underwear produced from synthetic material was associated with colonisation of the perianal skin with Candida spp.

Conclusions
Extragenital sites are often colonised by Candida spp. in women with a history of recurrent vulvovaginal candidosis, but significantly more often if the genital tract is also colonised. Extragenital sites are significantly more commonly colonised with species other than C. albicans. Extragenital sites may be reservoirs for recolonisation of the genital tract in women with recurrent vulvovaginal candidosis. This has implications for treatment.
Acute increase in femoral artery resistance in response to direct physical stimuli in the human fetus
Authors: Smith Richard P. , Glover Vivette , Fisk Nicholas M.
Published: December 2003

Objective
To determine whether fetal response to needling resembles the fetal ‘brain sparing’ response seen with hypoxaemia.

Design
Prospective observational study.

Setting
Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, London.

Population
Eighty‐five pregnant women undergoing invasive procedures associated with fetal prenatal diagnosis and/or management.

Methods
The femoral artery and the middle cerebral artery pulsatility index were measured by Doppler ultrasonography before and after 89 invasive procedures (fetal blood sampling, transfusion, bladder or cyst aspiration, shunt insertion and amniocentesis, between 17 and 36 weeks). Cases in which the fetal body was transgressed were compared with ‘control’ fetuses undergoing invasive procedures which did not directly involve needling the fetus (amniocentesis and placental cord insertion procedures).

Main outcome measures
Femoral artery and middle cerebral artery pulsatility index.

Results
The femoral artery pulsatility index rose after transgression [median change (Δ) 0.73; 95% confidence interval (CI) 0.51 to 0.98]. In contrast, there was no significant change in femoral artery pulsatility index after non‐transgression procedures (mean Δ 0.28; 95% CI −0.20 to 0.76). Analysis confirmed the fall in middle cerebral artery pulsatility index after transgression procedures (median Δ−0.19; 95% CI −0.07 to −0.35), but there was also a significant fall in middle cerebral artery pulsatility index after non‐transgression procedures (mean Δ−0.47; 95% CI −0.23 to −0.71).

Conclusions
The human fetus mounts a peripheral haemodynamic response to invasive procedures involving transgression of the fetal body, which is consistent with the brain sparing effect. However, the change in middle cerebral artery pulsatility index in both transgression and control procedures suggests that the changes and mechanisms may be more complex than previously thought.
IDentify, Educate and Alert (IDEA) trial: an intervention to reduce postnatal depression
Authors: Webster Joan , Linnane John , Roberts Janice , Starrenburg Susan , Hinson Janis , Dibley Linda
Published: December 2003

Objective
To test the effectiveness of a prenatal intervention in reducing the incidence of postnatal depression.

Design
A randomized controlled trial.

Setting
A large metropolitan obstetric hospital.

Population or sample
Pregnant women with risk factors for postnatal depression.

Methods
Women attending their first prenatal visit at the Royal Women's Hospital, Brisbane, were screened for risk factors for postnatal depression (IDentify). Positively screened women were randomly allocated to the intervention group or the control group. The intervention consisted of a booklet about postnatal depression, which included contact numbers; prenatal screening using the Edinburgh Postnatal Depression Scale; a discussion with the woman about her risk of developing postnatal depression (Educate); and a letter to the woman's referring general practitioner and local Child Health Nurse, alerting them of the woman's risk for postnatal depression (Alert).

Main outcome measure
Edinburgh Postnatal Depression Scale Score> 12 at 16 weeks postpartum.

Results
Of the 509 women who were sent a follow up questionnaire, 371 (72.9%) responded. The proportion of women who reported an Edinburgh Postnatal Depression Scale score of>12 was 26%. There were no significant differences between intervention (46/192, 24%) and control groups (50/177, 28.2%) on this primary outcome measure (OR 0.80; 95% CI 0.50–1.28).

Conclusion
Over one‐quarter of women with risk factors will develop postnatal depression. It is a treatable disorder but under‐diagnosis is common. Efforts to reduce postnatal depression by implementing interventions in the prenatal period have been unsuccessful.