bluuebunny/crossref_metadata_2025 huggingface dataset:
Systemic and fetal–maternal nitric oxide synthesis in normal pregnancy and pre‐eclampsia
Authors: Boccardo Paola , Soregaroli Mirella , Aiello Sistiana , Noris Marina , Donadelli Roberta , Lojacono Andrea , Benigni Ariela
Published: August 2005

Objective
To investigate systemic and fetal‐placental nitric oxide synthesis by biochemical and molecular biology means in normal human pregnancy and pre‐eclampsia.

Design and participants
Three groups of women were studied healthy pregnant women (n= 8), pregnant women with pre‐eclampsia (n= 8), and age‐matched nonpregnant controls (n= 8). Pre‐eclamptic patients were treated with nifedipine (30–60 mg/day) for severe hypertension. Systemic nitric oxide synthesis was assessed in normal pregnant women at weeks 18–21, 29–32 and 38–39 and in pre‐eclamptic women on admission to the hospital (29–32 weeks, 30 on average), before the morning nifedipine administration. Nonpregnant women were studied twice at four‐week intervals as controls. The pattern of nitric oxide biosynthesis in fetal‐placental circulation was studied in normal and pre‐eclamptic women at the delivery.

Setting Mario
Negri Institute for Pharmacological Research, Bergamo, and the Division of Obstetrics and Gynaecology of the University of Brescia.

Main outcome measures
Plasma cGMP levels and platelet nitric oxide synthesis, assessed by measuring the conversion of [3H]L‐arginine to [3H]L‐citrulline as well as intracellular cGMP, were evaluated. Constitutive nitric oxide synthase (EC‐NOS) gene expression by Northern blot analysis and nitric oxide release by the conversion of [3H]L‐arginine to [3H]L‐citrulline were assessed in umbilical vein endothelial cells (HUVEC) and in placenta. Inducible nitric oxide synthase activity was also evaluated in HUVEC exposed to tumour necrosis factor α (TNFα) and in placenta homogenates incubated in calcium free medium.

Results
Plasma cGMP was higher in both normal pregnant and pre‐eclamptic women than in nonpregnant controls. In normal pregnancy cGMP rose as early as 18–21 weeks and remained elevated throughout pregnancy. [3H]L‐citrulline production and intracellular cGMP were comparable in platelets from all women. EC‐NOS gene expression and nitric oxide synthesis were identical in HUVEC and placenta from normal pregnant and pre‐eclamptic women.

Conclusions
Systemic levels of cGMP, the nitric oxide second messenger, are increased in normal pregnancy. Excessive nitric oxide production does not derive from platelets. Pre‐eclampsia is not associated with changes in fetal‐placental nitric oxide synthesis.
Posterior colporrhaphy: its effects on bowel and sexual function
Authors: Kahn Margie A. , Stanton Stuart L.
Published: August 2005

Objective
To determine the anatomical cure rate of posterior colporrhaphy and its effect on bowel and sexual function one to six years later.

Design
Retrospective observational study.

Setting
Urogynaecology Unit, St George's Hospital, London.

Participants
Two hundred and thirty‐one women who underwent posterior colporrhaphy.

Main outcome measures
Anatomical and symptomatic cure of rectocoele.

Methods
The charts of 231 women who underwent 244 posterior colporrhaphies between 1 January 1989 and 4 January 1994 were reviewed. One hundred and seventy one (74%) were interviewed; 140 (61%) were examined. Mean follow up time was 42.5 months (range 11–74).

Results
Two hundred and nine women had prior or concurrent vaginal and/or bladder neck surgery including 38 previous posterior colporrhaphies. Postoperatively prolapse symptoms due to rectocoele decreased (64%vs 31%). Constipation (22%vs 33%), incomplete bowel emptying (27%vs 38%), incontinence of faeces (4%vs 11%) and sexual dysfunction (18%vs 27%) increased. Those with incontinence of stool were more likely to have had two or more posterior colporrhaphies. Sixty‐two percent felt that they improved over all after surgery. Additional postoperative symptoms included: vaginal and/or perineal splinting (33%), soiling and/or inability to wipe clean (16%), rectal digitation (23%), incontinence of flatus (19%), and rectal and/or vaginal pain (22%). Thirty‐three women (24%) had large rectocoeles, seven of whom did not have impaired bowel emptying.

Conclusions
Posterior colporrhaphy corrects the vaginal defect in 76% of women. It does not necessarily correct and may contribute to bowel and sexual dysfunction, particularly in those requiring multiple procedures. The presence of the anatomical defect does not imply dysfunction. The prevalence of bowel symptoms suggests the need for close questioning about bowel habits and the selective use of bowel investigations for some women before surgery.
Low dose dopamine in postpartum pre‐eclamptic women with oliguria: a double‐blind, placebo controlled, randomised trial
Authors: Mantel Gerald D , Makin Jenny D.
Published: August 2005

Objective
To assess the effect of low dose dopamine on the urine output in postpartum pre‐eclamptic or eclamptic women with oliguria.

Design
A double blind, randomised controlled study.

Setting
The high care area of the labour ward in a teaching hospital.

Sample
Forty postpartum pre‐eclamptic women with oliguria, defined as < 30 mL/hour, who have not responded to a 300 mL crystalloid fluid challenge.

Intervention
Dopamine was infused at a rate of 1 to 5 ng/kg per minute, or sterile water was given as placebo in the same dilution.

Main outcome measure
Urine output, blood pressure and pulse was measured for six hours before and for six hours after the intervention.

Results
Women who received dopamine (344 mL over 6 hours) showed a clinically and statistically significant (P= 0.0014, Mann‐Whitney U test) higher median urine output compared with those receiving placebo (135 mL over 6 hours) for the duration of therapy. The respective 95% confidence intervals were 212.3 to 712.7 mL compared with 73.8 to 244.7 mL. No differences in blood pressure or pulse were found between the two groups.

Conclusions
The use of low dose dopamine in a labour setting improved urine output in postpartum pre‐eclamptic women with oliguria who had not responded to a single fluid challenge without a detrimental effect on the blood pressure or pulse.
Effects of embryo reduction from trichorionic triplets to twins
Authors: Sebire N. J. , D'Ercole C. , Sepulveda W. , Hughes K. , Nicolaides K. H.
Published: August 2005

Sixty‐six trichorionic triplet pregnancies reduced to twins were compared with 47 triplet pregnancies that were not reduced. The miscarriage rate was higher (7.6% compared with 2.6%) but the number delivering between 24 and 32 weeks was lower (8.2% compared with 24.0%). Since severe preterm delivery is associated with risks of neonatal death and severe handicap, embryo reduction of triplets to twins may not improve the chance of survival but may reduce the rate of handicap.
Fetal heart rate at 10 to 14 weeks and birthweight
Authors: Sebire N. J. , Nayar R. , Carvalho M. , Scares W. , Nicolaides K. H.
Published: August 2005

In 6644 singleton pregnancies resulting in live births, the fetal heart rate was measured at 10 to 14 weeks of gestation (median 12). There was no significant association between fetal heart rate and birthweight. These findings demonstrate that if there is an association between fetal heart rate, birthweight and subsequent development of cardiovascular disease the responsible intrauterine insult and/or the adaptive fetal response are not present at 10 to 14 weeks of gestation.
Hyperhomocysteinaemia and protein S deficiency in complicated pregnancies
Authors: de Vries J. I. P. , Dekker G. A. , Huijgensb P. C. , Jakobs C. , Blomberg B. M. E. , van Geijn H. P.
Published: August 2005

Objective
The aim of our study was to investigate whether women with placental abruption, intrauterine fetal death or small for gestational age infants have metabolic and/or haemostatic abnormalities which are known to be risk factors for intravascular thrombosis.

Design
For two years blood tests were performed at > 10 weeks after delivery on all women without hypertensive disorders either before or during pregnancy, who had been consecutively admitted to our hospital with placental abruption, intrauterine fetal death and small for gestational age.

Sample
A total of 62 women who had placental abruption (n= 13), intrauterine fetal death (n = 18) and a small for gestational age infant (n= 13).

Setting
Obstetric outpatient clinic in a university hospital (Free University Hospital, Amsterdam).

Methods
Presence of hyperhomocysteinaemia, various coagulation abnormalities and anticardiolipins was investigated.

Results
Abnormalities were found in 20 women in the placental abruption group (20/31, 65%), in 10 women in the intrauterine fetal death group (10/18, 56%) and in 11 women in the small for gestational age group (11/13, 85%). Eight out of these 31 women had more than one abnormality. In the group of 62 women protein S deficiency was demonstrated in 26%, hyperhomocysteinaemia in 24%, Protein C deficiency in 6%, anticardiolipin IgG in 11%, anticardiolipin IgM in 5%, Lupus anticoagulant in 2%. An antithrombin III deficiency was not found. Thirty‐three women were tested for activated protein C resistance (9% positive) and factor V Leiden mutation (6% positive). Hyperhomocysteinaemia was treated with a daily oral dose of 250 mg pyridoxine and 5 mg folic acid. After six weeks of vitamin supplementation homocysteine levels were tested again. At that tune a mean reduction of fasting homocysteine value of 68% (95% CI 57–79) was found and of post‐load value of 65% (95% CI 55–76).

Conclusions
Based on the results of our study, it can be concluded that women whose pregnancies are complicated by either placental abruption, intrauterine fetal death or small for gestational age, even if there is no history of thrombo‐embolic disorders or hypertension during pregnancy, should be advised to undergo an examination for metabolic and/or haemostatic abnormalities.
Satisfaction and the three C's: continuity, choice and control. Women's views from a randomised controlled trial of midwife‐led care
Authors: Hundley V. A. , Milne J. M. , Glazener C. M. A. , Mollison J.
Published: August 2005

Objective
1. To explore whether there are differences in women's satisfaction with care in a midwife‐managed delivery unit compared with that in a consultant‐led labour ward. 2. To compare factors relating to continuity, choice and control between the two randomised groups.

Design
A pragmatic randomised controlled trial.

Setting
Aberdeen Maternity Hospital, Grampian.

Sample
2844 women, identified at booking as low risk, were randomised in a 2:1 ratio between the midwives’ unit and the labour ward.

Main outcome measures
Satisfaction, continuity of carer, choice, and control.

Results
Satisfaction with the overall experience did not differ between the groups. Satisfaction with how labour and delivery was managed by staff was slightly higher in the midwives’ unit group, but this did not reach the 0.1% level of significance. Women allocated to the midwives’ unit group saw significantly fewer medical staff and were less likely to report numerous individuals entering the room. They were more likely to report having had a choice regarding mobility and alternative positions for delivery and were significantly more likely to have made their own decisions regarding pain relief.

Conclusions
The issues surrounding the measurement of satisfaction with childbirth need further investigation. Until this area is clarified it would be unwise to use an overall measure of satisfaction as an indicator of the quality of maternity service provision. In particular, the current measures are not sensitive enough to examine the specific factors which affect women's satisfaction. Further research is required to assess which factors are important to women if they are to have a positive experience of childbirth and how these priorities change over time.
Recurrence of endometrial carcinoma and the value of routine follow up
Authors: Salvesen H. B. , Akslen L. A. , Iversen T. , Iversen O. E.
Published: August 2005

ObjectiveTo identify women treated for endometrial carcinoma with increased risk for recurrent disease, to examine how and when recurrences are discovered, and to assess the clinical benefit of routine follow up investigations.

DesignRetrospective case analysis.

SettingHordaland county, Norway.

PopulationAll women treated for endometrial carcinoma in a demographically well defined area, in a 10‐year period (1981–1990).

MethodsData concerning patient characteristics and course of the disease were collected through review of the medical records, correspondence with the primary physician and from the Norwegian Cancer Registry. Univariate and multivariate survival analysis.

ResultsAfter curative surgical treatment 249 women diagnosed with endometrial carcinoma were followed for a median period of 9 years (range 4–16) or until death. Among these 249 radically treated patients, 47 had recurrent disease, 32 within the first two years. Ten of the recurrences were diagnosed at routine follow up, but only four were asymptomatic. In our follow up programme, one asymptomatic recurrence was detected for every 653 routine consultations. A low risk group, with FIGO Stage IA/IB or patient age below 60 years at primary operation was identified in multivariate recurrence‐free survival analysis. No asymptomatic recurrences were found in this group.

ConclusionsLow risk women should be considered for an alternative, less frequent follow up. The sensitivity for current practice of routine follow up in detecting asymptomatic recurrences is so low that other beneficial effects should be documented to defend the large resources spent on this programme.
What changes in the organisation of cancer services will improve the outcome for women with ovarian cancer?
Authors: Woodman Ciaran , Baghdady Ashraf , Collins Stuart , Clyma Julie‐Anne
Published: August 2005

ObjectiveTo examine the influence of operator specialty, volume of work and referral to an oncologist on the survival of women with ovarian cancer.

DesignPopulation‐based retrospective cohort study, using hospital records and Cancer Registry data.

SettingThe North Western Region, UK.

PopulationSix hundred and ninety‐one women undergoing laparotomy for histologically confirmed ovarian malignancy during 1991 to 1992.

MethodsUnivariate and multivariate survival analyses.

Main outcome measuresUnivariate survival estimates. Relative risks, derived from Cox's proportional hazards model, describing the effect on survival of surgeonsvsgynaecologists as baseline, high volumevslow volume operators and referralvsnonreferral to an oncologist.

ResultsAfter adjusting for woman and disease‐related prognostic factors, operation by a surgeon was shown to have an adverse impact on survival (RR = 1.58, 95% CI 1.19 to 2.10). Regardless of how a high volume operator was defined (in terms of the number of laparotomies performed), no survival advantage over low volume operators could be demonstrated. Women referred to an oncologist had significantly better survival than women not referred (RR = 0.54, 95% CI 0.43 to 0.68)

ConclusionsAll women undergoing surgery for ovarian cancer should have access to a gynaecological opinion and postoperatively should be referred for a nonsurgical oncological opinion.
Hormone replacement therapy with dydrogesterone and 17β‐oestradiol: effects on serum lipoproteins and glucose tolerance during 24 month follow up
Authors: Crook David , Godsland Ian F. , Hull Jane , Stevenson John C.
Published: August 2005

Objective
To assess serum lipid and lipoprotein concentrations and oral glucose tolerance in postmenopausal women treated with 17β‐oestradiol (2 mg/day) and cyclical dydrogesterone (10 mg/day for 14 days per 28 day cycle).

Design
A 24 month prospective study of 29 women acting as their own controls. On‐treatment samples were taken during the combined (oestrogen–progestogen) phase of therapy.

Setting
Metabolic research unit in London.

Population
Postmenopausal women with no previous exposure to hormone replacement therapy attending a menopause clinic in a London hospital.

Methods
Fasting serum sampling and oral glucose tolerance testing.

Main outcome measures
Serum lipids and lipoprotein concentrations and plasma glucose, insulin and C‐peptide responses to an oral glucose load.

Results
Restricting the analysis to the 17 women who completed the study, no effect was seen on serum triglyceride concentrations. There was a mean fall of 5.9% (95% CI 1.2 to −13.0) in concentrations of serum total cholesterol, reflecting the balance of a 10.7% fall (95% CI 4.3 to −25.8) in low density lipoprotein cholesterol concentrations and a 16.3% increase (95% CI 7.3 to −25.3) in those of high density lipoproteins. Fasting glucose concentrations and glucose tolerance test responses were unchanged. Fasting insulin concentrations fell substantially (–41.6%, 95% CI −23.4 to −59.8) with falls also being seen in insulin responses to glucose. Fasting C‐peptide concentrations increased by 36.2% (95% CI 9.17 to 63.3), with no consistent effect on C‐peptide responses to glucose.

Conclusions
Dydrogesterone did not appear to oppose the potentially beneficial effects of oestradiol on insulin or either low or high density lipoproteins, making the combination with 17β‐oestradiol a potentially useful option for postmenopausal women particularly those at risk of cardiovascular disease or diabetes mellitus.
The influence of oestrogen replacement on faecal incontinence in postmenopausal women
Authors: Donnelly Valerie , O'Connell P. Ronan , O'Herlihy Colm
Published: August 2005

Objective
To assess the value of hormone replacement therapy (HRT) in postmenopausal women with faecal incontinence.

Design
Prospective observational study using a bowel function questionnaire and anorectal physiological testing before and after six months of standard oestrogen hormone replacement therapy.

Setting
Menopause and colorectal clinics of two university teaching hospitals.

Participants
Twenty postmenopausal women (mean age 61 years) with demonstrable faecal incontinence (mean duration 6.1 years) previously untreated with HRT.

Main outcome measures
Improvement in symptoms and objective alteration in anorectal physiology tests.

Results
All women had significant symptoms of anorectal dysfunction before treatment, whereas 5/20 (25%) were asymptomatic after six months of HRT, and a further 13/20 (65%) were symptomatically improved in terms of flatus control, urgency, and faecal staining. There was no change in bowel frequency or stool consistency following HRT, but social activity was considerably improved. Anal resting pressures and voluntary squeeze increments were significantly increased following oestrogen therapy, although no differences in anal canal vector symmetry index were observed. Insignificant changes occurred in threshold volume of rectal sensation and volume of defaecatory urge, but there was a significant change in maximum tolerated rectal volume after six months. Neither anal canal electrosensitivity nor pudendal nerve terminal motor latency was altered following HRT. Seven of the 20 women (35%) had an identifiable anal sphincter defect on anal endosonography. Statistical analysis, however, showed no significant difference in outcome in this group compared with those with an intact anal sphincter. A larger population sample may demonstrate this.

Conclusion
This observational study has shown a possible benefit of oestrogen replacement in postmenopausal women with symptoms of impaired faecal continence. A prospective randomised controlled trial is now advisable to test this hypothesis.
Topical anaesthesia for diagnostic hysteroscopy and endometrial biopsy in postmenopausal women: a randomised placebo‐controlled double‐blind study
Authors: Cicinelli Ettore , Didonna Teodora , Ambrosi Glauco , Schönauer Luca Maria , Fiore Giuseppe , Matteo Maria G.
Published: August 2005

Objective
To evaluate the efficacy and safety of topical anaesthesia in reducing pain and incidence of vasovagal reactions during diagnostic hysteroscopy with endometrial biopsy in postmenopausal women.

Design
Randomised placebo‐controlled double‐blind study. Setting University hospital.

Participants
Eighty postmenopausal women undergoing diagnostic hysteroscopy and endometrial biopsy.

Interventions
Two millilitres of 2% mepivacaine or saline solution were injected transcervically into the uterine cavity before performing the procedures.

Main outcome measures
Evaluation of pain reduction on a visual analogue scale and continuous monitoring of heart rate and blood pressure.

Results
The use of the anaesthetic significantly reduced the pain experienced at hysteroscopy and endometrial biopsy. The occurrence of vasovagal reactions was significantly lower in the anaesthetised group.

Conclusions
Topical anaesthesia attenuated pain and effectively prevented the occurrence of vasovagal reactions during hysteroscopy and endometrial biopsy in postmenopausal women.
Can 24‐hour ambulatory blood pressure measurement predict the development of hypertension in primigravidae?
Authors: Higgins John R. , Walshe Joseph J. , Halligan Aidan , O'Brien Eoin , Conroy Ronan , Darling Michael R. N.
Published: August 2005

Objective
To assess the role of 24‐hour ambulatory blood pressure measurement in the mid‐second trimester as a predictive test for the development of hypertension in pregnancy.

Design
Prospective intervention.

Setting
The Rotunda Hospital, Dublin.

Participants
One thousand one hundred and two healthy primigravid women.

Intervention
24‐hour ambulatory blood pressure measurement at 18 to 24 weeks of gestation.

Main outcome measures
The development of pre‐eclampsia or gestational hypertension.

Results
A total of 1048 women had sufficient readings to be included in the final analysis. Of these, 23 (2.2%) developed pre‐eclampsia, 64 (6.1%) developed gestational hypertension and 961 (91.7%) remained normotensive. Significantly higher ambulatory blood pressures were recorded in both the pre‐eclamptic and gestational hypertensive group compared with the normotensive group. In addition, the gestational hypertensive group had significantly higher clinically measured blood pressure compared with the normotensive group. There were no differences between the pre‐eclamptic and the gestational hypertensive group for any of the blood pressure parameters analysed. The best overall predictor for pre‐eclampsia was 24‐hour mean diastolic pressure which using a cutoff level of 71 mmHg gave a test with a sensitivity of only 22% and a positive predictive value of 15%.

Conclusion
Because the absolute differences are small and the overlap between the hypertensive and normotensive groups large, ambulatory blood pressure measurement, in a healthy primigravid population, between 18 and 24 weeks of gestation is not a useful predictor of hypertension.
Clinical effect of meso‐tetrahydroxyphenylchlorine based photodynamic therapy in recurrent carcinoma of the ovary: preliminary results
Authors: Wierrani F. , Fiedler D. , Grin W. , Henry M. , Dienes E. , Gharehbaghi K. , Krammer B. , Grünberger W.
Published: August 2005

This article addresses the use of meso‐tetrahydroxyphenylchlorin‐based photodynamic therapy (m‐THPC‐PDT) to treat recurrent gynaecologic malignancies of the ovary. Photodynamic therapy is an experimental approach in the treatment of neoplasms and results indicate it is a highly tissue selective, relatively simple intervention with few side effects, therefore reducing the overall burden on the patient. Of the three patients involved in the initial study, two were treated solely with photodynamic therapy by laparoscopy, and one underwent additional palliative debulking surgery of metastatic tumours. After a post‐operative period of more than two years all three women remained free of relapses.
Increased levels of intercellular adhesion molecules and vascular cell adhesion molecules in pre‐eclampsia
Authors: Djurovic Srdjan , Schjetlein Rune , Wislaff Finn , Haugen Guttorm , Berg Kare
Published: August 2005

Objective
To investigate the correlation between soluble forms of the intercellular adhesion molecule (SICAM‐1) and vascular cell adhesion molecule (sVCAM‐1) and the severity of pre‐eclampsia or its possible consequences for fetal growth.

Design
Prospective observational study.

Setting
Institute of Medical Genetics, University of Oslo, Department of Medical Genetics and Haematological Research Laboratory, Ullevål University Hospital; and the Department of Obstetrics and Gynaecology, The National Hospital, Oslo, Norway.

Participants
Seventy‐six women with normotensive pregnancies and 157 women with pre‐eclampsia divided into three subgroups: mild, severe and pre‐eclampsia with fetal growth retardation.

Methods
ELISA‐measurements of plasma SICAM‐1 and sVCAM‐1 were performed in a group of healthy pregnant normotensive women and three groups of women with varying degrees of pre‐eclampsia.

Results
SICAM‐1 concentrations were higher in the pre‐eclampsia group compared with the control group, but this difference was not statistically significant. Plasma concentrations of sVCAM‐1 were significantly greater (P < 0.0001) in all pre‐eclampsia subgroups (835.34, 855.25 and 964.05 ng/mL) compared with the control group (667.62 ng/mL). Within the pre‐eclampsia group, plasma concentration of sVCAM‐1 was significantly higher in the subgroup exhibiting fetal growth retardation (P= 0.03) compared with mild pre‐eclampsia.

Conclusion
The observed increases in plasma concentrations of sVCAM‐1 suggest that measurements of this adhesion molecule may be useful in monitoring pregnancies with respect to the development of pre‐eclampsia or fetal growth retardation.
Interleukin‐8 in urine: a new diagnostic parameter for intra‐amniotic infection after premature rupture of the membranes
Authors: Stiemer Beate , Buschmann Anke , Bisson Susanne , Hensel Karin , Gramm Hans‐Joachim , Hopp Hartmut , Weitzel Hans‐Karl
Published: August 2005

Interleukin‐8 (IL‐8), a 72 amino acid peptide secreted by cells of the immune system and of the amnion, chorion and decidua, was measured in women in late pregnancy. IL‐8 was detected in the urine of 91 of 104 women with premature rupture of the fetal membranes, with values exceeding 1000 ng/L in cases of severe intra‐amniotic infection. Women with urinary tract infections were excluded. The routine measurement of IL‐8 in urine, together with C‐reactive protein in serum, thus provides a low risk and technically simple approach to the assessment of intra‐amniotic infection.
Elevated levels of serum nitrate, a stable end product of nitric oxide, in women with pre‐eclampsia
Authors: Smárason Alexander , Allman Keith G. , Young Duncan , Redman Christopher W. G.
Published: August 2005

Objectives
Nitric oxide released from vascular endothelial cells is a potent vasodilator and inhibits platelet adhesion. It has been suggested that decreased nitric oxide production from dysfunctional endothelial cells is implicated in the pathophysiology of pre‐eclampsia. In this study evidence was sought for abnormal production of nitric oxide in pre‐eclamptic women.

Participants
Blood was collected from 20 women presenting with pre‐eclampsia, from 20 matched healthy pregnant controls and from 12 nonpregnant women of childbearing age.

Methods
Serum nitrate, the stable end metabolite of nitric oxide, was measured by vanadium III chloride reduction and chemiluminescence.

Results
Sera from women with pre‐eclampsia had significantly higher nitrate concentrations (mean 47.4 μmol/L [SD 13.6]) compared with healthy pregnant (mean 31.2 μmol/L [SD 9.14]) and nonpregnant (mean 32.1 μmol/L [SD 10.0]) controls.

Conclusions
These results do not support the hypothesis that decreased endothelial cell nitric oxide production may be important in the pathophysiology of pre‐eclampsia. On the contrary, serum nitrate levels are increased which may reflect either increased production of nitric oxide from an unidentified source or decreased elimination through the kidneys.
Epidemiology of genital prolapse: observations from the Oxford Family Planning Association study
Authors: Mant Jonathan , Painter Rosemary , Vessey Martin
Published: August 2005

Objective
To explore the epidemiology of uterovaginal and post‐hysterectomy prolapse.

Design
Cohort study.

Setting
Seventeen large family planning clinics in England and Scotland.

Population
17,032 women who attended family planning clinics between 1968 and 1974, aged between 25 and 39 years at study entry.

Methods
Annual follow up by interview, postal or telephone questionnaire until July 1994. Further details on all hospital admissions were obtained from the hospital discharge summaries. All women were flagged at time of recruitment in the NHS central registers.

Main outcome measure
In‐patient admission with diagnosis of prolapse (ICD codes 8th Revision 623.0–623.9).

Results
The incidence of hospital admission with prolapse is 2.04 per 1000 person‐years of risk. Age, parity, calendar period and weight were significantly associated with risk of an inpatient admission with prolapse after adjustment for principal confounding factors. Significant trends were observed with regard to smoking status and obesity (Quetelet Index) at entry to the study and risk of prolapse. Social class, oral contraceptive use and height were not significantly associated with risk of prolapse. The incidence of prolapse which required surgical correction following hysterectomy was 3.6 per 1000 person‐years of risk. The cumulative risk rises from 1% three years after a hysterectomy to 5% 15 years after hysterectomy. The risk of prolapse following hysterectomy is 5.5 times higher (95% CI 3.1–9.7) in women whose initial hysterectomy was for genital prolapse as opposed to other reasons.

Conclusion
Among the potential risk factors that were investigated, parity shows much the strongest relation to prolapse.
Long term influence of different postmenopausal hormone replacement regimens on serum lipids and lipoprotein(a): a randomised study
Authors: Hänggi Willy , Lippuner Kurt , Riesen Walter , Jaeger Phillippe , Birkhauser Martin H.
Published: August 2005

Objective
To assess the influence of three different postmenopausal hormone replacement therapies on levels of serum lipids and lipoprotein(a) [Lp(a)].

Design
Open, randomised, controlled study.

Participants
One hundred and forty healthy, early postmenopausal women.

Interventions
The women were randomised to receive continuous 17β‐oestradiol, either orally (2 mg daily; n= 35) or transdermally (50 μg daily; n= 35), plus 10 mg dydrogesterone daily for 14 days of each 28‐day cycle; or 2.5 mg tibolone daily (n= 35). Thirty‐five untreated women acted as controls.

Main outcome measures
Fasting blood samples were analysed at baseline, 6,12 and 24 months for low‐density lipoprotein (LDL)‐cholesterol, high‐density lipoprotein (HDL)‐cholesterol, very low density lipoprotein (VLDL), total cholesterol, triglycerides, lipoprotein(a) [Lp(a)], apolipoproteins A‐l, A‐2 and B, fibrinogen, and antithrombin factor III.

Results
At 24 months oral oestradiol increased mean HDL cholesterol (7%; 95% CI 1–14), compared with no change in the transdermal group and a decrease of 26.8% in the tibolone group (95% CI 22.9–30.5); oral oestradiol decreased mean LDL cholesterol (11.8%; 95% CI 6.3–19), compared with no change in the tibolone group. Changes in apolipoprotein A‐1 and B showed a similar pattern to HDL and LDL cholesterol, respectively. Oral oestradiol increased serum triglycerides (30%; 95% CI 18–42) after 24 months, compared with no change in the tibolone and transdermal oestradiol groups. Tibolone decreased serum Lp(a) by 36.6% after 24 months (95% CI 8.3–56.2), oral oestradiol decreased levels by 29.4% (95% CI 2–51.1), compared with no change in the transdermal oestradiol group.

Conclusions
Oral and to a lesser extent transdermal oestradiol when sequentially combined with dydrogesterone, showed a beneficial influence on serum lipids regarding the cardiovascular disease risk, which was not seen with tibolone. The significance of Lp(a) levels on cardiovascular disease risk remains to be determined.
A study of treatment failures following large loop excision of the transformation zone for the treatment of cervical intraepithelial neoplasia
Authors: Flannelly Grainne , Langhan Heather , Jandial Lata , Mann Evelyn , Campbell Marion , Kitchener Henry
Published: August 2005

Objective
To examine the long term efficacy of large loop excision of the transformation zone (LLETZ) in the treatment of cervical intraepithelial neoplasia (CIN) and to evaluate the relative diagnostic merits of colposcopy and cytology in the follow up of these women.

Design
A retrospective examination of cytology, colposcopy and histology records of the first 1000 women treated with LLETZ in Aberdeen from 1989 to 1991.

Setting
Colposcopy Clinic Aberdeen Royal Infirmary, Grampian Region, Scotland.

Results
Nine hundred and seventy‐seven women (97.7%) were seen for follow up at least once and 317 were followed for as long as four years. This comprises 2812 woman years of follow up. The incidence of recurrent CIN was 27/1000 woman years and the cumulative rate of recurrence at four years was 10.1 per 100 women. Twenty‐eight of the 59 women (47%) with abnormal colposcopy and proven CIN had a concurrent smear that did not show dyskaryosis.

Conclusions
LLETZ is an effective form of treatment for CIN. Colposcopy was useful in the follow up of these women and expedited the treatment of persistent disease. We recommend that any follow up protocol should include a colposcopic assessment and cytological follow up for at least four years following treatment. Further data are required to determine the risk of recurrence beyond this time.
The effect of long term oestradiol implantation on bone mineral density in postmenopausal women who have undergone hysterectomy and bilateral oophorectomy
Authors: Wahab M. , Ballard P. , Purdie D. W. , Cooper A. , Willson J. C.
Published: August 2005

Twelve women who had received oestradiol implantation on demand for at least 15 years following hysterectomy with bilateral oophorectomy, underwent bone densitometry of hip and spine. Bone mass of hip and spine was significantly elevated above that of both the age matched mean to a degree hitherto undocumented. This suggests that oestrogen in high doses or over a long period may produce a true anabolic effect on bone mass.
Dexamethasone‐induced leucocytosis in pregnancy
Authors: Denison Fiona C. , Elliott Catherine L. , Wallace Euan M.
Published: August 2005

The effect of intramuscular dexamethasone administration in late pregnancy on the maternal peripheral white cell count was examined in 20 women. The mean total white cell count increased from a baseline of 11–3 × 109/L (SD 2–3) to 16–2 × 109/L (SD 4–6) on day 1, normalising thereafter. This 43% increase represented composite changes in the neutrophil and lymphocyte counts which, on average, increased by 62% and decreased by 22%, respectively. It is concluded that prenatal dexamethasone induces a significant neutrophilia on the first day following administration. This information may be helpful when monitoring for infection.
Sjögren's syndrome in women presenting with chronic dyspareunia
Authors: Mulherin Diarmuid M. , Sheeran Thomas P. , Kumararatne Dinakantha S. , Speculand Bernard , Luesley David , Situnayake R. Deva
Published: August 2005

Objective
To identify cases of Sjögren's syndrome among women with chronic dyspareunia who did not already have a diagnosed rheumatological disorder.

Design
Prospective recruitment over 12 months.

Setting
Tertiary referral service for the assessment of vulval disease.

Participants
Women with chronic dyspareunia who had musculoskeletal symptoms, Raynaud's phenomenon or symptoms of ocular or oral dryness.

Methods
The women underwent a Schirmer tear test and a comprehensive auto‐antibody screen including latex fixation test for rheumatoid factor, antinuclear, anti‐Ro, anti‐La and anti‐salivary duct antibodies. A labial salivary gland biopsy and vaginal biopsy were taken for routine histological analysis.

Main outcome measures
Cases of definite and probable Sjögren's syndrome were identified using the European criteria.

Results
Eleven women were assessed for features of Sjögren's syndrome. Four had definite primary Sjögren's syndrome, two had probable primary Sjögren's syndrome and one had probable secondary Sjögren's syndrome. Among these seven women the median duration of vaginal symptoms was seven years (range 0.25–20), of ocular symptoms was one year (range 0.25–2) and of oral symptoms was 1.5 years (range 0–6). In all but one woman dyspareunia presented before ocular or oral symptoms, often by many years.

Conclusions
Although well‐recognised as a feature of established Sjögren's syndrome, this study emphasises that chronic dyspareunia can be a presenting feature in these women, antedating the emergence of ocular or oral symptoms by many years. Symptoms of ocular or oral dryness, Raynaud's phenomenon or musculoskeletal symptoms should be sought in women with chronic dyspareunia to identify those who merit further investigation.
Extra‐amniotic saline infusion for induction of labour in antepartum fetal death: a cost effective method worthy of wider use
Authors: Mahomed Kassam , Jayaguru Alex S.
Published: August 2005

Objective
To compare the effectiveness of extra‐amniotic saline with intra‐amniotic prostaglandin F2α in inducing labour in pregnancies with intrauterine fetal death.

Design
A randomised controlled trial.

Participants
One hundred and twenty‐one women in the extra‐amniotic saline group and 123 women in the intra‐amniotic prostaglandin group, performed at Harare Maternity Hospital, Zimbabwe during the period October 1994 to February 1996.

Results
The two methods were equally effective in achieving delivery. The number of women not delivering within 48 hours of recruitment was 6% for the extra‐amniotic saline group compared with 11% for the intra‐amniotic prostaglandin group (relative risk [RR] 0.51, 95% CI 0.21–1.22). The extra‐amniotic saline group required augmentation with Syntocinon more frequently than the intra‐amniotic prostaglandin group: 22% compared with 7% (RR 3.1, 95% CI 1.5–6.2). There were more complications associated with the intra‐amniotic prostaglandin group: five women developed hypertonic contractions compared with none in the extra‐amniotic saline group. In addition 23% of women in the intra‐amniotic prostaglandin group developed acute vasovagal‐like symptoms lasting for about 10 to 15 minutes which were distressing for the women. There was no evidence of any increase in febrile morbidity from extra‐amniotic saline (RR 0.8,95% CI 0.75–1.1).

Conclusion
Extra‐amniotic saline infusion is successful in inducing labour in antepartum fetal deaths after 20 weeks of gestation. This method has been shown to be safe and well tolerated by the women and should be considered in areas with limited resources. This method should be evaluated further for inductions of labour with a live fetus.
Fetal oxygen saturation during labour
Authors: Chua S. , Yeong S. M. , Razvi K. , Arulkumaran S.
Published: August 2005

Objective
To derive oxygen saturation by pulse oximetry (SpO2) values at each cervical dilatation in labour in fetuses with normal neonatal outcome.

Participants
One hundred and forty‐five women at term in established labour with ruptured membranes and cervical dilatation at least 2 cm who had normal delivery outcome. The infants had 5 minute Apgar scores 7, birthweight 2500 g, umbilical cord artery pH 7.15 and did not require assisted ventilation or admission to neonatal intensive care.

Methods
Women were monitored continuously with cardiotocography and fetal pulse oximetry using the Nellcor N‐400 fetal pulse oximeter and FS‐14 fetal oxisensor till delivery. Labour was managed according to established protocol without recourse to SpO2 readings.

Results
There was a wide range of SpO2 values during labour hi fetuses with normal outcome. Mean values averaged 50%±10% throughout the first stage of labour, with lower ranges of SpO2 values above 30%. There was no significant difference in SpO2 readings at different cervical dilatations in the first stage of labour. Mean SpO2 values in the last 10 minutes before delivery were also not significantly different from those in the first stage of labour.

Conclusion
The range of SpO2 in 115 healthy fetuses during normal labour was wide, but always above 30%. There was no trend of SpO2values in this study of 115 fetuses with normal neonatal outcome.
A double‐blind randomised placebo controlled trial of postnatal norethisterone enanthate: the effect on postnatal depression and serum hormones
Authors: Lawrie Theresa A. , Justus Hofmeyr G. , De Jager Marinda , Berk Michael , Paiker Janice , Viljoen Esther
Published: August 2005

Objectives
To determine the effect of postnatal administration of the long‐acting progestogen contraceptive, norethisterone enanthate, on postnatal depression and on serum hormone concentrations, and their association with depression.

Design
Double‐blind randomised placebo‐controlled trial.

Setting
A tertiary care hospital in Johannesburg, South Africa.

Population
Postnatal women using a non‐hormonal method of contraception (n= 180).

Methods
Random allocation within 48 hours of delivery to norethisterone enanthate by injection, or placebo.

Main outcome measures
1. Depression scores in the three months postpartum as rated by the Montgomery‐Åsberg Depression Rating Scale (MADRS) and the Edinburgh Postnatal Depression Scale (EPDS); 2. serum 17β‐oestradiol, progesterone, testosterone and the 17β‐oestradiol: progesterone ratio at six weeks postpartum.

Results
There was a chance excess of caesarean section deliveries in the progestogen group. Mean depression scores were significantly higher in the progestogen group than in the placebo group at six weeks postpartum (mean MADRS score 8.3 vs 4.9; P = 0.01 11; mean EPDS score 10.6 vs 7.5; P = 0.0022). Mean serum 17β‐oestradiol and progesterone concentrations were significantly lower in the progestogen group compared with the placebo group at six weeks postpartum. There were no correlations between any of the hormone parameters and depression at six weeks except in the formula feeding subgroup of the placebo group, where formula feeding and 17β‐oestradiol concentrations were positively associated with depression.

Conclusions
Long‐acting norethisterone enanthate given within 48 hours of delivery is associated with an increased risk of developing postnatal depression and causes suppression of endogenous ovarian hormone secretion.
Intra‐amniotic inflammation in human gastroschisis: possible aetiology of postnatal bowel dysfunction
Authors: Morrison John J. , Klein Nigel , Chitty Lyn S. , Kocjan Gabriella , Walshe Denise , Goulding Mark , Geary Michael P. , Pierro Agostino , Rodeck Charles H.
Published: August 2005

Objective
To assess amniotic fluid for evidence of an inflammatory exudate in association with fetal gastroschisis.

Setting
University College Hospital, London and Institute of Child Health, London.

Sample
Samples of amniotic fluid in the third trimester from pregnant women with a diagnosis of fetal gastroschisis (n = 10) and from a control group (n= 10) with a normal fetus.

Methods
Cytological analysis of the fluid was performed. Flow cytometry was performed on the amniotic fluid using antibodies for the myeloid cell antigen CD 15, the leucocyte beta integrin CDI1b/CD18 and CD3, CD19, CD56 and CD25. Tumour necrosis factor alpha and interleukin‐8 levels were assayed in the amniotic fluid.

Results
An acute inflammatory exudate, composed predominantly of neutrophil polymorphs and mononuclear cells, was found in the amniotic fluid in fetal gastroschisis but not in control cases. When amniotic fluid samples from cases of fetal gastroschisis were stained with CD 15, analysis by flow cytometry showed a clear positive population. This CD 15 population showed markedly elevated levels of CD 11b. No distinct population of CD 15 positive cells was seen in amniotic fluid samples examined from the control group. No staining was seen with antibodies to CD3, CD 19, CD56 or CD25 in amniotic fluid obtained from either group. There was no significant difference between tumour necrosis factor alpha levels measured in the amniotic fluid of cases of fetal gastroschisis (median 102 pg/mL; range 20–340) and those of the control group (140 pg/mL; range 20–548) (P= 0.1). The levels of interleukin‐8 were markedly elevated in the amniotic fluid of cases of fetal gastroschisis (median 6320 pg/mL; range 4732–13,800) compared with the control group (median 1738 pg/mL; range 623–2861;) (P < 0.01).

Conclusion
Human fetal gastroschisis is associated with an inflammatory exudate in the amniotic fluid which may have implications for postnatal bowel function.
Anti‐U and haemolytic disease of the fetus and newborn
Authors: Smith G. , Knott P. , Rissik J. , de la Fuente J. , Win N.
Published: August 2005

The red cell alloantibody, anti‐U, is uncommon but is a recognised cause of haemolytic disease of the fetus and newborn. We describe six pregnancies complicated by the presence of maternal anti‐U, and review nine other well‐documented cases. In these 15 cases severe haemolytic disease occurred only with titres of ≥ 1/512, and titres as high as 1/4000 were not necessarily associated with significant haemolysis. We recommend that an anti‐U titre of ≥ 1/128 or more at ≥ 17 weeks of gestation is an indication for assessment of haemolysis in the fetus. Amniocentesis is the preferred initial investigation.
Do gastrointestinal symptoms vary with the menstrual cycle?
Authors: Moore Jane , Barlow David , Jewell Derek , Kennedy Stephen
Published: August 2005

This systematic review presents both the physiological and symptom‐based studies which have explored gastrointestinal variation across the menstrual cycle. Understanding this variation may be helpful in identifying the origin of pelvic pain, particularly as the symptoms associated with causes, such as endometriosis, also vary across the cycle. One‐third of otherwise asymptomatic women may experience gastrointestinal symptoms at the time of menstruation, and almost 50% of women with irritable bowel syndrome report a perimenstrual increase in symptoms.