bluuebunny/crossref_metadata_2025 huggingface dataset:
Successful treatment of infertile women with oligomenorrhoea using a combination of an LHRH agonist and exogenous gonadotrophins
Authors: FLEMING R. , HAXTON M. J. , HAMILTON M. P. R. , McCUNE G. S. , BLACK W. P. , MACNAUGHTON M. C. , COUTTS J. R. T.
Published: August 2005

Summary. Eight oligomenorrhoeic patients with increased luteinizing hormone (LH) and androgen levels who had failed to conceive during prolonged anti‐oestrogen therapy received a new treatment. Large doses of an LH‐releasing hormone (LHRH) analogue (HOE 766) were used to suppress circulating gonadotrophin concentrations and block the positive feedback gonadotrophin surge. Ovulation was induced during continued LHRH analogue treatment with exogenous gonadotrophins without interference from the patient's own pituitary. Seven of eight patients conceived rapidly without premature luteinization and without excessive ovarian enlargement. These complications had occurred in control treatment cycles using exogenous gonadotrophins in the absence of the LHRH analogue.
Reduced in‐vitro fertilization of human oocytes from patients with raised basal luteinizing hormone levels during the follicular phase
Authors: STANGER JAMES D. , YOVICH JOHN L.
Published: August 2005

Summary. A series of 62 women were managed in the University of Western Australia/PIVET Laboratory in‐vitro fertilization programme. In 60 of them follicle growth was stimulated with clomiphene citrate’ with or without additional human menopausal gonadotrophin (hMG) and in two with hMG alone. Follicles were aspirated at laparoscopy following an hCG trigger injection and occasionally following a spontaneous luteinizing hormone (LH) surge. Oocytes were inseminated with 0·5×105−105 sperm/ml 3–6 h later. A significant reduction (P<0·001) in the fertilization rate of mature oocytes was observed in those patients whose basal serum LH values were >1 SD above the mean. Fifty‐nine women subsequently had embryo transfer and of 10 clinical pregnancies, none occurred in those with elevated LH values. Reduced fertilization may be a reflection of premature oocyte maturation or ageing. This may have clinical implications in the management of some patients with unexplained infertility.
The treatment of cervical intraepithelial neoplasia by laser vaporization
Authors: JORDAN J. A. , WOODMAN C. B. J. , MYLOTTE M J , EMENS J. M. , WILLIAMS D. R. , MACALARY M. , WADE‐EVANS T.
Published: August 2005

Summary. Of 711 women with cervical intraepithelial neoplasia (CIN) treated by laser vaporization 675 (95%) remain colposcopically and cytologically free from disease after a median follow‐up of 20 months. Thirty‐six patients needed other forms of treatment to eradicate suspected residual disease. One patient presented with invasive carcinoma of the cervix 34 months after treatment with the carbon dioxide laser. It is concluded that in selected cases laser vaporization is an effective method of treating pre‐invasive disease of the cervix.
The significance of uncertain gestation for obstetric outcome
Authors: HALL MARION H. , CARR‐HILL ROY A.
Published: August 2005

Summary. An analysis of 11454 singleton births in a ‘total obstetric population’ (Aberdeen City District) from 1976 to 1980 showed that women whose gestation was assessed as approximate or uncertain had less favourable characteristics than the certain group. Uncertainty was significantly related to adverse pregnancy outcomes such as perinatal mortality, low birthweight, and spontaneous preterm delivery, and the association with the adverse outcomes was independent of unfavourable maternal characteristics. Moreover, uncertainty ‘explained’ adverse outcomes better than the traditional sociodemographic variables used in the analysis. It is argued that research findings based only on women of certain gestation cannot be generalized to total populations including women of uncertain gestation and will be subject to bias.
A comparison of prostaglandin E2 pessaries and laminaria tents for ripening the cervix before termination of pregnancy
Authors: KILLICK S. R. , VAUGHAN WILLIAMS C. A. , ELSTEIN MAX
Published: August 2005

Summary. Forty primigravid womcn aged 15–45 years were randomly allocated to receive either an intravaginal pessary of 3 mg prostaglandin E, (PGE2) or an intracervical 5‐mm laminaria tent (LT) 12–16 h before termination of pregnancy at 6–14 weeks gestation. The degree of dilatation of the cervix a t operation and its resistance t o further dilatation during the procedure were assessed by a ‘blind’ operator. Laminaria tents were more effective in achieving dilatation and softening of the cervix than were PGE2 pessaries and in 40% of women no further dilatation was necessary. There were no associated side‐effects or complications. A cervical tear occurred in two of 20 patients treated with PGE2 pessaries and all 20 required further dilatation of the cervix. Laminaria tents provide a simple. safe, acceptable and effective means of ‘ripening’ the cervix prior to termination of early pregnancy.
Tumour‐associated antigen CA 125 in patients with ovarian cancer
Authors: HEINONEN PENTTI K. , TONTTI KAIJA , KOIVULA TIMO , PYSTYNEN PAAVO
Published: August 2005

Summary. The serum levels of antigen CA 125 expressed by epithelial ovarian carcinoma were measured in 27 postmenopausal women with ovarian tumours and in 16 controls. Increased serum levels of CA 125 were found in nine (75%) out of 12 patients with ovarian cancer; in three with stage I disease levels were not elevated. No significant difference was found in the concentration of CA 125 detected in peripheral or ovarian venous blood. Decreased antigen levels were found 6–30 weeks after radical operation and cytostatic chemotherapy in the ovarian cancer group. The results indicate the value of measuring CA 125 as a tumour marker in the follow‐up of ovarian cancer.
Wessex Perinatal Mortality Survey 1982
Authors: BUCKELL E. W. C. , WOOD B. S. B.
Published: August 2005

Summary. A survey of 335 perinatal deaths in the Wessex region revealed a perinatal mortality rate of 10·1 per 1000 total births. Lethal malformations accounted for 82 (24%) deaths. Of the 253 normally formed infants, 124 (49%) died during pregnancy and 33 (13%) in labour. More than 60% of the stillbirths weighed >1500 g. Of the 96 postpartum deaths, half occurred within 24 h of delivery, mostly following complications of labour and circumstances suggesting hypoxia. The Aberdeen classification showed half of the mothers had pregnancy complications: other predisposing factors were identified in 10% of perinatal deaths. There were 185 neonatal deaths of which 150 occurred within 7 days and 35 within the next 3 weeks. Sixteen (46%) of the late neonatal deaths were due to a congenital abnormality; pregnancy or labour complications were present in six (32%) of the remaining 19 normally formed infants. Review of existing methods of antenatal supervision in particular, followed by the use of better monitoring systems for earlier detection of fetal distress and prompt action when indicated, together with improvement in neonatal care in the first 24 h after birth should further reduce the perinatal mortality.
Plasma catecholamines and modes of delivery: the relation between catecholamine levels and in‐vitro platelet aggregation and adrenoreceptor radioligand binding characteristics.
Authors: JONES C. R. , McCULLOUCH J. , BUTTERS L. , HAMILTON C. A. , RUBIN P. C. , REID J. L.
Published: August 2005

Summary. Catecholamines were measured in maternal venous, and mixed umbilical cord blood. Maternal catecholamines were significantly (P<0·01) reduced by epidural analgesia with a 36% reduction in nor‐adrenaline and a 33% reduction in adrenaline. Fetal catecholamines were elevated at birth with a 3–8 fold increase in noradrenaline but not adrenaline during spontaneous vaginal delivery. The lowest fetal catecholamines were obtained in the group delivered under epidural analgesia; lower plasma catecholamines were not associated with adverse respiratory effects. Fetal platelets showed impaired a2‐adrenoceptor function with absent aggregatory responses to adrenaline in vitro. The defect in platelet function was unlikely to be related to changes in the number of fetal platelet α‐receptors or to changes in receptor affinity for adrenaline, as fetal platelets failed to aggregate to adrenaline from deliveries with high and low cord blood catecholamines.
Involvement of the vulval skin appendages by intraepithelial neoplasia
Authors: MENE ARUNA , BUCKLEY C. HILARY
Published: August 2005

Summary. In the treatment of vulval intraepithelial neoplasia (VIN) by laser, the extent to which the skin appendages are involved is an important factor in determining the depth of tissue to be destroyed. An investigation of 50 patients with VIN revealed that in 28 the skin appendages were involved and the maximum depth of involvement reached 4.6 mm from the surface of the epidermis. It is suggested that eradication of tissues to a depth of 5·0 mm would eliminate all atypical epithelium in the skin appendages.
Umbilical and uterine artery flow velocity waveforms in pregnancy associated with major fetal abnormality
Authors: TRUDINGER B. J. , COOK C. M.
Published: August 2005

Summary. Flow velocity waveforms from the umbilical artery and branches of the uterine artery in the placental bed were recorded using continuous wave Doppler ultrasound. The records of 26 patients with pregnancy complicated by major fetal abnormality were reviewed to determine the changes of a primary fetal disturbance. The systolic/diastolic (A/B) ratio was used as an index of blood flow resistance. In 13 of the 26 patients the umbilical artery waveform systolic/diastolic ratio was high. It is postulated that in these patients there is a process of obliteration of small arteries in the placenta that is triggered by the abnormal fetus. In all patients the uterine artery waveform was normal. In seven of these 13 patients the infant had a birthweight > 10th centile. Placental weights were examined. A small placenta expressed as either low weight for gestational age or low placental/feta1 weight ratio was associated with a normal umbilical artery waveform. It is suggested that fetuses in these groups have a low growth potential. In contrast a high placental/fetal weight ratio was associated with an abnormal umbilical artery waveform pattern.
Homozygous α‐thalassaemia: clinical presentation, diagnosis and management. A review of 46 cases
Authors: LIANG S. T. , WONG V. C. W. , SO W. W. K. , MA H. K. , CHAN V. , TODD D.
Published: August 2005

Summary. Forty‐six hydropic infants with homozygous α‐thalassaemia born during a period of 10 years have been reviewed. The incidence was 1: 1550 total births, and accounted for 81% of all non‐immune hydrops. The male to female ratio was 1: 1.4. There was increased incidence of anaemia, pregnancy induced hypertension, antepartum haemorrhage, malpresentation, prematurity, fetal distress, difficult vaginal delivery, caesarean section, retained placenta. postpartum haemorrhage and congenital abnormalities. Antenatal diagnosis by DNA hybridization with subsequent abortion of the affected fetuses is the best method to decrease maternal morbidity and to reduce the incidence of hydrops fetalis in couples at risk. For those with no previous history, but with early onset hypertension and/or polyhydramnios, sonography is useful in making an earlier diagnosis, and in reducing avoidable morbidity, because DNA analysis can be done before caesarean section and aggressive neonatal management is instituted.
A comparative study of methods of oxytocin administration for induction of labour
Authors: GIBB D. M. F. , ARULKUMARAN S. , RATNAM S. S.
Published: August 2005

Summary. Equipment has become available for the automatic infusion of oxytocin in a closed loop system for the induction of labour. This system was compared with manual administration of oxytocin by peristaltic infusion pump, the dosage being based on data derived from an intrauterine catheter or by clinical assessment of uterine activity. A total of 121 patients classified according to parity and cervical score were allocated to an automatic infusion system (AIS) or a peristaltic infusion pump system. Patient characteristics were similar in both groups. Labour was significantly longer in those induced by automatic infusion system particularly in nulliparae and patients with poor cervical scores. In 53.3% of the nulliparae with poor cervical scores the automatic infusion system proved inadequate to effect vaginal delivery. Neonatal outcome was similar in both groups. Automatic infusion of oxytocin by the present system increased the length of induced labour and had no statistically significant effect on neonatal outcome, conferring no advantage over a more traditional method of oxytocin administration.
Placental transfer of bupivacaine, pethidine and lignocaine in the rabbit. Effect of umbilical flow rate and protein content
Authors: HAMSHAW‐THOMAS ANNE , REYNOLDS FELICITY
Published: August 2005

Summary. The factors determining the placental transfer of drugs used in labour were studied in the rabbit placenta perfused in situ with Krebs bicarbonate buffer. During concurrent maternal intravenous infusion of bupivacaine, lignocaine, pethidine and antipyrine, drug concentrations were measured in maternal arterial plasma and placental effluent perfusate, the flow rate and protein content of which were varied. Protein binding and content were also measured. Placental clearance of antipyrine, which is unbound, was unaltered by perfusate protein content, and increased with umbilical perfusate flow up to 2 ml/min. Clearance of lignocaine and pethidine, which were 20–30% protein bound, increased to a small extent with perfusate protein, and were flow‐dependent up to the maximum perfusate flow of 4 ml/min. Clearances of bupivacaine, which was > 80% bound, increased markedly with perfusate protein but, though flow‐dependent, was one‐tenth to one‐fifth that of the other drugs. Fetal binding and glycoprotein content were less than maternal, hence the equilibrium fetal: maternal ratio is predictably lower for the highly bound bupivacaine than for lignocaine or pethidine. Measured fetal: maternal ratios of bupivacaine were, however, only one‐half to one‐third of the predicted equilibrium values, suggesting that bupivacaine does not unbind readily in a single transit through the rabbit placenta. Thus, though bupivacaine crosses the placenta more slowly than thc other drugs, the fetal dose of all these drugs will be greatest in healthy babies with good placental blood flows and high plasma proteins.
Quantitative structural studies on human placentas associated with pre‐eclampsia, essential hypertension and intrauterine growth retardation
Authors: BOYD PATRICIA A. , SCOTT ANDREW
Published: August 2005

Summary. Placentas from pregnancies complicated by pre‐eclampsia, essential hypertension, hypertension complicated by pre‐eclampsia and from normotensive pregnancies resulting in the birth of a singleton small‐for‐dates (SFD) infant have been studied by quantitative mor‐phometry. The findings have been compared with those from placentas of uncomplicated pregnancies. The placentas from pregnancies compli‐cated by pre‐eclampsia and those resulting in a SFD baby had a signifi‐cantly lower total volume, volume of parenchyma and villous surface area when compared with normal pregnancies of comparable gestation. They also had an increase in areas of multiple infarction and in the volume proportions occupied by fetal capillaries. The placentas from women with essential hypertension uncomplicated by pre‐eclampsia were as large as those from normal pregnancies and the villous surface areas were as high. Villous surface arca measurements in the different groups were related to gestation and to fetal weight.
Sympatho‐adrenal and cardiovascular reactivity in pregnancy‐induced hypertension. I. Responses to isometric exercise and a cold pressor test
Authors: NISELL HENRY , HJEMDAHL PAUL , LINDE BIRGITTA , LUNELL NILS‐OLOV
Published: August 2005

Summary.Sympatho‐adrenal and cardiovascular reactivity was studied in patients with pregnancy‐induced hypertension (PIH) and healthy pregnant controls subjected to an isometric handgrip test and a cold pressor test both during and after the pregnancy. At rest, heart rate was higher in thePIHgroup than in the control group both during and after pregnancy. Forearm vascular resistance was not affected by PIH or by pregnancyper se. During pregnancy arterial plasma adrenaline levels were suppressed in the control group both when compared with thePIHgroup and postpartum values. Arterial noradrenaline levels were similar and normal in the two groups at both examinations. The iso‐metric exercise increased systolic and diastolic blood pressures, heart rate and noradrenaline and reduced vascular resistance similarly in thePIHand control groups on both occasions. Vasoconstrictor responses to the cold pressor test were reduced during prenancy but there were no differences between the groups on either occasion. Noradrenaline responses to the cold pressor test were not influenced by PIH or by pregnancyperse. During pregnancy adrenaline responses to the two tests tended to be reduced in the controls but not in PIH. Our results indicate enhanced adrenomedullary activity in PIH when compared with the suppressed activity in normal pregnancy. Cardiovascular reactivity to the tests was similar in the PIH and control groups. The normal arterial noradrenaline levels at rest and during provocation do not support the contention of ageneralizedincrease in sympathetic nerve activity in PIH
The normal menstrual cycle has no effect on gastric emptying
Authors: HOROWITZ M. , MADDERN G. J. , CHATTERTON B. E. , COLLINS P. J. , PETRUCCO O. M. , SEAMARK R. , SHEARMAN D. J. C.
Published: August 2005

Summary. Recent studies have demonstrated that orocaecal transit time is prolonged both in the luteal phase of the ovulatory cycle in normal women and during pregnancy, but have made no attempt to differentiate between the individual effects of gastric emptying and small intestinal transit. We have assessed the effect of the normal menstrual cycle on gastric emptying of solids and liquids in 10 women, using a dual isotope scintigraphic technique. In each subject gastric emptying was measured on 2 days: first during the follicular phase (day 8–10) and then during the luteal phase (day 18–20) of one ovulatory menstrual cycle (where day 1 was the first day of menstrual bleeding). Measures of solid and liquid gastric emptying did not change significantly between the follicular and luteal phases indicating that the normal menstrual cycle has no effect on gastric emptying.
Silastic sling for urethral sphincter incompetence in women
Authors: STANTON STUART L. , BRINDLEY GILES S. , HOLMES DAVID M.
Published: August 2005

Summary. Conventional sling materials have numerous disadvantages. A reinforced Silastic sling is described and its use reported in 30 patients. There was an 83% symptomatic and objective cure of stress incontinence. The advantages of this material include its consistent strength, adjustability and ease of removal.
Combination chemotherapy of ovarian carcinoma with cisplatinum and treosulfan‐a phase II study
Authors: DUNCAN IAN D. , CLAYTON LINDA A.
Published: August 2005

Summary. Twenty‐one patients with advanced ovarian carcinoma were treated with a Combination of cisplatinum and treosulfan. The overall response rate by clinical and ultrasound assessment was 86%, but ultrasound was less optimistic in assessing ‘completeness’ of response (48% compared with 67% clinically). The median actuarial survival was 21 months. There was a 54.9% probability of survival at 43 months in those patients with a complete response and a median survival of 15 months in patients with a partial response. The data suggest that while short‐term survival may depend upon the extent of residual disease, longer‐term survival is determined by response to chemotherapy. The only toxicity of note was haematological
Nuclear magnetic resonance imaging—a new look at the fetus
Authors: SMITH F. W. , KENT C. , ABRAMOVICH D. R. , SUTHERLAND H. W.
Published: August 2005

Summary. A new form of obstetric imaging using nuclear magnetic resonance (NMR) has been assessed for use in pregnancy. A total of 92 examinations were performed in 62 women during the second and third trimesters in both normal and complicated pregnancies including 14 with diabetes, six with pre‐eclampsia and four with intrauterine growth retardation. Our experience has shown that NMR imaging gives excellent differentiation of both maternal and fetal tissues, and because of complete penetration both superficial and deep structures have been clearly identified. The best fetal images were obtained most consistently in the third trimester providing good detail of brain, lungs, liver, heart, bladder, subcutaneous fat, placenta and umbilical cord while maternal tissues were clearly seen at all gestations. As this form of imaging uses no ionizing radiation it offers an alternative means with unique capabilities for investigating pregnancy.
Quickening—a re‐evaluation
Authors: O'DOWD MICHAEL J. , O'DOWD TIMOTHY M.
Published: August 2005

Summary. In a prospective study, 200 patients with accurate menstrual data, assessed clinically and b y early ultrasound, recorded their date of quickening. Fetal movements were first noted by primigravidae at a mean gestation of 19.04 weeks (SD 1.5) and by multigravidae at 17–4 weeks (SD 1.7). Since the range in both groups was wide: 15–22 weeks for primigravidae and 14–22 weeks for multigravidae, quickening was of limited value in estimating gestational age.
Factor VIII related antigen in gestational gestational trophoblastic disease
Authors: CHAN P. H. , CHAN S. Y. W. , HO P. C. , MA H. K.
Published: August 2005

Summary. Serum factor VIII related antigen (factor VIII R:Ag) levels were determined in 34 patients with hydatidiform mole at diagnosis and at 2, 4 and 6 weeks after evacuation of uterus and in 272 normal pregnant women. Serum factor VIII R:Ag levels in molar pregnancies before evacuation of the uterus were significantly higher than those in normal pregnancies of the same gestation age. Serum factor VIII R:Ag levels in the group of patients with residual trophoblastic disease were significantly higher than those in the group without residual tropho‐blastic disease before evacuation and at 6 weeks after evacuation of uterus, but there is considerable overlap in the levels of factor VIII R:Ag between the two groups of patients especially before evacuation of uterus. Factor VIII R:Ag level does not appear to be an useful marker in predicting the outcome of hydatidiforin mole.
Marshall‐Marchetti‐Krantz procedure and Burch colposuspension in the surgical treatment of female urinary incontinence
Authors: MILANI R. , SCALAMBRINO S. , QUADRI G. , ALGERI M. , MARCHESIN R.
Published: August 2005

Summary. Urinary stress incontinence was treated by the Marshall‐Marchetti‐Kranz (MMK) procedure in 42 and by Burch coloposuspension in 44 women. All were assessed preoperatively and for <1 year postoperatively, both clinically and by urodynamic tests. Cure of incontinence was achieved to a similar extent by both procedures, in 71% after the MMK and 79% after the Burch operation. Results were better than average if there was no prolapse and if the bladder was stable preoperatively.
The value of the monoclonal antibody (cancer antigen 125) in serial monitoring of ovarian cancer: a comparison with circulating immune complexes
Authors: DODD J. , TYLER J. P. P. , CRANDON A. J. , BLUMENTHAL N. J. , FAY R. A. , BAIRD P. J. , HICKS L. J. , HUDSON C. N.
Published: August 2005

Summary. The use of circulating immune complexes and a commercial monocolonal antibody to ovarian cancer (CA125 kit) in monitoring progress in patients with ovarian cancer has been assessed. While changes in immune complexes were apparent in some patients with active progression of disease, the marked change in values and linear trend make the use of CA125 a useful clinical marker.
Human papillomavirus types 6 and 16 in multifocal intraepithelial neoplasias of the female lower genital tract
Authors: McCANCE D. J. , CLARKSON P. K. , DYSON J. L. , WALKER P. G. , SINGER A.
Published: August 2005

Summary. Five women with multifocal intraepithelial neoplasia of the lower genital tract were investigated for the presence of human papillomavirus (HPV) infection by the method of DNA‐DNA hybridization which detects the viral DNA. The DNA sequences of HPV types 6 and 16 were detected in each of the five patients and in each of the areas biopsied: cervix, vagina and vulva. DNA sequences of both viral types were also found in vulval intraepithelial neoplasia grades I‐III and in cervical intraepithelial neoplasia grades I and III. The detection of HPV DNAs in multifocal letions suggests a possible common aetiology for the lower genital tract intraepithelial neoplasias.
Prevalence of human papillomavirus type 16 DNA sequences in cervical intraepithelial neoplasia and invasive carcinoma of the cervix
Authors: McCANCE D. J. , CAMPION M. J. , CLARKSON P. K. , CHESTERS P. M. , JENKINS D. , SINGER A.
Published: August 2005

Summary. The frequency of human papillomavirus (HPV) type 16 in premalignant and malignant lesions of the cervix was investigated and compared with the detection of HPV type 6. In cervical intraepithelial neoplasia (CIN) grades I‐III HPV 6 was detected in 28% and HPV 16 in 62% of patients whereas 90% of malignant lesions contained HPV 16 only. In the CIN lesions there was an increase in HPV 16 detection as the severity of disease increased while the level of detection of HPV 6 decreased. Only three (18%) of the cervices that were colposcnpically and histologically normal contained HPV genomes: although two of these three women had either a history of genital warts or a sexual partner with penile warts.
A multicentre prospective randomized controlled trial of induction of labour with an automatic closed‐loop feedback controlled oxytocin infusion system
Authors: STEER P. J. , CARTER M. C. , CHOONG K. , HANSON M. , GORDON A. J. , PKADHAN P.
Published: August 2005

Summary. A randomized prospective controlled trial of an automatic feed‐back controlled oxytocin infusion system (AIS) for the induction of labour at term was carried out in three hospitals. In primiparae, a four‐fold reduction in the total dose of oxytocin infused, for the same induction‐delivery interval, was achieved with the AIS compared with standard labour ward protocols relying on midwife control of oxytocin infusion rate. In multiparae, the total dose of oxytocin infused was almost halved when the AIS was used, while the mean duration of labour was increased by 1.6 h to 7.5 h. There were no differences in the mode of delivery or Apgar scores. It is concluded that the AIS is a safe technique for induction of labour. Its use has demonstrated that term labour can be induced efficiently with a mean oxytocin infusion rate between 2–5 and 3 mU/min (max 8.8 mU/min) and a total oxytocin dose infused of < 5 U.
Placental protein 10 (PP10) in normal pregnancy and cholestasis of pregnancy
Authors: TIITINEN A. , LAATIKAINEN T. , RUTANEN E. M. , RANTA T. , KOISTINEN R. , BOHN H. , SEPPÄLÄ M.
Published: August 2005

Summary. The circulating concentrations of placental protein 10 (PP10) were measured by radioimmunoassay in 288 women with normal pregnancy and ten women (55 samples) with cholestasis of pregnancy. Serum PP10 levels were not affected by changes in incubation and storage temperature, and no diurnal variation was observed. The highest PP10 levels (36–85 μg/1) in normal pregnancy were found at 34 weeks. The postpartum decline of serum PP10 concentration corresponded to an average half‐life of 18h. In cholestasis of pregnancy at 32–39 weeks, the serum PP10 levels were found to be lower than normal. Negative correlation was observed between aminotransferase and PP10 levels in serum and between the bile acid levels and the PP10 concentration. These results suggest that the severity of maternal liver disorder is reflected in the circulating PP10 concentration.
Placental protein 12 (PP12): a new test for the prediction of the small‐for‐gestational‐age infant
Authors: HOWELL R. J. S. , PERRY L. A. , CHOGLAY N. S. , BOHN H. , CHARD T.
Published: August 2005

Summary. The circulating levels of placental protein 12 (PP12) and placental lactogen (hPL) were measured in 501 women between 36 and 41 weeks gestation. There was a significant positive association between hPL levels and infant birthweight and a significant negative association in the case of PP12 levels. The clinical efficiency of elevated PP12 levels in the prediction of low‐birthweight infant at term compared favourably with that of reduced hPL levels.
Distribution of placental protein 14 in tissues and body fluids during pregnancy
Authors: JULKUNEN MERVI , RUTANEN EEVA‐MARJA , KOSKIMIES AARNE , RANTA TAPIO , BOHN HANS , SEPPÄLÄ MARKKU
Published: August 2005

Summary. Placental protein 14 (PP14) levels were measured in serum samples from non‐pregnant and pregnant women. amniotic fluid, cord blood, and extracts of placenta, decidua and fetal membranes. The levels were low (15–40 μg/l) in serum of non‐pregnant women. In four pregnancies following in‐vitro fertilization, the serum PP14 levels started to rise 2–12 days after embryo replacement. In normal pregnancy, the highest serum PP14 concentrations (up to 2200 μg/l) were detected between 6 and 12 weeks. After 16 weeks the level decreased and plateaued at 24 weeks to around 200 μg/l. In amniotic fluid, the highest PP14 levels (232 mg/l) were found between 12 and 20 weeks, being considerably higher than those in maternal serum throughout pregnancy. In cord blood, the levels were low (15–22 μg/l) or undetectable. In early pregnancy decidua. the PP14 content was higher (41–160 mg/g total protein) than in late pregnancy decidua (60–2700 μg/g total protein). In amnion and chorion laeve, the PP14 concentration varied from 50 to 750 and 50 to 1000 μg/g protein, respectively. Early pregnancy placenta contained 0‐25‐15 mg/g and late pregnancy placenta 3–430 μg/g protein of PP14. These results show that the levels of PP14 in pregnancy serum have a similar profile to hCG, but in contrast to other placental proteins, the amniotic fluid PP14 levels are remarkably high. This may be explained by suggesting that decidua is a source of PP14.
Clinical and urodynamic assessment of the porcine dermis bladder sling in the treatment of genuine stress incontinence
Authors: JARVIS G. J. , FOWLIE ALISON
Published: August 2005

Summary. Fifty women, aged between 37 and 76 years, underwent a bladder sling operation for urinary incontinence using porcine dermis. All patients had undergone previous unsuccessful vaginal surgery for genuine stress incontinence and had stable bladders. Thirty‐nine patients (78%) were made continent of urine, both subjectively and on urodynamic testing.
Relation between pregnancy‐associated plasma protein A (PAPP‐A) in human peri‐ovulatory follicle fluid and the collection and fertilization of human ova in vitro
Authors: STANGER JAMES D. , YOVICH JOHN L. , GRUDZINSKAS JURGIS G. , BOLTON ANTHONY E.
Published: August 2005

Summary. In 42 patients, blood‐free peri‐ovulatory follicular fluid was aspirated from 86 follicles for estimation of pregnancy‐associated plasma protein A (PAPP‐A) and related to several variables associated with the fertilization of human ova in vitro. Follicle growth was stimulated by clomiphene citrate alone or in combination with human menopausal gonadotrophin (hMG) and ovulation was triggered by human chorionic gonadotrophin (hCG) except in six patients who had a spontaneous surge of luteinizing hormone (LH). PAPP‐A was detected in 83 of the 86 follicles aspirated, ranging from ‘undetectable’ to 1044 μg/l. The concentration of PAPP‐A was statistically significantly correlated with increasing follicle size, follicular oestradiol‐17β concentration and oocyte recovery. At PAPP‐A concentrations of >200 μgl, there was no correlation noted with the ability of the ovum to be fertilized, to cleave, or between PAPP‐A levels in follicles from pregnant and non‐pregnant cycles. There was no significant difference in the mean PAPP‐A concentration for the two stimulation regimens, but concentrations were greater in follicular fluid from patients who surged spontaneously (P<0.001). It appears PAPP‐A levels may provide an index of follicle maturity but not of the pregnancy potential of the ovum.
Risks of midtrimester amniocentesis; assessment in 3000 pregnancies
Authors: LESCHOT N. J. , VERJAAL M. , TREFFERS P. E.
Published: August 2005

Summary. The obstetric outcome of 3000 pregnancies with midtrimester amniocentesis was followed in all but one patient. Thirty pregnancies ended in fetal death or abortion within 3 weeks after amniocentesis. Chronologically 23 of these occurred in the first series of 1500 pregnancies and the remaining seven fetal deaths/abortions within 3 weeks after amniocentesis occurred in the second series of 1500 pregnancies. Fetal loss within 3 weeks after amniocentesis was apparently related to the experience of the obstetrician and to the use of modern ultrasound guidance. It is concluded that the risk of fetal death after midtrimester amniocentesis is approximately 0.5%, if only experienced obstetricians using modern techniques are involved.
The induction of ovulation using pulsatile luteinizing hormone releasing hormone in clinical practice
Authors: ROSS L. D. , ROBERTSON G. , MILTON P. J. D. , BLOWS R.
Published: August 2005

Summary. Until recently induction of ovulation in patients resistant to clomiphene has required gonadotrophin therapy. This has entailed intensive biochemical monitoring to ascertain the correct dosage and to avoid ovarian hyperstimulation. Described here is a simple, safe effective method of ovulation induction, using pulsed luteinizing hormone releasing hormone and requiring only minimal, readily available monitoring methods.
Zinc and copper in Asian pregnancies–is there evidence for a nutritional deficiency?
Authors: CAMPBELL‐BROWN M. , WARD R. J. , HAINES A. P. , NORTH W. R. S. , ABRAHAM R. , MCFADYEN I. R. , TURNLUND J. R. , KING J. C.
Published: August 2005

Summary.In 92 Hindu Asians, 59% of them vegetarian, and 51 Europeans longitudinal measurements were made during pregnancy of the zinc and copper concentrations in plasma and hair together with urinary zinc excretion, as indices of their zinc and copper status. Maternal diets were assessed once at booking. Zinc intakes ranged from 3·1 to 16·9 mg/day, with average intakes least in vegetarian Hindus and most in Europeans. Average copper intakes ranged between 1·48 and 1·80 mg/day and were similar in the three patient groups. Both ethnic groups showed the pregnancy‐associated fall in the plasma concentration of zinc and rise in that of copper but throughout the study Hindus had statistically significant lower levels of zinc and higher levels of copper than Europeans. Urinary zinc excretion was not only significantly lower throughout the study in Hindus than in Europeans but the increase in excretion which occurred after 20 weeks gestation was smaller. There were no ethnic differences in the zinc content of hair. Urinary zinc excretion correlated with both plasma zinc levels and dietary zinc. Mean birth‐weight in the Hindus was 2912 g and 34% of infants were below the 10th centile, using the Aberdeen standards, compared with 6% of the European babies (mean birthweight 3349 g). No association was found between crude or adjusted birthweight and any of the measures of zinc or copper status in either ethnic group. The Hindus had an apparently lower average zinc status than the Europeans, but there was no evidence that this had acted as a nutritional constraint and was the cause of their slower rate of intrauterine growth.
The effects of oral iron supplementation on zinc and magnesium levels during pregnancy
Authors: SHELDON W. L. , ASPILLAGA M. O. , SMITH P. A. , LIND T.
Published: August 2005

Summary. Serial changes in serum zinc and magnesium concentrations have been studied before conception, throughout pregnancy and at 12 weeks postpartum in 15 normal healthy women not receiving iron supplementation, 10 women receiving iron supplementation but other‐wise having healthy pregnancies and five insulin‐dependent diabetics who also received oral iron. Relative to pre‐pregnancy values zinc concentrations progressively decreased throughout pregnancy reaching a nadir at 36 weeks gestation followed by an increase; pre‐pregnancy values were achieved by 12 weeks postpartum. Magnesium concentrations also decreased throughout pregnancy reaching a nadir at 32 weeks gestation increasing thereafter again with pre‐pregnancy values achieved by 12 weeks postpartum. Iron supplementation in non‐diabetic and diabetic women had no significant effect upon the changes in serum concentration of either zinc or magnesium. These results suggest that the decrease in the concentrations of both elements is a normal physiological adjustment to pregnancy and that iron supplementation does not influence these changes
Fetal blood chromosome analysis: some new indications for prenatal karyotyping
Authors: GOSDEN CHRISTINE , RRODECK C. H. , NICOLAIDES K. H. , CAMPBELL S. , EASON PATRICIA , SHARP J. C.
Published: August 2005

Summary. Prenatal karyotyping using stimulated fetal blood lymphocytes was undertaken in 170 pregnancies between 16 and 36 weeks gestation for the following reasons‐(1) mosaicism or marker chromo somes found in amniotic fluid culture; (2) a family history of X‐linked mental retardation with fragile Xq28; (3) fetal abnormalities detected ultrasonographically; (4) late booking or amniotic fluid culture failure in patients with advanced age or balanced translocations; and (5) twin pregnancies discordant for a chromosomal anomaly. Forty‐one karyotypic abnormalities were detected (24%). These were: 45,X (7 cases). trisomy 13 (5 cases), trisomy 18 (6 cases), trisomy 21 (4 cases), twin pregnancy where one twin had trisomy 21 (1 case), supernumerary marker chromosome (3 cases, one of which occurred in a twin pregnancy). triploidy (3 cases), X‐linked mental retardation with fragile site at Xq28 in males (6 cases), fetal erythroleukaemia (3 cases including 2 cases with Turner's), Fanconi's anaemia (1 case), unbalanced chromosome translocation 47,XY+der22,t(l1;22) mat (1 case), mos 46,XXI8p‐/46,XX.‐18,+i(l8q) (1 case), 46,XXde1(2q) (1 case), and 46,XYt(5;17) de novo (1 case). In fetuses at high risk of a chromosome aberration. a rapidly obtaincd karyotype is helpful and fetoscopy and fetal blood sampling are justified in the second or third trimester.
The repetition of spontaneous preterm labour
Authors: CARR‐HILL ROY A. , HALL MARION H.
Published: August 2005

Summary. The likelihood of repetition of preterm birth after spontaneous onset of labour has been studied in 6572 reproductive careers after excluding stillbirths. multiple births. all careers in which any labour had been induced, and all careers in which the gestation length in any pregnancy was not certain. The analysis was controlled not only for pregnancy number, but for the nature of the reproductive outcomes. In most reproductive xqucnces thcrc was a weak correlation bctween the gestation in one pregnancy and subsequent ones. The risk of preterm birth was tripled after one previous preterm birth with or without a preceding abortion, and increased six‐fold after two previous preterin births. However, the attributable risk was low, and most multiparae with preterm births did not have a previous history.
Intrauterine volume, fetal abdominal area and biparietal diameter measurements with ultrasound in the prediction of small‐for‐dates babies in a high‐risk obstetric population.
Authors: GEIRSSON R. T. , PATEL N. B. , CHRISTIE A. D.
Published: August 2005

Summary. . The value of fetal biparietal diameter and abdominal area, total intrauterine, intra‐amniotic and placental volume measurements for predicting small‐for‐dates babies in a high‐risk obstetric population was investigated in 130 women. A parallel planimetric area method was used to measure volume. The commonest risk factors were suspected intrauterine growth‐retardation, hypertensive complications and previous poor obstetric history. The prevalence of birthweight at and below the 10th or 3rd centiles was 30 and 16% respectively. Fetal abdominal area and total intrauterine volume measurements had the highest and comparable sensitivity, specificity and positive predictive value in the detection of infants with birthweights of 10th and 3rd centiles. While these measurements are of use in consolidating the clinical diagnosis of small‐for‐dates fetuses (growth retardation), high false positive rates (10% and 16–17% for birthweights 10th centile, and 3rd centile respectively) make further discriminatory tests necessary for part of the population.
Interruption of first trimester human pregnancy following Epostane therapy. Effect of prostaglandin E2 pessaries
Authors: WEBSTER M. A. , PHIPPS S. L. , GILLMER M. D. G.
Published: August 2005

Summary. The effect of Epostane, a competitive inhibitor of the 3β hydroxy steroid dehydrogenase enzyme system in combination with prostaglandin E2 (PGE2) for induction of abortion in early first trimester pregnancy has been studied in a group of 20 women awaiting termination of pregnancy. The women were consecutively assigned to four treatment groups. The first group was treated with PGE2 alone, administered vaginally as a lipid based (Witepsol) pessary. The remaining three groups received Epostane at differing doses for 5 days, and were treated with PGE2 on the fourth day. Significant falls in serum progesterone and oestradiol occurred in the Epostane‐treated patients. Abortion was induced in one of the five control patients and in three of 10 patients treated with low doses (300–400 mg) of Epostane. Intra‐utrine pressure monitoring showed an increased reactivity to PGE2 in the treated groups. At the highest dose (600 mig) of Epostane, serum progesterone and oestradiol showed the greatest decline to 8% and 21% of the pretreatment values, a prompt and sustained pressure response occurred to PGE2 and abortion was induced in all five patients. A critical degree of progesterone suppression appears to sensitize the myometrium to exogenous prostaglandin. This combined treatment is an effective method of early pregnancy termination and may have a role in the management of mid‐trimester abortion.
AIDS and HTLV‐III/LAV infection: consequences for obstetrics and perinatal medicine
Authors: PINCHING ANTHONY J. , JEFFRIES DONALD J.
Published: August 2005

Summary. This paper was prepared at the request of the Scientific Advisory Committee of the Royal College of Obstetricians and Gynaecologists It includes data distilled from many published and unpublished reports, including those presented at the International Conference on AIDS held in Atlanta, Georgia in April 1985. The urgency of the issues raised would seem to merit including all available data in this way.
The pill does not cause ‘thrush’
Authors: DAVIDSON FIONA , OATES J. K.
Published: August 2005

Summary. Contraceptive method, presence or absence of genital candidosis and other genital infections or conditions were recorded in 1363 new patients attending three different genitourinary medical clinics. Genital candidosis was present in 28% but was not associated with oral contraceptive usage; it seemed more likely t o be associated with other genital disorders, especially non‐specific infection and viral infections.
The relation between vaginal pH and the microbiological status in vaginitis
Authors: HANNA N. F. , TAYLOK‐ROBINSON D. , KALODIKI‐KARAMANOLI M. , HAKRLS J. K. W. , McFADYEN I. R.
Published: August 2005

Summary.The vaginal pH, microbial flora and presence of clue cells were investigated in 89 women who were seen a t a sexually transmitted diseases clinic with a vaginal discharge or because they were contacts of men with gonococcal or non‐gonococcal urethritis or because they were seeking a routine examination. None of the women had received antibiotics for at least 4 weeks before examination. A clinically normal vaginal secretion was found in 21 (55%) of 38 women who had a vaginal pH of 5.0–5.5. while such a secretion was found in only 7 (14%) of 51 women who had a pH value of 6·0–7·5. Clue cells,Chlatmydia trachomatisandMycoplasrna hominiswere found two to three times more often in women with the higher pH value than in those with the lower value andUreaplasma urealyticumandTrichomonas vaginalisalso occurred more frequently in the former group. Furthermore. large numbers ofM. hominisorganisms ( 106colour changing units/ml) were associated significantly with the higher pH value. However, there was no appreciable difference in the distribution ofCandida albicansbetween the two groups.C. trachomatisbut not the other micro‐organisms was isolated most often from women who were taking oral contraceptives. The results indicate that a pH of 2.6.0 is strongly predictive of infection and may be more useful than the type of discharge in suggesting a need for confirmatory microbiological tests.
Low survival of South African urban black women with cervical cancer
Authors: WALKER A. R. P. , WALKER B. F. , SIWEDI D. , TSAACSON C. , VAN GELDEREN C. J. , ANDRONIKOU A. , SEGAL I.
Published: August 2005

Summary. In Soweto, Johannesburg, the incidence of cervical cancer, the most common cancer in black women, is higher than in most white populations but lower than in many other populations. In a series of 210 patients who were diagnosed in 1981 and 1982, 50% had died within 1.6 years of diagnosis, a third of the reported survival time in white patients. The pattern of stage at presentation was similar to, although sometimes later than, those reported for various white communities. Data on patients' age at birth of first child, parity, smoking practice, and socioeconomic status, differed little from those in a control group. Neither these factors, nor availability of medical services, could be correlated with the distressingly short period of survival, which also occurs among urban black patients with breast and ocsophageal cancers. Presumably, unidentified factors linked with low socioeconomic status affect survival time.
The anisotropic nature of urethral occlusive forces
Authors: WARD G. H. , HOSKER G. L.
Published: August 2005

Summary. A newly‐developed unidirectional force gauge was used to demonstrate that the urethral occlusive forces are unequal around the circumference of the female urethra. In the proximal two‐thirds of the urethra significantly greater forces are exerted in the anterior position compared with those exerted in the lateral and posterior positions. By contrast the occlusive forces in the distal third of the urethra are greater in the posterior and lateral positions than in the anterior position. These findings hold true for both women with normal and abnormal urinary control. Rotational variations have previously been reported but have been thought to be artefact due to catheter stiffness; this study shows that rotational variations are genuine and not due to artefact.
External cephalic version and spontaneous version rates: ethnic and other determinants
Authors: HOFMEYR G. J. , SADAN O. , MYER I. G. , GALAL K. C. , SIMKO G.
Published: August 2005

Summary. Variable rates of external cephalic version (ECV) success in late pregnancy and of spontaneous version have been reported for different population groups. An ECV attempt by one operator in 80 patients beyond 36 weeks gestation was successful less frequently in white nulliparous patients and in those with lateral or cornual placental situation. A similar influence of ethnic and other variables was found on the spontaneous version rate in 108 patients in whom no ECV was attempted. Despite population differences in ECV success rates, the ratio of successful ECV to spontaneous version in reported randomized control trials is consistent at about 3:1.