bluuebunny/crossref_metadata_2025 huggingface dataset:
Bacterial vaginosis: a double‐blind randomized trial of the effect of treatment of the sexual partner
Authors: VEJTORP MOGENS , BOLLERUP ANNE CATHRINE , VEJTORP LISSIE , FANØE ERIK , NATHAN EVA , REITER ANITA , ANDERSEN MARY E. , STRØMSHOLT BODIL , SCHRØDER STEEN STEENSBÆK
Published: August 2005

Summary. In a double‐blind randomized controlled trial we assessed the effect of metronidazole treatment of the male partner on the recurrence rate of bacterial vaginosis. Women who fulfilled the diagnostic criteria for bacterial vaginosis were treated with metronidazole given in single doses of 2 g on days 1 and 3. The sexual partners were randomized to receive either the same dosage of metronidazole or a placebo. A total of 107 pairs completed the study. One week after the start of treatment 89% of the women considered themselves improved or cured and 93% no longer had the diagnostic criteria for bacterial vaginosis. At assessment 5 weeks after the treatment, 75% reported that they were cured or improved and the diagnostic criteria were not present in 73%. Treatment of the male partner did not affect subjective symptoms, clinical signs and isolation rates of Gardnerella vaginalis at 1 and 5 weeks after treatment.
Amniotic fluid alpha‐fetoprotein subfractions in fetal Trisomy 21 affected pregnancies
Authors: JONES STEPHEN R. , EVANS STUART E. , GILLAN LOUISE
Published: August 2005

Summary. The percentage contribution to the total AFP concentration in amniotic fluid from the yolk sac derived AFP was measured at 15–17 weeks gestation in 15 pregnancies affected by fetal Trisomy 21 and compared with that in 75 pregnancies with a normal outcome. The yolk sac form of AFP was reduced in parallel to the total AFP and differentiation of the subtraction from the yolk sac would offer no increase in diagnostic efficiency.
Artificial insemination with cryopreserved donor semen: a decade of experience
Authors: KOVACS GABOR , BAKER GORDON , BURGER HENRY , DE KRETSER DAVID , LORDING DOUGLAS , LEE JUNE
Published: August 2005

Summary. Ten years’experience of artificial insemination with cryopreserved donor semen for 1023 courses in 783 women resulting in 572 pregnancies is reported. A simple approach with multiple inseminations timed on the basis of cycle length, temperature charts, mucus symptoms and signs was used. The life table pregnancy rate was 61% after 12 cycles of treatment and 75% after 24 cycles. Women had a significantly higher rate of pregnancy in second and subsequent courses of treatment, and the pregnancy rate for treatment beyond 12 cycles was significantly less successful. Women over 35 years of age were significantly less successful.
Bacteriological contamination during laparoscopy with dye injection
Authors: PYPER R. J. D. , AHMET ZERIN , HOUANG ELIZABETH T.
Published: August 2005

Summary. Peritoneal contamination with bacteria during the laparoscopy and dye procedure was studied in 38 subfertile women by culturing samples of peritoneal fluid, aspirated before, and after, injection of dye solution. Bacteria were carried with the dye into a previously sterile peritoneal cavity in 34 women (90%). These vaginal organisms were present in low concentrations, not exceeding 105 organisms/ml. These findings explain the low incidence of acute salpingitis after tubal patency tests, but the selective use of antibiotic prophylaxis is recommended.
Rapidly progressive cervical cancer: is it a real problem?
Authors: SILCOCKS P. B. S. , MOSS S. M.
Published: August 2005

Summary. The appearance, in younger women, of a rapidly progressive form of cervical carcinoma has been suggested. This, together with evident deficiencies in the provision and technique of screening services, has been taken to indicate a need for more frequent screening. We show that a substantial increase in the observed number of such rapidly progressive cancers would be expected simply on the basis of changes in population structure, a general increase in cervical cancer rates and increases in the proportion of women screened.
Screening of the fetal heart rate in early labour
Authors: PELLO L. C. , DAWES G. S. , SMITH J. , REDMAN C. W. G.
Published: August 2005

Summary. The fetal heart rates (FHR) of 588 women admitted in labour, or in early labour after induction, were screened for up to 60 min (average 17 min) using computerized numerical analysis. Decelerative records with normal FHR variation occurred in eight (1.4%) and were not associated with acidaemia or depression at birth. Forty women (6.8%) had fetuses with a reduced FHR variation. They were more likely to be in spontaneous labour, to be at an earlier gestational age, and to be delivered operatively for fetal distress of babies that were more hypoxaemic and acidaemic. However, none of the fetuses with the least variable FHR patterns required resuscitation at birth or special care. The results of the screening procedure were not fully concealed and could have influenced clinical management. This is unlikely to have caused the associations that were observed, but could have reduced an association between low FHR variation and poor outcome. We conclude that there is a basis for a randomized controlled trial of FHR screening in early labour, but that this would need to be large (more than 10 000 patients) to test the benefit of detecting the most sinister pattern (decelerations with reduced variation) of which only one example was found in this study.
Demonstration of ectopic pregnancy by transvaginal ultrasound
Authors: DE CRESPIGNY LACHLAN CH.
Published: August 2005

Summary. Transvaginal ultrasound was used in the assessment of 148 patients clinically suspected of having an ectopic pregnancy. Transvaginal ultrasound allowed earlier demonstration of an intrauterine pregnancy without confusion with a pseudosac. Of the 36 patients with an ectopic pregnancy, this was strongly suspected in 29 (81%). A live extrauterine fetus was seen in 8 (22%), ectopic trophoblast or a gestation‐sac‐like structure in 19 (53%), and a pelvic haematoma in 2 (6%). Transvaginal ultrasound is advocated as the technique of choice in patients suspected of having an ectopic pregnancy.
Antenatal serum levels of relaxin in patients having preterm labour
Authors: BELL ROBIN J. , EDDIE LAWRENCE W. , LESTER ARLENE R. , WOOD E. CARL , JOHNSTON PAUL D. , NIALL HUGH D.
Published: August 2005

Summary. This study is the first report of antenatal levels of relaxin measured by homologous radioimmunoassay in peripheral serum from patients who subsequently had a preterm delivery. Serial blood samples were collected antenatally from a group of subjects known to be at increased risk of preterm labour because of a past history of shortened pregnancy. Serum relaxin was measured using an homologous radioimmunoassay based on a synthetic bioactive analogoue of the native hormone. In women whose pregnancies ended preterm most measurements were within the range of values previously established in normal antenatal patients although some measurements early in pregnancy were above the normal range. These findings suggest that low serum levels of relaxin are not causatively related to the onset of labour before term.
Blood flow velocity waveforms in large maternal and uterine vessels throughout pregnancy and postpartum: a longitudinal study using Duplex sonography
Authors: BAUMANN H. , KIRKINEN P. , MUELLER R. , SCHNARWYLER B. , HUGH A. , HUGH R.
Published: August 2005

Summary. Blood flow velocity waveforms in large maternal and uterine vessels were measured longitudinally from 16 weeks gestation onwards until 12 weeks postpartum in 21 singleton pregnancies by duplex sonography. In the maternal carotid artery, time average mean velocity (TAVmean) did not show significant changes. In both the femoral artery and vein, however, significant changes were observed. In the femoral artery, TAVmean and systolic maximum velocities decreased with advancing gestation. In the femoral vein, TAVmean remained constant throughout pregnancy and was lower than postpartum. The resistance index in the uterine arteries decreased with advancing gestation and increased after delivery. Among many factors contributing to femoral arterial blood flow velocity changes in pregnancy, we suggest that a major one is the increase in uterine blood flow. Reduction in venous femoral blood flow velocity and increase in the femoral vein diameter might be associated with the common occurrence of venous disorders in pregnancy.
Decrease in pulsatile flow in the internal carotid artery in fetal hydrocephalus
Authors: DEGANI S. , LEWINSKY R. , SHAPIRO I. , SHARF M.
Published: August 2005

Summary. The effect of ventriculomegaly on pulsatile flow in the internal carotid arteries has been studied by Doppler ultrasound in four hydrocephalic fetuses. The pulsatility index showed progressive elevation proportional to the developing ventriculomegaly and thus may be a valuable index for the study of the mechanism of brain injury and for the determination of optimal timing of intervention.
Beta‐mimetics in preterm labour: an overview of the randomized controlled trials
Authors: KING JAMES F. , GRANT ADRIAN , KEIRSE MARC J. N. C. , CHALMERS IAIN
Published: August 2005

Summary. Controversy continues about the use of beta‐mimetic drugs in preterm labour. One reason for this is that the adequately controlled trials of these drugs have all been small and have thus provided very imprecise estimates of their effects. We have therefore conducted a‘meta‐analysis’ using data relating to 890 women who participated in the 16 methodologically acceptable controlled trials of these agents in the treatment of preterm labour. This analysis demonstrates an unequivocal effect of beta‐mimetic tocolytic administration in delaying delivery, and this is reflected in a reduction in the frequency of preterm birth and low birthweight. However, no beneficial effect of this treatment on perinatal mortality or severe neonatal respiratory disorders could be detected.
Insulin sensitivity in third trimester pregnancy. A randomized study of dietary effects
Authors: FRASER R. B. , FORD F. A. , LAWRENCE G. F.
Published: August 2005

Summary. The metabolic effects of three diets were investigated in a randomized study in 15 non‐pregnant women and 14 pregnant women in the third trimester; all the women were of normal weight. After 2‐week periods of habituation to each diet, metabolic profiles were performed on standardized intakes. Diet 1 contained 40% of energy as carbohydrate and 10 g dietary fibre representing typical Western intakes. Diet 2 contained 40% energy as carbohydrate and 52 g dietary fibre and diet 3 contained 60% of energy as carbohydrate and 84 g dietary fibre, representing typical developing world intakes. No deterioration in glucose homeostasis in pregnancy was seen on any of the three diets in contrast to previous work. On diet 1 there was a loss of insulin sensitivity in pregnancy, but not on diets 2 and 3. The loss of insulin sensitivity which is typical of Western women in the third trimester of pregnancy and is considered to be physiological, may be a diet‐induced artefact.
Preterm caesarean section
Authors: PINION SHEENA B. , MOWAT JAMES
Published: August 2005

Summary. A retrospective study of 1921 caesarean sections at Rutherglen Maternity Hospital in Glasgow during the years 1979–1983, inclusive, showed that 229 (12%) were performed at less than 37 weeks gestation. Of these 229 preterm caesarean sections 41% were elective, 21% were for antepartum haemorrhage and 38% took place during labour. Of the 254 babies born 18 (7%) died in the neonatal period. These deaths comprised 31% of all neonatal deaths during the study period in this hospital. The neonatal death rate was 70% for babies weighing <1000 g (7 of 10) and 23% for babies weighing 1000–1500 g (6 of 26), but only 3% for babies heavier than this (7 of 217). Of the 75 women with a subsequent pregnancy after the preterm caesarean section 56% were again delivered by caesarean section. In view of the maternal morbidity associated with caesarean section and the poor neonatal outcome at birthweights of <1500g, the use of operative delivery for very low birthweight infants deserves further scrutiny.
Smoking in pregnancy: effects of stopping at different stages
Authors: MACARTHUR CHRISTINE , KNOX E. G.
Published: August 2005

Summary. Of 4341 pregnant women, 3106 were non‐smokers and 1235 were smokers at the start of pregnancy. Eighty‐five had stopped smoking before 6 weeks gestation, 119 between 6 and 16 weeks, and 56 stopped after 16 weeks. A further 51 stopped temporarily and 924 smoked throughout pregnancy. The mean birthweight of the groups differed. There were also social and biological differences such as might partly explain birthweight variations so comparisons were repeated after allowing for these factors. Standardized mean birthweights were greater for all groups who stopped than for persistent smokers. Those who stopped before 6 weeks and between 6 and 16 weeks gestation had infants 217 and 213 g, respectively, heavier than the persistent smokers and similar to the non‐smokers. Babies born to those who stopped after 16 weeks, or temporarily, were intermediate in weight. Appropriate advice is that stopping any time before 16 weeks is best, but stopping after this is still beneficial.
The effect of the antiprogestin mifepristone (RU 486) on maturation and in‐vitro fertilization of human oocytes
Authors: MESSINIS IOANNIS E. , TEMPLETON ALLAN
Published: August 2005

Summary. The effect of RU 486 (mifepristone), a potent antiprogestin, on the in‐vitro fertilization of human oocytes was investigated. In 40 normal volunteer women requesting laparoscopic sterilization, follicle aspiration for oocyte recovery was attempted 34 h after the injection of 5000 i.u. human chorionic gonadotrophin (hCG). Twenty women were allocated to receive 100 mg RU 486 orally 1 h before the hCG injection, the remaining 20 women acted as controls. There was no significant difference in the cleavage rate of the ooctyes after fertilization in vitro between the two groups (56% and 66% respectively). Also, the morphological characteristics of the cleaving oocytes and the concentrations of oestradiol, progesterone and androstenedione in the follicular fluid of the leading follicle did not differ significantly between the two groups. Since RU 486 was detected in substantial amounts in the follicular fluid specimens, these results suggest that progesterone is not critical for the final stages of human oocyte maturation.
Detrusor instability following colposuspension for urinary stress incontinence
Authors: LANGER R. , RON‐EL R. , NEWMAN M. , HERMAN A. , CASPI E.
Published: August 2005

Summary. Sixty‐two patients with genuine stress incontinence (group A) and 30 women with combined detrusor instability and genuine stress incontinence (group B) had a colposuspension operation. The proportion with symptoms of detrusor instability was significantly reduced from 24% before operation to 9% after operation in group A and from 73% to 33% in group B. Urodynamically, detrusor instability developed after surgery in 17 of the 62 patients (27%) in group A whereas only 12 of the 30 women (40%) in group B had detrusor instability after surgery. No urodynamic explanation was found to explain the effect of colposuspension in relieving the symptoms of detrusor instability in some and causing them in others. Nevertheless, it is suggested that colposuspension is helpful for most patients with combined detrusor instability and genuine stress incontinence.
A randomized trial of the use of cocaine spray to provide pain relief during laser vaporization of the cervix
Authors: MIKHAIL M. G. S. , BEVAN J. R.
Published: August 2005

Summary. In a double‐blind trial, 50 patients undergoing laser vaporization of the cervix for cervical intraepithelial neoplasia were randomly allocated to one of two groups. One group had the cervix sprayed with 3–4 ml of a solution containing 10% cocaine, the other a placebo solution during the laser treatment. Women in the cocaine group had significantly less pain as assessed by a visual analogue scale (P < 0.001) and by a verbal rating scale (P = 0.002). The cocaine group also had less blood loss (P = 0.001) as assessed subjectively by the operator.
Degradation of radiolabelled arginine vasopressin (125I‐AVP) by the human placenta perfused in vitro
Authors: LANDON M. J. , COPAS DEBBIE K. , SHIELLS ELIZABETH A. , DAVISON J. M.
Published: August 2005

Summary. The capacity of the human placenta to degrade 125I‐labelled arginine vasopressin (125I‐AVP) was studied in vitro using a dual circuit perfused lobule preparation. Seven placentas were perfused with the perfusate on the maternal side of the lobule containing 125I‐AVP at the upper limit of the physiological range. On average, over a 30‐min period, 48% of the 125I‐AVP appeared to have been metabolized. With one exception, a patient whose labour was augmented with intravenous oxytocin, no 125T‐AVP apparently crossed the placental lobule to the fetal circulation. These data indicate that the human placenta has a considerable capacity to degrade AVP.
Thyroxine concentration and outcome of hyperemetic pregnancies
Authors: CHIN R. K. H. , LAO T. H.
Published: August 2005

Summary. Plasma total thyroxine (TT4) and free thyroxine (FT4) were measured in 23 women with hyperemesis gravidarum at presentation, on average at about 10 weeks, in the second trimester, and before delivery. The first TT4 was raised abnormally in eight women and the FT4 in nine, but by the second trimester the TT4 was abnormally high in only three although in eight the FT4 remained high. By the third trimester all measurements, except one slightly raised FT4, were normal. Birth weight was not related to the thyroxine levels but there was a weak significant negative correlation between FT4 in the second trimester and gestational age at delivery.
Maternal mortality in Hong Kong 1961–1985
Authors: DUTHIE S. J. , GHOSH A. , MA H. K.
Published: August 2005

Summary. The maternal mortality rate in Hong Kong feil from 0·45/1000 total births in 1961 to 0·05/1000 total births in 1985. During the period between 1961 and 1985 there were a total of 438 maternal deaths and 2 193 012 births. Of the 438 deaths 150 (34%) were due to haemor‐rhage during pregnancy and childbirth (ICD 640, 641, 666), 89 (20%) were due to pre‐eclampsia (ICD 642, 643) and 60 (13·7%) were due to ectopic pregnancy (ICD 633). Comparison of maternal deaths by cause between the periods 1961–1965 and 1981–1985 showed an 86% reduc‐tion in deaths due to haemorrhage and pre‐eclampsia and a 72% reduc‐tion in deaths due to ectopic pregnancy. Pulmonary embolism was not a major cause of maternal mortality.
The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolapse and stress incontinence of urine. A neurophysiological study
Authors: SMITH A. R. B. , HOSKER G. L. , WARRELL D. W.
Published: August 2005

Summary. Single‐fibre electromyography of the pubococcygeus muscle of the pelvic floor was performed in 69 asymptomatic women and 105 women with stress incontinence of urine or genitourinary prolapse or both. The results suggest that partial denervation of the pelvic floor with subsequent reinnervation is a normal accompaniment of ageing and is increased by childbirth. Women with stress incontinence of urine or genitourinary prolapse or both have a significant increase in denervation of the pelvic floor compared with asymptomatic women.
Maternal zinc and selenium status in pregnancies with a neural tube defect or elevated plasma alpha‐fetoprotein
Authors: HINKS L. J. , OGILVY‐STUART A. , HAMBIDGE K. M. , WALKER V.
Published: August 2005

Summary. Zinc and selenium status was assessed in 30 non‐pregnant women, 69 women during normal pregnancy, six with a fetus with a neural tube defect (NTD) and 16 who had a raised plasma alpha‐fetoprotein (AFP) but no detectable fetal abnormality. Plasma zinc and selenium concentrations were significantly reduced in the second trimester of normal pregnancy compared with non‐pregnant levels. A significant decrease in concentrations of zinc in plasma and selenium in plasma and leucocytes was observed in women in the third trimester compared with women in the second trimester. Women with a fetal NTD and women with an unexplained elevation of plasma AFP had significantly lower leucocyte concentrations of zinc and of selenium. Mean values for plasma zinc, plasma and erythrocyte selenium, and for the activity of glutathione peroxidase in whole blood did not differ from those for normal pregnancy.
Aldosterone is secreted intermittently during pregnancy
Authors: STEVENS KATHRYN J. , PAINTIN D. B. , FEW J. D.
Published: August 2005

Summary. Saliva aldosterone concentration was measured in samples collected at hourly intervals from healthy pregnant women (approximately 26 and 36 weeks gestation) who were going about their normal daily activities, and from some women hospitalized for disorders of pregnancy. In the healthy women diurnal saliva aldosterone fluctuated considerably, the highest values being 2–22 times the lowest on a given day. Because of the known correlation between saliva and plasma aldosterone concentrations we believe that the fluctuating salivary level is indicative of fluctuating plasma levels and that this is due to the intermittent secretion of aldosterone. The rate of decline of saliva aldosterone from peak levels indicated a half life (t½) of 72 (SD 31) min which was not significantly different from that in non‐pregnant subjects. The temporal pattern of saliva aldosterone suggests an enhanced response of the zona glomerulosa to the factors that cause aldosterone secretion to fluctuate in non‐pregnant subjects, rather than the development of a more potent stimulus to the zona glomerulosa during pregnancy. In addition to hour‐to‐hour variation there is also substantial day‐to‐day variation, so that estimation of aldosterone in a single sample of saliva or plasma is of little value during pregnancy. The mean diurnal aldosterone concentration can be estimated from five saliva samples so this measurement presents a convenient technique for the assessment of aldosterone status in pregnancy. In contrast to healthy pregnancy, a patient with pre‐eclampsia at 39 weeks gestation showed no elevation of saliva aldosterone above non‐pregnant levels at any time during the day.
Division of uterine adhesions (Asherman's syndrome) with the Nd‐YAG laser
Authors: NEWTON JOHN R. , MacKENZIE WILLIAM E. , EMENS MICHAEL J. , JORDAN JOSEPH A.
Published: August 2005

Summary. Two women with Asherman's syndrome after postpartum curettage are presented. The diagnosis was confirmed by hysteroscopy. The adhesions were vaporized under hysteroscopic control, using a Nd‐YAG laser (neodymium‐yttrium‐aluminium‐garnet laser). The method was precise, casued minimal thermal injury and resulted in immediate return of regular menstrual cycles. The use of the Nd‐YAG laser for Asherman's syndrome warrants further study.
The place of laparoscopy in women with ascites
Authors: SHETH SHIRISH S.
Published: August 2005

Summary. Laparoscopy was performed in 70 women with ascites of unknown origin, and in 56 a visual diagnosis, aided by biopsy, was made. There was carcinoma in 32, tuberculosis in 20 and cirrhosis of the liver in four. No abnormality was seen in 14.
Transmission of human immunodeficiency virus by heterosexual contact with reference to antenatal screening
Authors: HOWARD L. C. , HAWKINS D. A. , MARWOOD R. , SHANSON D. C. , GAZZARD B. G.
Published: August 2005

Summary. Twenty‐seven women all of childbearing age, eight of whom were pregnant, were identified as human immunodeficiency virus (HIV‐1) antibody positive in the genitourinary medicine clinics of East Riverside up to March 1987. Of these 27 women 11 had acquired the virus by heterosexual contact. Between 1 March 1987 and 29 February 1988, all 1328 women attending the antenatal clinic were offered an HIV screening test, 982 accepted and the other 346 declined to be tested. Two of the 982 tested women were found to be HIV‐1 antibody positive. Two other pregnant HIV‐1‐positive women were identified during this time, one was tested in the genitourinary medicine clinic and the other whilst an in‐patient for drug withdrawal. All except one of the 12 HIV‐1‐antibody‐positive pregnant women were in known high‐risk groups. In addition up to March 1988, 32 heterosexual men were identified as HIV‐1 antibody positive and 22 of these were intravenous drug abusers. If the present trend continues, more women will become infected, often unaware that they are at risk and this may not be detected unless HIV testing is offered to all pregnant women and widely accepted. Decisions on local policy should be based on the available estimates of prevalence of HIV infection in that community.
Congenital human immunodeficiency virus (HIV) infection in the Bahamas
Authors: HOWARD‐GARDINER HELENA , ROBERTS P. D. , DUNN P. M.
Published: August 2005

Summary. In the 13‐month period between June 1985 and July 1986, 27 children were found to be HIV positive in the Princess Margaret Hospital in Nassau. Nineteen of the children had clinical AIDS, four were in the prodromal phase and four were symptom free. The clinical course of these infants is presented. Of the 18 mothers 16 were screened and were all seropositive and asymptomatic. They remained healthy in spite of subsequent pregnancies in nine of them (56%) during a follow‐up period of between 13 and 65 months (mean 40 months). Fifteen of the 18 mothers were Haitian but only three had other risk factors, throwing doubt on the value of selective screening in Afro‐Caribbean countries.
A comparison of single‐dose oral fluconazole with 3‐day intravaginal clotrimazole in the treatment of vaginal candidiasis
Authors: Andersen G. M. , Barrat J. , Bergan T. , Brammer K. W. , Cohen J. , Dcllenbach P. , Diernaes E. , Dorazil E. , Gjonnaess H. , Jerve F. , Klausen M. , Lassus A. , Lundgren R. , Marhic C. , Plantema F. , Serfaty D. , Taurelle R. , Thommessen B.
Published: August 2005

Summary. A total of 369 women with clinical and mycological evidence of vaginal candidiasis received treatment, after random allocation, with either a single oral 150‐mg dose of fluconazole (188 women) or 200 mg of intravaginal clotrimazole given daily for 3 consecutive days (181 women). They were assessed at 5–16 days and again at 27–62 days after treatment. Candida species were completely eradicated from the vagina in 72% of the fluconazole group and in 62% of the clotrimazole group at the long‐term assessment (P=0·07). Favourable clinical responses were obtained in 99% of the fluconazole group and in 97% of the clotrimazole group at the short‐term assessment and in 93% and 84% respectively at the long‐term assessment when there was a significant advantage for fluconazole treatment (P=0·02). Symptoms in patients receiving fluconazole were relieved more rapidly (P<0·001). Treatment‐related side‐effects were few and minor in both groups. It is concluded that treatment of vaginal candidiasis with fluconazole, as a single oral dose, was more effective in the long term, relieved symptoms more rapidly, and was as safe as treatment with intravaginal clotrimazole.
Tuberculous meningitis in pregnancy
Authors: KINGDOM JOHN C. P. , KENNEDY DERMOT H.
Published: August 2005

Summary. Four women with tuberculous meningitis in association with pregnancy are described to illustrate both the serious nature and varied presentation of this condition. Mortality or neurological morbidity may occur more frequently during pregnancy, but in general correlate closely with delay in diagnosis and initiation of appropriate therapy. Treatment often needs to be started empirically, and neurosurgical intervention may prove life saving.
Placental hormones and maternal glucose metabolism. A study of fetal growth in normal pregnancy
Authors: LANGHOFF‐ROOS JENS , LINDMARK GUNTLLA , WIBELL LARS , GEBRE‐MEDHIN MEHARI
Published: August 2005

The interrelations between three placental hormones (oestradiol, progesterone and hPL), maternal glucose metabolism, maternal anthropometry and fetal growth were studied in a sample of 52 carefully selected pregnant women. A relation was found between infant birthweight and both fasting blood glucose and t½ of glucose of an intravenous glucose tolerance test at week 37 of pregnancy. The serum concentrations of the placental hormones were not significantly related to the glucose variables. The correlation between birthweight and the maternal levels of hPL in late pregnancy (r= 0·60) persisted when fasting blood glucose and tt½ of glucose were taken into account. Maternal fat mass was found to explain more of the Variation in basal insulin levels around week 37 than did the placental hormones.
Discrepancy between curettage and hysterectomy histology in patients with stage l uterine malignancy
Authors: SOOTHILL P. W. , MacKENZIE I. Z. , ALCOCK C. J.
Published: August 2005

Summary. Histology reports of endometrial curettage and hysterectomy specimens were compared in patients with stage l uterine malignancy. In 63 of 117 (54%) the tumour grade or type reported in the curettage specimen differed from that described in the hysterectomy specimen; the grading was as likely to be more as less well differentiated at hysterectomy. The differences were not related to endometrial sampling technique or pre‐operative intracavity radiotherapy. The results suggest that if decisions about patient management continue to be based on histological grading of tumours in endometrial curettage samples, unnecessary morbidity will be caused to some patients and inadequate treatment will be given to others.
A study of the experience of Glasgow women in the climacteric years
Authors: BARLOW D. H. , GROSSET K. A. , HART H. , HART D. M.
Published: August 2005

Overall, 424 women between 40 and 60 years of age were interviewed with reference to their experience of the menopause; 179 (42%) expressed a ‘need for treatment’ which was more marked in those who had had a hysterectomy (57%) or oophorectomy (76%). Of those who sought help (174) a large majority (92%) had seen their general practitioner and 72% received some form of drug therapy, predominantly hormone replacement therapy (HRT) or psychotropic drugs. Twenty‐eight women were currently having HRT (7%) and 39 (9%) had previously had HRT. Only 12 women (3%) had received >3 years of HRT and nine of these had had an oophorectomy. Only 1% of other women were ‘long‐term’ users of HRT. Of the 424 women 11% expressed dissatisfaction with their general practitioner's approach to this subject.
Ethnic influence on uterine activity in spontaneous normal labour
Authors: ARULKUMARAN S. , GIBB D. M. F. , CHUA S. , SINGH P. , RATNAM S. S.
Published: August 2005

Uterine activity in spontaneous normal labour was studied in Singaporean Malay women at term with a singleton vertex presentation. Nulliparae had significantly higher uterine activity compared with their multiparous counterparts. Uterine activity in the Malay population was compared with that of a similar Chinese population. When controlled for parity, maternal height and birthweight of babies, there was no difference in uterine activity between the two groups.
Some endocrinological events associated with early pregnancy failure
Authors: WHITTAKER P. G. , STEWART M. O. , TAYLOR A. , LIND T.
Published: August 2005

Serial measurements of serum progesterone, oestradiol, human chorionic gonadotrophin (hCG) and human placental lactogen (hPL) have been determined in 33 women experiencing early pregnancy failure and compared with the values of the same hormones in 72 healthy women having uncomplicated pregnancies. Steroid production by the corpus luteum seemed similar in both groups up to 6 weeks gestation but thereafter placental steroidogenesis was not evident in those women in whom spontaneous pregnancy losses occurred. Placental production of the two protein hormones, hCG and hPL, did take place, and whereas the circulating levels were not as high as in normal pregnancies, levels did usually increase before clinical evidence of miscarriage occurred. hCG was not a sensitive discriminator of subsequent failure. In these women there were no significant hormone differences between those with evidence of a fetus and those without.
Nausea and vomiting of early pregnancy and pregnancy outcome. A meta‐analytical review
Authors: WEIGEL RONALD M. , WEIGEL M. MARGARET
Published: August 2005

The generalizability of the apparent decreased risk of miscarriage and perinatal mortality associated with early pregnancy nausea and vomiting was investigated by examining data available from 11 previous studies. Statistical reanalyses of these studies indicated a strong significant association of nausea and vomiting of pregnancy with decreased risk of miscarriage, and no consistent associations with perinatal mortality. A statistical meta‐analysis confirmed the decreased risk of miscarriage associated with gestational nausea and vomiting (common odds ratio = 0·36, 95% CI 0·32 to 0·42) and indicated that the association with decreased fetal mortality was restricted to the first 20 weeks gestation. The meta‐analysis also revealed that over 150 additional possibly unreported studies with contradictory evidence would be required to refute this observed association.
Vulval intraepithelial neoplasia—management and outcome
Authors: SHAFI M. I. , BYRNE P. , LUESLEY D. M. , REDMAN C. W. , ROLLASON T. P. , SAMRA J. S. , JORDAN J. A.
Published: August 2005

Forty‐six patients with a primary diagnosis of vulval intraepithelial neoplasia (VIN) have been managed over a 10‐year period. The prevalence of VIN has increased and the age at presentation has decreased over the last decade; 59% of our patients had histological evidence of human papillomavirus infection. Pruritis was the commonest symptom at presentation (59%). Of the 46 patients 44 were treated by laser skinning vulvectomy, local excision or simple vulvectomy. Symptomatic relief was best achieved by local excision. Clinical and definitive relapse occurred more often in the laser‐treated group. The median time to relapse was 38 months in the laser‐treated group and 74 months in the surgically treated group (excision and simple vulvectomy). Two patients have not been treated and their disease has not progressed. The carbon dioxide laser almost certainly has a role in conservative management and although our data possibly do not reflect its full potential they demonstrate a need for a controlled prospective study.
Survival of younger cervical carcinoma patients treated by radical radiotherapy in the West of Scotland 1964–1984
Authors: JUNOR E. J. , SYMONDS R. P. , WATSON E. R. , LAMONT D. W.
Published: August 2005

Summary.Between 1964 and 1984, 2011 patients in the West of Scotland were treated by radical radiotherapy for carcinoma of cervix. In keeping with the rise in incidence amongst younger patients nationally, the number of women aged <35 years seen during the 20‐year period has doubled. Younger women (aged <35 or <45) have a better prognosis mainly because more present with earlier disease. Stage for stage there has been no change in survival of women of all ages treated by identical radiotherapy during this period. The rise in mortality of younger patients from carcinoma of cervix may be due to the increased incidence of the condition rather than a more virulent form of the disease.
Serum CA 125 in acute pelvic inflammatory disease
Authors: PAAVONEN J. , MIETTINEN A. , HEINONEN P. K. , AARAN R‐K. , TEISALA K. , AINE R. , PUNNONEN R. , LAINE S. , KALLIONIEMI O‐P. , LEHTINEN M.
Published: August 2005

Summary. Serum levels of CA 125 and other selected tumour markers were measured in 31 patients with proven pelvic inflammatory disease (PID). Ten (32%) of the patients had elevated CA 125, one (4%) had elevated CEA, and none had elevated CA 15–3, AFP or β2‐micro‐globulin. Compared to patients with normal CA 125, patients with elevated CA 125 were older, more often users of intrauterine contraceptive devices, had longer duration of symptoms, higher erythrocyte sedimentation rates, and more often had an adnexal mass on pelvic examination. There was a correlation between CA 125 levels and the severity of adnexal inflammation as defined by laparoscopy. Isolation of specific micro‐organisms from the upper genital tract was not associated with elevated CA 125. In most women serum levels of CA 125 decreased during treatment. PID should be considered as a major cause of positive CA 125 findings among young women.
Oxybutinin versus propantheline in the management of detrusor instability. A patient‐regulated variable dose trial
Authors: HOLMES DAVID M. , MONTZ FRITZ J. , STANTON STUART L.
Published: August 2005

Summary. Two of the principal drugs used to treat detrusor instability, oxybutinin hydrochloride and propantheline bromide, were compared using clinical and urodynamic outcome measures in a randomized crossover trial with a patient‐regulated variable dose regimen. Of the 23 women in the trial, 14 reported subjective improvement during treatment with oxybutinin hydrochloride compared with 11 during treatment with propantheline bromide. Apart from a greater increase in the maximum cystometric capacity with oxybutinin, there were no other objective differences between the two drugs. Oxybutinin significantly delayed the first desire to void, increased the maximum cystometric capacity and reduced the maximum detrusor pressure rise on filling. Propantheline significantly increased the maximum cystometric capacity and reduced the maximum detrusor pressure rise on filling. Three patients stopped treatment due to side‐effects.
Calcium supplementation reduces the risk of pregnancy‐induced hypertension in an Andes population
Authors: LÓPEZ‐JARAMILLO P. , NARVÁEZ M. , WETGEL R. M. , YÉPEZ R.
Published: August 2005

Summary. Previous studies have suggested that increased dietary calcium is associated with a decreased occurrence of pregnancy‐induced hypertension. In this study 106 young healthy nulliparous women, residing in Quito, Ecuador, were enrolled in a double‐blind, randomized, controlled clinical trial. From 24 weeks gestation until delivery they received either 2 g of elemental calcium per day or a placebo. Calcium supplementation was associated with a significantly decreased risk of pregnancy‐induced hypertension, with 4.1% developing pregnancy‐induced hypertension in the treatment group versus 27.9% in the placebo group. Treatment was associated with a decrease in both systolic and diastolic blood pressure over the course of pregnancy. In addition, there was a small but significant increase in serum ionized calcium levels in the calcium‐supplemented group during the treatment period.
Fetal diaphragmatic hernia: the value of fetal echocardiography in the prediction of postnatal outcome
Authors: CRAWFORD D. C. , WRIGHT V. M. , DRAKE D. P. , ALLAN L. D.
Published: August 2005

Summary. Nineteen pregnancies complicated by fetal congenital diaphragmatic hernia (CDH) referred for fetal echocardiography have been reviewed. Congenital heart disease was diagnosed prenatally in three fetuses; in one of these the pregnancy was terminated, the two other infants died in the neonatal period. The presence of the fetal stomach within the thorax or a hernia/heart area ratio greater than 1·7 was associated with a large diaphragmatic defect. Polyhydramnios was not associated with a poor postnatal outcome. Evidence of cardiac ventricular disproportion before 24 weeks gestation in isolated CDH was associated with 100% mortality. Development of ventricular disproportion during the third trimester was associated with a survival rate of 75%. In three fetuses, all of whom survived, no ventricular disproportion was detected during the third trimester examination.
A comparison of fetal abdominal circumference measurements and Doppler ultrasound in the prediction of small‐for‐dates babies and fetal compromise
Authors: CHAMBERS S. E. , HOSKTNS P. R. , HADDAD N. G. , JOHNSTONE F. D. , McDICKEN W. N. , MUIR B. B.
Published: August 2005

Summary. A total of 145 pregnancies clinically suspected of being small‐for‐dates was studied at presentation with a single measurement of the fetal abdominal circumference and Doppler studies of the umbilical and arcuate arteries. The abdominal circumference measurement gave the best prediction of the small‐for‐gestational‐age (SGA) baby (sensitivity 73%, umbilical artery sensitivity 47%, arcuate artery sensitivity 29%). The umbilical artery measurement gave the best prediction of antenatal fetal compromise; the performance of the tests was compared for a fixed sensitivity of 100% (i. e. all cases of antenatal compromise would be detected), the specificity of the umbilical artery measurement was 77%, abdominal circumference measurement 12% and arcuate artery measurement 2%. In our data, umbilical artery studies were not a sensitive predictor of the SGA baby but they did give an accurate prediction of the potentially compromised SGA fetus.
Bladder neck electrical conductivity in female urinary urgency and urge incontinence
Authors: HOLMES D. M. , PLEVNIK S. , STANTON S. L.
Published: August 2005

Summary. Thirty‐nine consecutive women, referred because of lower urinary tract symptoms of stress incontinence, urgency and urge incontinence, were interviewed and their symptoms were graded using a standardized questionnaire. They were investigated with conventional, fast‐fill cystometry and with a new bladder neck electrical conductivity (BNEC) test which measures bladder neck activity. A highly significant correlation between the symptoms of urgency and urge incontinence and the maximum amplitude of bladder neck activity was found with the new test. The correlation of the maximum deflection at rest with the symptom of urgency was significantly better than the best correlation found with the cystometric measurements. The values for sensitivity and specificity of cystometry for the detection of an abnormality associated with urgency were 58% and 92% respectively, and the corresponding values for a positive BNEC test (as defined by a maximum deflection at rest >13 μA) were 100% and 77%.
Binding of anti‐EMA, AGF 4:48 and the lectin UEA‐1 to human ovarian carcinomas: histological and clinical correlations
Authors: BRADGATE M. G. , REDMAN C. W. E. , ROLLASON T. P. , WILLIAMS ANN , BYRNE P. , KELLY K.
Published: August 2005

Summary. The staining reactions of the monoclonal antibodies anti‐EMA, AGF 4:48 and the lectin UEA‐1 from Ulex europaeus were investigated in formalin‐fixed, paraffin‐embedded sections of 36 primary ovarian carcinomas. The staining patterns were graded and related to tumour type, differentiation, FIGO stage and patient survival. Both antibodies and UEA‐1 showed variations in their staining between and within tumours. The staining of mucinous tumours using anti‐EMA was significantly less than in non‐mucinous tumours. No other significant associations were found between staining grade and the different variables under study. The variations in staining were not demonstrated to have any prognostic significance.
Effect of external cephalic version in late pregnancy on presentation at delivery: a randomized controlled trial
Authors: VAN VEELEN A. J. , VAN CAPPELLEN A. W. , FLU P. K. , STRAUB M. J. P. F. , WALLENBURG H. C. S.
Published: August 2005

Summary. The effect of repeated external cephalic version, performed at between 33 and 40 weeks gestation, on presentation at delivery was studied in a randomized controlled trial comprising 180 pregnant women with breech presentation. No tocolysis, analgesia or anaesthesia was used. Approximately 25% of all attempts in the study group of 90 women were successful; repeated external version resulted in cephalic presentation at delivery in 48% of patients. Spontaneous version to cephalic presentation occurred in 23 (26%) of the 90 women in the control group in whom version was not attempted, indicating a therapeutic gain from the procedure of 22%, with a 95% confidence interval of 8 to 35%. No severe complications of external cephalic version were noted. We conclude that external cephalic version reduces the frequency of breech presentation at delivery. This mainly benefits the mother because of the decrease in the number of caesarean sections and their inherent maternal morbidity.
Oral contraceptive steroids and breast secretions
Authors: MILLER W. R. , ELTON R. A. , LOUDON N.
Published: August 2005

Summary. Breast secretions were obtained by nipple aspiration from 164 (44·7%) of 368 consecutive premenopausal non‐pregnant women volunteers attending family planning clinics. Women currently taking oral contraceptive steroids were significantly less likely to yield breast secretions than women who had never taken such preparations. The effect was confined to parous women of whom 94% not taking oral contraceptives yielded breast secretions compared with only 51% currently using the pill and 60% of those with a previous history of use. The percentage of nulliparous women yielding breast secretions (30%) was significantly less than that in parous women and was not affected by a present or previous history of contraceptive steroid use. These results provide further evidence of the difference in hormone responsiveness of parous and nulliparous breasts and the potential of oral contraceptive steroids to influence breast function.
The effect of maternal bladder volume on fundal height measurements
Authors: ENGSTROM J. L. , OSTRENGA K. G. , PLASS R. V. , WORK B. A.
Published: August 2005

Summary. The effect of maternal bladder volume on fundal height measurements was studied in 200 non‐obese Black women between 16 and 42 weeks gestation. Fundal height measurements were obtained by the same examiner immediately before and immediately after each subject voided. Examiners were blinded to fundal height measurements and the amount of urine voided. Prevoid fundal height measurements were significantly larger than postvoid fundal height measurements. The differences between pre‐ and postvoid fundal height measurements varied from −2·8 to 4·6 cm (mean 0·63 cm, SD 1·26). Postvoid fundal height measurements were smaller than the prevoid measurements in 69·5% of the women, and 34·5% of the differences were > 1·0 cm. Women who had voided within 30 min before measurement had significantly smaller differences between pre‐ and postvoid fundal height measurements (n=20, mean 0·16, SD 1·22) than women who voided more than 30 min before measurement (n=179, mean 0·68, SD 1·27). These findings indicate that women should be instructed to void within 30 min before fundal height measurements are obtained.
Uteroplacental Doppler flow velocity waveforms in the second trimester. A complex circulation
Authors: BEWLEY S. , CAMPBELL S. , COOPER D.
Published: August 2005

Summary. Continuous wave Doppler ultrasound was used to examine the Uteroplacental circulation of an unselected group of 993 women between 16 and 24 weeks gestation. Reference ranges for resistance index (RI) were determined and throughout this gestation range there was a significant fall in RI with increasing gestation. The RI was lower from placental than non‐placental sites and from distal ‘arcuate’ than proximal ‘uterine’ sites. There is a need to define fixed standardized sites for sampling and for normal ranges to account for variables such as placental site.
Large loop excision of the transformation zone (LLETZ). A new method of management for women with cervical intraepithelial neoplasia
Authors: PRENDIVILLE WALTER , CULLIMORE JOHN , NORMAN SUE
Published: August 2005

Summary. The paper describes the technique of ‘LLETZ’ (large loop excision of the transformation zone), a new method of management for women with an abnormal cervical smear which offers the advantages of conization with those of local destruction. A large loop of thin wire forms a diathermy electrode that allows deep excision of the transformation zone with minimal tissue damage. The tissue removed can be examined histologically. The technique was used to investigate and treat 111 women with abnormal smears referred to the Bristol Royal Infirmary during 1986. Microinvasive disease was revealed in one woman where it was not suspected by cytology or colposcopic examination. Of 102 women followed up for at least 1 year by cytology, colposcopy and, where appropriate, histology, two women were found to have residual/recurrent cervical intraepithelial neoplasia.