bluuebunny/crossref_metadata_2025 huggingface dataset:
Secondary colposuspension: results of a prospective study from a tertiary referral centre
Authors: Thakar Ranee , Stanton Stuart , Prodigalidad Lisa , den Boon Jan
Published: December 2003

Objective
To evaluate the results of secondary colposuspension in women with recurrent urinary stress incontinence.

Design
Prospective cross sectional observational study.

Setting
Tertiary referral urogynaecology unit.

Population
Fifty‐six women with recurrent stress incontinence.

Main outcome measures
Determine prognostic factors that may affect the outcome of surgery, long term subjective and objective success rates and identify complications of secondary colposuspension.

Results
The mean age was 54 years (range 34–83) and the median parity was 3 (range 1–5). The median length of follow up was four years (range 1.01–7.07). Forty‐two (75%) women had genuine stress incontinence and 14 (25%) had mixed incontinence on subtracted cystometry. The subjective cure rate was 71% and the objective cure rate was 80% and, as per Kaplan–Meier life time analysis, 65% had not failed surgery five years after the operation. The complication rate was low. However at follow up, eight women had required a posterior colporrhaphy for rectocele and three had a sacrocolpopexy for vault prolapse. Another eight women required further treatment for stress incontinence (seven urethral bulking agents and one tension‐free vaginal tape). There was no correlation of the outcome to age, past hysterectomy, number of previous incontinence procedures, parity, body mass index or blood loss at operation.

Conclusion
Colposuspension after failed continence surgery has a good outcome with a low complication rate, but many still require further surgery for prolapse.
Evaluation of distance interactive learning in obstetrics and gynaecology (DIALOG)
Authors: Jha Vikram , Duffy Sean , McAleer Sean
Published: December 2003

Objectives
1. To determine whether DIALOG, a multimedia interactive CD‐ROM designed for postgraduate education, was achieving its educational aim; 2. to assess DIALOG as a computer‐assisted learning tool by evaluating its design, presentation, usability, effective use of multimedia and interactions and availability; 3. to measure end user satisfaction and the impact of DIALOG in achieving an improvement in clinical practice as an index of educational value.

Methods
Postal questionnaires were sent out to 150 users of DIALOG. A combination of the CIPP model, the CRISIS criteria and Kirkpatrick's model was used to design the evaluation questionnaire.

Results
There was a 61.3% response rate to the questionnaire. Overall, 86.9% of respondents were happy with the use of DIALOG, 60.8% had a positive comment on the concept of distance learning using DIALOG and computer‐assisted learning, 50% agreed that it had helped sharpen their analytic skills and 45.6% reported an improvement in clinical practice after using DIALOG.

Conclusion
This assessment proved to be a useful formative assessment of DIALOG. It has provided feedback on the availability and use of DIALOG and has highlighted the potential areas of improvement for future issues.
Computerised intrapartum diagnosis of fetal hypoxia based on fetal heart rate monitoring and fetal pulse oximetry recordings utilising wavelet analysis and neural networks
Authors: Salamalekis E. , Thomopoulos P. , Giannaris D. , Salloum I. , Vasios G. , Prentza A. , Koutsouris D.
Published: December 2003

ObjectiveTo develop a computerised system that will assist the early diagnosis of fetal hypoxia and to investigate the relationship between the fetal heart rate variability and the fetal pulse oximetry recordings.

DesignRetrospective off‐line analysis of cardiotocogram and FSpO2recordings.

SettingThe Maternity Unit of the 2nd Department of Obstetrics and Gynaecology, Aretaieion Hospital, University of Athens.

PopulationSixty‐one women of more than 37 weeks of gestation were monitored throughout labour.

MethodsMultiresolution wavelet analysis was applied in each 10‐minute period of second stage of labour focussing on long term variability changes in different frequency ranges and statistical analysis was performed in the associated 10‐minute FSpO2recordings. Self‐organising map neural network was used to categorise the different 10‐minute fetal heart rate patterns and the associated 10‐minute FSpO2recordings.

Main outcome measuresUmbilical artery pH of ≤7.20 and Apgar score at 5 minutes of ≤7 formed the inclusion criteria of the risk group.

ResultsAfter usingk‐means clustering algorithm, the two‐dimensional output layer of the self‐organising map neural network was divided into three distinct clusters. All the cases that mapped in cluster 3 belonged in the risk group except one. The sensitivity of the system was 83.3% and the specificity 97.9% for the detection of risk group cases.

ConclusionsA relationship between the fetal heart rate variability in different frequency ranges and the time in which FSpO2is less than 30% was noticed. Fetal pulse oximetry seems to be an important additional source of information. Computerised analysis of the fetal heart rate monitoring and pulse oximetry recordings is a promising technique in objective intrapartum diagnosis of fetal hypoxia. Further evaluation of this technique is mandatory to evaluate its efficacy and reliability in interpreting fetal heart rate recordings.
Enhancement of the perception of systemic pain in women with vulvar vestibulitis
Authors: Granot Michal , Friedman Michael , Yarnitsky David , Zimmer Etan Z.
Published: December 2003

Objective
The aim of this study was to determine whether the characteristics of systemic pain perception and anxiety differ between women with vulvar vestibulitis and healthy women.

Design
Case control study.

Setting
Tertiary care hospital.

Population
Forty‐four women with vulvar vestibulitis and 41 healthy women participated in the study.

Methods
First, the women's state and trait anxiety was evaluated. Thereafter, heat pain stimuli were applied to the women's forearm and the pain and unpleasantness thresholds, as well as magnitude estimation of perceived intensity and unpleasantness of suprathreshold stimuli, were assessed. Finally, blood pressure was measured before, during and after a heat stimulus of 46°C.

Main outcome measures
Pain threshold and suprathreshold, and anxiety levels of women with vulvar vestibulitis.

Results
Women with vulvar vestibulitis had a higher anxiety state (40.0 [12.8] vs 34.1 [10.8], P= 0.044), a higher anxiety trait (42.1 [10.2] vs 35.6 [7.5], P= 0.005), a lower pain threshold (42.2°C [2.5] vs 43.6°C [1.9], P= 0.006), a lower unpleasantness threshold (40.2°C [2.9] vs 41.7°C [2.3], P= 0.023), a higher magnitude estimation of suprathreshold pain at 47°C (88.3 [14.9] vs 70.8 [14.9], P= 0.0001) and at 48°C (96.1 [7.3] vs 84.6 [14.8], P < 0.0001), a higher scoring of tonic pain perception (65.2 [17.3] vs 53.0 [18.6], P= 0.006) and a higher increase in systolic blood pressure during tonic pain stimuli (4.6 [9.6] vs−2.1 [8.7] mmHg, P= 0.005).

Conclusion
Women with vulvar vestibulitis have an enhanced systemic pain perception and are more anxious.
Microvascular changes in the peripheral microcirculation of women with chronic pelvic pain due to congestion
Authors: Foong L.C. , Gamble J. , Sutherland I.A. , Beard R.W.
Published: December 2003

Objective
Pelvic venous congestion is a common finding in women with chronic pelvic pain. While the pathophysiology of this condition is poorly understood, there are clear indications that it involves vascular dysfunction. The present studies sought abnormalities in microvascular function in these patients.

Design
Prospective longitudinal study.

Setting
A teaching hospital tertiary referral.

Population
Eighteen women with pelvic congestion and 13 nomal women.

Methods
Parameters of microcirculatory function were measured in the calves of women using venous congestion plethysmography during the midfollicular and midluteal phases of the menstrual cycle. The women with pelvic congestion were studied again after treatment for the condition.

Main outcome measures
Isovolumetric venous pressure, microvascular filtration capacity and limb blood flow.

Results
Of the measured parameters of microvascular function, only isovolumetric venous pressure (Pvi) was significantly higher in women with congestion when compared to the controls during the same phase of the cycle. There were no menstrual cycle related differences in any of the other measured parameters in either patients or controls. Following successful treatment for the condition, values of Pvi in women with pelvic congestion were significantly reduced, achieving a level similar to that observed in the controls.

Conclusion
The observed changes in Pvi suggest that this parameter is intimately associated with the pathophysiology of pelvic congestion. The increase in Pvi, without alterations in other measured microvascular parameters, may be attributable to systemic increases in postcapillary resistance secondary to neutrophil activation. These findings support the notion of systemic microvascular dysfunction in these women.
Sublingual compared with oral misoprostol in term labour induction: a randomised controlled trial
Authors: Shetty Ashalatha , Mackie Lisa , Danielian Peter , Rice Pat , Templeton Allan
Published: December 2003

Objective
To compare the efficacy and patient acceptability of 50 μg of sublingual misoprostol with 100 μg of oral misoprostol in the induction of labour at term.

Design
Non‐blinded randomised comparative trial.

Setting
Tertiary level UK Hospital.

Sample
Two hundred and fifty women at term with indications for labour induction.

Methods
Fifty micrograms of sublingual misoprostol or 100 μg of oral misoprostol was administered every four hours after random allocation, to a maximum of five doses.

Main outcome measures
Number of patients delivering vaginally within 24 hours of the induction, mode of delivery, neonatal outcomes and patient acceptability.

Results
There was no significant difference in the number of women delivering vaginally within 24 hours of the induction in the sublingual group as compared with the oral group (62.8%vs 59%, RR 1.1, 95% CI 0.6–2.1), or in the mean induction to delivery time (21.8 vs 24.1 h, mean difference 2.3 h 95% CI −2.2 to +6.7). There was no difference in the uterine hyperstimulation rates (1.6% in both groups), operative delivery rates or neonatal outcomes. In the sublingual group, 92.6% found the induction acceptable with 15.8% finding the tablets with an unpleasant taste, while in the oral group it was 96.9% and 4%, respectively. More patients in the oral group thought that they would consider the same method of induction again as compared with the sublingual group (58.6%vs 40%, RR 1.4, 95% CI 1.04–1.9).

Conclusion
Fifty micrograms of sublingual misoprostol every four hours has the same efficacy and safety profile as compared with 100 μg orally, but the oral route might be preferred by women.
A comparison of outpatient hysteroscopy with saline infusion hysterosonography
Authors: Rogerson Lynne , Bates Jane , Weston Mike , Duffy Sean
Published: December 2003

Objectives
To establish the accuracy of saline infusion hysterosonography in diagnosing uterine pathology when compared with outpatient hysteroscopy.

Design
Prospective, parallel, blinded comparative study.

Setting
Outpatient hysteroscopy clinic in a large university teaching hospital.

Population
All women referred for outpatient hysteroscopy in a 15‐month period.

Interventions
Women underwent saline infusion hysterosonography followed by flexible hysteroscopy. The ultrasonographer was blinded to the hysteroscopy result and the gynaecologist was blinded to the saline infusion hysterosonography result.

Main outcome measures
The relative success rates and pain scores for each procedure. The validity of saline infusion hysterosonography as a diagnostic test.

Results
One hundred and seventeen women entered the study; 70 women were premenopausal and 47 postmenopausal. In 27 women, one or both procedures could not be performed. Saline infusion hysterosonography failed in 20 women, on one occasion hysteroscopy failed and both investigations failed in six women. Ninety cases remained for direct comparison, with 78 cases of agreement on the uterine findings in both investigations. Twelve cases disagreed; in one case, an adhesion was seen, two cases with polyps and five with fibroids seen on ultrasound but not seen on hysteroscopy. There were four cases where polyps were identified on hysteroscopy but not on saline infusion hysterosonography. The median pain scores were 1.6 for saline infusion hysterosonography and 3.2 for hysteroscopy.

Conclusions
Both saline infusion hysterosonography and hysteroscopy are well tolerated by women. Saline infusion hysterosonography has a high failure rate but has a lower pain score than hysteroscopy.
Screening for aneuploidy in the first trimester by assessment of blood flow in the ductus venosus
Authors: Mavrides Eleni , Sairam Shanthi , Hollis Brian , Thilaganathan Baskaran
Published: December 2003

Objective
To assess the role of ductus venosus Doppler assessment in screening for fetal aneuploidy in pregnancies at 11–14 weeks of gestation.

Design
Prospective observational study.

Setting
In a tertiary referral fetal medicine unit.

Population
Two hundred fifty‐six consecutive pregnancies between 11 and 14 weeks of gestation referred to our unit.

Methods
Nuchal translucency was measured and colour Doppler imaging was used to assess normal (forward) or abnormal (absence/reversed) ductus venosus flow during atrial contraction.

Main outcome measures
Fetal karyotype, structural abnormalities and pregnancy outcomes.

Results
The nuchal translucency measurement was ≥95th centile in 90 (35.2%) pregnancies, and 123 (48.0%) had a nuchal translucency‐related risk of ≥1:300. There were 46 chromosomally abnormal pregnancies and six euploid pregnancies with adverse outcome. The prevalence of abnormal ductus venosus Doppler waveforms in normal pregnancies was 4.49% (95% CI 1.76–8.76%). The sensitivities of abnormal nuchal translucency measurement alone, ductus venosus velocimetry alone or nuchal translucency and ductus venosus combined for Down's Syndrome were 80.4%, 58.7% and 93.5%, respectively. The likelihood ratios for aneuploidy with abnormal nuchal translucency measurement alone, ductus venosus velocimetry alone or nuchal translucency and ductus venosus combined were 3.33, 9.83 and 3.48, respectively.

Conclusion
There is clear association between abnormal flow in the ductus venosus and fetal aneuploidy. The use of ductus venosus velocimetry in combination with nuchal translucency is better than either test alone, since it increases the sensitivity in the detection of Down's Syndrome to 94% and decreases the likelihood ratio of a negative test to 0.08.
Randomised controlled trial of reflexology for menopausal symptoms
Authors: Williamson Jan , White Adrian , Hart Anna , Ernst Edzard
Published: December 2003

Objective
Clinical experience suggests that reflexology may have beneficial effects on the symptoms occurring in menopausal women, particularly psychological symptoms. This study aims to examine that effect rigorously.

Design
Randomised controlled trial with two parallel arms.

Setting
School of Complementary Health in Exeter, Devon, UK.

Sample
Seventy‐six women, aged between 45 and 60 years, reporting menopausal symptoms.

Methods
Women were randomised to receive nine sessions of either reflexology or nonspecific foot massage (control) by four qualified reflexologists given over a period of 19 weeks.

Main outcome measures
The Women's Health Questionnaire (WHQ), the primary measures being the subscores for anxiety and depression. Severity (visual analogue scale, VAS) and frequency of flushes and night sweats.

Results
Mean (SD) scores for anxiety fell from 0.43 (0.29) to 0.22 (0.25) in the reflexology group and from 0.37 (0.27) to 0.27 (0.29) in the control group over the course of treatment. Mean (SD) scores for depression fell from 0.37 (0.25) to 0.20(0.24) in the reflexology group and from 0.36 (0.23) to 0.20 (0.21) in the control (foot massage) group over the same period. For both scores there was strong evidence of a time effect (P < 0.001) but no evidence of a time–group interaction (P > 0.2). Similar changes were found for severity of hot flushes and night sweats. In the control group, 14/37 believed they had not received true reflexology.

Conclusion
Foot reflexology was not shown to be more effective than non‐specific foot massage in the treatment of psychological symptoms occurring during the menopause.
A randomised, double‐blind trial comparing raloxifene HCl and continuous combined hormone replacement therapy in postmenopausal women: effects on compliance and quality of life
Authors: Voss Simon , Quail Deborah , Dawson Alison , Bäckström Tjorbörn , Aguas Fernanda , Erenus Mithat , The Hok Sien , Bonnar John , De Geyter Christian , Hunter Myra , Nickelsen Thomas ,   for the Euralox Investigators Group
Published: December 2003

Objective
To compare continuous combined hormone replacement therapy (ccHRT) and raloxifene with respect to compliance and quality of life, which were predefined secondary endpoints of a large, prospective study designed to investigate the uterine effects of both treatments.

Design
Double‐blind, randomised controlled trial of six‐month duration.

Setting
One hundred and twenty‐nine gynaecology hospital departments, clinics or practices specialised in women's healthcare, located in Europe, South Africa and Israel.

Population
Healthy postmenopausal women (n= 1008).

Main outcome measures
Changes in quality of life using the Women's Health Questionnaire (WHQ) and compliance using a compliance questionnaire and pill count. Adverse event and early discontinuation rates and satisfaction with treatment using a visual analogue scale (VAS).

Results
Women taking raloxifene reported greater satisfaction with their treatment as assessed on the VAS (P= 0.004),and a lower proportion, as compared with ccHRT, reported being worried by the treatment (9.6%vs 20.2%, P < 0.01). Women taking ccHRT reported greater deterioration in scores from the WHQ for depressed mood and menstrual symptoms than those taking raloxifene (P < 0.01). For memory, vasomotor symptoms and sexual behaviour, the ccHRT group reported significantly greater mean improvements (P < 0.05). Over half (58.8%) of those taking raloxifene noticed no effect, 37.7% felt better and 3.4% felt worse as measured using the compliance questionnaire. Fifty percent of the women taking ccHRT felt better, 37.8% noticed no effect but over 10% felt worse. More women on raloxifene (94.6%) than on ccHRT (85.9%) reported that they were taking their double‐blinded medication regularly (P < 0.01).

Conclusions
A lower rate of adverse event‐related discontinuations, the lack of negative effects on quality of life and a smaller proportion of women being worried by the drug treatment were associated with higher treatment satisfaction and better compliance in postmenopausal women taking ccHRT or raloxifene.
In vitro study of tocolytic effect of rofecoxib, a specific cyclo‐oxygenase 2 inhibitor. Comparison and combination with other tocolytic agents
Authors: Doret Muriel , Mellier Georges , Benchaib Mehdi , Piacenza Jean Michel , Gharib Claude , Pasquier Jean Charles
Published: December 2003

Objective
The aim of this work was to study and compare the tocolytic effects of rofecoxib with indomethacin, ritodrine, nicardipine and atosiban. We also studied the combination of rofecoxib with each agent.

Design
In vitro animal experimental study.

Setting
Non‐selective cyclo‐oxygenase (COX) inhibitors have potent tocolytic effect. However, they also have major fetal side effects that seem to be due to COX‐1 inhibition. A specific COX‐2 inhibitor could be a potent tocolytic agent with less fetal toxicity.

Sample
Myometrial strips from pregnant Wistar rats at 18 days of gestation.

Methods
Isometric tension was recorded from 112 pregnant rat myometrial strips in vitro. Strips were exposed to increase molar concentration of one drug or combination.

Main outcome measures
Contractile activity was assessed by calculating the area under the curve, to obtain a dose–response curve of each drug. EC50 and mean maximal inhibiting concentration were compared using ANOVA. Chemical interaction was defined for each combination.

Results
The in vitro tocolytic effect of rofecoxib was demonstrated. Contractile activity stopped at a concentration of 1.6 × 10−7 M. Effective concentrations were 1000 times less than for indomethacin and significantly lower than ritodrine and atosiban. Rofecoxib combined with ritodrine had a synergic effect. Other combinations only had an additive effect.

Conclusions
Rofecoxib has a potent tocolytic effect in vitro. The high specificity and low effective concentrations of COX‐2 may result in low fetal toxicity. Animal fetal side effects need to be explored.
Low molecular weight heparin for the treatment of venous thromboembolism in pregnancy: a case series
Authors: Rodie V.A. , Thomson A.J. , Stewart F.M. , Quinn A.J. , Walker I.D. , Greer I.A.
Published: December 2003

Objectives
To assess the use of low molecular weight heparin for the treatment of venous thromboembolism in pregnancy.

Design
A prospective observational study.

Setting
The maternity units in two university teaching hospitals and one district general teaching hospital.

Population
Thirty‐six consecutive women presenting with objectively diagnosed venous thromboembolism during pregnancy and the immediate puerperium.

Methods
Treatment with the low molecular weight heparin enoxaparin, approximately 1 mg/kg sc, twice daily, based on early pregnancy weight.

Main outcome measures
Peak anti‐Xa activity (three hours post‐injection), alterations in treatment, side effects and the use of regional anaesthesia.

Results
In 33 women, the initial dose of enoxaparin provided satisfactory peak anti‐Xa activity (median 0.8 u/mL, range 0.44–1.0 u/mL) and was continued. Three women required dose reduction since peak anti‐Xa activities were above the therapeutic range (1.2, 1.2 and 1.1 u/mL). No woman developed thrombocytopaenia, haemorrhagic complication or further thromboembolic episode. Two women developed allergic skin reactions on enoxaparin and were changed to tinzaparin. Fifteen women had regional anaesthesia for delivery, with a reduced dose of enoxaparin (40 mg once daily), all without complication.

Conclusions
Enoxaparin is a safe and effective treatment for venous thromboembolism during pregnancy and confers a major advantage over unfractionated heparin through its simplified regimen of administration.
Corticosteroids and fetal vasculature: effects of hydrocortisone, dexamethasone and betamethasone on human umbilical artery
Authors: Potter S.M. , Dennedy M.C. , Morrison J.J.
Published: December 2003

Objective
To investigate the direct effects of corticosteroids on human umbilical artery resistance, in vitro.

Design
Prospective laboratory study.

Setting
University teaching hospital.

Samples and methods
Umbilical artery samples were obtained following normal, term deliveries (n= 50) and dissected rings were suspended for isometric recording under physiological conditions. The effects of hydrocortisone (10−9–10−4 M), dexamethasone (10−9–10−4 M) and betamethasone (10−9–10−4 M) on umbilical artery resistance were measured in vitro.

Main outcome measures
Changes in umbilical artery resistance, in vitro.

Results
Hydrocortisone (n= 12) exerted a vasodilatory effect on human umbilical artery at all concentrations studied compared with vehicle control experiments (n= 12) (P < 0.0001). The mean net relaxant effect of hydrocortisone ranged from 11.77% (10−9 M) to 57.01% (10−4). Both exogenous compounds, dexamethasone (n= 12) and betamethasone (n= 12), similarly exerted a significant relaxant effect on human umbilical artery tone (P < 0.05–0.01), compared with vehicle control experiments (n= 12). The mean net relaxant effect of dexamethasone ranged from 14.43% (10−9 M) to 38.12% (10−4) and that of betamethasone ranged from 6.02% (10−9 M) to 42.30% (10−4), in a cumulatively increasing fashion. There was a non‐significant trend towards a greater vasodilatory effect of dexamethasone than betamethasone at lower bath concentrations studied.

Conclusion
Corticosteroids exert a direct and potent vasodilatory effect on human umbilical artery resistance in vitro, thus providing an explanation for the previously unexplained vascular effects associated with antenatal administration of corticosteroids.
A study of hormone replacement therapy in postmenopausal women with ischaemic heart disease: the Papworth HRT Atherosclerosis Study
Authors: Clarke S.C. , Kelleher J. , Lloyd‐Jones H. , Slack M. , Schofield P.M.
Published: December 2003

Objective
To assess the possible benefit of hormone replacement therapy (HRT) in the secondary prevention of ischaemic heart disease.

Design
A prospective randomised trial of transdermal HRT in women with definite ischaemic heart disease.

Setting
A regional cardiac unit.

Population
Postmenopausal women with angiographically ischaemic heart disease.

Methods
A total of 255 postmenopausal women with angiographically proven ischaemic heart disease were recruited and randomised; 134 were treated with transdermal HRT and 121 acted as controls. The women were seen at six monthly intervals. The primary end points, which were determined by a blinded assessor, were admission to hospital with unstable angina, proven myocardial infarction or cardiac death. A total of 53 (40%) patients withdrew from the HRT group and eight (7%) from the control group. The mean duration of follow up was 30.8 months.

Main outcome measures
Admission to hospital with unstable angina, proven myocardial infarction or cardiac death.

Results
During follow up, there were 53 primary end‐point events in the HRT group and 37 in the control group. Using an intention‐to‐treat analysis, the primary end‐point event rate was 15.4 events per 100 patient years for the HRT group compared with 11.9 for the control group (event rate ratio 1.29 (95% CI 0.84–1.95, P= 0.24)). Using a per‐protocol analysis, there was an event rate ratio of 1.49 (0.93–2.36, P= 0.11) for the HRT arm compared with the control arm. Particularly during the first two years of follow up, the HRT group had a higher, but not statistically significant, event rate than the control group.

Conclusion
Our findings suggest that transdermal HRT should not be commenced for the purpose of secondary prevention in postmenopausal women with angiographically proven ischaemic heart disease.
The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria
Authors: Okonofua F.E. , Larsen U. , Oronsaye F. , Snow R.C. , Slanger T.E.
Published: December 2003

Objective
To examine the association between female genital cutting and frequency of sexual and gynaecological symptoms among a cohort of cut versus uncut women in Edo State of Nigeria.

Design
Cross sectional study.

Setting
Women attending family planning and antenatal clinics at three hospitals in Edo State, South–south Nigeria.

Population
1836 healthy premenopausal women.

Methods
The sample included 1836 women. Information about type of female genital cutting was based on medical exams while a structured questionnaire was used to elicit information on the women's socio‐demographic characteristics, their ages of first menstruation (menarche), first intercourse, marriage and pregnancy, sexual history and experiences of symptoms of reproductive tract infections. Associations between female genital cutting and these correlates of sexual and gynaecologic morbidity were analysed using univariate and multivariate logistic regression and Cox models.

Main outcome measures
Frequency of self‐reported orgasm achieved during sexual intercourse and symptoms of reproductive tract infections.

Results
Forty‐five percent were circumcised and 71% had type 1, while 24% had type 2 female genital cutting. No significant differences between cut and uncut women were observed in the frequency of reports of sexual intercourse in the preceding week or month, the frequency of reports of early arousal during intercourse and the proportions reporting experience of orgasm during intercourse. There was also no difference between cut and uncut women in their reported ages of menarche, first intercourse or first marriage in the multivariate models controlling for the effects of socio‐economic factors. In contrast, cut women were 1.25 times more likely to get pregnant at a given age than uncut women. Uncut women were significantly more likely to report that the clitoris is the most sexually sensitive part of their body (OR = 0.35, 95% CI = 0.26–0.47), while cut women were more likely to report that their breasts are their most sexually sensitive body parts (OR = 1.91; 95% CI = 1.51–2.42). Cut women were significantly more likely than uncut women to report having lower abdominal pain (OR = 1.54, 95% CI = 1.11–2.14), yellow bad‐smelling vaginal discharge (OR = 2.81, 95% CI = 1.54–5.09), white vaginal discharge (OR = 1.65, 95% CI = 1.09–2.49) and genital ulcers (OR = 4.38, 95% CI = 1.13–17.00).

Conclusion
Female genital cutting in this group of women did not attenuate sexual feelings. However, female genital cutting may predispose women to adverse sexuality outcomes including early pregnancy and reproductive tract infections. Therefore, female genital cutting cannot be justified by arguments that suggest that it reduces sexual activity in women and prevents adverse outcomes of sexuality.
Persistent infection with human papillomavirus following the successful treatment of high grade cervical intraepithelial neoplasia
Authors: Cruickshank Margaret E. , Sharp Linda , Chambers George , Smart Louise , Murray Graeme
Published: December 2003

In a nested case–control study, we identified women who were successfully treated for CIN 3. Cases had biopsy proven recurrence, whilst controls remained disease free for at least five years. One hundred and seventy‐two women were β‐globin positive at diagnostic biopsy and at six‐month post‐treatment smear (90 controls and 82 cases). Thirty‐nine cases (47.6%) were HPV16/18 positive at biopsy or follow up smear and 14 (17.1%) of 82 were positive at both. Of the controls, 37 (41.1%) were HPV positive at biopsy or smear with 3 (3.3%) positive at both. The unadjusted OR associated with being HPV positive at both points compared to being HPV negative at both was 8.0 (95% CI 2.13–30.37). The persistence of HPV 16/18 infection following the confirmed eradication of CIN is a highly significant risk factor for recurrence.
A new method to determine the feto‐placental volume based on dilution of fetal haemoglobin and an estimation of plasma fluid loss after intrauterine intravascular transfusion
Authors: Hoogeveen M. , Meerman R.H. , Pasman S. , Egberts J.
Published: December 2003

Objectives
(1) To calculate the feto‐placental volume (FPV), using the haematocrit (Ht) values and the percentages of fetal haemoglobin (HbF), before and after red blood cell transfusion. (2) To estimate the transfusion‐induced loss of plasma fluid.

Design
Retrospective analysis of data of 42 anaemic fetuses at the first transfusion [gestational age (GA) 19–36 weeks].

Setting
Department of Obstetrics, Leiden University Medical Centre, The Netherlands.

Sample
Fifteen hydropic and 27 non‐hydropic fetuses.

Methods
Donor blood volume (Vdonor) and Ht (Htdonor), fetal pre‐ and post‐transfusion Ht values (Htinitial, Htfinal) and percentages of HbF (HbFinitial and HbFfinal) were used to calculate the FPV. The total red cell volume after transfusion (RCVfinal) and Htfinal were used to estimate the plasma fluid loss.

Main outcome measures
Feto‐placental blood volume and loss of plasma fluid.

Results
The equations that use Htfinal over‐estimate the FPV when the formula does not account for the difference between donor and post‐transfusion Ht (FPVHt= 21.36 * GA − 390; r= 0.89). FPV is under‐estimated (FPVHt= 9.90 * GA − 172; r= 0.84) when the blood volume increases with a volume less than the added donor blood volume. The calculation of FPV, using HbF percentages and the initial fetal RCV, is independent of volume changes (FPVHbF= 15.10 * GA − 279; r= 0.85). Comparing RCVfinal and Htfinal values showed that 31.1 ± 14.5% of the transfused volume was lost. Results of the hydropic fetuses did not differ from those of the non‐hydropic fetuses.

Conclusions
FPV values based on Ht values are less reliable than those based on RCV and HbF findings. When, for practical reasons, Ht values have to be used, we propose an adapted equation for the calculation of the necessary volume of donor blood: Vdonor= FPVHbF* (Htfinal− Htinitial) / (Htdonor− 0.70 * Htfinal).
Effectiveness of pain relief during perineal suturing
Authors: Sanders Julia , Campbell Rona , Peters Tim J.
Published: December 2003

The amount of pain women experience during perineal suturing is previously unreported, although anecdotal evidence suggests that the procedure can be associated with considerable pain. Of 68 women who participated in this descriptive study, 16.5% reported ‘distressing’, ‘horrible’ or ‘excruciating’ pain while receiving perineal sutures. Contrary to expectations, pain scores did not diminish as the time between suturing and pain reporting increased. Regional analgesia was associated with lower reported pain. The findings of this small study suggest that further detailed investigation of this aspect of care is urgently required.
Infertility, blood mercury concentrations and dietary seafood consumption: a case–control study
Authors: Choy Christine M.Y. , Lam Christopher W.K. , Cheung Lorena T.F. , Briton‐Jones Christine M. , Cheung L.P. , Haines Christopher J.
Published: December 2003

Objective
To compare blood mercury concentrations of infertile couples with those of fertile couples in Hong Kong, and to examine the relationship between blood mercury concentrations and seafood consumption.

Design
Case–control study.

Setting
In vitro fertilisation (IVF) Unit and Antenatal Unit of a university teaching hospital.

Sample
One hundred fifty‐seven infertile couples attending IVF treatment and 26 fertile couples attending antenatal care without known occupational exposure to mercury.

Methods
Mercury concentrations in whole blood were measured by cold vapour atomic absorption spectrophotometry. A dietitian recorded the quantity of seafood consumption among infertile couples via a food‐frequency questionnaire. Blood mercury concentrations and quantity of seafood consumption were compared between infertile and fertile couples.

Main outcome measures
Whole blood mercury concentrations, quantity of seafood consumption.

Results
Infertile couples had higher blood mercury concentrations than fertile couples. ‘Infertile males with abnormal semen’ and ‘infertile females with unexplained infertility’ also had higher blood mercury concentrations than their fertile counterparts. Blood mercury concentrations were positively correlated with quantity of seafood consumption. Infertile subjects with elevated blood mercury concentrations consumed a larger amount of seafood.

Conclusion
Higher blood mercury concentration is associated with male and female infertility. Higher seafood consumption is associated with elevated blood mercury concentrations in our infertile population.
A double‐blind, randomised, placebo controlled study on the influence of carbohydrate solution intake during labour
Authors: Scheepers Hubertina C.J. , Thans Marion C.J. , de Jong Pieter A. , Essed Gerard G.M. , Le Cessie Saskia , Kanhai Humphrey H.H.
Published: December 2003

Objective
Although there has been much debate on whether women should be allowed to eat and drink during labour, little scientific data are available on the effects of caloric intake on the course of labour.

Design
Double‐blind, randomised, placebo controlled.

Setting
Leyenburg Hospital, The Hague, The Netherlands.

Population
Two hundred and one consecutive nulliparous women, pregnant of a single fetus in cephalic presentation.

Methods
All women were included in early labour (2cm–4cm of cervical dilatation) and were allowed to drink at will.

Main outcome measures
The duration of labour, the need for augmentation and pain medication and the incidence of abdominal and vaginal instrumental deliveries.

Results
Drinking of carbohydrate solutions was well tolerated, but did not show any beneficial effects regarding labour outcome when compared with the control group. In the carbohydrate group, a higher caesarean section rate was observed (RR 2.9, 95% CI 1.29–6.54).

Conclusions
Women in the carbohydrate group had worse labour outcome. It is unclear whether a statistical coincidence, a negative effect of the carbohydrate intake or an incorrect carbohydrate intake strategy is responsible for these results. Further studies are necessary before any definite conclusion can be drawn.
Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility: a randomised controlled trial of antenatal pelvic floor exercises
Authors: Reilly E.T.C. , Freeman R.M. , Waterfield M.R. , Waterfield A.E. , Steggles P. , Pedlar F.
Published: December 2003

Objective
To test whether supervised pelvic floor exercises antenatally will reduce the incidence of postpartum stress incontinence in at‐risk primigravidae with bladder neck mobility, ultrasonically proven.

Design
Single blind, randomised controlled trial.

Setting
Antenatal clinic in a UK NHS Trust Hospital.

Sample
Two hundred and sixty‐eight primigravidae attending an antenatal clinic at approximately 20 weeks of gestation with bladder neck mobility, on standardised valsalva, of 5mm or more linear movement. The median age was 28, ranging from 16 to 47 years.

Intervention
Patients randomised to supervised pelvic floor exercises (n= 139) attended a physiotherapist at monthly intervals from 20 weeks until delivery. The exercises comprised three repetitions of eight contractions each held for six seconds, with two minutes rest between repetitions. These were repeated twice daily. At 34 weeks of gestation the number of contractions per repetition was increased to 12. Both the untreated control group and the study group received verbal advice on pelvic floor exercises from their midwives antenatally.

Main outcome measures
Subjective reporting of stress incontinence at three months postpartum. Pelvic floor strength, using perineometry, and bladder neck mobility measured by perineal ultrasound.

Results
Of the 268 women enrolled, information on the main outcome variable was available for 110 in the control group and 120 in the study group. Fewer women in the supervised pelvic floor exercise group reported postpartum stress incontinence, 19.2% compared with 32.7% in the control group (RR 0.59 [0.37–0.92]). There was no change in bladder neck mobility and no difference in pelvic floor strength between groups after exercise, although all those developing postpartum stress incontinence had significantly poorer perineometry scores than those who were continent.

Conclusions
The findings suggest that antenatal supervised pelvic floor exercises are effective in reducing the risk of postpartum stress incontinence in primigravidae with bladder neck mobility.
Use of mifepristone as an example of conflicting and misleading medical information on the internet
Authors: Mashiach Roy , Seidman Guy I. , Seidman Daniel S.
Published: December 2003

Objective
To evaluate the accuracy and reliability of medical information available on the internet regarding medical abortion using mifepristone, with special emphasis on the possible bias of the internet websites providing the information.

Methods
A systematic search of the internet identified patient‐oriented websites distributing medical information about mifepristone. The sites were divided into three groups according to their views of the drug (i.e. in favour, against or indifferent).

Results
Forty sites met the criteria for inclusion in our analysis: 15 sites (37.5%) were in favour of using mifepristone, 16 (40%) were against and nine (22.5%) were indifferent. Incorrect information, found in 12 sites (30%), was significantly more common (P < 0.006) in websites that opposed the use of mifepristone than in websites that favoured it, 56.3% and 6.7%, respectively. Websites against the use of mifepristone provided significantly more (P < 0.05) graphic descriptions (31.3%vs 0%) and significantly fewer (P < 0.03) links (18.8%vs 60%), than the sites in favour of the use of mifepristone.

Conclusions
We found that information provided on the internet regarding the use of mifepristone was significantly less complete and accurate and included more graphic descriptions when the site opposed medical termination of pregnancy. These findings reinforce the concerns regarding the reliability and credibility of medical information on the internet and the need for quality control.
Insertion of an intrauterine contraceptive device after induced or spontaneous abortion: a review of the evidence
Authors: Stanwood Nancy L. , Grimes David A. , Schulz Kenneth F.
Published: December 2003

Objective Assess the safety and efficacy of intrauterine contraceptive device (IUCD) insertion immediately after induced or spontaneous abortion.

Design Systematic search for randomised trials that had at least one treatment arm that involved IUCD insertion immediately after an induced or spontaneous miscarriage using Medline, Popline, EMBASE, and review articles supplemented by correspondence with investigators.

Population Women of any age or gravidity who had an IUCD inserted immediately after evacuation for spontaneous or induced abortion.

Methods Articles were abstracted and the raw data from tables were analysed with RevMan 3.1 software. We focused on Tietze‐Potter gross life table probabilities with denominators of person‐time of exposure.

Main outcome measures Rates of perforation, expulsion, pelvic inflammatory disease, contraceptive failure, and method continuation.

Results Complication rates for immediate post‐abortal IUCD insertion were low. Perforation was rare with a rate of approximately one per 1000 insertions. One year gross cumulative expulsion rates ranged from 1.8% to 12.6%, pregnancy rates from 0.6% to 2.1%, and continuation rates from 54% to 90%. The net discontinuation rate due to pelvic inflammatory disease was low, ranging from 0.0 to 0.8 per 100 women at one year. Increasing gestational age at insertion was associated with increased expulsion rates.

Conclusions Post‐abortal IUCD insertion is safe and effective. The risks of perforation, expulsion, pelvic inflammatory disease and contraceptive failure were low and similar to those reported for interval insertion. Second trimester gestational age is associated with an increased risk of expulsion. Immediate insertion may have a higher expulsion rate than delayed insertion. However, these risks may be outweighed by the benefit of immediate contraception.
The relationship between cervical dilatation at initial presentation in labour and subsequent intervention
Authors: Holmes Paul , Oppenheimer Lawrence W. , Wu Wen Shi
Published: December 2003

Objective To examine the relationship between the cervical dilatation at which women present in labour and the subsequent likelihood of caesarean section.

Design Retrospective cohort study.

Setting University teaching hospital.

Population 3220 women met the entry criteria from 14,050 deliveries between January 1995 and December 1999.

Methods Women meeting the following criteria were identified: those in spontaneous labour with a singleton pregnancy and a cephalic presentation at 37–42 weeks of gestation; all women delivering within 36 hours of first presentation were included. Women who had spontaneous rupture of the membranes before first attendance were excluded.

Main outcome measures The primary outcome was the rate of caesarean section. Secondary outcomes were operative vaginal delivery, fetal weight, cord pH, five minute Apgar score, length of labour, labour augmentation with oxytocin and epidural analgesia.

Results The risk of caesarean section decreased with increasing cervical dilatation at presentation. This was true for nulliparous (n=1168) and parous women (n=2052). The caesarean section rate of nulliparous women presenting at 0–3cm (n=812) was 10.3%, compared with 4.2% for those presenting at 4cm–10cm (n=356), and the mean duration of labour before presentation was 2.0 hours versus 4.5 hours, respectively (P=0.0001). For parous women the caesarean section rates were 5.7% and 1.3%, respectively (P=0.0001). There were significantly greater frequencies of use of oxytocin and epidural analgesia by women presenting earlier in labour. The caesarean section rate of 185 nulliparae (15.8%) who were initially allowed home was no different from those admitted immediately (9.2%vs 8.2%, P=0.67). Similarly, 196 (9.5%) of multiparae went home and had a caesarean section rate of 3.6%, compared with 3.1% if admitted immediately (P=0.76).

Conclusions Women who present to hospital at 0–3cm spend less time in labour before presentation and are more likely to have obstetric intervention than those presenting in more advanced labour. Outcomes were similar whether or not the woman was initially allowed home.
Pregnancy and the erythrocyte sedimentation rate
Authors: van den Broek N.R. , Letsky E.A.
Published: December 2003

Objectives To determine the range of erythrocyte sedimentation rate values obtained in healthy pregnant women. To examine the effect of gestational age and haemoglobin concentration on erythrocyte sedimentation rate.

Setting Queen Charlotte's Hospital, London, UK.

Design Cross sectional descriptive study.

Population Healthy pregnant women attending for routine outpatient antenatal visits at Queen Charlotte's Hospital in London.

Methods Erythrocyte sedimentation rate was determined by the Westergren method, haemoglobin concentration by automated cell counter and gestational age by ultrasonography. The median and 95% reference range was determined for erythrocyte sedimentation rate values obtained. Linear regression analysis was used to determine the influence of haemoglobin concentration and gestational age on erythrocyte sedimentation rate.

Results For 1019 women examined, the range of erythrocyte sedimentation rate values obtained was 4–112 mm/h. Gestational age and haemoglobin concentration both significantly influenced erythrocyte sedimentation rate. (P<0.0001). For non‐anaemic women the 95% reference range rose from 18–48 mm/h in the first half of pregnancy to 30–70 mm/h in the second half of pregnancy. For anaemic women the corresponding reference ranges were 21–62 mm/h and 40–95 mm/h, respectively.

Conclusion For the correct interpretation of erythrocyte sedimentation rate values obtained during pregnancy gestational age and haemoglobin concentration must be taken into account.
Seasonal variation in the occurrence of pre‐eclampsia
Authors: Magnus Per , Eskild Anne
Published: December 2003

Objective To obtain evidence for seasonal variability in pre‐eclampsia using the assumption that environmental factors may have a role in the causal mechanisms.

Design Cross sectional population‐based study.

Population All 1,869,388 deliveries in Norway in the years 1967 to 1998.

Method For each month, the percentage of births complicated by pre‐eclampsia was calculated. The relative risks of pre‐eclampsia by month of delivery were estimated as odds ratios using the month with lowest risk as the reference category.

Results Mothers of children born in August had the lowest risk of pre‐eclampsia, and the risk was highest in the winter months (for December adjusted OR: 1.26, 95% CI 1.20–1.31). This pattern was independent of parity, maternal age, year and place of living.

Conclusion The finding may provide a new clue for understanding the causes of pre‐eclampsia. Environmental factors that show a similar seasonal variation should be investigated as possible causes.