bluuebunny/crossref_metadata_2025 huggingface dataset:
Haematological risk factors for pregnancy outcome in Jamaican women with homozygous sickle cell disease
Authors: Morris Joanne S. , Dunn David T. , Poddar Damayanti , Serjeant Graham R.
Published: August 2005

Objective
To examine the association between fetal outcome and the steady state haematology of mothers with homozygous sickle cell disease.

Design
A retrospective observational study. The data were taken from dockets kept at the Sickle Cell Clinic and verified by interview with 45% of the patients.

Setting
The Sickle Cell Clinic at the University Hospital of the West Indies or two peripheral clinics operated by the staff of the MRC Laboratories.

Subjects
All women aged 14 years or older with homozygous sickle cell disease who had experienced at least one pregnancy in the period 1977 to 1986.

Main outcome measures
Three fetal outcomes including miscarriages, perinatal deaths, and birthweight.

Results
There were 270 singleton pregnancies in 175 women with an overall fetal wastage of 32.2%. There was a significant increased risk of perinatal death with low maternal fetal haemoglobin level, but there were no haematological associations with miscarriages or birthweight.

Conclusions
These data suggest that maternal steady‐state haematology has little influence on fetal outcome, with the exception that mothers with high HbF levels are less prone to perinatal deaths. Further study is required to investigate acute haematological changes associated with pregnancy.
The prevalence of lupus anticoagulant and anticardiolipin antibodies in women with a history of first trimester miscarriages
Authors: MacLean M. A. , Cumming G. P. , McCall Frances , Walker I. D. , Walker J. J.
Published: August 2005

Objective
To determine the prevalence of lupus anticoagulant and raised anticardiolipin antibodies in women with a history of two or more miscarriages in the first trimester of pregnancy.

Design
A prospective study of lupus anticoagulant and anticardiolipin antibody levels in unselected women with a history of two or more first trimester miscarriages.

Setting
The prepregnancy clinic and miscarriage antenatal clinic in a tertiary referral centre.

Subject
Two hundred and forty‐three women, of whom 113 (47%) had a past history of two miscarriages, and 130 (53%) had three or more miscarriages.

Main outcome measures
Quantitative detection of lupus anticoagulant and anticardiolipin antibodies; number of miscarriages in women in the normal and the abnormal groups.

Results
Of the 243 women tested, 41 (16.8%) had an abnormality of lupus anticoagulant or anticardiolipin antibodies. This was significantly different from the normal population as previously reported. Sixteen women (6.6%) were positive for lupus anticoagulant, 20 (8.2%) had elevated anticardiolipin antibodies, and five (2%) had both abnormalities. The most frequently positive test for lupus anticoagulant was the dilute Russel viper venom time, and IgG was the most frequently elevated anticardiolipin antibody. Of the women with a history of only two miscarriages, 15 % had an abnormality of lupus anticoagulant or anticardiolipin antibodies, compared with 18.5% of those with a history of three or more miscarriages. This did not reach statistical significance. There were 117 (48%) primary miscarriers and 126 (52%) secondary miscarriers. Of the primary miscarriers, 17% had an abnormality, compared to 18 % of the secondary miscarriers.

Conclusions
These findings provide further evidence of an association between lupus anticoagulant and anticardiolipin antibodies and early pregnancy loss. It is not known if these are the cause of miscarriage, markers for miscarriage, or if antiphospholipid antibodies develop as a result of a noncontinuing pregnancy. Further studies comparing various treatments are required before women with these antibodies can be optimally managed.
Intervention debulking surgery in advanced epithelial ovarian cancer
Authors: Redman C. W. E. , Warwick J. , Luesley D. M. , Varma R. , Lawton F. G. , Blackledge G. R. P.
Published: August 2005

Objective
To study whether intervention debulking surgery improves survival in patients with advanced ovarian cancer who have bulky (> 2 cm) residual disease after primary surgery.

Design
A prospective multicentre randomised study.

Setting
Hospitals in the West Midlands.

Subjects
Ovarian cancer patients with bulky residual disease after primary surgery who are considered well enough to receive cis‐platinum based chemotherapy and further surgery.

Methods
Eligible patients were randomised to receive combination chemotherapy alone or combined with intervention debulking surgery.

Main outcome measure
Survival was assessed using product limit method and log‐rank test.

Results
Seventy‐nine patients were entered into the study. Thirty‐seven patients were randomised to intervention debulking surgery, 25 (67%) of whom underwent intervention debulking surgery, which was performed a median of 13 weeks after primary surgery. The median survival for the intervention debulking surgery group was 15 months (95% CI 10–20 mo) and that of those randomised to chemotherapy alone, which was 12 months (95% CI 8–16 mo), were not significantly different (hazard ratio = 0.71; 95% CI 0.44–1.13).

Conclusion
Intervention debulking surgery may not improve survival in patients with advanced ovarian cancer.
Initial experience with supracervical laparoscopic hysterectomy and removal of the cervical transformation zone
Authors: Ewen Simon P. , Sutton Christopher J. G.
Published: August 2005

Objective
To assess the feasibility and outcome of laparoscopic supracervical hysterectomy with removal of the cervical transformation zone.

Design
A prospective clinical study.

Setting
The department of Gynaecology, Royal Surrey County Hospital, Guildford.

Subject
Eleven consecutive women who were on the waiting list for abdominal hysterectomy and fulfilled the selection criteria.

Intervention
Laparoscopic supracervical hysterectomy using a modification of the classical abdominal supracervical hysterectomy technique with removal of the cervical transformation zone.

Main outcome measures
Operating time, blood loss, duration of hospital stay, time to full recovery and complications.

Results
All 11 procedures were successfully completed laparoscopically. The mean operating time was 111 min, and mean blood loss was 185 ml. The mean duration of hospital stay was three days, and the mean time to full recovery was 20 days. There were no major complications.

Conclusions
Laparoscopic supracervical hysterectomy appears to result in a shorter hospital stay and more rapid recovery than total abdominal hysterectomy. This shortened convalescence is of benefit to the patient. The operation appears to be safe when carried out by surgeons experienced in laparoscopic surgery. A randomised comparative study with total abdominal hysterectomy is currently being undertaken.
Prenatal determination of human platelet antigen type using DNA amplification following amniocentesis
Authors: Bennett Phillip R. , Warwick Ruth , Vaughan Janet , Chana Haj , Lubenko Anatole , Fisk Nicholas M.
Published: August 2005

Objectives
To demonstrate that fetal human platelet antigen (HPA1) type can be determined, without the need for fetal blood sampling, by amplification of fetal DNA from amniotic fluid cells using polymerase chain reaction and allele specific oligonucleotide hybridisation.

Design
Oligonucleotide DNA primers were designed to amplify a portion of the platelet glycoprotein GpIIIa gene which spans the site of the single base change which differentiates HPAla from HPAlb. Specific oligonucleotides were designed to hybridise either to the amplified HPAla allele or to the HPAlb allele. Amniotic cells were used as the DNA template both directly and following formal isolation of DNA. Fetal HPA1 type, determined by this method in fifteen pregnancies not at risk of perinatal alloimmune thrombocytopaenia, was compared to typing of fetal blood obtained following cordocentesis. The methodology was then used to HPA type the fetus in two pregnancies at risk of the disease.

Setting
Department of Molecular Biology and Centre for Fetal Care, Queen Charlotte's Hospital.

Subject
Fifteen women undergoing amniocentesis and fetal blood sampling for other indications and two women at risk of perinatal allo‐immune thrombocytopaenia whose partners were heterozygotes.

Results
In the 15 control cases and the two clinical cases, determination of fetal HPA1 type from amniotic fluid cells agreed with typing of fetal blood. There was no difference in the efficiency of amplification from amniotic fluid cells directly or from isolated DNA.

Conclusions
Fetal HPA type may be reliably determined by amplification of DNA from amniotic fluid cells, eliminating the need for fetal blood sampling or immunoglobulin administration when the fetus is HPAla negative.
Causes and clinical consequences of Rhesus (D) haemolytic disease of the newborn: a study of a Scottish population, 1985–1990
Authors: Hughes R. G. , Craig J. I. O. , Murphy W. G. , Greek I. A.
Published: August 2005

Objective
To identify the reasons behind failures to prevent the development of Rhesus (D) haemolytic disease of the newborn.

Design
Retrospective analysis of the case records of all pregnancies that resulted in the birth of an infant with a positive direct antiglobulin test on the cord red cells born to Rh(D) negative women between 1 April 1985 and 31 March 1990.

Setting
Obstetric units in the South East Scotland region and the South East Scotland Regional Blood Transfusion Service Antenatal Laboratory.

Main outcome measures
The causes and clinical consequences of maternal immunisation to the Rhesus (D) antigen.

Results
Between 1985 and 1990, 80 pregnancies resulted in the birth of an infant sensitised with anti‐D on the cord red cells. There were no deaths due to haemolytic disease, but considerable resources were deployed in obstetric and neonatal care for these pregnancies. Sufficient data were available to categorise the cause of maternal immunisation in 70 pregnancies. Seven cases were due to immunisation by pregnancy before 1970. Sixty‐three cases could be attributed to failure of the Rhesus programme: 10 cases (16%) were due to failure to implement the programme adequately, the other 53 cases (84%) were due to failure of the current guidelines to provide adequate protection. Late immunisation in an uncomplicated pregnancy was the single commonest identifiable cause.

Conclusions
It is likely that substantial further reductions in Rhesus (D) immunisation and haemolytic disease of the newborn will require changes in the Rhesus prevention programme. In particular the role of antenatal prophylaxis requires detailed consideration.
Effects of maternal age, parity, and smoking on the risk of stillbirth
Authors: Raymond Elizabeth G. , Cnattingius Sven , Kiely John L.
Published: August 2005

Objective
To examine the effects of advanced maternal age, nulliparity, and smoking on risk of stillbirth as gestation advances, and to explore possible clinical mediators of these effects.

Design
A population based cohort study.

Setting
Sweden, 1983 to 1989.

Subjects
All singleton pregnancies of 28 weeks gestation or greater in Nordic citizens at least 20 years old (n= 638242).

Main outcome measures
Crude and adjusted risks of stillbirth; gestational age specific risks of stillbirth.

Results
Older women (35 years or older), smokers, and nulliparas had elevated risks of stillbirth. The elevated stillbirth risk in smokers was eliminated when women with intrauterine growth retardation, placental abruption, and placenta previa were excluded from the analysis. However, the higher risks in older women and nulliparas persisted even when the analysis excluded women with hypertension, diabetes, placental complications, or growth retardation. Over the course of the third trimester, the age related risk of stillbirth increased, the smoking related risk decreased, and the higher risk in nulliparas showed no clear trend with gestational age.

Conclusions
The association between smoking and stillbirth is explained entirely by the higher incidence of growth retardation and placental complications in smokers. The clinical mediators of the associations of maternal age and parity with stillbirth remain unexplained. Gestational age is an important modifier of the effects of advanced maternal age and smoking on stillbirth risk.
Late fetal heart decelerations and changes in cerebral oxygenation during the first stage of labour
Authors: Aldrich C. J. , D'Antona D. , Spencer J. A. D. , Wyatt J. S. , Peebles D. M. , Delpy D. T. , Reynolds E. O. R.
Published: August 2005

Objective To test the hypothesis that late fetal heart rate decelerations are associated with a decrease in cerebral oxygenation.

Design Changes in fetal cerebral concentrations of oxyhaemoglobin and deoxyhaemoglobin were measured by near infrared spectroscopy, before, during and after contractions with late fetal heart rate decelerations and compared with changes during contractions with no alteration of heart rate.

Setting Teaching hospital obstetric unit.

Subjects Ten women in labour at term.

Results The changes in fetal cerebral oxyhaemoglobin and deoxyhaemoglobin concentrations that occurred during contractions were quantitatively similar, irrespective of the fetal heart rate changes. However, late fetal heart rate decelerations were associated with a significantly greater fall, after the uterine contraction, in the mean concentration of fetal cerebral oxyhaemoglobin of 0.52μmol/100g (SD 0.25) (P < 0.001) and a significantly greater rise in the mean concentration of deoxyhaemoglobin of 0.36 pmol/100 g (SD 0.35) (P < 0.01).

Conclusion Late fetal heart rate decelerations are associated with a significant decrease in cerebral oxygenation.
Screening for cervical neoplasia in Dundee and Angus 10 years on
Authors: van Wijngaarden W. J. , Duncan I. D. , Hussain K. A.
Published: August 2005

Objective To evaluate the effect of changed cervical screening policies on a steady population with low migratory tendencies.

Design A retrospective analysis study.

Setting Dundee and Angus, Scotland.

Subjects All women who developed cervical carcinoma between 1957 and 1992.

Main outcome measures The incidence of and mortality from cervical cancer after the introduction of organised cervical screening in 1962, according to age, stage, histology and screening history.

Results The initial fall in incidence of cervical cancer seen in women between 35 and 54 years after the introduction of cervical screening was not sustained during the last 10 years of our study and appears to have been transferred to women aged 55 years and older instead. After 1976 an increase in the incidence of cervical cancer was seen in women under 35 years. The reduction in mortality from cervical cancer appears to have reached a plateau since 1976. No effect of cervical screening was seen on the incidence of adenocarcinoma of the cervix.

Conclusions The effect of changed cervical screening policies has been shown for a small population for a period of 35 years. The incidence of the higher stages of squamous cervical cancer continues to fall. The increase in incidence of cervical cancer in women under 35 years confirms similar trends seen in other countries. A background mortality rate refractory to further intensification of screening appears to have been reached. Adenocarcinoma of the cervix appears to gain in importance as cervical screening policies are shown to have their effect on its squamous counterpart.
Oral contraceptives, pregnancy and the risk of cerebra1 thromboembolism: the influence of diabetes, hypertension, migraine and previous thrombotic disease
Authors: Lidegaard ØJvind
Published: August 2005

Objective To assess the risk of developing cerebral thromboembolism among pregnant women and among fertile women with hypertension, migraine, diabetes, and previous thrombotic disease, and to investigate the interaction of these risk factors with the use of oral contraceptives.

Design A retrospective case‐control study.

Setting All gynaecological, medical, neurological, and neurosurgical departments in Danish hospitals.

Subjects Seven hundred and ninety‐four women in Denmark aged 15 to 44 who suffered a cerebral thromboembolic attack during the period 1985 to 1989 and 1588 age‐matched, randomly selected controls.

Response Of the 692 case and 1584 control questionnaires sent out, 590 (85.1%) and 1396 (88.1 %), respectively, were returned. Of the 590 cases, nine had had cerebral thrombosis before 1980, 15 refused to participate, 44 had a revised diagnosis (primarily multiple sclerosis) and 25 had an unreliable diagnosis, leaving 497 with a reliable cerebral thromboembolic diagnosis. Among the 1396 controls, 26 either refused to participate, were mentally handicapped, lived abroad or returned an uncompleted questionnaire, leaving 1370 controls included in the study.

Results After multivariate analysis, pregnancy implied an odds ratio (OR) for a cerebral thromboembolic attack of 1.3 (nonsignificant), diabetes an OR of 5.4 (P < 0.001), hypertension an OR of 3.1 (P < 0.001) and migraine an OR of 2.8 (P < 0.01). Women with previous non‐cerebral thrombotic disease had an OR for cerebral thrombo‐embolism of 5.3 (P < 0.001). Women with other predisposing medical diseases had an OR of 8.3 (P < 0.001). These ORs were identical among users and non‐users of combined oral contraceptives.

Conclusion In this study pregnancy implied a non‐significant elevated odds ratio of 1.3 for cerebral thromboembolism whereas diabetes, hypertension, migraine and past thromboembolic events increased the risk of cerebral thromboembolism significantly. Women with these increased thrombotic risks should use oestrogen‐containing oral contraceptives only after careful considerations of the risks, if at all.
Delayed gastric emptying as a factor in delayed postprandial glycaemic response in pregnancy
Authors: Stanley Katharine , Magides Andrea , Arnot Michelle , Bruce Chris , Reilly Charles , Mcfee Alasdair , Fraser Robert
Published: August 2005

Objective To determine whether an alteration in gastric emptying contributes to an altered postprandial glycaemic response in normal pregnancy.

Design A longitudinal study in normal pregnancy and postpartum.

Setting Teaching hospital in Sheffield.

Subjects Primigravid women with uncomplicated pregnancies.

Interventions Simultaneous meal tolerance and paracetamol absorption tests.

Main outcome measures 1. Gastric emptying: maximum concentration (Cmax) and time to maximum concentration (Tmax) of paracetamol; 2. glycaemic response: Cmax, Tmax, and area under the curve of plasma glucose; 3. insulinaemic response: Cmax, Tmax, area under the curve of plasma insulin.

Results An increased, but not delayed, insulin response, and an increased initial glucose response to a test meal in the third trimester were not accompanied by any simultaneous delay in gastric emptying.

Conclusion Gastric emptying does not seem to be a factor in the glycaemic response of pregnancy.
Selective miscarriage of Down's syndrome fetuses in women aged 35 years and older
Authors: Macintosh M. C. M. , Wald N. J. , Chard T. , Hansen J. , Mikkelsen M. , Therkelsen A. J. , Petersen G. B. , Lundsteen C.
Published: August 2005

Objective
To estimate the fetal loss of Down's syndrome fetuses between the time of chorionic villus sampling (10 weeks gestation) and the time of amniocentesis (16 weeks gestation) and term in women aged 35 years and older.

Design
The age specific prevalence rates in the first trimester of Down's syndrome were estimated using the Danish cytogenetic register in combination with results from four published studies. These were compared with the reported prevalence at the time of amniocentesis and at birth.

Subjects
5927 singleton pregnancies undergoing chorionic villus sampling (71 cases of Down's syndrome and 5856 unaffected cases). This was combined with published data on a further 231 cases of Down's syndrome and 16620 unaffected cases.

Main outcome measures
Age specific prevalences at the time of chorionic villus sampling. Proportion of pregnancies lost between the time of chorionic villus sampling and the time of amniocentesis and term.

Results
Thirty‐two percent of Down's syndrome pregnancies are lost between the time of chorionic villus sampling (10 weeks) and the time of amniocentesis (16 weeks) and 54% are lost by term.

Conclusions
The high fetal loss rates of Down's syndrome between the time of chorionic villus sampling and term introduce problems when evaluating first trimester screening tests with respect to their effective detection rates at term. A recommendation for quoting term risks is made.
The effect of maternal pushing on fetal cerebral oxygenation and blood volume during the second stage of labour
Authors: Aldrich C. J. , D'Antona D. , Spencer J. A. D. , Wyatt J. S. , Peebles D. M. , Delpy D. T. , Reynolds E. O. R.
Published: August 2005

Objective
To measure the effect of maternal pushing during the second stage of labour on fetal cerebral oxygenation and blood volume.

Design
A prospective study comparing changes in the fetal cerebral concentrations of oxy‐haemoglobin, deoxyhaemoglobin and cerebral blood volume, before and during maternal pushing in the second stage of labour.

Setting
Teaching hospital obstetric unit.

Subjects
Ten term fetuses during labour.

Results
Following the onset of maternal pushing, mean cerebral deoxyhaemoglobin concentration increased by a mean of 0.79 (SD 0.59) μmol.100 g‐1, (P < 0.01) without any consistent change in the oxyhaemoglobin concentration. These changes were associated with a significant decrease in the calculated mean cerebral oxygen saturation from a mean of 46.8% (SD 8.6) to 38.1% (SD 5.2) (P < 0.01). Pushing was also associated with a significant increase in the mean cerebral blood volume, which rose by a mean of 0.33 ml. 100 g‐1 (SD 0.37) (P < 0.05).

Conclusion Maternal pushing during the second stage of labour leads to a significant decrease in fetal cerebral oxygenation, together with an increase in cerebral blood volume.
Indications for and outcome of total abdominal hysterectomy for benign disease: a prospective cohort study
Authors: Clarke Aileen , Black Nick , Rowe Pam , Mott Sarah , Howle Karen
Published: August 2005

Objective
To describe the indications for total abdominal hysterectomy for women with nonmalignant disease and to determine the immediate (initial ten days) and medium term outcome.

Design
A prospective cohort study.

Setting
Three district general hospitals in shire counties, two in outer London and one London teaching hospital.

Subjects
Three hundred and sixty‐six women undergoing total abdominal hysterectomy (with or without other procedures) for nonmalignant disease.

Interventions
Self‐completed patient questionnaires before and ten days, six weeks and three months after surgery. Data extracted from patients' hospital case notes.

Main outcome measures
Complications plus change in symptoms, urinary and bowel function, general health status, sexual function, activities of daily living and quality of life.

Results
The principal indications were bleeding, pain or both. Symptoms were severe enough to be socially debilitating and have a major impact on lifestyle. Otherwise, the women were in good health. During the first ten post‐operative days the women suffered more pain, urinary discomfort, constipation and a reduction in their ability to perform activities of daily living. Urinary (25%) and wound (25%) infections were the commonest complications. At the same time, significant improvements in psychological health occurred. By six weeks, the principal symptoms had resolved for 95% of the women and early adverse effects on urinary and bowel function had settled. This was reflected in improvements in health status and quality of life including sexual activity. Despite this, these changes did not meet the pre‐operative expectations of some women.

Conclusions
Most women reported substantial benefits from hysterectomy. However, women should be warned about early, transient adverse effects. These findings can serve as a benchmark for nonexperimental evaluations of the effectiveness of new treatment modalities.
The effect of uterine contractions on fetal oxygen saturation
Authors: McNamara Helen , Johnson Nicholas
Published: August 2005

Objective
To find out what happens to fetal arteriolar oxygen saturation during a uterine contraction.

Design
Prospective observational study.

Setting
Labour ward, St James's University Hospital, Leeds.

Subjects
Eighteen women in normal labour monitored with a fetal scalp surface pulse oximetry sensor, an intrauterine pressure catheter, and a head to cervix force transducer.

Methods
The effect of intrauterine pressure and head to cervix force on fetal arteriolar oxygen saturation was examined using time series analysis and a regression model of 159 contractions.

Outcome measure
Fetal oxygen saturation during a contraction.

Results
The average oxygen saturation drops after a contraction. The greatest drop in oxygen saturation is reached 92 s after the peak of a contraction and takes approximately 1 min 30 s to recover (P= 0.036).

Conclusion
Uterine contractions during normal labour affect fetal oxygen saturation.
Screening for trisomy 21 in twin pregnancies by maternal age and fetal nuchal translucency thickness at 10–14 weeks of gestation
Authors: Sebire Neil J. , Snijders Rosalinde J. M. , Hughes Karen , Sepulveda Waldo , Nicolaides Kypros H.
Published: August 2005

Objective
To determine the prevalence of increased fetal nuchal translucency thickness in twin pregnancies and to evaluate screening for trisomy 21 by a combination of translucency thickness and maternal age.

Design
Prospective screening study at 10 to 14 weeks of gestation.

Setting
Fetal Medicine Centre.

Population
22,518 self‐selected pregnant women at 10 to 14 weeks of gestation, including 21,477 singleton and 448 twin pregnancies with live fetuses.

Methods
Fetal nuchal translucency thickness was measured by ultrasound examination at 10–14 weeks. Sensitivity and false positive rates of screening for trisomy 21 by a combination of fetal nuchal translucency thickness and maternal age were calculated.

Main outcome measures
Prevalence of increased nuchal translucency thickness and detection of trisomy 21.

Results
In the 448 twin pregnancies the nuchal translucency thickness was above the 95th centile of the normal range (for crown‐rump length in singletons) in 65/896 fetuses (7.3%), including 7/8 (88%) with trisomy 21. Increased translucency was also present in four fetuses with other chromosomal abnormalities. In the chromosomally normal twin prebmancies the prevalence of increased nuchal translucency was higher in fetuses from monochorionic (8.4%; 16/190) than in those with dichori‐onic pregnancies (5.4%; 37/688). The minimum estimated risk for trisomy 21, based on maternal age and fetal nuchal translucency thickness, was 1 in 300 in 19.5% (175/896) of the twins including all eight of those with trisomy 21.

Conclusions
In twin pregnancies the sensitivity of fetal nuchal translucency thickness in screening for trisomy 21 is similar to that in singleton pregnancies, but the specificity is lower because translucency is also increased in chromosomally normal monochorionic twin pregnancies.
Anal and urinary incontinence in women with obstetric anal sphincter rupture
Authors: Tetzschner Tine , Sørensen Michael , Lose Gunnar , Christiansen John
Published: August 2005

Objective
To assess the long term impact of obstetric anal sphincter rupture on the frequency of anal and urinary incontinence and to identify factors to predict women at risk.

Design
An observational study.

Settings
Departments of Obstetrics and Gynaecology and of Surgery D, Glostrup County University Hospital, Denmark.

Participants
Ninety‐four consecutive women who had sustained an obstetric anal sphincter rupture.

Interventions
Assessment of history, anal manometry, anal sphincter electromyography and pudendal nerve terminal motor latency at three months postpartum. A questionnaire regarding anal and urinary incontinence was sent two to four years postpartum.

Main outcome measures
The frequency of anal and urinary incontinence and risk factors for the development of incontinence.

Results
Thirty of 72 women (42%) who responded had anal incontinence two to four years postpartum; 23 (32%) had urinary incontinence and 13 (18%) had both urinary and anal incontinence. Overall, 40 of 72 women (56%) had incontinence symptoms. The occurrence of anal incontinence was associated with pudendal nerve terminal motor latencies of more than 2.0 ms, and the occurrence of urinary incontinence was associated with the degree of rupture, the use of vacuum extraction and previous presence of urinary incontinence. Seventeen women had subsequently undergone a vaginal delivery in relation to which four (24%) had aggravation of anal incontinence, and three (18%) had aggravation of urinary incontinence. Of the women with incontinence, 38% wanted treatment but only a few had sought medical advice.

Conclusions
Obstetric anal sphincter rupture is associated with a risk of approximately 50% for developing either anal or urinary incontinence or both. The prediction of women at risk is difficult. Information and routine follow up of all women with obstetric anal sphincter rupture is mandatory.
Randomised study assessing the effect of phenytoin and magnesium sulphate on maternal cerebral circulation in eclampsia using transcranial Doppler ultrasound
Authors: Naidu S. , Payne A. J. , Moodley J. , Hoffmann M. , Gouws E.
Published: August 2005

Objective
To assess maternal middle cerebral artery flow velocity patterns as measured by transcranial Doppler ultrasound (TCD) in eclampsia and to investigate the effect of the anticonvulsants magnesium sulphate (MgSO4) and phenytoin on cerebral circulation.

Design
Prospective randomised study.

Setting
High care obstetric unit, King Edward VIII Hospital, Durban, South Africa.

Participants
Twenty‐four eclamptic patients: 13 received MgSO, and 11 phenytoin.

Intervention
Middle cerebral artery flow velocity waveforms were measured using 2 MHz pulsed Doppler ultrasound via the transtemporal approach in eclamptic patients, before and 15 minutes after the loading dose of anticonvulsant.

Results
Magnesium sulphate significantly reduced the pulsatility index (P= 0.002) and mean flow velocity (P= 0.02) in the middle cerebral artery, whereas phenytoin failed to produce any statistically significant effect. However, differences between groups were not statistically significant. Systolic and diastolic blood pressures were reduced in both the MgSO, and phenytoin groups.

Conclusion
These findings provide firm evidence that MgSO, relieves cerebral vasospasm, compared with phenytoin, and may therefore be the better drug for the prevention of eclamptic convulsion.
Very preterm birth–a regional study. Part 1: Maternal and obstetric factors
Authors: Hagan R. , Benninger H. , Chiflings D. , Evans S. , French N.
Published: August 2005

Objective
To ascertain the demographic, pregnancy and obstetric factors associated with the delivery of a live born very preterm infant (< 33 weeks of gestation) and to investigate any differences in these factors between identifiable aetiological groups.

Design
Cohort analytical study.

Setting
King Edward Memorial Hospital for Women (KEMH), Western Australia.

Main variables examined
Maternal demographic and obstetric history, primary complication associated with delivery, obstetric management and mode of delivery.

Results
Six hundred and eight women who were delivered of 693 live born very preterm infants in Western Australia between 1.1.90 and 31.12.91, representing 1.22% of all women who were delivered of a live born infant in those years. Singleton pregnancy occurred in 517 (85%) and 541 (89%) were delivered in KEMH. Mean maternal age was 28 years with an excess of mothers less than 20 years of age and older than 34 years compared with the statewide perinatal data. Pre eclampsia (n= 128, 21.1 %), preterm prelabour rupture of membranes (n= 148, 24.3%), idiopathic preterm labour (n= 195, 30.4%) and antepartum haemorrhage (n= 111, 18.3%) were associated with 94.1% of deliveries. These proportions varied with plurality and period of gestation. Demographic details, use of antenatal steroids, exposure to labour and caesarean section delivery differed between mothers depending on the primary complication. Overall 322 (53.0%) received antenatal steroids and 297 (48.8%) were delivered by caesarean section. Factors associated with decreased use of steroids were gestational age of less than 27 weeks (odds ratio (OR) 0.54; 95% CI 0.36–0.83), preterm prelabour rupture of the membranes (OR 0.48; 95% CI 0.29–0.78) and idiopathic preterm labour (OR 0.56; 95% CI 0.35–0.91). Factors associated with increased use of steroids were multiple pregnancy (OR 1.70; 95% CI 1.02–2.41) and pre‐eclampsia (OR 1.87; 95% CI 1.09–3.19).

Conclusions
These very preterm deliveries account for only a small proportion of all deliveries. There are differences in the mother's demographic history, obstetric management and delivery depending on the primary aetiological factor.
Serum screening for Down's syndrome between 8 and 14 weeks of pregnancy
Authors: Wald N. J. , George L. , Smith D. , Densem J. W. , Pettersonm K. ,   on behalf of the International Prenatal Screening Research Group
Published: August 2005

Objective
To determine the value of serum screening for Down's syndrome at 8–14 weeks of pregnancy using seven potential serum markers (alpha‐fetoprotein, unconjugated oestriol, total human chorionic gonadotrophin (hCG), free α‐hCG, free P‐hCG, pregnancy associated plasma protein A (PAPP‐A), and dimeric inhibin A).

Design
Stored blood samples collected from women at about 10 weeks of pregnancy, prior to having a chorionic villus sampling procedure on account of advanced maternal age, were retrieved from pregnancies associated with Down's syndrome and from matched unaffected pregnancies.

Setting
Twenty‐one obstetric centres in nine countries.

Subjects
Seventy‐seven pregnancies associated with Down's syndrome each matched with five controls (except in two cases that were matched with four controls) for maternal age (same five year age groups), duration of storage of the serum sample (same calendar year), and gestational age (usually same week of pregnancy).

Results
The levels of two potential markers differed between affected and unaffected pregnancies sufficiently to be of value in screening—free β‐hCG and PAPP‐A. The median free P‐hCG level in affected pregnancies was 1.79 times the median level for unaffected pregnancies, and the median PAPP‐A level was 0.43 times the normal median. These two markers were combined with maternal age to estimate a woman's risk of having a fetus with Down's syndrome. A screening programme that used a risk cutoff level of 1:300 would detect 63 % of affected pregnancies and also classify 5.5% of unaffected pregnancies as screen positive. None of the other five markers added more than 2 % detection for the same false‐positive rate.

Conclusion
The performance of screening using maternal age and serum‐free β‐hCG and PAPP‐A at 10 weeks of pregnancy was better than the double test (alpha‐fetoprotein and hCG with maternal age) and similar to the triple test (alpha‐fetoprotein, unconjugated oestriol and hCG with maternal age) at 15–22 weeks.
Cardiac abnormalities in pulmonary oedema associated with hypertensive crises in pregnancy
Authors: Desai D. K. , Moodley J. , Naidoo D. P. , Bhorat I.
Published: August 2005

Objective
To describe the cardiac abnormalities by two‐dimensional and Doppler echo‐cardiography (echo‐Doppler) in hypertensive crises in pregnancy (HCP) complicated by pulmonary oedema and identify pathogenic factors.

Design
A prospective observational study.

Setting
King Edward VIII Hospital, Durban, South Africa.

Participants
Sixteen patients with HCP complicated by pulmonary oedema over a six‐month period. Two control groups, 55 patients with HCP alone and 16 with normotensive pregnancies, were also studied.

Results
Echocardiography diagnosed impaired left ventricular systolic function in 4 of 16 (25 %) patients with HCP and pulmonary oedema. In the remaining 12 patients with preserved systolic function, left ventricular diastolic filling abnormalities were demonstrated in a significant proportion compared to control hypertensive and normotensive groups. Fifteen of 16 (94%) study patients presented with pulmonary oedema antepartum; in seven of these patients, the use of dexamethasone to enhance fetal lung maturity appeared to be a contributing factor in precipitating pulmonary oedema.

Conclusion
This study demonstrates the value of echo‐Doppler to diagnose structural and functional cardiac abnormalities in HCP complicated by pulmonary oedema. The potential role of left ventricular diastolic filling abnormalities in the pathogenesis of pulmonary oedema complicating HCP is discussed.
Is intrapartum vibratory acoustic stimulation a valid alternative to fetal scalp pH determination?
Authors: Irion Olivier , Stuckelberger Pierre , Moutquin Jean‐Marie , Morabia Alfredo , Extermann Philippe , Béguin Frangois
Published: August 2005

Objective
To determine the association between fetal heart rate accelerations, whether spontaneous or induced by vibratory acoustic stimulation, and subsequent scalp pH values in presence of a suspicious intraparturn fetal heart rate tracing, and thereby assess the ability of accelerations to predict a concurrent normal fetal scalp blood pH.

Design
Prospective observational study of 253 labours involving 421 pH samples.

Setting
Tertiary care university hospital of Geneva.

Intervention
Vibratory acoustic stimulation through the maternal abdominal wall for five seconds prior to fetal blood sampling.

Main outcome measures
Spontaneous fetal heart rate reactivity (accelerations) in the 10 min preceding vibratory acoustic stimulation, vibratory acoustic‐induced reactivity prior to fetal blood sampling, and scalp pH value.

Results
The positive predictive value of a reactive fetal heart rate response after vibratory acoustic stimulation was 78% (95% CI 73–84%) and 97% (95% CI 94–99%) for scalp pH values of > 7.25 and ≥ 7.20, respectively. Similar observations occurred with spontaneous reactivity. Of concern, 7 out of 31 (23%) occasions where the scalp blood pH was less than 7–20 appeared to be associated with a normal fetal heart rate response to vibratory acoustic stimulation.

Conclusions
Fetal heart rate acceleration induced by vibratory acoustic stimulation was significantly associated with a normal scalp blood pH higher than 7.25. However, vibratory acoustic stimulation offers no advantage over observation of spontaneous fetal heart rate tracings and cannot safely replace fetal blood sampling during labour.
Is there any value in the long term follow up of women treated for endometrial cancer?
Authors: Owen* Philip , Duncan Ian D.
Published: August 2005

Objective
To evaluate the clinical benefit of routine follow up of women after treatment for endometrial adenocarcinoma.

Design
Retrospective case analysis.

Participants
All cases diagnosed and treated for endometrial adenocarcinoma in Tayside, Scotland during 1982 to 1984 inclusive.

Methods
Case‐note and cancer registration document review.

Results
Of 102 patients, 97 had complete follow up for 10 years or until death. Recurrent disease was diagnosed in 17 women, only six of whom were asymptomatic at the time of diagnosis. There was no difference in survival between cases with symptomatic and asymptomatic recurrences. No recurrences were diagnosed more than six years after initial diagnosis.

Conclusions
The diagnosis of asymptomatic recurrent endometrial carcinoma was not associated with improved long term survival. This small study showed no evidence of improved survival from the current practice of routine clinical review following treatment for endometrial adenocarcinoma. The effect of follow up on patient anxiety remains to be assessed.
Clinical and ultrasound prediction of macrosomia in diabetic pregnancy
Authors: Johnstone Frank D. , Prescott Robin J. , Steel Judith M. , Mao J. H. , Chambers Sarah , Muir Nicé
Published: August 2005

Objective
To study prospectively the prediction power, at different gestations, of clinical and ultrasound measurements for fetal size in diabetic pregnancy.

Setting
A large combined obstetric diabetic clinic in a teaching hospital.

Participants
One hundred and eighty‐one pregnancies in which women had scans at least two of three specific time points and who were delivered of singletons after 34 weeks: 73% were pre‐gestational insulin‐dependent diabetics, the others were pre‐gestational White class A or gestational diabetics.

Interventions
Clinical estimates of fundal height and fetal size and ultrasound estimates of abdominal circumference and head circumference were routinely carried out at gestational ages of 28, 34 and 38 weeks or before delivery.

Main outcome measures
Standardised birthweight, corrected for gestation and parity. The relation with clinical and ultrasound measurements was investigated using multiple linear regression and the capability of the measurements to predict macrosomic births (>95th centile of normals) using receiver‐operator characteristic curves.

Results
All measurements are poor predictors of eventual standardised birthweight. Prediction improves with closeness to delivery. Prediction is significantly improved by adding ultrasound to clinical information, but at 34 weeks or later this only contributes 8 % of the variance. There is no difference in the prediction power for macrosomia between clinical and ultrasound measurements.

Conclusions
Even regular serial scanning and clinical examination will not always diagnose the macrosomic fetus in diabetic pregnancy. In our hands, clinical examination is as predictive as ultrasound measurements. Ultrasound does add to clinical prediction power but only to a small extent. Ultrasound should be used in a selected way, as defined by clinical findings, and with recognition and understanding of the errors and biases involved.
A randomised trial of two expectant managements of prelabour rupture of the membranes at 34 to 42 weeks
Authors: Ladfors Lars , Mattsson Lars‐Åke , Eriksson Margareta , Fall Ole
Published: August 2005

Objective
To compare obstetric and perinatal outcome between two different expectant managements in women with prelabour rupture of the membranes (PROM).

Design
A randomised study.

Participants
One thousand three hundred and eighty‐five women with rupture of the membranes at 34 to 42 weeks without contractions.

Interventions
Women without contractions 2 h after admission were randomised to early induction the following morning after PROM (early induction group) or induction two days later (late induction group). Women with contractions starting within 2 h after admission were included in the calculations as a short latency group. Digital examinations of the cervix were avoided until onset of active labour. Labour was induced with oxytocin in both groups if no spontaneous contractions occurred or if chorioamnionitis or fetal distress was detected.

Main outcome measures
The frequency of spontaneous deliveries, operative deliveries, maternal and neonatal infections.

Results
In nulliparous women, a higher rate of spontaneous deliveries was found in the late induction group (89%) compared with the early induction group (81%) (P < 0.05). The ventouse extraction rate was 7% and 14% respectively (P < 0.05). A low (2–4%) caesarean section rate was recorded and did not differ between the groups. Endometritis was detected in six women after delivery. Sixty‐one children were treated with antibiotics, and no difference could be detected between the groups.

Conclusions
A higher rate of spontaneous deliveries was found among nulliparous women with prolonged latency as compared with brief latency prior to induction. A protocol of no digital examination before labour was associated with infrequent maternal and fetal morbidity, regardless of latency.
Smoking during pregnancy: the dose dependence of birthweight deficits
Authors: Ellard Gordon A. , Johnstone Frank D. , Prescott Robin J. , Ji‐Xian Wang , Jian‐Hua Mao
Published: August 2005

ObjectiveTo assess whether a simple urine based estimate of relative daily nicotine intake could predict smoking related birthweight deficits more accurately than self‐reported cigarette consumption.

DesignActive smokers were identified by a simple qualitative colorimetric urine test procedure and their relative nicotine intakes assessed by determining the ratios of the urinary concentrations of nicotine plus its metabolites to creatinine using automated colorimetric methods.

SettingA large teaching hospital.

ParticipantsThree thousand and thirty‐eight mothers from whom smoking histories had been elicited and who gave birth to live singleton babies after 28 weeks of gestation.

Main outcome measuresBirthweights (adjusted for maternal weight, maternal age, baby's sex, parity and length of gestation), maternal weight gains during pregnancy and placental weights.

ResultsThe adjusted birthweight deficits of babies born to proven active smokers averaged 226 g (95 % confidence interval 194 g to 258 g), but dose dependent effects were only apparent when nicotine intake was based on urinary nicotine metabolites/creatinine ratios. Among the smokers, adjusted birthweights fell linearly with increasing nicotine intakes but gave a predicted mean birthweight for nonsmokers that was 102 g (95 % CI 50 g to 154 g) lighter than that actually found (P< 0.0001). Maternal weight gains during pregnancy were substantially reduced in smokers and correlated more closely with urinary nicotine metabolite excretions than with reported daily cigarette consumptions. Placental weights were unaffected by smoking.

ConclusionsThere was a closer dose‐effect relationship between birthweight deficits and urinary nicotine metabolites/creatinine ratios than with self‐reported daily cigarette consumptions. The influence of nicotine exposure on birthweight appears to be biphasic, with one mechanism operating at very low levels of tobacco smoke intake and the other causing seemingly linearly related effects over the whole range of nicotine intakes of active smokers. These findings support recent evidence that passive smoking can cause substantial birthweight deficits.