bluuebunny/crossref_metadata_2025 huggingface dataset:
In vivo controlled release of PGE2 from a vaginal insert (0.8 mm, 10 mg) during induction of labour
Authors: Lyrenäs Sven , Clason Ingegerd , Ulmsten Ulf
Published: December 2003

Objective To measure the release rate of prostaglandin E2 (PGE2) in vivo from a controlled‐release vaginal insert used for cervical ripening and induction of labour at term in women with intact membranes or pre‐labour rupture of membranes (PROM).

Design Open‐label, single centre study.

Population Women at term (≥ 37 gestational weeks) with unripe cervices (Bishop score ≤ 6) scheduled for labour induction for mainly medical reasons.

Methods sixty‐eight women (47 with intact membranes and 21 with PROM) had the PGE2 vaginal insert placed in the posterior fornix of the vagina. Each insert was removed from the women at a predetermined time interval between 0.5 h and 24 h, or earlier if labour was induced, fetal distress was detected or maternal complications occurred. After removal, the vaginal insert was frozen and stored for subsequent assay of residual PGE2. Blood samples were collected immediately before insertion and at 4‐hour intervals until removal of the vaginal insert to determine plasma concentrations of PGE2 and the major PGE metabolite, 15‐Keto‐13, 14‐dihydro‐PGF2α (PGEm). Vaginal pH was measured immediately before insertion and directly after removal of the vaginal insert. Bishop score was assessed before induction, after 8 h, 12 h and immediately after removal of the vaginal insert.

Results There was a positive linear relationship between the amount of PGE2 released from the insert and the duration of treatment in women with intact membranes (rp= 0.95, P= 0.0001), with a calculated PGE2 release rate of 0.52 ± 0.33 mg/h over 24 h. The PGE2 release rate in women with PROM was not linear. The PGE2 release rate was dependent on vaginal pH, with a faster release rate at higher vaginal pH. Forty‐seven women (69.1%) had the insert removed due to the successful induction of labour and consequently discontinued study treatment before their allocated time period. At vaginal delivery, the released amount of PGE2 at onset of labour was 4.0±3.0 mg and 2.4±2.1 mg for nulliparous women with PROM and intact membranes, respectively (P= 0.1). In multiparous women, the equivalent mean released amount was 3.2±2.6 mg and 1.9±1.4 mg, respectively (P= 0.14). In women with intact membranes, the mean plasma concentrations of PGE2 and PGEm after treatment were not statistically different to those women with PROM (P= 0.27 and 0.64, respectively). In women who were delivered vaginally, the median induction to delivery time interval was 17.0 h (range 4–42) in nulliparous women and 8.7 h (range 5–19) in multiparous women (P= 0.003). Ten (14.7%) women, who were all nulliparous, were delivered by caesarean section.

Conclusions In women with intact membranes, the PGE2 release rate was linear over 24 hours. There was a positive linear relationship between vaginal pH and PGE2 release rate. The metabolite analysis revealed no evidence of dose dumping neither in women with intact membranes or in women with PROM.
Return of fertility in nulliparous women after discontinuation of the intrauterine device: comparison with women discontinuing other methods of contraception
Authors: Doll Helen , Vessey Martin , Painter Rosemary
Published: December 2003

Objective
To clarify the effect of the using the intrauterine device on fertility in nulliparous women.

Design
Prospective cohort study of two groups of nulliparous women, one recruited while using an intrauterine device and the other while using an oral contraceptive.

Setting
Seventeen family planning clinics in England and Scotland.

Sample
1071 nulliparous, married women, aged 18–40 years, 558 of whom contributed information to the main objective of the study.

Methods
The women were recruited between 1982 and 1985 and followed up annually to 1994. Dates and reasons for any contraceptive method changes (which were most frequently to barrier methods) were recorded, together with the outcome of any pregnancies, at each follow up.

Main
outcome measures The number of nulliparous women giving birth at term after stopping contraception (oral contraceptive, intrauterine device or barrier method) in order to conceive.

Results
Women who stopped using a barrier method to achieve a planned pregnancy conceived most quickly: 54% were delivered after one year vs 39% of intrauterine device and 32% of oral contraceptive users (log rank P=0.002). There was no association between fertility and duration of oral contraceptive use: However, short term intrauterine device users (< 42 months) showed a fertility pattern more favourable than seen in those discontinuing oral contraceptives, with increasing duration of intrauterine device use being associated with decreasing fertility (linear trend P=0.005); the fertility of women who had used the intrauterine device for 78+ months was the most impaired (28% were delivered by 12 months vs 46% of short term users; at 36 months the corresponding figures were 79%vs 91%). This association remained after adjusting for potential confounding factors, including maternal age, husband's social class, and history of gynaecological illnesses, factors which themselves had independent associations with fertility.

Conclusions
Long term intrauterine device use in nulliparous women appears to be associated with an increased risk of fertility impairment.
Familial Mediterranean fever and menstruation
Authors: Ben‐Chetrit Eldad , Ben‐Chetrit Avraham
Published: December 2003

Objective
To study the prevalence, the nature and the genotype correlation of menstruation associated familial Mediterranean fever attacks.

Methods
One hundred and forty‐one female patients with familial Mediterranean fever were studied. A questionnaire regarding the presence and nature of menstruation associated with familial Mediterranean fever was designed and filled in by the authors during the patients’ visits to the familial Mediterranean fever clinic. The patients who had a positive history for this manifestation were analysed for their familial Mediterranean fever mutations.

Results
Ten out of 141 familial Mediterranean fever female patients (7%) had menstruation‐associated familial Mediterranean fever attacks. These patients varied in their disease age of onset and disease duration. Increase of colchicine dose, daily or during the perimenstrual period or oral contraceptives were beneficial in preventing these familial Mediterranean fever attacks. No correlation was found with specific mutations causing familial Mediterranean fever.

Conclusions
Menstruation‐associated familial Mediterranean fever attacks are relatively uncommon. They are not related to the age of the women, the chronicity of their disease or to the mutations they bear. Various therapeutic approaches have to be tried in order to abolish these attacks. A decrease in oestrogen level during menstruation may have a role in this unique manifestation of familial Mediterranean fever.
Risk factors for third degree perineal ruptures during delivery
Authors: de Leeuw J.W. , Struijk P.C. , Vierhout M.E. , Wallenburg H.C.S.
Published: December 2003

Objective
To determine risk factors for the occurrence of third degree perineal tears during vaginal delivery.

Design
A population‐based observational study.

Population
All 284,783 vaginal deliveries in 1994 and 1995 recorded in the Dutch National Obstetric Database were included in the study.

Methods
Third degree perineal rupture was defined as any rupture involving the anal sphincter muscles. Logistic regression analysis was used to assess risk factors.

Main outcome measures
An overall rate of third degree perineal ruptures of 1.94% was found. High fetal birthweight, long duration of the second stage of delivery and primiparity were associated with an elevated risk of anal sphincter damage. Mediolateral episiotomy appeared to protect strongly against damage to the anal sphincter complex during delivery (OR: 0.21, 95% CI: 0.20–0.23). All types of assisted vaginal delivery were associated with third degree perineal ruptures, with forceps delivery (OR: 3.33, 95%‐CI: 2.97–3.74) carrying the largest risk of all assisted vaginal deliveries. Use of forceps combined with other types of assisted vaginal delivery appeared to increase the risk even further.

Conclusions
Mediolateral episiotomy protects strongly against the occurrence of third degree perineal ruptures and may thus serve as a primary method of prevention of faecal incontinence. Forceps delivery is a stronger risk factor for third degree perineal tears than vacuum extraction. If the obstetric situation permits use of either instrument, the vacuum extractor should be the instrument of choice with respect to the prevention of faecal incontinence.
Hysterectomy prevalence and adjusted cervical and uterine cancer rates in England and Wales
Authors: Redburn J.C. , Murphy M.F.G.
Published: December 2003

Objective
To present recent trends in cervical and uterine cancer adjusted for true population at risk, using accurate estimates of the prevalence of hysterectomy where the cervix has been removed or not. To describe trends and projections of hysterectomy incidence and prevalence with and without cervix removal.

Design
Collation of available NHS and private sector information.

Setting
England and Wales.

Sample
NHS operations from Hospital Inpatient Enquiry, Hospital Episode Statistics and Hospital Activity Analysis for England and Wales. Private sector data from surveys with up to 97% coverage.

Methods and Main Outcome Measures
NHS data by 5–year age group, year and operation type were collated for 1961–1995. non–NHS operations for 1981, 1986, and 1992/3 were back–projected. Hysterectomy incidence rates, 1961–95, were back–projected to estimate prevalence rates by accumulation. True populations at risk of disease and hysterectomy were calculated by applying one minus the relevant hysterectomy prevalence rates to the population by age group and year.

Results
When based on the true population at risk, the age standardised cervical cancer incidence rate in 1992 was 14.4 per 100,000, compared with 12.6 when based on the all women population estimate. Incidence rates for earlier years were also affected, but there was no important effect on the rate of change over time. Absolute changes for uterine cancer are greater because the true population at risk is proportionally smaller particularly at the older ages, but there are again no major effects on the rate of change. By 1995 2.3 million women in England and Wales were without a uterus, with a peak prevalence of 21.3% in the age group 55–59. Projections based on 1995 incidence rates show hysterectomy prevalence for the screened age groups, 25–64, will now fall. Subtotal hysterectomy is 3.5% of operations and increasing.

Conclusions
True populations at risk must be used to assess the impact of screening if further reductions in cervix cancer incidence rates are not to be masked. It is essential to monitor hysterectomy by type, as subtotal hysterectomy is becoming more common. Hysterectomy incidence may have peaked. Hysterectomy prevalence in England and Wales may not be as high as would be estimated from some regional studies.
Women's views on the practice of prenatal perineal massage
Authors: Labrecque Michel , Eason Erica , Marcoux Sylvie
Published: December 2003

Objective
To determine how women who practised perineal massage during pregnancy assessed the technique.

Design
Observational study within one arm of a randomised controlled trial.

Setting
Five secondary and tertiary care hospitals in the Province of Quebec, Canada.

Participants
Among 763 women randomised to the massage arm of a clinical trial of perineal massage during pregnancy, 684 (90%) who completed a questionnaire after delivery.

Main
outcome measures A 20‐item questionnaire completed a few days after birth. The first 18 questions elicited opinions using a 6‐point Likert scale. Based on a factor analysis, 17 of these questions were classified into four categories: acceptability of perineal massage (8 items); preparation for birth (4 items); relationship with the partner (2 items); and effect of massage on delivery (3 items). Scores of each scale varied between 1 (highly negative assessment) to 6 (highly positive assessment). The last two questions asked whether women would perform the massage in their next pregnancy and whether they would recommend perineal massage to another pregnant woman. In addition, 262 also provided comments about their experience in the daily diary provided to record compliance during the trial.

Results
On average, perineal massage was felt to be quite acceptable [mean (standard deviation) 4.09 (0.93)]. Pain and technical problems reported during the first week or two of massage tended to disappear after a few weeks. Women's assessment of the effect of massage on preparation for birth [4.34 (1.08)] and on delivery [4.18 (1.37)] was positive. Women's views about the effect on their relationship with their partner were either positive or negative [3.54 (1.74)] and were proportional to the partner's participation with the massage. Most women said they would massage again if they were to have another pregnancy (79%; 95% CI, 76%–82%) and would recommend it to another pregnant woman (87%; 95% CI 84%–90%).

Conclusion
Overall, women's assessment of prenatal perineal massage is positive.
The efficacy of fluoxetine in improving physical symptoms associated with premenstrual dysphoric disorder
Authors: Steiner Meir , Romano Steven J. , Babcock Susan , Dillon Julia , Shuler Cathy , Berger Charlene , Carter Diana , Reid Robert , Stewart Donna , Steinberg Susanne , Judge Rajinder
Published: December 2003

Objective
To determine the effectiveness of fluoxetine in alleviating physical symptoms of premenstrual dysphoric disorder.

Design
Randomised, double‐blind, placebo controlled, parallel study.

Setting
Canadian University based outpatient clinics.

Participants
Four hundred and five subjects, of whom 320 with prospectively determined premenstrual dysphoric disorder were randomised.

Methods
Randomised women were assigned to fluoxetine 20 or 60 mg/day or placebo. Common physical symptoms associated with premenstrual dysphoric disorder including breast tenderness, bloating, and headache were evaluated by visual analog scales and the self‐rated and observer premenstrual tension syndrome scales.

Outcome measures
Luteal phase change from mean baseline scores to mean treatment scores for all scales.

Results
Fluoxetine treatment was statistically superior to placebo, with no significant differences between the two fluoxetine dosages in their effects on physical symptoms.

Conclusion
Daily fluoxetine treatment is superior to placebo in improving the most common physical symptoms associated with premenstrual dysphoric disorder.
Psychosocial characteristics of women and their partners fearing vaginal childbirth
Authors: Saisto Terhi , Salmela‐Aro Katariina , Nurmi Jari‐Erik , Halmesmäki Erja
Published: December 2003

Objectives
To examine the personal characteristics and socio‐economic background of women and their partners fearing vaginal childbirth.

Design
Questionnaire survey by the 30th week of pregnancy.

Setting
Sixteen outpatient maternity centres in the capital area of Finland.

Participants
Two hundred and seventy‐eight women and their partners.

Main
outcome measures Personality traits, socio‐economic factors, life and partnership satisfaction and pregnancy‐ and delivery‐associated anxiety and fear.

Results
The more anxiety, neuroticism, vulnerability, depression, low self‐esteem, dissatisfaction with the partnership, and lack of social support the women reported, the more they showed pregnancy‐related anxiety and fear of vaginal delivery. In multiple regression analyses psychological variables of the woman contributed most to the prediction of pregnancy‐related anxiety (increase in R2=0.20, P<0.001), the strongest predictor being general anxiety (beta = 0.28, P<0.001). Lack of support contributed most to the prediction of severe fear of vaginal delivery (increase in χ2= 13.66, P<0.01), the strongest predictor being dissatisfaction with the partnership (Wald 8.61, P<0.01). Life‐dissatisfaction reported by the partner contributed to pregnancy‐related anxiety and his dissatisfaction with the partnership contributed to the woman's fear of vaginal delivery.

Conclusions
The personalities of a pregnant woman and her partner, and their relationship, influences the woman's attitude to her pregnancy and her forthcoming delivery.
The role of comparative genomic hybridisation in prenatal diagnosis
Authors: Thein Angela , Charles Adrian , Davies Teresa , Newbury‐Ecob Ruth , Soothill Peter
Published: December 2003

The aims of this study were to assess the feasibility of using comparative genomic hybridisation instead of conventional cytogenetics in prenatal diagnosis and to determine the size of DNA loss that can be detected. Using comparative genomic hybridisation, six cases with standard aneuploidies were diagnosed correctly. This technique clearly identified a partial duplication of the long arm of chromosome 1 but was not capable of detecting the associated inversion. A small interstitial deletion on short arm of chromosome 10 also was detected precisely. Although the current comparative genomic hybridisation resolution is similar to the sensitivity of the highest resolution G banding, the latter is not a routine strategy in prenatal diagnosis. Comparative genomic hybridisation can allow full chromosome assessment equal to the highest resolution cytogenetic studies without the need for cell culture.
Changes in the vaginal flora after two percent clindamycin vaginal cream in women at high risk of spontaneous preterm birth
Authors: Vermeulen Gustaaf M. , van Zwet Anton A. , Bruinse Hein W.
Published: December 2003

Objective To analyse alterations in the vaginal flora after 2% clindamycin vaginal cream or placebo administered for the prevention of preterm delivery in high risk women.

Design Observational study during a randomised multicentre double‐blind placebo controlled trial.

Setting Twelve city hospitals in The Netherlands.

Participants One hundred and sixty‐eight women were enrolled. Alterations in the vaginal flora could be analysed in one hundred and twenty‐four women by comparing the Nugent score on entry to the trial and at 31 weeks’ gestation. The Nugent score was classified into normal, intermediate and bacterial vaginosis.

Interventions Two percent clindamycin vaginal cream or placebo cream administered daily for seven days at week 26 of pregnancy.

Main outcome Changes in the vaginal flora at week 31 of pregnancy.

Results The placebo group consisted of 64 women and the clindamycin group of 60 women. At week 31 the vaginal flora was similar to week 26 with placebo cream but changed from normal vaginal flora to intermediate or bacterial vaginosis with 2% clindamycin vaginal cream.

Conclusion Obstetricians should not prescribe 2% clindamycin vaginal cream to pregnant women with normal vaginal flora in order to reduce the incidence of preterm birth, because it has no beneficial effects and is actually harmful. 2% Clindamycin vaginal cream encourages the presence of bacterial vaginosis which is epidemiologically associated with preterm birth.
Growth hormone binding protein in normal and aneuploid pregnancy: a paradoxical decrease in trisomy 18
Authors: Wallace Euan M. , D'Antona Donato , Veveris‐Lowe Tara , Crossley Jennifer A. , Barnard Ross
Published: December 2003

Objective To explore whether abnormalities in growth hormone binding protein (GHBP) may underlie the growth restriction associated with fetal aneuploidy.

Design A retrospective casecontrol study.

Setting Monash Medical Centre, Clayton, Victoria, Australia.

Population Twenty‐one trisomy 18, and 30 trisomy 21 pregnancies, and 170 chromosomally normal pregnancies at 15–18 weeks of gestation representing three to five controls per case matched for source, gestation and duration of storage.

Methods GHBP was measured using a ligand immunofunctional assay

Results In the chromosomally normal pregnancies GHBP levels decreased slightly but significantly across the narrow gestational window studied. Compared with controls, levels of GHBP, expressed as median (95% CI) multiples of the median (MoM), in the trisomy 21 pregnancies were similar, 1.0 (0.92–1.39) MoM and 1.27 (1.04–1.50) MoM, respectively; P=0.061 (Mann‐Whitney U test) but were significantly reduced in the trisomy 18 pregnancies, 0.68 (0.51–0.84) MoM; P=0.0014 (Mann‐Whitney U test).

Conclusions These data suggest that decreased levels of maternal growth hormone binding protein, and by implication growth hormone receptor complement, may underlie the early severe growth restriction that is characteristic of trisomy 18.
Does a second delivery increase the risk of anal incontinence?
Authors: Faltin Daniel L. , Sangalli Michel R. , Roche Bruno , Floris Lucia , Boulvain Michel , Weil Antoine
Published: December 2003

Objective To evaluate the prevalence of anal incontinence and anal sphincter defects after a first vaginal delivery and assess the effect of a second delivery.

Design Prospective cohort study using postal questionnaires assessing incontinence to flatus and stools at three and thirty months postnatally and anal endosonography at three months following delivery.

Setting Recruitment was from the antenatal clinic at the University Hospitals of Geneva, Switzerland.

Population One hundred women with a vaginal delivery of their first child.

Main outcome measures Prevalence of anal incontinence and anal sphincter defects.

Results Anal incontinence was reported by 16/92 (17%) of women at three months after delivery and by 11/77 (14%) at 30 months. At that time, 5/54 (9%) with no further delivery reported incontinence, compared with 6/23 (26%) of those who had had another delivery (RR 2.8, 95% CI 1.0‐8.3). Anal sphincter defects were diagnosed by endosonography in 46/87 (53%) women and were associated with reported incontinence at both three months (RR 1.9; 95% CI 1.4‐2.6) and 30 months (RR 1.9; 95% CI 1.3‐2.8) after delivery. The prevalence of anal incontinence at 30 months was highest (5/13, 39%) among those in whom a sphincter defect was diagnosed by endosonography after their first delivery and with a second delivery.

Conclusion Anal incontinence after childbirth is associated with defects of the anal sphincter diagnosed by endosonography. Subsequent deliveries increase the risk of incontinence, particularly among women with a sphincter defect diagnosed after the first delivery.
Birthweight in liveborn twins: the influence of the umbilical cord insertion and fusion of placentas
Authors: Loos Ruth J. F. , Derom Catherine , Derom Robert , Vlietinck Robert
Published: December 2003

Objective
To assess the relation of umbilical cord insertion and fusion of placentas with birthweight in monozygotic monochorionic, monozygotic dichorionic, and dizygotic twins.

Design
A prospective population study.

Population
4529 liveborn twin pairs whose birthweight was recorded, placentas were examined, and site of umbilical cord insertion was determined after delivery.

Results
Infants with a peripheral cord insertion weighed 150g less (P<0.001) than infants with a central cord insertion. Dizygotic infants had a significantly (P<0.001) higher incidence of central cord insertion (82%) than monozygotic dichorionic (65%) and monozygotic monochorionic (53%) infants. Monozygotic dichorionic infants with fused placentas and a peripheral cord insertion weighed on average 300g less (P<0.01) than infants with separate placentas and a central cord insertion. In dizygotic infants, fusion of the placentas did not affect birthweight.

Conclusions
Umbilical cord insertion is associated with birthweight in all types of twins. Fusion of the placentas only affects the birthweight of monozygotic dichorionic, not that of dizygotic infants. This might be due to the greater proximity of implantation of monozygotic dichorionic twins. Dizygotic twins weighed more than monozygotic twins only when placentas were fused and cord insertion was peripheral. Hence, the difference between the mean birthweights of dizygotic, monozygotic dichorionic, and monozygotic monochorionic infants may originate from the least favourable antenatal situation, namely fused placentas with a peripheral cord insertion, which occurs most frequently in monozygotic twins.
Abnormal Doppler velocimetry and blood flow volume in the middle cerebral artery in very severe intrauterine growth restriction: is the occurrence of reversal of compensatory flow too late?
Authors: Konje Justin C. , Bell Stephen C. , Taylor David J.
Published: December 2003

Objectives
To determine the time course of quantified volumetric flow and pulsatility index changes in the middle cerebral arteries of severe intrauterine growth restricted fetuses with absent or reversed end diastolic flow velocities (AREDFV) on umbilical artery Doppler with a view to defining the threshold for early intervention before the onset of reversal of adaptation.

Setting
Fetal growth clinic of a large UK teaching hospital.

Sample
Seventeen severe intrauterine growth restricted (AC<third centile for gestation and gender) fetuses with abnormal umbilical artery Doppler velocimetry and oligohydramnios (amniotic fluid index <third centile for gestation).

Methods
One to three daily Doppler velocimetry and quantified volume flow of the middle cerebral artery Doppler velocimetry of the umbilical arteries and daily cardiotocography.

Results
Reversal of adaptation occurred in eight fetuses, four of which ended as stillbirths and four as neonatal deaths. In two of these fetuses, this had already occurred before the diagnosis of intrauterine growth restriction. In the others, the onset was rapid and difficult to predict. Volume flow in the middle cerebral arteries decreased in those fetuses exhibiting reversal of adaptation but rose in the nine in which compensatory Doppler indices persisted. The decrease in volume flow occurred before the onset of reversal of adaptation in the pulsatility index. In the fetuses exhibiting reversal of adaptation, the rise in the pulsatility index was consistent over 48 hours compared with the physiological fluctuations in pulsatility index in some fetuses where the rise was only for 24 hours followed by a fall. Quantified volume flow fell in the fetuses before reversal of adaptation set‐in. The umbilical artery Doppler indices fluctuated between absent and reversed end diastolic velocities within the same fetus irrespective of the changes in the middle cerebral artery Doppler indices.

Conclusion
Reversal of adaptation is of sudden onset and is associated with poor prognosis. Predicting its occurrence on Doppler indices is difficult as the changes may be very rapid. However, volume flow changes appear to be slower and of earlier onset than the pulsatility index changes. This may therefore be a more useful tool in predicting imminent reversal of adaptation and therefore early delivery.
Spontaneous contractions of myometrium from humans, non‐human primate and rodents are sensitive to selective oxytocin receptor antagonism in vitro
Authors: Wilson R.J. , Allen M.J. , Nandi M. , Giles H. , Thornton S.
Published: December 2003

Objectives
To determine whether: 1. oxytocin receptor antagonists influence spontaneous contractions of myometrium from humans, non‐human primates and rodents (in vitro), and 2. vasopressin V1a receptor antagonism is important for inhibition of spontaneous contractions in human myometrium.

Design
In vitro pharmacology of spontaneous contractions of myometrium from humans and animals.

Setting
The research laboratories of a university department of obstetrics and gynaecology and a pharmaceutical industry research centre.

Interventions
Samples of human myometrium were obtained at caesarean section. Tissue strips were suspended in organ baths for isometric force recording. Cumulative concentration effect curves to a selective oxytocin receptor antagonist (L‐371,257) and a mixed oxytocin/vasopressin V1a receptor antagonist (atosiban) were obtained. The effect of L‐371,257 was also determined in myometrium from non‐pregnant rats and marmosets.

Main
outcome measures The inhibition of spontaneous myometrial contractions in vitro.

Results
L‐371,257 and atosiban significantly inhibited spontaneous activity of human myometrium in a concentration‐related manner (P<0.05), although the effect was more pronounced with L‐371,257. Spontaneous contractions of myometrium from non‐pregnant rats and marmosets were also inhibited by L‐371,257 (atosiban was not tested).

Conclusions
Spontaneous contractions of myometrium from humans, marmosets and rats are, at least in part, dependent on oxytocin receptor activity, in vitro. L‐371,257 and atosiban may be inverse agonists. Selective non‐peptide oxytocin receptor antagonists may be effective tocolytics.
The selenium status of women with a history of recurrent miscarriage
Authors: Al‐Kunani A.S. , Knight R. , Haswell S.J. , Thompson J.W. , Lindow S.W.
Published: December 2003

Objective
To assess the relationship between selenium levels in human blood and hair, and the risk of recurrent miscarriages.

Design
Case–control study.

Participants
Two groups of non‐pregnant women: 18 women with one or more successful pregnancies and no history of miscarriage (control group); 26 women with a history of recurrent miscarriage (≥ 3) with no subsequent successful pregnancies (study group).

Methods
Samples of venous blood and scalp hair were collected and the selenium content analysed by inductively coupled plasma mass spectrometry.

Results
No significance difference was found between the level of selenium in the blood samples of the women in each group. There was a significant reduction in the mean hair selenium level in the recurrent miscarriage group compared with the control group (0.14μg/g vs 0.34μg/g). Further analysis of the recurrent miscarriage group revealed no relationship between levels of serum or hair selenium with parity. There was a significantly greater proportion of women in the control group who ate cereals, vitamin supplements, and liver or kidney.

Conclusion
There was evidence of selenium deficiency in women with recurrent miscarriages compared with a control group of women with a good reproductive performance. This difference was seen in hair samples but not serum samples and therefore may not represent a simple nutritional deficiency. The importance of selenium deficiency in miscarriage has still not been determined.
Administration of low molecular weight heparin within two hours before caesarean section increases the risk of wound haematoma
Authors: van Wijk F.H. , Wolf H. , Piek J.M.J. , Büller H.R.
Published: December 2003

A retrospective analysis of the relation between time interval from prophylactic administration of low molecular weight heparin (LMWH) to delivery and the occurrence of wound haematoma was performed in all women, who had a caesarean section in 1998. After administration of LMWH within 2 hours of surgery, the percentage of women with a wound haematoma was significantly larger (12%vs 3%). Multivariate regression analysis, including other risk factors for wound haematoma, indicated administration of LMWH within 2 hours prior to delivery as the only statistically significant factor, which influenced the development of wound haematoma (odds ratio = 5.3, 95% CI = 1.2–22.8).
Evaluation of serum creatine kinase in ectopic pregnancy with reference to tubal status and histopathology
Authors: Develioglu Osman H. , Askalli Cenk , Uncu Gurkan , Samli Billur , Daragenli Omer
Published: December 2003

Objective
To study the value of creatine kinase in ectopic pregnancy with reference to tubal histopathology.

Design
Prospective controlled study.

Setting
Academic tertiary‐care institution.

Population
Thirty‐two women with ectopic pregnancy and 20 controls with intrauterine pregnancies.

Methods
Creatine kinase and β‐hCG levels were measured on admission. Ectopic pregnancies were removed at surgery and examined histologically.

Main outcome measures
Tubal localisation and integrity of ectopic pregnancies as judged at surgery and later histologically, and placental growth patterns in unruptured ectopic pregnancies classified as intraluminal, extraluminal or mixed as determined histologically.

Results
Creatine kinase levels were higher in isthmic than ampullary ectopic pregnancies (P= 0.011), and higher in ruptured than in unruptured cases (P= 0.003) and normal pregnancies (P < 0.0001). A creatine kinase value >120iu/L was 65% sensitive and 87% specific in discriminating ruptured from unruptured ectopic pregnancies. Creatine kinase levels were above this cutoff in two of five unruptured ampullary ectopic pregnancies with invasive trophoblastic growth, yet in none of nine cases with intraluminally confined placentation (P= 0.04). Creatine kinase was positively correlated with gestational age in ruptured (P= 0.007), but not in unruptured ectopic pregnancies or normal pregnancies.

Conclusions
Serum creatine kinase may help in discriminating ruptured from unruptured ectopic pregnancies, while it is not useful for the primary diagnosis of ectopic pregnancy. An increase in creatine kinase levels accompanying muscular damage in ectopic pregnancy probably antedates tubal rupture, and may be related to trophoblastic growth patterns.
Maternal use of cannabis and pregnancy outcome
Authors: Fergusson David M. , Horwood L. John , Northstone Kate ,   ALSPAC Study Team
Published: December 2003

Objective
To document the prevalence of cannabis use in a large sample of British women studied during pregnancy, to determine the association between cannabis use and social and lifestyle factors and assess any independent effects on pregnancy outcome.

Design
Self‐completed questionnaire on use of cannabis before and during pregnancy.

Sample
Over 12,000 women expecting singletons at 18 to 20 weeks of gestation who were enrolled in the Avon Longitudinal Study of Pregnancy and Childhood.

Methods
Any association with the use of cannabis before and during pregnancy with pregnancy outcome was examined, taking into account potentially confounding factors including maternal social background and other substance use during pregnancy.

Main outcome measures
Late fetal and perinatal death, special care admission of the newborn infant, birthweight, birth length and head circumference.

Results
Five percent of mothers reported smoking cannabis before and/or during pregnancy; they were younger, of lower parity, better educated and more likely to use alcohol, cigarettes, coffee, tea and hard drugs. Cannabis use during pregnancy was unrelated to risk of perinatal death or need for special care, but, the babies of women who used cannabis at least once per week before and throughout pregnancy were 216g lighter than those of non‐users, had significantly shorter birth lengths and smaller head circumferences. After adjustment for confounding factors, the association between cannabis use and birthweight failed to be statistically significant (P= 0.056) and was clearly non‐linear: the adjusted mean birthweights for babies of women using cannabis at least once per week before and throughout pregnancy were 90g lighter than the offspring of other women. No significant adjusted effects were seen for birth length and head circumference.

Conclusions
The results of this study suggest that the use of cannabis during pregnancy was not associated with increased risk of perinatal mortality or morbidity in this sample. However, frequent and regular use of cannabis throughout pregnancy may be associated with small but statistically detectable decrements in birthweight.
Can ultrasound replace ambulatory urodynamics when investigating women with irritative urinary symptoms?
Authors: Robinson Dudley , Anders Kate , Cardozo Linda , Bidmead John , Toozs‐Hobson Philip , Khullar Vikram
Published: December 2003

Objective
To determine whether transvaginal ultrasound measurement of bladder wall thickness could replace ambulatory urodynamics when investigating women with lower urinary tract dysfunction not explained by conventional laboratory urodynamic studies.

Design
A blinded prospective study.

Setting
Tertiary referral unit in a London teaching hospital.

Population
One hundred and twenty‐eight women referred for ambulatory urodynamics with equivocal laboratory urodynamic findings or whose symptoms were not explained by the laboratory urodynamic findings.

Methods
Transvaginal ultrasound assessment of bladder wall thickness was performed in three planes with an empty bladder prior to ambulatory urodynamics. Mean bladder wall thickness was calculated and the results analysed with respect to the ambulatory urodynamic diagnosis.

Main outcome methods
Mean bladder wall thickness in women with a normal ambulatory study or a diagnosis of detrusor instability, genuine stress incontinence (GSI) or mixed incontinence.

Results
Using a one way analysis of variance (ANOVA) bladder wall thickness was found to be significantly different in all diagnostic groups and this reached significance (P= 0.0001). There was no overlap in the 95% confidence intervals representing a diagnosis of detrusor instability or genuine stress incontinence.

Conclusions
Transvaginal ultrasound assessment of mean bladder wall thickness is a sensitive screening tool, which can detect detrusor instability in those women with equivocal laboratory urodynamics. In women who have no evidence of GSI on laboratory studies, a cutoff of 6.0mm is highly suggestive of detrusor instability. However, in those women with GSI then ambulatory studies probably remain the investigation of choice.
Charts of fetal size: limb bones
Authors: Chitty Lyn S. , Altman Douglas G.
Published: December 2003

Objective
To construct new size charts for all fetal limb bones.

Design
A prospective, cross sectional study.

Setting
Ultrasound department of a large hospital.

Sample
663 fetuses scanned once only for the purpose of the study at gestations between 12 and 42 weeks.

Methods
Centiles were estimated by combining separate regression models fitted to the mean and standard deviation, assuming that the measurements have a normal distribution at each gestational age.

Main outcome measures
Determination of fetal limb lengths from 12 to 42 weeks of gestation.

Results
Size charts for fetal bones (radius, ulna, humerus, tibia, fibula, femur and foot) are presented and compared with previously published data.

Conclusions
We present new size charts for fetal limb bones which take into consideration the increasing variability with gestational age. We have compared these charts with other published data; the differences seen may be largely due to methodological differences. As standards for fetal head and abdominal measurements have been published from the same population, we suggest that the use of the new charts may facilitate prenatal diagnosis of skeletal dysplasias.
Sperm motility in the semen analysis affects the outcome of superovulation intrauterine insemination in the treatment of infertile Asian couples with male factor infertility
Authors: Lee Vincent M.S. , Wong Joycelyn S.Y. , Loh Sheila K.E. , Leong Noel K.Y.
Published: December 2003

Objective
To ascertain the relationship between the initial and unprocessed sperm parameters and pregnancy rates in SOIUI, for Asian couples with male factor infertility

Design
Retrospective study.

Setting
A large government tertiary‐care women's hospital with 15,000 deliveries per year

Population
One thousand four hundred and seventy nine couples undergoing 2846 cycles of SOIUI

Methods
All couples enrolled in the SOIUI programme were analysed, comparing initial sperm parameters and the post‐processed total motile sperm, against pregnancy rates per cycle

Main outcome measures
Pregnancy rates in relation to initial sperm parameters and post‐processed total motile sperm

Results
Ninety‐three percent of the couples had male factor infertility. The average normal forms for these men was 14.7%. Overall pregnancy rate was 12.1% per completed SOIUI cycle. We found a significant drop in pregnancy rates if the percentage of motile sperms in the unprocessed sperm sample fell below 30%. We also found that insemination of at least 1 million motile sperm resulted in a significant increase in pregnancy rates

Conclusions
We recommend SOIUI as an effective treatment of suitable couples with male infertility, before embarking on IVF. However, if the initial percentage of motile sperm fell below 30%, or if after processing, the total motile sperm count was fewer than 1 million, these couples should consider in vitro fertilisation
High incidence of cervical human papillomavirus infection in women during their first sexual relationship
Authors: Collins Stuart , Mazloomzadeh Saeideh , Winter Heather , Blomfield Penny , Bailey Andrew , Young Lawrence S. , Woodman Ciaran B.J.
Published: December 2003

The prevalence of cervical human papillomavirus increases with increasing numbers of sexual partners, leaving the impression that this infection is acquired only as a result of high risk sexual behaviour. Using longitudinal data from 242 women who had only had one sexual partner, we found that the risk of acquiring cervical human papillomavirus infection was 46% (95% CI 28–64) at three years after first intercourse and that the median time from first intercourse to first detection of human papillomavirus was only three months.
A randomised placebo‐controlled trial of vaginal misoprostol for cervical priming before hysteroscopy in postmenopausal women
Authors: Fung T.M. , Lam M.H. , Wong S.F. , Ho L.C.
Published: December 2003

Objective
To investigate the effectiveness of misoprostol given vaginally for cervical priming before hysteroscopy in postmenopausal women.

Design
Double‐blind randomised controlled study.

Setting
Regional hospital, Hong Kong.

Participants
One hundred women with postmenopausal bleeding scheduled for hysteroscopy from October 1998 to September 2001 were randomly assigned to receive either misoprostol or placebo vaginally before the operation.

Main outcome measures
The number of women requiring cervical dilatation, outcome of hysteroscopy and side effects of the medication were assessed.

Results
Forty‐eight women receiving misoprostol and 48 women receiving placebo were compared. The mean degree of endocervical diameter estimated by Hegar's dilator was similar between the treatment group and the control group. A similar number of women in the treatment group and the control group required cervical dilatation. The operative times for both groups were similar. The incidence of side effects was comparable in both groups. The most common side effects for misoprostol were febrile episodes and diarrhoea. There was no cervical tear nor uterine perforation encountered in both groups. The mean duration of hospital stay in both groups were similar. Subanalysis of results were similar in women receiving vaginal medication at least five hours before the operation.

Conclusion
Vaginal misoprostol was not shown to reduce the need for cervical dilatation in postmenopausal women. It cannot convert diagnostic hysteroscopy from a hospital procedure into an office one in postmenopausal women with tight cervical os.
Are some perinatal deaths in immigrant groups linked to suboptimal perinatal care services?
Authors: Essén Birgitta , Bödker Birgit , Sjöberg N.‐O. , Langhoff‐Roos Jens , Greisen Gorm , Gudmundsson Saemundur , Östergren P.‐O.
Published: December 2003

Objective
To test the hypothesis that suboptimal factors in perinatal care services resulting in perinatal deaths were more common among immigrant mothers from the Horn of Africa, when compared with Swedish mothers.

Design
A perinatal audit, comparing cases of perinatal deaths among children of African immigrants residing in Sweden, with a stratified sample of cases among native Swedish women.

Population and setting
Sixty‐three cases of perinatal deaths among immigrant east African women delivered in Swedish hospitals in 1990–1996, and 126 cases of perinatal deaths among native Swedish women. Time of death and type of hospital were stratified.

Main outcome measures
Suboptimal factors in perinatal care services, categorised as maternal, medical care and communication.

Results
The rate of suboptimal factors likely to result in potentially avoidable perinatal death was significantly higher among African immigrants. In the group of antenatal deaths, the odds ratio (OR) was 6.2 (95% CI 1.9–20); the OR for intrapartal deaths was 13 (95% CI 1.1–166); and the OR for neonatal deaths was 18 (95% CI 3.3–100), when compared with Swedish mothers. The most common factors were delay in seeking health care, mothers refusing caesarean sections, insufficient surveillance of intrauterine growth restriction (IUGR), inadequate medication, misinterpretation of cardiotocography (CTG) and interpersonal miscommunication.

Conclusions
Suboptimal factors in perinatal care likely to result in perinatal death were significantly more common among east African than native Swedish mothers, affording insight into socio‐cultural differences in pregnancy strategies, but also the suboptimal performance of certain health care routines in the Swedish perinatal care system.
Epidemiology of pelvic organ prolapse in rural Gambia, West Africa
Authors: Scherf Caroline , Morison Linda , Fiander Alison , Ekpo Gloria , Walraven Gijs
Published: December 2003

Objectives
To investigate the prevalence of pelvic organ prolapse in rural Gambia.

Design
Community‐based reproductive health survey.

Population
1348 women residing in 20 villages in rural Gambia.

Methods
Health questionnaire and standard gynaecological examination to detect symptoms and signs of pelvic organ prolapse and other reproductive diseases. Association between prolapse, socio‐demographic data and other morbidities was examined.

Main outcome measures
Presence and degree of pelvic organ prolapse.

Results
Out of 1067 women consenting to speculum examination 488 (46%) were found to have some degree of prolapse. In 152 women (14%) the prolapse was severe enough to warrant surgical intervention. After adjustment for confounders the likelihood of pelvic organ prolapse increased with parity and age and was higher in women of the Wolof tribe, pregnant women, those with insufficient perineum, and moderately and severely anaemic women. Only 13% of women with moderate or severe prolapse reported symptoms on direct questioning.

Conclusions
Pelvic organ prolapse has a high prevalence in this first community‐based study of prolapse in West Africa. Many of those affected did not complain about their problem, thus increasing the large, silent burden of reproductive morbidity in this population. Parity was confirmed to be the strongest risk factor followed by age and anaemia. Ethnic origin was a previously unknown risk factor suggesting possible genetic factors in the pathogenesis of prolapse.