bluuebunny/crossref_metadata_2025 huggingface dataset:
Postpartum haemorrhage in Zimbabwe: a risk factor analysis
Authors: Tsu Vivien D.
Published: August 2005

Objectives
To identify risk factors associated with postpartum haemorrhage (PPH) in order to improve the effectiveness of antenatal screening.

Design
A population‐based case control study.

Setting
Harare, Zimbabwe.

Subjects
Two groups of women, one group consisting of those with postpartum haemorrhage after a normal vaginal delivery and the other of women with normal unassisted vaginal delivery without PPH.

Method
Data abstracted from the medical records; relative risks were estimated by multivariate logistic regression.

Results
Low parity, advanced maternal age, and antenatal hospitalisation were among the strongest risk factors, with more modest associations for history of poor maternal or perinatal outcomes and borderline anaemia at the time of booking. No association with grand multiparity was found.

Conclusions
These findings confirm the importance of previously recognised factors such as low parity, poor obstetric history, anaemia, and prolonged labour, but call into question the significance of grand multiparity. Previously undocumented factors such as maternal age greater than 35 years and occiput posterior head position emerged as predictors worthy of further investigation.
Polycystic ovaries and levels of gonadotrophins and androgens in recurrent miscarriage: prospective study in 50 women
Authors: Tulppala Maija , Stenman Ulf‐Håkan , Cacciatore Bruno , Ylikorkala Olavi
Published: August 2005

Objective
To compare the serum levels of gonadotrophins and androgens, as well as ovarian morphology, in 50 women with a history of recurrent miscarriage and in 20 healthy controls.

Design
Prospective study on women with a history of at least three consecutive miscarriages in Department I and II of Obstetrics and Gynecology, University Central Hospital of Helsinki, Finland.

Results
The recurrent miscarriage group as a whole exhibited gonadotrophin and androgen levels comparable to those seen in the controls. Ultrasound examination revealed polycystic ovaries (PCO) in 22 patients (44%) and in four control women (20%, P=0.06) but no differences in the levels of gonadotrophins and androgens emerged between the patients with or without PCO. During follow up, 33 (66%) women with a history of recurrent miscarriage who became pregnant; 16 miscarried again (48.5%), whereas 17 (51.5%) succeeded. The presence of PCO did not predict miscarriage, but the patients who miscarried had higher levels of total testosterone, free testosterone and dehydroepiandrosterone sulphate than RSA women with continuing pregnancies.

Conclusions
PCO and hyperandrogenism may be associated with repeated miscarriage.
Longitudinal assessment of amniotic fluid index
Authors: Nwosu E. C. , Welch C. R. , Manasse P. R. , Walkinshaw S. A.
Published: August 2005

Objective
To derive a longitudinal gestational reference range for amniotic fluid index and to compare it with the established cross‐sectional reference range.

Design
Longitudinal prospective study.

Setting
Liverpool Maternity Hospital and Mill Road Maternity Hospital, both teaching hospitals in central Liverpool.

Subjects
One hundred and fifteen pregnant women, in whom the expected date by the last menstrual period and ultrasound scan at 18 to 19 weeks were in agreement by seven days, were recruited. They were divided into two groups and scanned at four weekly intervals as follows: Group A: scanned at 20, 24, 28, 32, 36, 40; and Group B: scanned at 22, 26, 30, 34, 38, 42.

Results
Amniotic fluid index varies with gestation, rising from early gestation to peak at 30 weeks and then falling from 36 to 42 weeks. Comparison of our reference range with that of Moore and Cayle (1990) shows obvious differences at the lower limit.

Conclusion
We have established a normal longitudinal reference range for the amniotic fluid index. Our ranges, derived from longitudinal data, would seem a more appropriate reference than the established reference ranges derived from cross‐sectional data. In particular, the differences at the lower limits may have considerable clinical implication in the use of amniotic fluid index in the prediction of fetal compromise.
Antiphospholipid antibodies in pregnancy: prevalence and clinical associations
Authors: Pattison N. S. , Chamley L. W. , McKay E. J. , Liggins G. C. , Butler W. S.
Published: August 2005

Objective
To determine prevalence, clinical association and predictive power of antiphospholipid antibodies in pregnancy.

Design
To test for the presence of anticardiolipin antibodies and lupus anticoagulant in order to confirm prevalence data which imply that each antibody has the same clinical significance. A detailed obstetric history and the outcome measures were obtained from each patient in the study.

Setting
National Women's Hospital, Auckland, New Zealand.

Subjects
Nine hundred and thirty‐three consecutively booked pregnant women.

Main outcome measures
Prevalence of auto‐antibodies; perinatal morbidity and mortality; incidence of preeclampsia, growth retardation and fetal distress.

Results
Nine women (1.0%) had anticardiolipin antibodies, 11 (1.2%) had lupus anticoagulant and two had both antibodies. The fetal mortality rate for women with antibodies was 167/1000. Pre‐eclampsia occurred significantly more often in women with auto‐antibodies.

Conclusion
The presence of antiphospholipid antibodies is frequently associated with adverse pregnancy outcome (9/18 pregnancies). High titre anticardiolipin antibodies carry a poor prognosis.
Urine production rate is related to behavioural states in the near term human fetus
Authors: Oosterhof Henk , vd Stege Jolande G. , Lander Monique , Prechtl Heinz F. R. , Aarnoudse Jan G.
Published: August 2005

Objective
To investigate the relation between hourly fetal urine production rate (HFUPR) and behavioural states 1F and 2F (corresponding to quiet and active sleep, respectively) in normal near term fetuses.

Design
An observational study.

Setting
A clinic for antenatal care at a university hospital.

Subjects
Nineteen healthy pregnant women examined at 37 to 40 weeks of gestation.

Main outcome measures
Fetal behavioural states (1F and 2F) were assessed by means of fetal heart rate patterns (FHR A and FHR B). Using real time ultrasonography, HFUPR (ml/h) was estimated during behavioural states 1F and 2F.

Results
During behavioural state 1F, HFUPR was significantly higher than during state 2F (P<0.01). HFUPR falls by 47% from 50.8 ± 24.4 ml/h in state 1F to 25.7 ± 15.0 ml/h in state 2F.

Conclusions
During active sleep (state 2F) hourly fetal urine production rate is considerably reduced as compared to quiet sleep (state 1F).
The interrelationship of eclampsia, HELLP syndrome, and prematurity: cofactors for significant maternal and perinatal risk
Authors: Martin James N. , Perry Kenneth G. , Miles Johnny F. , Blake Pamela G. , Magann Everett F. , Roberts William E. , Martin Rick W.
Published: August 2005

Objective
To determine if there are differences between mothers and fetuses in eclamptic pregnancies with or without concurrent HELLP syndrome.

Design
Retrospective review.

Setting
A single tertiary perinatal centre, the University of Mississippi Medical Center.

Subjects
All eclamptic pregnancies treated during a 141 month period from 1980 until the end of 1991.

Methods
Pregnancies were grouped according to the presence or absence of HELLP syndrome subclassified as class 1 = platelet nadir ≤50 000/μl, class 2 = platelet nadir >50 000 to ≤100 000/μl, and class 3 = platelet nadir >100 000 to ≤150 000/μl.

Results
Among 49 782 live births, there were 117 women with eclampsia prior to delivery (incidence 1:425), 62 of which had HELLP syndrome. The group with HELLP syndrome were delivered significantly earlier (32.1 vs 36.4 weeks), and had lower birthweights (1821 vs 2550 grams) and higher perinatal mortality (113 vs 18:100). They were also transfused more frequently (65%vs 35%), and suffered greater overall serious maternal morbidity and mortality.

Conclusion
Eclampsia is more likely to be associated with the HELLP syndrome at early gestations. Although eclamptic patients are already at risk, the presence of HELLP syndrome accentuates the risk for adverse maternal‐perinatal outcome.
Abnormal cervical cytology following large loop excision of the transformation zone: a case controlled study
Authors: Shafi M. I. , Dunn J. A. , Buxton E. J. , Finn C. B. , Jordan J. A. , Luesley D. M.
Published: August 2005

Objectives
To determine factors that may predict cytological outcome at 6 months following large loop excision of transformation zone (LLETZ) for cervical intra epithelial neoplasia (CIN) and to investigate the outcome in women with continuing cytological abnormality.

Design
Case controlled retrospective study.

Setting
Dudley Road Hospital, Birmingham and Midland Hospital for Women.

Subjects
Fifty‐eight women with abnormal follow up cytology and a control group of 116 women.

Main outcome measures
The relation between pretreatment and treatment factors and cytological outcome, and the relation between cytology and histology in women who had biopsies for persistent adnormal cytology.

Results
Univariate and stepwise logistic regression analysis showed that the number of sectors of atypical transformation zone (lesion size) and the excision margin status of the large loop excision specimen are of prognostic importance for the prediction of cytological abnormality at the 6 month follow up visit. Sixteen women have undergone further cervical biopsy. Of the five cases of persistent CIN, four had cytological changes showing moderate or severe dyskaryosis. Of the 11 women with koilocytosis or normal histology, 10 had mild dyskaryosis or borderline changes on their follow up cytology.

Conclusion
Lesion size and excision margin status are important correlates of follow up cytology when treating patients for CIN with LLETZ. All women with abnormal cervical cytology at follow up should undergo colposcopic assessment. Excision biopsy is indicated if follow up cytology shows moderate or severe dyskaryosis, especially if still present 12 months after treatment.
Adverse effects on sperm movement characteristics in women with minimal and mild endometriosis
Authors: Curtis P. , Lindsay P. , Jackson A. E. , Shaw R. W.
Published: August 2005

Objective
To test the effect of peritoneal fluid from infertile women with minimal or mild endometriosis on sperm movement characteristics in comparison with fertile and infertile women with no endometriosis.

Design
A prospective observer‐blind trial.

Setting
Academic infertility department.

Subjects
57 women undergoing diagnostic laparoscopy or laparoscopic sterilisation.

Main outcome measures
Changes in sperm movement characteristics in semen samples provided during routine infertility investigation or from sperm donors. Computer assisted semen analysis (CASA) performed using a Celltrack‐S system.

Results
Significant reductions in linearity (P <0.05), amplitude of lateral head displacement (P <0.01), straight line velocity (P <0.01), and curvilinear velocity (P <0.01) (but not percentage motility) were observed.

Conclusions
Peritoneal fluid from women with minimal or mild endometriosis adversely effects sperm movement characteristics in comparison to fertile women.
Cardiovascular autonomic reflexes in mid‐pregnancy
Authors: Ekholm E. M. K. , Piha S. J. , Antila K. J. , Erkkola R. U.
Published: August 2005

Objective
To study the physiological responses to noninvasive cardiovascular autonomic function tests in normal pregnancy.

Design
Cardiovascular autonomic responses in 60 women at 22 to 29 weeks gestation and 62 nonpregnant women were investigated using the Valsalva manoeuvre as well as orthostatic, quiet breathing, deep breathing, and isometric handgrip tests.

Results
Compared with nonpregnant women, those who were pregnant showed significantly lower heart rate variability during normal breathing and a blunted tachycardic reaction to blowing during the Valsalva manoeuvre. The vagally controlled biphasic heart rate response to standing was also attenuated in the pregnant group.

Conclusions
The cardiovascular responses were blunted in mid‐pregnancy indicating a decrease in parasympathetic cardiovascular control.
A national survey to assess current use of computerised information systems in obstetrics
Authors: Yoong A. , Das S. , Carroll S. , Chard T.
Published: August 2005

Objective
To ascertain the number and type of obstetric computer systems (OCS) in Great Britain, and to ascertain user satisfaction with these systems.

Design
A postal questionnaire was circulated to every consultant obstetrician in Great Britain at the beginning of 1992.

Main outcome measures
Information was sought on the hardware, software and uses of obstetric computer systems. Satisfaction with, benefits and problems of the system were also assessed.

Results
There was an 87.5% response rate. Of the 264 units questioned, 100 units reported that they had a computer system. Sixty‐five units used terminals connected to a mainframe or minicomputer and 17 used stand‐alone personal computers (PCs). Local area networks (LANs) were used in 19 units and wide area network (WANs) in 22 units. Software varied from commercial turnkey systems to in‐house systems. The quoted annual running cost ranged from £50 to £48 000. Most units were satisfied with their system. Problems included slow operating times, unreliability, user unfriendliness, deficiencies in training and inadequate customer support services.

Conclusions
Obstetric computer systems are now coming into widespread use. Despite problems, the use of such systems is likely to increase. This survey establishes a database for those units who are considering acquiring or changing their computer system for the purpose of audit or research.
The effect of induced abortion on subsequent fertility
Authors: Frank Peter , Mcnamee Roseanne , Hannaford Philip C. , Kay Clifford R. , Hirsch Sybil
Published: August 2005

ObjectiveTo investigate the effect of induced abortion on subsequent fertility.

Design1. Prospective cohort study of women who had an unplanned pregnancy at recruitment. 2. Retrospective study of women who had a planned pregnancy at recruitment.

SettingJoint Royal College of General Practitioners/Royal College of Obstetricians and Gynaecologists study based in general practice in England, Scotland and Wales, between 1976 and 1987.

Subjects1. Prospective study: Four hundred and thirty‐three women with a recruitment unplanned pregnancy ending in induced abortion (abortion group) and 1035 women with a recruitment unplanned pregnancy which ended naturally (nonabortion group). All subsequently had a planned pregnancy, or were known to be trying to conceive at some point during the follow‐up

2. Retrospective study: Nine thousand two hundred and ninety‐nine women who presented at recruitment with a planned pregnancy.

Main outcome measureThe women's estimated length of planning time, expressed as a fertility rate ratio.

ResultsInduced abortion was not related to future fertility. In the prospective study, the fertility rate ratio (FRR) of the abortion group relative to the nonabortion group was 0.94 (95% CI0.83 to 1.07,P= 0.37). This result was supported by the retrospective study, which again showed no important difference between the two groups.

ConclusionInduced abortion does not appear to have an important effect on future fertility.
Structural characteristics of term human fetal membranes: a novel zone of extreme morphological alteration within the rupture site
Authors: Malak T. M. , Bell S. C.
Published: August 2005

Objective
To determine the structural characteristics of the rupture site of term fetal membranes (amniochorion and decidua) that rupture spontaneously after the onset of labour.

Design
Fourteen term fetal membranes were examined immediately after delivery at the light microscope level. Multiple samples were taken along the whole rupture site and along an axis between this site and placental edge. Morphometric analysis of the thickness of the constituent layers of the fetal membranes was performed.

Setting
Leicester Royal Infirmary Maternity Hospital.

Results
A restricted zone of extreme altered morphology, characterised by marked swelling and disruption of the connective tissue, thinning of the trophoblast layer and thinning or absence of decidua, was identified in the rupture site of all patients. Morphometric analysis of the thickness of membrane layers showed that these changes and the ratio between the thickness of the connective tissue layers and that of the trophoblast and decidua (termed fetal membrane morphometric index) were significant between the zone of extreme altered morphology and the rest of the membranes.

Conclusions
The morphological features of the zone of extreme altered morphology suggests that it represents an area of structural weakness of the membranes. Since this zone did not include the whole length of the rupture site, it is likely that it was present before membrane rupture and was generated during pregnancy. We hypothesise that the zone of extreme altered morphology represents the site of initial rupture after which the tear is transmitted through the membranes to produce the rupture site. It is possible that if these changes become more extreme, then prelabour membrane rupture may occur. Further characterisation of this zone may help to understand the mechanism of its genesis and its role in predisposing the fetal membranes to rupture.
Assessment of maternal mortality in Tanzania
Authors: Walraven G. E. L. , Mkanje R. J. B. , van Roosmalen J. , van Dongen P. W. J. , Dolmans W. M. V.
Published: August 2005

Objective
To assess maternal mortality.

Design
Prospective community‐based survey, a sisterhood method survey and hospital data.

Setting
The study was performed in communities in a rural area in Northwestern Tanzania and the local district hospital.

Results
Four hundred and forty‐seven pregnant women in the community survey were followed up as far as six weeks after delivery; there were 2865 respondents in the sisterhood survey; the hospital study involved 7526 deliveries. Maternal morality ratios derived from the prospective community‐based survey, the sisterhood method survey and hospital data analysis were 241, 297, and 845 per 100000 live births, respectively.

Conclusions
Hospital data tend to overestimate maternal mortality in these communities. The sisterhood method is easier and more convenient than a prospective community‐based study.
Circulating levels of placental protein 14 in ectopic pregnancy
Authors: Stabile I. , Olajide F. , Chard T. , Grudzinskas J. G.
Published: August 2005

Objective
To determine circulating levels of placental protein 14 (PP14) in complications of early pregnancy.

Design
Biochemical monitoring of women presenting with vaginal bleeding and/or abdominal pain.

Setting
An emergency gynaecological ultrasound clinic in a London teaching hospital.

Subjects
Venous blood samples were obtained from 67 women with normal pregnancy (n= 9), ectopic pregnancy (n= 26) and failed intrauterine pregnancy (n= 32). This group included anembryonic pregnancy (n= 18), missed miscarriage (n= 2), spontaneous miscarriage of a previously demonstrated live fetus (n= 6), incomplete miscarriage (n= 4), complete miscarriage (n= 1) and molar pregnancy (n= 1).

Main outcome measures
Serum PP14 levels in the group of women with a failed intrauterine pregnancy in relation to the normal range for PP14.

Results
Eighty‐one percent of women who miscarried spontaneously had normal serum PP14 levels; 81% of women with ectopic pregnancy had depressed (< 5th centile) serum PP14 levels.

Conclusion
Measurements of PP14 may be useful in distinguishing spontaneous miscarriage from ectopic pregnancy, but not in the management of threatened miscarriage.
Early abortion induction by a combination of mifepristone and oral misoprostol: a comparison between two dose regimens of misoprostol and their effect on blood pressure
Authors: El‐Refaey Hazem , Templeton Allan
Published: August 2005

Objectives
1. To investigate the efficacy of 800 μg misoprostol (a PGE1 analogue) when administered to women pretreated with mifepristone for early pregnancy termination. 2. To establish means of minimising gastrointestinal side effects by comparing two different misoprostol regimens. The impact of these regimens on blood pressure was investigated in a subgroup of patients.

Design
A randomised study of 150 women of 56 days gestation, or less, allocated to receive oral misoprostol either in a single dose of 800 μg or as two doses of 400 μg administered sequentially 2 h apart; in each case misoprostol was administered 36 to 48 h after receiving mifepristone 200 mg orally.

Main outcomes
Complete abortion rates, the frequency and severity (patients' perception) of gastrointestinal side effects, and blood pressure changes in response to prostaglandin administration.

Results
The overall success rate was 93%. Seventy‐one (95%) women who received a single dose of misoprostol and sixty‐nine (92%) who received the sequential dose aborted completely. There were two ongoing pregnancies in the first group (2.5%) and three (4%) in the second. The overall ongoing pregnancy rate was 3%. The incidence of diarrhoea was significantly lower for women receiving the sequential dose, and no significant differences were found in the incidence of the other gastrointestinal side effects. The only noted significant change in blood pressure was in diastolic pressure 4 h after the administration of the higher dose of prostaglandin, but this was slight.

Conclusions
The combination of mifepristone and oral misoprostol provides an alternative method to inducing abortion of pregnancies of up to eight weeks gestation. Patients receiving the single dose of 800 μg were more troubled by diarrhoea than those on the sequential regimen. The ongoing pregnancy rate was higher than previously reported with vaginal or parenteral administration of prostaglandin.
Relation between frequency of uterine contractions and human fetal cerebral oxygen saturation studied during labour by near infrared spectroscopy
Authors: Peebles D. M. , Spencer J. A. D. , Edwards A. D. , Wyatt J. S. , Reynolds E. O. R. , Cope M. , Delpy D. T.
Published: August 2005

Objective
To investigate the effect of the frequency of uterine contractions on fetal cerebral oxygenation, using near infrared spectroscopy.

Design
An observational study relating changes in the fetal cerebral concentrations of oxyhaemoglobin and deoxyhaemoglobin, measured from the start of one contraction to that of the next, to the time interval between contraction peaks observed by external tocography.

Setting
A teaching hospital obstetric and neonatal unit.

Subjects
Ten term fetuses during labour.

Results
Changes in cerebral oxyhaemoglobin concentration were positively, and in deoxyhaemoglobin negatively, correlated with the time interval between contractions (P < 0.001). A mean contraction interval of 2.3 min was found below which the concentration of oxyhaemoglobin usually fell and that of deoxyhaemoglobin rose, indicating a fall in cerebral haemoglobin saturation. Conversely, longer contraction intervals were associated with findings indicative of a rise in cerebral haemoglobin saturation.

Conclusion
Short contraction intervals (< 2.3 min) were associated with a decrease, and longer contraction intervals with an increase in fetal cerebral oxygen saturation. Contractions occurring repeatedly at intervals less than 2.3 min are likely to result in progressive cerebral desaturation.
Cigarette smoking and histological outcome in wom with mildly dyskaryotic cervical smears
Authors: Luesley David , Blomfield Penelope , Dunn Janet , Shafi Mahmood , Chenoy Rashna , Buxton John
Published: August 2005

Objective
To determine which patient related variables, available at the point of referral, predict the presence of high grade intraepithelial neoplasia when the smear result is mild dyskaryosis with or without co‐existent koilocytosis.

Design
Multivariate analysis of prospective programme trial.

Setting
Academic Department Colposcopy clinics at Dudley Road Hospital, Birmingham, UK.

Subjects
One hundred and sixty‐seven women, whose worst ever cervical smear was mild dyskaryosis with or without koilocytosis, referred to colposcopy clinics. All the women had complete data sets, as determined by the format of an ongoing programme, and all were treated by diathermy loop excision of the cervical transformation zone.

Main outcome measures
Age, parity, contraceptive practice, smoking habit, duration of abnormal cytology and the grade of histology in the excised transformation zone.

Results
Forty‐seven out of 78 (60%) smokers, compared with 18 out of 73 (25%) nonsmokers, had high grade disease. The other variables considered in the analysis were not significant or very weakly associated with histological grade when analysed in a univariate analysis. Stepwise logistic regression identified cigarette smoking as a powerful independent predictor of high grade disease.

Conclusion
These data suggest a strong association between smoking and high grade intraepithelial neoplasia in a population of women whose worst ever smear report was mild dyskaryosis. Smoking is a variable that could be built into models to facilitate referral for colposcopic assessment.
The effects of maternal vascular pressure on the dimensions of the placental capillaries
Authors: Karimu A. L. , Burton G. J.
Published: August 2005

Objective
The study sought stereological evidence for the sluice flow phenomenon in the human term placenta.

Design
Two series of experiments were conducted on Caesarian delivered placentae. In both, two fetal arteries were cannulated and perfused. In the first series, five placentae were perfusion‐fixed under arterial pressures of 40 mmHg and 60 mmHg, and an external pressure of 10 mmHg in the intervillous space. In the second series, five placentae were perfusion‐fixed at arterial pressures of 70 mmHg and 90 mmHg with an external pressure of 30 mmHg. Stereological estimates relating to the size of the capillaries and the thickness of the villous membrane were then made.

Results
In each series, as the arterial pressure rose, there was an increase in the volume fraction and surface area of the fetal capillaries, and a concomittant decrease in the mean thickness of the villous membrane. These changes were negated as the external pressure rose, indicating the importance of the pressure differential between the capillary lumen and the intervillous space in determining the dimensions of the fetal capillaries.

Conclusions
The study demonstrated that placental capillaries are elastic and hence deformable. If a sufficiently high pressure is generated in the intervillous space, they may therefore be compressed. This may explain the increase in umbilical vascular resistance demonstrated by doppler studies in pregnant women scanned in the supine position. In this situation the venous drainage from the intervillous space is believed to be impeded by the gravid uterus compressing the inferior vena cava.
Neonatal platelet reactivity and serum thromboxane B2production in whole blood: the effect of maternal low dose aspirin
Authors: Louden K. A. , Pipkin F. Broughton , Heptinstall S. , Fox S. C. , Tuohy P. , O'Callaghan C. , Mitchell J. R. A. , Symonds E. M.
Published: August 2005

Objectives
Concern has been expressed about possible neonatal side effects after the use of maternal anti‐platelet agents in pregnancy, particularly low dose aspirin treatment. We have studied neonatal platelet behaviour using whole blood techniques, and assessed the neonatal effect of the maternal ingestion of 60 mg aspirin daily.

Design
Cross sectional and randomised, double‐blind, placebo‐controlled.

Setting
University hospital.

Subject
1. Eight normal women, studied before conception, and their infants. 2. Twenty‐four infants whose mothers had been randomised to receive either 60 mg aspirin daily, or placebo, in double‐blind fashion.

Methods
The Clay Adams Ultra Flo 100 whole blood single platelet counter was employed to measure platelet aggregation in response to various agonists. The platelet release reaction was also measured in whole blood, and serum thromboxane B2 (TxB2) production was measured by radio‐immunoassay. Umbilical cord blood samples were obtained at delivery.

Results
1. Neonatal platelet aggregation induced by adrenaline, ADP and platelet activating factor was reduced in comparison with their mothers (P < 0.01), whereas the neonatal platelet release reaction was reduced when stimulated by collagen and U46619 (a thromboxane mimetic) (P < 0.01). Serum TxB2 production was similar in mothers and babies. 2. Neonatal platelet aggregation, release reaction and serum TxB2 production were not significantly reduced in infants exposed to maternal aspirin in comparison with those neonates exposed to maternal placebo. This is in contrast to the effect on maternal platelets.

Conclusions
Although only a small number of patients were studied, we interpret this as a relative sparing of neonatal platelet reactivity due to the presystemic action of low dose aspirin.
Induced abortion: an audit of reported current pracl among consultant gynaecologists in Scotland*
Authors: Penney Gillian C. , Templeton Allan
Published: August 2005

Objective
To obtain an overview of current abortion practice in Scotland for comparison with agreed criteria for good quality care based on literature review.

Design
Postal questionnaire survey.

Subjects
All 132 consultant gynaecologists practising in the NHS in Scotland.

Results
Response rate 92%. The survey revealed regional inequalities in the availability of services, particularly with regard to early medical abortion and second trimester procedures. It also revealed great individual variations in many areas of practice notably in screening for genital tract infection, the use of cervical predilatation, contraceptive provision, and follow up. Several aspects of practice compared poorly with the agreed criteria for good quality care.

Conclusions
The postal questionnaire approach achieved a good response rate and has provided an informative overview of current practice on a national basis. Variations in the provision of services and in clinical practice, both among regions and among individual consultants, have been identified. Elements of abortion care in which great variations exist and in which current practice compares poorly with the agreed criteria have been highlighted as appropriate areas for the development of national guidelines and for educational initiatives. Such a questionnaire approach to assessing current practice can complement, and possibly replace, some aspects of casenote review audit.
Pelvic exenteration: a review of the Gateshead experience 1974–1992
Authors: Robertson Greg , Lopes Alberto , Beynon Gareth , Monaghan John M.
Published: August 2005

Objective
To examine morbidity and survival among women treated by pelvic exenteration for gynaecological malignancy.

Design
Retrospective review by analysis of case records.

Setting
Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead, UK.

Subjects
Eighty‐three consecutive patients referred from within the UK from 1974 to 1992 for initial treatment of advanced gynaecological malignancy or management of recurrent disease following unsuccessful initial therapy.

Results
Overall five year actuarial survival was 41%, falling to 36 % at 10 years. Serious morbidity was low, and there were only three perioperative deaths.

Conclusions
For patients with limited options for treatment of advanced primary or recurrent cancer, exenteration offers a reasonable prospect of survival with good quality of life.
Transvaginal sacrospinous colpopexy for vault and marked uterovaginal prolapse
Authors: Carey Marcus P. , Slack Mark C.
Published: August 2005

Objective
To assess the results of the sacrospinous colpopexy procedure for the treatment of vault prolapse following hysterectomy and marked uterovaginal prolapse.

Design
A prospective study of all patients undergoing sacrospinous colpopexy for vault and marked uterovaginal prolapse between December 1991 and December 1992.

Setting
Kent and Canterbury Hospital, Canterbury.

Subjects
Forty women with vault prolapse following hysterectomy and 24 with marked uterovaginal prolapse.

Interventions
All patients underwent posterior vaginal repair, enterocele sac obliteration and sacrospinous colpopexy. In 48 patients an anterior vaginal repair with suburethral buttressing sutures was also performed. A long‐needle bladder neck suspension operation (Raz procedure) was included for three women with coexistent stress incontinence. In 13 patients a vaginal hysterectomy was performed and in 11 the uterus was conserved. A postanal sacrorectopexy was performed on one patient with marked rectal prolapse.

Results
The mean follow up period was five months. So far, there have been three failures in the group treated for vault prolapse. One of these underwent a successful repeat sacrospinous colpopexy and repair. The main long term complication was cystocele formation. One sexually active patient complained of dyspareunia following surgery.

Conclusion
The sacrospinous colpopexy is effective in the treatment of vault prolapse and compares favourably with abdominal vault supporting procedures. It avoids major abdominal surgery and allows the surgeon to correct coexistent cystocele and rectocele. This procedure is also a useful adjuvant when treating marked uterovaginal prolapse.
Dexamethasone and fetal heart rate variation
Authors: Dawes G. S. , Serra‐Serra V. , Moulden M. , Redman C. W. G.
Published: August 2005

Objective
To determine the effect of maternal administration of dexamethasone on fetal heart rate and its variation.

Design
Retrospective analysis of computerised data derived from cases studied over three years.

Setting
High risk pregnancy unit, John Radcliffe Hospital, Oxford.

Subjects
Twenty‐eight pregnant women, at 27 to 32 weeks of gestation, to whom dexamethasone was given to accelerate pulmonary maturation in the expectation of preterm delivery.

Methods
Dexamethasone (two doses of 12 mg intramuscularly, 12 h apart) was given on 51 occasions at weekly intervals (one to four occasions per patient). Complete data were available for cardiotocograph analysis from computerised measurement of fetal heart rate variables for two days before and four days after dexamethasone and, in 19 women, measurements of umbilical arterial flow velocity waveforms before and after dexamethasone.

Results
In 10 pregnancies without fetal distress there was a highly significant (P < 0.01) transient rise in short term fetal heart rate variation after dexamethasone administration, from means (SE) 6.4 (028) to 9.8 (0.4) ms. In 18 pregnancies with subsequent delivery for fetal distress (abnormal fetal heart rate pattern) and high umbilical arterial resistance index [mean 0.93 (0.06 SE)], the rise in short term fetal heart rate variation was less (P < 0.01), from mean (SE) 5.4 (0.26) to 6.1 (0.48) ms. In a further case of discordant twin pregnancy, the larger twin continued to respond to dexamethasone administrations with a rise in fetal heart rate variation for five weeks; the smaller twin, with maintained tachycardia and reduced umbilical arterial end‐diastolic flow velocity, failed to respond after the first two weeks.

Conclusion
The results show that maternal dexamethasone administration normally causes a rise in fetal heart rate variation for up to a day. This rise is reduced in pre‐eclampsia or intrauterine growth retardation, associated with a reduction in umbilical flow, perhaps because of a consequential lower concentration of steroid in the fetus. The results contrast with those for betamethasone which has been reported to reduce fetal heart rate variation.
The quality of routinely collected maternity data
Authors: Cleary R. , Beard R. W. , Coles J. , Devlin H. B. , Hopkins A. , Roberts S. , Schumacher D. , Wickings H. I.
Published: August 2005

Objective
To assess the validity of clinical information held on a regional maternity database, the St Mary's Maternity Information System (SMMIS).

Design
A retrospective review of 892 maternity case notes and matched SMMIS records, by a midwife trained in clinical coding techniques.

Setting
Three maternity units in the North West Thames Region.

Main outcome measures
Percentage agreement for 17 directly recorded SMMIS data items and equivalent data abstracted from the notes. Frequencies of diagnosis codes abstracted from case notes, as compared with those generated by SMMIS on the basis of directly recorded data.

Results
A generally high level of agreement was observed between the abstracts of the notes and the SMMIS records. Of the 17 data items examined, 10 showed 95% agreement or better, and all but two exceeded 80% agreement. Little difference was found between the levels of agreement observed at the three sites. A greater number and range of diagnosis codes were abstracted from the notes than were generated by SMMIS.

Conclusions
The directly recorded clinical data held on the SMMIS regional database is largely accurate and consistently recorded across a variety of units. The database can therefore be considered a valuable resource for the comparative audit of maternity practice. The SMMIS technique for deriving, on a semi‐automatic basis, diagnosis codes from the directly recorded fields, appears to work moderately well. We suggest that the direct method of data collection used in SMMIS could provide a model for other specialties in the National Health Service.
A randomised trial of routine versus selective counselling in perinatal bereavement from congenital disease
Authors: Lilford Richard J. , Stratton Peter , Godsil Susan , Prasad Anjali
Published: August 2005

Objective
To find out whether routine counselling improves psychological wellbeing after bereavement for fetal abnormality.

Design
A randomised trial among bereaved couples who did not demonstrate any unexpected strain or psychopathology after bereavement.

Setting
St. James's University Hospital, Leeds.

Subjects
Fifty‐seven couples.

Interventions
Independent counselling by an experienced psychotherapist.

Main outcome measures
Self‐administered questionnaires measuring grief, anxiety and depression and a structured psychological interview 16 to 20 months after the loss. Anniversaries of a death or expected birth date were avoided.

Results
There were no differences in outcome between women randomised to the study group or randomised to the control group with respect to grief, anxiety, depression or the results of the structured overview. Among those in the randomised study group, women who attended for counselling had a much better outcome than women who defaulted from counselling. Overall, women who underwent termination of pregnancy did slightly worse than those who had experienced stillbirth or neonatal death. On an informal basis, the clinician concerned believes that he was better able to help bereaved couples as a result of feedback and criticism from the independent counsellor.

Conclusions
(1) The hypothesis that all couples should have independent counselling after prenatal loss for congenital abnormality is unproven, but it is likely that clinicians can benefit from feedback from a counsellor; (2) it is possible that termination of pregnancy is more psychopathogenic than other forms of fetal loss; (3) people who attend for their counselling sessions are probably inherently better able to adjust to bereavement; (4) trials of psychological intervention are feasible, but follow up is either difficult to achieve or expensive.
Expectant management of twin pregnancy with single fetal death
Authors: Santema Job G. , Swaak Astrid M. , Wallenburg Henk C. S.
Published: August 2005

Objective To evaluate the course and outcome of expectantly managed twin pregnancies with single fetal death in the second half of gestation.

Design Case‐controlled study of 29 consecutive pregnancies from 1973 to 1993, with sonographic evidence of a twin at 20 weeks gestation with antenatal demise later in pregnancy, matched for maternal parity with 58 twin pregnancies without fetal death and delivered in the same year as the index case. Outcome measures included the incidence of complications of pregnancy, gestational age and mode of delivery, placentation, and perinatal outcome.

Setting University Hospital Rotterdam.

Results The frequency and severity of pregnancy‐induced hypertensive disorders was significantly higher in the study group than in controls. We found no differences between the study group and controls with regard to median gestational age at delivery (33 weeks versus 34 weeks) and median birthweight of liveborn infants (1880 g versus 2160 g). No consumptive coagulopathy was apparent in our 29 patients. The main cause of neonatal death was prematurity; multicystic encephalomalacia was not observed.

Conclusions Our results support expectant management in twin pregnancies complicated by single fetal death.
The incidence of cervical intraepithelial neoplasia among women with renal transplant in relation to cyclosporine
Authors: Ter Haar‐van Eck Sylvia A. , Rischen‐Vos Jacqueline , Chadha‐Ajwani Savi , Huikeshoven Frans J. M.
Published: August 2005

Objective To evaluate the policy of an annual smear to screen renal transplant recipients for cervical intraepithelial neoplasia and invasive carcinoma and to determine the incidence of abnormal smears and CIN before and after the introduction of cyclosporine (1983).

Design A retrospective study over the period 1971 to 1992.

Subjects Postmenarchial women who received renal transplants and who were on immuno‐suppressive treatment for at least one month.

Mean outcome measures Cytology and histology results.

Results A total of 144 women who received renal transplantation were eligible for our study. Observation time varied from 1 to 227 months (median 59 months) with a mean for the group transplanted before 1983 (Group A) of 103 months, and for the group transplanted after 1983 (Group B) of 46 months. Of these women, 25 had an abnormal smear. Of these, 14 were confirmed by histology and repeated smears of the other 11 patients were negative. Within the 60 women in Group A with an abnormal smear, six had CIN I or CIN II, three had CIN III and one showed adenocarcinoma of the endometrium. Among the 84 women in Group B, four had CIN I or CIN II and none had CIN III. The overall incidence of abnormal cytology was 17.3%, with no invasive cervical carcinoma in this group.

Conclusions Our policy of screening is adequate. With the introduction of cyclosporine the incidence of abnormal cytology and histology has a tendency to decrease. However, the duration of risk is not comparable yet.
A randomised double blind placebo controlled trial of fish oil in high risk pregnancy
Authors: Onwude J. L. , Lilford R. J. , Hjartardottir H. , Staines A. , Tuffnell D.
Published: August 2005

Objective To determine whether n‐3 fatty acid (EPA/DCHA) prophylaxis is beneficial in high risk pregnancies.

Design A randomised, double blind, placebo controlled trial.

Setting Antenatal clinic of St James's University Hospital, Leeds.

Subjects Two hundred and thirty‐three pregnant women at high risk of developing proteinuric or nonproteinuric pregnancy induced hypertension or asymmetrical intrauterine growth retardation.

Intervention Active treatment was 2.7 g of MaxEpa daily (1.62 g of eicosapentaenoic acid and 1.08 g of docosahexaenoic acid). Placebo were matching air‐filled capsules.

Main outcome measures Occurrence of proteinuric, nonproteinuric pregnancy induced hypertension or birthweight < 3rd centile.

Results There was no difference in an intention to treat analysis between the placebo and active treatment groups for occurrence of proteinuric pregnancy induced hypertension (relative risk (RR) = 0.88;95% CI 0.47–1.66), nonproteinuric pregnancy induced hypertension (RR = 0.89; 95% CI0.48–1.64), birthweight < 3rd centile (RR = 0.89; 95% CI 0.48–1.64), or the duration of pregnancy (difference of mean durations = 0.1 days; 95% CI ‐4.8 to 4.9 days). Analyses stratified by use of tobacco, and analyses excluding known major protocol violators gave essentially identical results.

Conclusion There is no evidence from ths study for any useful effect of fish oil supplementation for women at high risk of adverse outcomes from a pregnancy, but a small protective effect remains a possibility.
Temporising management of severe pre‐eclampsia with and without the HELLP syndrome
Authors: Visser Willy , Wallenburg Henk C. S.
Published: August 2005

Objective To test the null hypothesis that the course and outcome of pregnancy in patients with severe pre‐eclampsia receiving temporising haemodynamic treatment does not depend on the presence or absence of the syndrome of haemolysis, elevated liver enzymes, and a low platelet count (HELLP).

Design A case‐controlled study.

Setting High risk obstetric unit, University Hospital Rotterdam‐Dijkzigt, Rotterdam.

Subjects One hundred and twenty‐eight consecutive pre‐eclamptic patients with HELLP, ges‐tational age less than 34 weeks, matched for maternal and gestational age with 128 pre‐eclamptic patients without HELLP.

Intervention Both groups were treated with volume expansion and pharmacologic vasodilatation under invasive haemodynamic monitoring with the aim of prolonging gestation and enhancing fetal maturity.

Main outcome measures Maternal and perinatal outcome in patients with and without HELLP.

Results Except for variables pertaining to HELLP, clinical and laboratory data and median prolongation of pregnancy did not differ between both groups. Complete reversal of HELLP occurred in 43% of patients. Perinatal mortality was 14.1% in HELLP patients and 14.8% in patients without HELLP. No maternal complications occurred.

Conclusion We cannot reject the null hypothesis. Our data do not support a general recommendation of prompt termination of pregnancy in HELLP. Temporising treatment may improve fetal and neonatal as well as maternal outcome.
Corticotrophin‐releasing hormone and corticotrophin‐ releasing hormone binding protein in normal and pre‐eclamptic human pregnancies
Authors: Perkins A. V. , Linton E. A. , Eben F. , Simpson J. , Wolfe C. D. A. , Redman C. W. G.
Published: August 2005

Objective To measure the plasma levels of corticotrophin‐releasing hormone and corticotrophin‐releasing hormone binding protein in normal pregnancy and in pregnancies complicated by pre‐eclampsia.

Setting John Radcliffe Hospital, Oxford and St Thomas's Hospital, London.

Subjects One hundred and twenty pregnant women sampled prospectively throughout gestation, of whom 91 experienced a normal pregnancy and eight developed pre‐eclampsia; in a second study, 10 women with severe pre‐eclampsia, presenting at a range of gestational ages, were sampled once and compared with appropriately matched normal pregnant women.

Main outcome measure Plasma levels of corticotrophin‐releasing hormone determined by immunoradiometric assay. Plasma levels of corticotrophin‐releasing hormone binding protein measured by direct radioimmunoassay.

Results In the prospective study, plasma samples from women with pre‐eclampsia exhibited higher (390.2 versus 292.7 pmol/l at 36 weeks) levels of corticotrophin‐releasing hormone and significantly lower (5.24 versus 8.14 nmol/l at 36 weeks, P 0.002) levels of corticotrophin‐releasing hormone binding protein than normal controls. In the second, single time point study a significant elevation in CRH (P < 0.002) and reduction in CRH‐BP (P < 0.001) was found in pre‐eclamptic pregnancies compared with controls.

Conclusions In human pregnancies complicated by pre‐eclampsia there is an elevated level of corticotrophin releasing hormone whilst there is less corticotrophin‐releasing hormone binding protein; therefore there is a net increase in free potentially bioactive hormone which may play a role in the pathology of the disease.