bluuebunny/crossref_metadata_2025 huggingface dataset:
Faecal incontinence after childbirth
Authors: MacArthur Christine , Bick Debra E. , Keighley Michael R. B.
Published: August 2005

Objective
To measure the prevalence and severity of postpartum faecal incontinence, especially new incontinence, and to identify obstetric risk factors.

Design
A cohort study with information on symptoms collected in home‐based interviews and obstetric data from hospital casenotes.

Setting
Deliveries from a maternity hospital in Birmingham.

Participants
Nine hundred and six women interviewed a mean of 10 months after delivery.

Main outcome measures
New faecal incontinence starting after the birth, including frank incontinence, soiling and urgency.

Results
Thirty‐six women (4%) developed new faecal incontinence after the index birth, 22 of whom had unresolved symptoms. Twenty‐seven had symptoms several times a week, yet only five consulted a doctor. Among vaginal deliveries, forceps and vacuum extraction were the only independent risk factors: 12 (33%) of those with new incontinence had an instrumental delivery compared with 114 (14%) of the 847 women who had never had faecal incontinence. Six of those with incontinence had an emergency caesarean section but none became incontinent after elective sections.

Conclusions
Faecal incontinence as an immediate consequence of childbirth is more common than previously realised, and medical attention is rarely sought. Forceps and vacuum extraction deliveries are risk factors, with no protection demonstrated from emergency caesarean section. Identification and treatment is a priority.
Local immune response in endometrial carcinomas
Authors: Hachisuga Toru , Fukuda Koichi , Nakamura Satoru , Iwasaka Tsuyoshi , Sugimori Hajime
Published: August 2005

Objective
To determine whether Langerhans cells act as antigen‐presenting cells in endometrial carcinomas and their related lesions.

Samples
Frozen endometrial samples were obtained from 13 women with normal menstrual cycles, 3 postmenopausal women, 11 women with hyperplasia (simple 4, complex 4 and atypical 3) and 32 women with endometrial carcinomas.

Main outcome measures
Langerhans cells (CD1), T lymphocytes (CD4 and CD8), B lymphocytes (CD22), natural killer (NK) cells (CD57) and HLA‐DR were all quantitatively assessed in endometrial samples using immunohistochemical method.

Results
The numbers of Langerhans, CD4+, CD8+ and B cells were higher in the secretory phase than in the proliferative endometrium. The CD8+ cells appeared to be more plentiful than the CD4+ cells. When compared with the proliferative endometrium, the numbers of Langerhans cells were higher in hyperplasias and carcinomas. Most of Langerhans cells were HLA‐DR+, showing a strong correlation with CD4+ cells in carcinomas. This suggests that MHC class II antigen restricted lymphocytes in carcinomas are activated by HLA‐DR+ Langerhans cells. However, epithelial expression of HLA‐DR in carcinomas did not show on association with high numbers of Langerhans and CD4+ cells. No correlation was observed between Langerhans cells and clinicopathologic features of carcinomas. In contrast, the number of NK cells significantly decreased in noninvasive carcinomas but increased in Grade 3 tumours.

Conclusion
Based on the above findings, Langerhans cells are considered to act as antigen‐presenting cells in carcinomas, but it was not shown that they were activated by epithelial expression of HLA‐DR in carcinomas.
Amniotic fluid nitric oxide and uteroplacental blood flow in pregnancy complicated by intrauterine growth retardation
Authors: Di Iorio Romolo , Marinoni Emanuela , Coacci Federica , La Torre Renato , Cosmi Ermelando V.
Published: August 2005

Objective
To examine the correlation between placental nitric oxide production and uteroplacental blood flow.

Participants
Thirty‐one pregnant women with fetuses with intrauterine growth retardation and 27 normal pregnancies as controls.

Design
Correlation between amniotic fluid measurements of nitrite metabolite in the third trimester and flow velocimetry waveforms recorded from uterine, umbilical and fetal middle cerebral arteries. Intrauterine growth retarded pregnancies were compared with controls.

Main outcome measures
Concentrations of nitric oxide metabolites (NO2‐ and NO3‐) in amniotic fluid were correlated with flow velocimetry waveforms findings by the determination of correlation coefficient.

Results
Overall median nitrite values in amniotic fluid were higher (P < 0.01) in intrauterine growth retarded patients (median 8.6 μmol/mg creatinine) than in controls (5.6 μmol/mg creatinine). Pathologic uterine flow velocimetry waveforms in uterine artery (‐2SD) were observed in 12 women of the intrauterine growth retarded group, and the concentration of amniotic fluid nitrite was significantly lower (P < 0.01) in these patients (median 4.45 μmol/mg creatinine) than in those with normal flow velocity waveforms (median 11.43 μmol/mg creatinine). A significant negative correlation was observed between nitrite concentrations and uterine artery resistance index, umbilical artery pulsatility index and umbilical artery pulsatility index:middle cerebral artery pulsatility index ratio.

Conclusions
We conclude that placental nitric oxide is significantly associated with uteroplacental blood flow and may be important in maintaining adequate uteroplacental perfusion in intrauterine growth retarded pregnancies.
A randomised controlled comparison of betamethasone with dexamethasone: effects on the antenatal fetal heart rate
Authors: Magee L. A. , Dawes G. S. , Moulden M. , Redman C. W. G.
Published: August 2005

Objective
To compare the effects of maternal administration of betamethasone and dexamethasone on fetal heart rate, using computerised numerical analyses, and to examine the association between changes in short term variation and the timing and indication for delivery.

Setting
John Radcliffe Hospital, Oxford.

Sample
Fifty‐nine women with singleton pregnancies, who were at risk of delivery before 34 weeks of gestation, had received no steroids in the preceding week and could give informed consent.

Methods
Women were randomised on a double‐blind basis to receive either betamethasone or dexamethasone. The fetal heart rate was recorded (60‐minute duration at similar times of day) before steroid administration and on each of the following two days; changes were measured by computerised analyses.

Main outcome measures
Changes in short term variation and long term variation of fetal heart rate or the number of fetal movements. Statistical analysis was nonparametric.

Results
Betamethasone and dexamethasone had no differential effects on the computerised cardiotocography. However, both steroids decreased baseline fetal heart rate, increased long term variation, increased short term variation, and decreased fetal movements on the first day after steroid administration, and decreased high fetal heart rate variation and decelerations on the second day. Among 13 women who were delivered within one week of steroid administration, smaller rises in short term variation on day one were associated with delivery for fetal indications.

Conclusions
Both betamethasone and dexamethasone produced transient, unexplained changes in the fetal heart rate over the two days following steroid administration. Larger changes in short term variation were associated with fetal wellbeing. It is important to recognise that such changes are a physiological response of the human fetus to steroid administration.
Urodynamics: prediction, outcome and analysis of mechanism for cure of stress incontinence by periurethral collagen
Authors: Monga Ash K. , Stanton Stuart L.
Published: August 2005

Objective
To assess the role of urodynamics in the prediction and assessment of outcome and analysis of the mechanism of cure for stress incontinence using periurethral collagen as our treatment model.

Design
Prospective longitudinal study.

Setting
A teaching hospital tertiary referral centre.

Patients
Sixty women with genuine stress incontinence.

Results
The objective cure rate was 54% (n= 54) at 12 months. Subtracted cystometry, urethral electrical conductivity and bladder neck excursion measurements did not predict cure. A low pre‐injection maximum urethral closure pressure adversely affects outcome (31 cmH2O (success) vs 19 cmH2O (failure), P= 0.004); all women with a maximum urethral closure pressure > 39 cmH2O were rendered dry. Urethral pressure profilometry can analyse mechanism of cure. Total profile length, stress maximum urethral closure pressure, stress functional urethral length and pressure transmission ratio in the first quarter of urethral length were increased in successful cases (P < 0.05), and rest maximum urethral and maximum urethral closure pressures, area under rest profile and pressure transmission ratio in the second quarter of urethral length were increased in failed cases (P < 0.02).

Conclusions
In successful cases the increased area and pressure transmission ratio in the first quarter of the functional urethral length suggest that collagen placement occurs at the bladder neck or proximal urethra. Cure appears to be due to prevention of bladder neck opening during stress and not obstruction. In addition the cephalad elongation of the urethra caused by collagen probably accounts for the increased abdominal pressure transmission in the first quarter of the urethra. In failures, there is an increased length and increased area to peak pressure suggesting collagen is deposited more distally. This study confirms the role of certain urethral pressure profilometry variables in the prediction and analysis of mechanism of cure.
The mythology of hormone replacement therapy
Authors: Hartmann Beda W. , Huber Johannes C.
Published: August 2005

Objective
To evaluate the literature on contraindications contained in pharmaceutical data sheets of five currently available oestrogen replacement preparations (HRT). These contraindications include cardiovascular disease, diabetes, liver diseases, otosclerosis, endometriosis, melanoma and hormone‐dependent tumours.

Design
Systematic review.

Interventions
Oestrogen replacement regimens.

Results
The contraindications to the five HRT preparations have been taken uncritically from the data sheets of oral contraceptives. In some of these conditions not only is HRT not contraindicated, it is indicated. The data sheets for the HRT preparations all state that cardiovascular disease is a contraindication, but systematic review shows that ischaemic heart disease, hypertension and hyperlipidaemia are not contraindications, and in ischaemic heart disease HRT may actually be indicated. Similarly, systematic review shows that diabetes, chronic liver disease, endometriosis, some cases of treated cancer of the endometrium and breast, melanoma and otosclerosis are not contraindications to HRT.

Conclusions
The information in the pharmaceutical data sheets of HRT regimens should be modified as more accurate information could influence how these preparations are prescribed by doctors as well as affect patient compliance.
Association of gestational diabetes with abnormal maternal vascular endothelial function
Authors: Knock Gregory A. , McCarthy Andrew L. , Lowy Clara , Poston Lucilla
Published: August 2005

Objective
To evaluate vascular endothelial function in isolated small arteries from women with gestational diabetes.

Methods
Small subcutaneous arteries (mean luminal diameter ∼ 250μm) were dissected from biopsies obtained at caesarean section in 14 normotensive women with gestational diabetes and in 18 normotensive nondiabetic pregnant women. Vascular function was determined after mounting the arteries on a small vessel myograph.

Results
Pre‐constricted arteries from gestational diabetic pregnant women demonstrated poor relaxation to acetylcholine, an endothelium‐dependent vasodilator (pEC50, mean [SE], 6.98 [0.10] vs normal pregnant, 7.28 [0.08], P < 0.03; % maximum relaxation, median [range], 88.2 [42.4–994] vs normal pregnant 94.2 [71.8–100.0], P < 0.01). In the presence of indomethacin relaxation to acetylcholine was similar in both groups suggesting a deficiency in dilator prostaglandin synthesis in the arteries from the diabetic women. The nitric oxide synthase inhibitor N ‐monomethyl‐L‐arginine further reduced sensitivity of arteries to acetylcholine but to a similar degree in both normal pregnant and gestational diabetic women. Relaxation to sodium nitroprusside, an indicator of sensitivity of the vascular smooth muscle to nitric oxide, was similar in both groups.

Conclusions
Maternal vascular endothelial dysfunction may contribute to the increased incidence of cardiovascular disorders in women with gestational diabetes.
Impact of percutaneous oestradiol gels in postmenopausal hormone replacement therapy on clinical symptoms and endometrium
Authors: Foidart Jean‐Michel , Beliard Aude , Hedon Bernard , Ochsenbein Edith , Bernard Anne‐Marie , Bergeron Christine , Thomas Jean‐Louis
Published: August 2005

Objective
To compare the effects on endometrium, climacteric symptoms and the menstrual cycle, and the clinical and biological tolerance of two percutaneous oestradiol gels used as hormone replacement therapy.

Design
A large open randomised multicentre study.

Setting
France and Belgium.

Participants
Two‐hundred and fifty‐four women with an intact uterus and who had experienced a natural menopause received either Oestrogel® (n= 126) or Estreva®, a new formulation of oestradiol gel (n= 128), (1.5 mg of oestradiol/day) for the 24 first days of each calendar month during six consecutive months. Nomegestrol acetate (Lutenyl®), a norprogesterone derivative, was administered (5 mg/day) from day 11 to day 24 of each oestradiol cycle.

Main outcome measures
Examination of endometrial biopsies taken before treatment and between days 18 and 24 of the last treatment cycle, climacteric symptoms assessed using a modified Kupperman index, control of menstrual cycle evaluated by diary cards, and clinical and biological tolerance.

Results
Both treatments lowered the frequency and intensity of hot flushes and the global Kupperman index. 96% of the cycles were followed by withdrawal bleeding. Breakthrough bleeding or spotting resulted in premature discontinuation of treatment in one volunteer. Mastodynia occurred in 20 women and contributed to the premature termination of treatment in three of them. Endometrial biopsies taken at the end of treatment showed identical histologies in both groups, with a secretory pattern in the majority of women, and absence of hyperplasia.

Conclusions
This trial confirmed that, when the two oestradiol gels tested were administered cyclically with nomegestrol acetate to postmenopausal women, they were well tolerated, effective and suitable for the treatment of oestrogen deficiency syndrome.
Use of oral misoprostol in the prevention of postpartum haemorrhage
Authors: El‐Refaey Hazem , O'Brien Pat , Morafa Wale , Walder Jane , Rodeck Charles
Published: August 2005

Objective
To investigate the use of the oral prostaglandin E1 analogue, misoprostol in the prevention of postpartum haemorrhage.

Design
A prospective observational study.

Setting
A university teaching hospital.

Participants
Two hundred and thirty‐seven consecutive women undergoing vaginal delivery.

Methods
All the women were given 600 μg oral misoprostol just after delivery.

Main outcome measures
Rates of postpartum haemorrhage; need for therapeutic oxytocic drugs; retained placenta and length of the third stage of labour.

Results
Postpartum haemorrhage occurred in 6% of the women; the need for therapeutic oxytocics in 5%, retained placenta in 2% and the median length of the third stage was 5 min. Vomiting and diarrhoea in the first hour after delivery occurred in 8% and 3% respectively and shivering in 60%.

Conclusions
Misoprostol may be effective in the prevention of postpartum haemorrhage, and has few side effects. A double blind randomised trial is required.
The diagnostic accuracy of cervico‐vaginal fetal fibronectin in predicting preterm delivery: an overviev
Authors: Chien Patrick F. W. , Khan Khalid S. , Ogston Simon , Owen Philip
Published: August 2005

Objective
To determine the accuracy with which cervico‐vaginal fetal fibronectin predicts preterm delivery using systematic quantitative overview of the available literature.

Design
Online searching of MEDLINE database (1966 to April 1996), scanning of bibliography of known primary and review articles and review of recent journal issues. Study selection, assessment of study quality and data extraction were performed in duplicate under masked conditions. Likelihood ratios were generated in subgroups of symptomatic and asymptomatic pregnant women by pooling data from different studies. An LR of > 10 or < 0.1 indicated conclusive changes in the pretest probability of preterm delivery while an LR of 5–10 or 0.2–0.1 indicated only moderate changes.

Participants
Seven hundred and twenty‐three symptomatic women with threatened preterm labour included in nine studies and 847 asymptomatic women (635 low risk and 212 high risk) included in six studies selected for meta‐analyses.

Main outcome measures
Likelihood ratios for positive and negative test results using delivery at < 37 and < 34 weeks of gestation, and within one week of testing as outcome measures.

Results
In symptomatic women a positive test predicted delivery < 37 weeks of gestation with a pooled likelihood ratio (LR) of 4.6 (95% CI 3.5–6.1) while a negative test had a pooled LR of 0.5 (95% CI 0.4–0.6). For delivery < 34 weeks of gestation, the pooled LR was 2.6 (95% CI 1.8–3.7) for a positive test and 0.2 (95% CI 0.1–0.5) for a negative test. For delivery within one week of testing, the pooled LR was 5.0 (95% CI 3.8–6.4) for a positive test and 0.2 (95% CI 0.1–0.4) for a negative test. In asymptomatic women at low risk of delivery < 37 weeks of gestation the pooled LR was 3.2 (95% CI 2.2–4.8) for a positive test and 0.8 (95% CI 0.7–0.9) for a negative test. In high risk asymptomatic women using delivery < 37 weeks of gestation as an outcome measure the pooled LR was 2.0 (95% CI 1.5–2.6) for a positive test and 0.4 (95% CI 0.2–0.8) for a negative test. For delivery < 34 weeks of gestation in high risk, asymptomatic women the pooled LR was 2.4 (95% CI 1.8–3.2) for a positive test and 0.6 (95% CI 0.4–0.9) for a negative test.

Conclusion
The presence of fetal fibronectin in cervico‐vaginal mucus has limited accuracy in predicting preterm delivery as the likelihood ratios for positive and negative test results generated only minimal to moderate changes in the pretest probability of preterm birth.
Third degree obstetric perineal tears: risk factors and the preventive role of mediolateral episiotomy
Authors: Poen A. C. , Felt‐Bersma R. J. F. , Dekker G. A. , Devillé W. , Cuesta M. A. , Meuwissen S. G. M.
Published: August 2005

Objective
To determine risk factors for third degree obstetric perineal tears and to give recommendations for prevention.

Design
Retrospective case–control study.

Setting
A teaching hospital in The Netherlands.

Participants and methods
One hundred and twenty cases of vaginal delivery complicated by third degree perineal tear and 702 uncomplicated vaginal deliveries were compared, with respect to possible risk factors.

Results
In a multivariate model high birthweight, forceps delivery, induced labour, epidural anaesthesia and parity were risk factors for anal sphincter tear. In addition, mediolateral episiotomy was associated with fewer sphincter injuries. Separate analysis of nulli‐ and multiparous women demonstrated that high birthweight and epidural anaesthesia (increased risk) and mediolateral episiotomy (decreased risk) were factors associated with anal sphincter tear only in nulliparous women.

Conclusions
We found several risk factors for anal sphincter tear. Nulliparous women are at higher risk than multiparous women. Mediolateral episiotomy may be sphincter‐saving especially in nulliparous women and therefore prevent them from chronic faecal incontinence.
Significance of low birthweight for gestational age among very preterm infants
Authors: Spinillo Arsenio , Capuzzo Ezio , Piazzi Gaia , Baltaro Federica , Stronati Mauro , Ometto Alessandra
Published: August 2005

Objective
To estimate the risk of specific adverse neonatal events resulting from the combined effects of prematurity and low birthweight in very preterm infants (delivered at 24–31 weeks of gestation)

Design
A cohort study of specific adverse neonatal events in preterm infants born at between 24 and 31 weeks of gestation.

Setting
Pavia, Italy.

Population
Two hundred and thirty singleton infants with sonographically confirmed gestational age, delivered at 24 to 31 weeks of gestation.

Methods
To evaluate the impact of a lower than expected birthweight on selected neonatal events independently of gestational age, we calculated birthweight standard deviation scores (differences between actual birthweight and fitted birthweight divided by fitted standard deviation) for each week of gestation.

Results
After adjustment for gestational age and other confounders, there was a significant linear trend relating a decreasing birthweight SDS to an increased likelihood of neonatal death, intraventricular haemorrhage, severe respiratory distress syndrome, and acidosis. Compared with infants with SDS 0 ( 50th centile of birthweight), infants with birthweight SDS < −1 (< 16th centile) had increased odds for neonatal death [odds ratio (OR) 3.7, 95% confidence interval (CI) 1.42–9.6], grade III‐IV intraventricular haemorrhage (OR 17.5, 95% CI 4.04–75.9), and neonatal acidosis (OR 3.22, 95% CI 1.41–7.4). The significance of birthweight SDS as a predictor of neonatal outcome, however, was lower than that of gestational age.

Conclusions
A lower than expected birthweight affects the likelihood of several adverse neonatal events in very preterm infants. However, a decreasing birthweight SDS affects neonatal outcome less than decreasing gestation does.
Antioxidants in the treatment of severe pre‐eclampsis an explanatory randomised controlled trial
Authors: Gülmezoǧlu A. Metin , Hofmeyr G. Justus , Oosthuisen Mathys M. J.
Published: August 2005

Objective
To determine whether antioxidant therapy alters the disease process in severe early onset pre‐eclampsia, in support of the hypothesis that increased lipid peroxides and reactive oxygen species production play an important role in the pathogenesis of the disease.

Design
Randomised, double‐blind, placebo controlled trial.

Setting
Two tertiary care, referral hospitals in Johannesburg, South Africa.

Participants
Women with severe pre‐eclampsia diagnosed between 24 and 32 weeks of gestation.

Intervention
Combined antioxidant treatment with vitamin E (800 IU/day), vitamin C (1000 mg/day), and allopurinol (200 mg/day).

Main outcome measures
Primary outcomes: 1. prolongation of pregnancy and 2. biochemical assessment of lipid peroxides and antioxidants. Secondary outcomes: data on maternal complications, side effects of treatment, infant outcomes and regular assessment of haematologic and renal parameters.

Results
The proportion of women delivered within 14 days in the antioxidant group was 52% (14/27) compared with 76% (22/29) in the placebo group (relative risk 0.68, 95% confidence interval 0.45–1.04). One woman in each group had eclampsia. Eleven women (42%) in the antioxidant and 16 (59%) in the placebo group required two antihypertensives for blood pressure control. Trial medications were well tolerated with few side effects. Lipid peroxide levels were not significantly altered in the antioxidant and placebo groups. Serum uric acid levels decreased and vitamin E levels increased significantly.

Conclusion
The results of this explanatory randomised trial do not encourage the routine use of antioxidants against pre‐eclampsia. However, further research with modified strategies such as earlier initiation of therapy or different combinations seem worthwhile.
Predictors of successful external cephalic version at term: a prospective study
Authors: Lau T. K. , Lo Keith W. K. , Wan D. , Rogers Michael S.
Published: August 2005

Objective
To investigate clinical and ultrasonographic predictors of outcome of external cephalic version at term.

Design
Prospective observational study.

Setting
University obstetric unit.

Population
All external cephalic versions performed over two years (n=243).

Methods
Nineteen different clinical and ultrasonographic variables were recorded before each procedure. The ability of each of the 19 variables to predict the success or failure of external cephalic version was assessed by univariate analysis. The study population was then divided into two subgroups of 129 and 114 patients by random allocation using computer generated numbers. Logistic regression was performed in each subgroup to assess the relative importance and independence of the important variables. The derived regression models were then applied to the other subgroup of patients to assess accuracy and reproducibility.

Results
The overall success rate of the procedure was 69.5%. Both regression models identified the same three variables as independent predictors of failed versions: 1. presenting part engaged; 2. difficult to palpate the fetal head, and 3. a tense uterus on palpation. The two models correctly predicted 75.2% and 84.2% of outcomes in the other subgroup. If uterine tone, which was assessed after administration of tocolytic, was excluded from the analysis, the other two factors remained in the models, with the addition of nulliparity as a significant predictor of failed external cephalic version. The chance of success of external cephalic version in the original 243 women was found to be < 20% if two of these variables were present, 0% if all three were present, and 94% if none were present.

Conclusions
The outcome of external cephalic version can be predicted by easily available clinical parameters.
The Kleihauer Technique: an accurate method of quantifying fetomaternal haemorrhage?
Authors: Duckett J. R. A. , Constantine G.
Published: August 2005

Blood was taken from 100 consecutive asymptomatic women at 17 to 18 weeks of pregnancy for Kleihauer testing. When a proportion of these slides were assessed at a different hospital there was agreement in only 46%. When the number of fetal cells were quantified there were differences of over 500%. These results show a large niter‐observer and inter‐hospital variation in interpreting Kleihauer slides. If these investigations are to be performed, it is essential that clinicians can rely on the results. There is a need for quality control measures and audit so that laboratories can rectify any deficiencies in their techniques.
Sweeping of the membranes at 39 weeks in nulliparous women: a randomised controlled trial
Authors: Cammu Hendrik , Haitsma Vera
Published: August 2005

Objective
To determine whether weekly sweeping of the membranes from 39 weeks of gestation results in a reduction in the number of women reaching 41 completed weeks and subsequently in a reduction of the number of women who will need induction of labour.

Design
Randomised controlled trial.

Participants
Two hundred and seventy‐eight nulliparous women, who were seen at the antenatal clinic of a university teaching hospital, were randomly allocated at 39 weeks of gestation to receive on a weekly basis either sweeping of the membranes (n=140) or a routine pelvic examination (n=138).

Main outcome measures
The time interval between randomisation and delivery, the incidence of prolonged pregnancy (i.e. > 41 completed weeks), and the incidence of induction of labour.

Results
In 24 women (17%) sweeping of the membranes was not possible. Fifty‐three women (38%) in the sweeping group and 50 women (36%) in the control group were delivered within one week after randomisation. Women allocated to sweeping showed a trend towards having a shorter randomization‐delivery interval: 9.4 days versus 10.6 days in the controls (P= 0.087). Sweeping had no statistically significant effect on the mean duration of pregnancy (282.8 days in the sweeping group versus 283.8 days in the control group, P= 0.127). The need for induction of labour was significantly reduced in those women who underwent sweeping (11%versus 26%, P= 0.004), merely as a result of a decrease in the number of women that exceeded 41 weeks (19%versus 33%, P= 0.016).

Conclusion
Sweeping of the membranes weekly from 39 weeks does not increase the number of women who will deliver within the first week but significantly decreases the number that will reach 41 weeks. Induction of labour then becomes less necessary.
A comparative study of women with chronic pelvic pain, chronic nonpelvic pain and those with no history of pain attending general practitioners
Authors: Collett B. J. , Cordle C. J. , Stewart C. R. , Jagger Carol
Published: August 2005

Objective
To investigate and compare the demographic and psychosocial profiles of women with chronic pelvic pain, chronic pain in a different site, and those with no history of pain with specific reference to a history of sexual abuse.

Design
A prospective comparative study.

Setting
Pelvic Pain Clinic at Leicester General Hospital NHS Trust, Pain Management Clinic at Leicester Royal Infirmary NHS Trust and two General Practices.

Participants
Thirty women with chronic pelvic pain, 30 women with chronic pain in a different site and 30 women attending their general practitioner with no history of pain.

Interventions
A specifically designed patient profile questionnaire to identify and explore incidents of sexual and physical abuse was administered to each woman by a research psychologist for confidential self‐completion. Data were also collected on other demographic, medical and psychosocial characteristics.

Results
Women with chronic pelvic pain were found to have a higher lifetime prevalence of sexual abuse, involving penetration or other genital contact compared with the two comparison groups. The prevalence of physical abuse was the same in all groups. Women in the pelvic pain group were more likely to have approached their GP for symptoms not related to pelvic pain than women in the other two groups and the incidence of clinical anxiety was significantly higher in this group compared with the pain‐free group. The prevalence of sexual problems was much higher in the group with pelvic pain compared with the other two groups.

Conclusion
These findings indicate that women with chronic pelvic pain have a higher incidence of past sexual abuse compared with women in a comparison pain group and with women with no pain.
Maternal serum inhibin A can predict pre‐eclampsia
Authors: Cuckle Howard , Sehmi Indera , Jones Richard
Published: August 2005

Objective
To compare median levels of maternal serum inhibin A in the second trimester blood samples of women who subsequently develop pre‐eclampsia and those who do not.

Design
Retrospective analysis of 13–18 week samples from a bank of serum stored at −40°C, originally taken for Down's syndrome screening.

Setting
Antenatal clinics in a teaching hospital.

Sample
Twenty‐eight pregnancies with pre‐eclampsia and 701 controls. Samples were taken, on average, 22 weeks before the diagnosis.

Main outcome measure
Median inhibin A level.

Results
The median inhibin A level in the cases was 2.01 multiples of the gestation‐specific median in the controls, a statistically significant elevation (P < 0.001). Twenty‐three (82%) had levels above the normal median; 19 (68%), 15 (54%), and 11 (39%) exceeded the normal 75th, 90th and 95th centiles, respectively.

Conclusions
In pre‐eclampsia the maternal serum inhibin A level can be increased months before the onset of symptoms. This provides an opportunity to study the early natural history of the disease and possibly to conduct treatment trials.
Antibodies against copper‐oxidised and malondialdehyde‐modified low density lipoproteins in pre‐eclamptic pregnancies
Authors: Uotila Jukka , Solakivi Tiina , Jaakkola Olli , Tuimala Risto , Lehtimaki Terho
Published: August 2005

Objective
To measure auto‐antibodies against oxidatively modified low density lipoprotein (LDL) in pre‐eclamptic pregnancies using two different techniques.

Design
Clinical study comparing pre‐eclamptic and normal pregnancies.

Setting
Tampere University Hospital, Finland.

Population
Twenty‐one primigravidae with pre‐eclampsia and 13 healthy, normotensive primigravidae as controls.

Methods
The serum titers of antibodies against both malondialdehyde‐modified and copper‐oxidised LDL (MDA‐LDL and copper‐ox LDL) were analysed and related to parameters reflecting the severity of pre‐eclampsia.

Results
There was a positive correlation (r= 0.58) between antibodies against MDA‐LDL and copper‐ox LDL in women with pre‐eclampsia but not in healthy pregnant controls. The antibody levels against copper‐ox LDL, but not against MDA‐LDL, were higher in women with pre‐eclampsia than in women with a normal pregnancy (P < 0.01). While the antibody titers against copper‐ox LDL did not correlate with any parameter reflecting the severity of pre‐eclampsia, those against MDA‐LDL showed a positive correlation with the level of diastolic blood pressure (r= 0.54) and a negative correlation with platelet count (r= 461) in women with pre‐eclampsia.

Conclusions
There are increased titers of serum autoantibodies against copper‐oxidised LDL in pre‐eclampsia, which may reflect enhanced lipid peroxidation involving circulating lipoproteins.
Perceptions of women on the impact of menorrhagia on their health using multi‐attribute utility assessment
Authors: Shaw R. W. , Brickley M. R. , Evans L. , Edwards M. J.
Published: August 2005

Objective
To assess patient preferences regarding the treatment of menorrhagia using the multi‐attribute utility methodologies, to produce a clinically applicable scale, and to assess health outcomes following treatment of menorrhagia.

Methods
Women referred to the gynaecology department for the treatment of menorrhagia were interviewed regarding the effects of menorrhagia on different aspects of their life. Their concerns were categorised into main components of health (domains). The relative importance of each domain was rated by the women using importance points which were distributed to represent the perceived importance of each domain. A series of statements (intra‐domain statements) was developed for each domain, which described various possible conditions of that component of health. These were also rated using a one metre visual analogue scale with numerical anchor points at zero (worst) and 100 (best).

Results
The components of health considered most important were, in order of impact, family life, followed by physical health, work life, psychological health, practical difficulties and social life. The scores for the intra‐domain statements were combined into a scale to allow the calculation of a final health state utility for a particular outcome based upon the statements the patient chooses within each domain.

Discussion
In planning treatment for menorrhagia clinicians can assess a woman's current perception of their health, using a simple to administer clinical scale.
Circulating markers of oxidative stress are raised in normal pregnancy and pre‐eclampsia
Authors: Morris Jonathan M. , Gopaul Nitin K. , Endresen Marit J. R. , Knight Marian , Linton Elizabeth A. , Dhir Suman , Ängård Eric E. , Redman Christopher W. G.
Published: August 2005

Objective
To determine whether circulating markers of oxidative stress are elevated in pre‐eclampsia when appropriate precautions are taken to prevent in vitro oxidation

Design
A prospective study.

Setting
Nuffield Department of Obstetrics and Gynaecology, Oxford and The William Harvey Institute, London.

Sample
Three groups of women: those with pre‐eclampsia (n = 19), control pregnant (n = 19) matched for gestation, age and parity and a group of non pregnant individuals reproductive age (n = 7).

Methods
Citrated plasma was stored at −80°C with 20 μmol β hydroxytoluene to prevent auto‐oxidation. Plasma samples were assayed for levels of 8 epi‐prostaglandin F2α, lipid hydroperoxides, malondialdehyde and also the lipid soluble antioxidant vitamin E.

Results
There were no differences in 8 epi‐prostaglandin F2α lipid peroxide or malondialdehyde levels between the groups of women with pre‐eclampsia and those acting as pregnant controls. However, lipid hydroperoxides and malondialdehyde were significantly raised in both pre‐eclampsia and normal pregnancy, compared with nonpregnant women. Vitamin E levels were similar in women with pre‐eclampsia and those with a normal pregnancy, but in both groups levels were significantly higher than in nonpregnant women.

Conclusion
Circulating markers of oxidative stress are raised in normal pregnancy and pre‐eclampsia.
The ability of the chemiluminescence test to predict clinical outcome and the necessity for amniocenteses in pregnancies at risk of haemolytic disease of the newborn
Authors: Hadley Andrew G. , Wilkes Anthony , Goodrick Jean , Penman David , Soothill Peter , Lucas Geoffrey
Published: August 2005

The chemiluminescence test measures the ability of anti‐D to sensitise red cells for recognition by monocytes. It predicts clinical outcome in haemolytic disease of the newborn with greater precision than quantification of anti‐D levels by Auto Analyzer. However, whether or not the chemiluminescence test can, or should, affect clinical management is not clear. Of 56 alloimmunised women referred to a single fetal medicine unit, 30 underwent a total 63 amniocenteses to establish the extent of fetal haemolysis. Overall, chemiluminescence test results were a better predictor of amniocenteses with elevated bilirubin levels than the AutoAnalyzer (P < 0.01). Chemiluminescence results > 30% were always associated with elevated bilirubin levels. The chemiluminescence test might be used to prompt the direct evaluation of fetal haemolysis in patients with borderline levels of anti‐D (5–15 IU/mL). However, the ability of the test to predict amniocenteses with normal bilirubin levels was less clear.
Pregnancy in women with von Willebrand's disease or factor XI deficiency
Authors: Kadir Rezan A. , Lee Christine A. , Sabin Caroline A. , Pollard Debra , Economides Demetrios L.
Published: August 2005

Objective
To assess the obstetric outcome in women with von Willebrand's disease or factor XI deficiency.

Setting
Haemophilia Centre and Haemostasis Unit, The Royal Free Hospital.

Population
Women with von Willebrand's disease (n= 31) and with factor XI deficiency (n= 11) registered at the Royal Free Hospital Haemophilia Centre who had had a pregnancy within the previous 17 years (1980–1996), including 84 in women with von Willebrand's disease and 28 in women with factor XI deficiency.

Methods
Women were interviewed and details of the obstetric history were obtained. The records of the Haemophilia Centre and the women's maternity records were also reviewed.

Results
Threatened miscarriage occurred in 33% and 14% of pregnancies with von Willebrand's disease and factor XI deficiency, respectively. Excluding recurrent miscarriages, 14/68 (21%) of pregnancies with von Willebrand's disease and one pregnancy with factor XI deficiency miscarried spontaneously. There was an increased incidence of primary and secondary post‐abortal bleeding complications. Factor VIJI and von Willebrand factor antigen and activity levels increased significantly in pregnancy in all women apart from those with severe von Willebrand's disease. Factor XI, however, did not show any significant change. No neonatal haemorrhagic complications in association with the birth process were reported, although ventouse and difficult forceps deliveries were avoided. Extensive perineal bruising and haematoma was reported in three women with von Willebrand's disease; two of these were associated with forceps delivery. The incidence of primary postpartum haemorrhage was 185% in von Willebrand's disease and 16% in factor XI deficiency. Blood transfusion was required in six cases of von Willebrand's disease and two cases of factor XI deficiency. Ten of fourteen instances of primary postpartum haemorrhage occurred when maternal factor levels were < 50 IU/dL with no prophylactic treatment for labour. The incidence of secondary postpartum haemorrhage was 20% in von Willebrand's disease and 24% in factor XI deficiency. None of the women who had prophylactic treatment during labour or the puerperium suffered any significant bleeding complications. There were three neonatal bleeding complications.

Conclusion
Pregnancy, labour and the puerperium are associated with significant bleeding problems in women with von Willebrand's disease or factor XI deficiency, but these are largely preventable. Specialist obstetric care in close liaison with the haemophilia centre is essential to minimise maternal deficiency. and neonatal complications.
Incidence of urinary incontinence and constipation during pregnancy and postpartum: survey of current findings at the Rotunda Lying‐in Hospital
Authors: Marshall Kathleen , Thompson Kate A. , Walsh Deirdre M. , Baxter George D.
Published: August 2005

Objective
To assess the impact of pregnancy upon continence and constipation.

Design
A questionnaire survey.

Setting
Maternity wards in the Rotunda Lying In Hospital, Dublin, Republic of Ireland.

Population
7771 women who were delivered of liveborn infants.

Methods
Questionnaires were delivered and collected by physiotherapy staff as part of routine postnatal care.

Results
Analysis of data using χ2 tests showed significant differences between three parity groups [primigravidae, multigravidae (2–4) and multigravidae (5+)] for symptoms of both urinary incontinence (χ2= 119.54, df = 2, P = 0.000) and constipation (χ2= 12.53, df = 3, P = 0.002); the incidence of both constipation and urinary incontinence increased with parity.

Conclusion
The results of this survey have emphasised the relation between parity and postpartum incontinence which stresses the importance of early diagnosis and intervention.
Prediction of pre‐eclampsia, low birthweight for gestation and prematurity by uterine artery blood flow velocity waveforms analysis in low risk nulliparous women
Authors: Irion Olivier , Massé Jacques , Forest Jean‐Claude , Moutquin Jean‐Marie
Published: August 2005

Objective
To assess the performance of four previously reported Doppler abnormalities of uterine artery velocity waveforms (presence of a protodiastolic notch, peak systolic over protodiastolic velocities (A:C ratio) > 2.5, peak systolic over end diastolic velocities (A:B ratio) > 90th centile, resistance index (RI) ([A‐B]/A) ≥0.58) in predicting pre‐eclampsia, low birthweight and prematurity.

Design
Prospective cohort study.

Setting
Tertiary care university hospital in Quebec City.

Population
1311 nulliparous women.

Methods
Evaluation of pulsed Doppler abnormalities of uterine artery velocity waveforms was carried out in 1000 and 1 194 of women at 18.3 (SD 0.9) or 26.7 (SD 0.9) weeks of pregnancy.

Main outcome measures
Pre‐eclampsia, birthweight below the 10th centile for gestational age and spontaneous preterm birth (< 37 completed gestation weeks).

Results
Pre‐eclampsia, low birthweight for gestation and prematurity occured in 4%, 11% and 7% of the pregnancies, respectively. At 26 weeks all the abnormalities of the studied Doppler indices were significantly associated with pre‐eclampsia and low birthweight for gestation as reflected by the 95% confidence intervals of the positive likelihood ratios which did not include the value 1. However, sensitivities (26% to 34%) and positive predictive values (7% to 28%) were low. No Doppler indices performed significantly better than the others. The abnormalities of the Doppler indices were not associated with spontaneous prematurity. The performance of the Doppler measurements performed at 18 weeks was poor.

Conclusions
Uterine artery Doppler velocimetry waveform analysis does not qualify as a reliable screening test for pre‐eclampsia or low birthweight for gestation in low risk pregnancies but may be useful in selected high risk populations.
Plasma from pre‐eclamptic women and functional change in myometrial resistance arteries
Authors: Ashworth Janet R. , Warren Averil Y. , Johnson Ian R. , Baker Philip N.
Published: August 2005

This study assesses the ability of plasma from women with pre‐eclampsia to induce altered endothelial function in myometrial resistance vessels from normotensive women. Vessels from normotensive pregnant women (n= 7) were incubated with plasma from other pregnant women who were normotensive (n= 6)or had pre‐eclampsia (n= 7). A wire myograph was used to test the endothelium‐dependent relaxatory response to bradykinin of preconstricted vessels. The relaxation in vessels incubated with plasma from women with pre‐eclampsia was markedly less than in vessels incubated with plasma from normotensive pregnant women (P = 0.039). This supports the theory that a plasma‐borne factor contributes to the endothelial changes seen in pre‐eclampsia.
Can women at risk of cervical abnormality be identified?
Authors: Blomfield P. I. , Lancashire R. J. , Woodman C. B. J.
Published: August 2005

Objective
To determine if use of a detailed risk factor profile accurately predicts the presence of cytological abnormality of the cervix or improves the appropriateness of referral for colposcopic assessment when women are found to have these abnormalities.

Design
Cross‐sectional survey.

Setting
Family planning clinic.

Population
1219 consecutive women, aged between 15 and 19 years, attending for contraceptive advice. Variables included age, social class, educational status, hormonal and obstetric history, smoking and alcohol habits, history of sexually transmitted diseases, the age of first intercourse, number of sexual partners, duration of each relationship, frequency of intercourse, contraception used and the age of each partner.

Main outcome measures
Presence or absence of cytological abnormality and the presence or absence of histological abnormality in those with cytological abnormality referred for colposcopic assessment.

Results
Univariate analysis confirmed many of the known associations of cervical abnormality. Discriminant analysis identified five independent significant predictors of cytological abnormality and four independent predictors of dyskaryotic cytology. At best models, derived from identified variables correctly predicted 10.1 % of individuals with cytological abnormality and 13.5% of those with dyskaryotic cytology. Of those referred for colposcopic assessment because of abnormal cytology, models were able to predict 23.5% of those with histological evidence of cervical intraepithelial neoplasia.

Conclusions
Despite the availability of detailed information regarding the known correlates of cervical neoplasia in this age group, it was not possible to identify the majority of women with cervical abnormality. It is concluded that the strength of these associations is not sufficient to allow useful prediction of membership of a high risk group.