bluuebunny/crossref_metadata_2025 huggingface dataset:
Outpatient diagnostic hysteroscopy
Authors: DE JONG PETER , DOEL FRANCES , FALCONER ANTHONY
Published: August 2005

Summary. Outpatient diagnostic hysteroscopy with endometrial sampling was performed in 160 women. The aim was to assess patient acceptance of the procedure when performed under para‐cervical block. The most common indication was abnormal uterine bleeding. In 152 patients the procedure was successful, allowing thorough inspection of the uterine cavity, and in almost half of them no abnormality was detected. Thirty‐one required subsequent elective admission, mainly for fibroid polypectomy. In most women the level of discomfort was assessed as ‘tolerable’, but in two the procedure was abandoned because of severe discomfort. Endometrial carcinoma was detected in six patients. There were no complications attributable to the procedure. Outpatient hysteroscopy considerably reduces the need for hospital admission and can provide early investigation for patients with a spectrum of gynaecological disorders, at low cost and with minimal facilities.
Oligohydramnios associated with prostaglandin synthetase inhibitors in preterm labour
Authors: HENDRICKS SUSAN K. , SMITH JAMES R. , MOORE DONALD E. , BROWN ZANE A.
Published: August 2005

Summary. The use of prostaglandin synthetase inhibitors (indomethacin and ibuprofen) for >72 h in women with preterm labour (n=67) was significantly (P<0.001) associated with ultrasoundrecorded oligohydramnios compared with the use of ritodrine or magnesium sulphate (control group, n=67). Oligohydramnios developed in 26 of 37 women (70%) treated with indomethacin and 8 of 30 women treated with ibuprofen (27%) (P<0.01). Oligohydramnios developed in only two control subjects and one of these pregnancies was associated with intrauterine growth retardation. All 34 cases of oligohydramnios in the treatment group resolved after stopping medication, whereas the two in the control group did not resolve. No instances of renal failure, premature closure of the ductus arteriosus, pulmonary hypertension, or bleeding disorders were noted in any of the treated or control infants.
The obstetric forceps–are we using the appropriate tools?
Authors: HIBBARD BRYAN M. , McKENNA DOUGLAS M.
Published: August 2005

Summary. A total of 166 pairs of obstetric forceps of three different types in regular use in two major obstetric units was measured and compared with manufacturers’ master instruments and drawings. As well as linear measurements of blade, shank and handle the distances between the tips and maximum distance between the blades, and the mean radius of the cephalic curve were determined. The purpose of the study was to assess the suitability of instruments in common use for present day pratice. It was found that the measurements differed significantly from the original descriptions and there were wide variations between instruments of the same type, even when supplied by the same manufacturer. In some cases the blades had not been packed in matching pairs in the Central Sterile Supplies Department. It is suggested that critical reappraisal of the forceps in current use in many obstetric units is overdue. As well as a need for reconsidering the type of forceps used the dimensions of individual pairs should be checked.
Reduced atrial natriuretic peptide concentrations in premenstrual syndrome
Authors: HUSSAIN S. Y. , O'BRIEN P. M. S. , DE SOUZA V. , OKONOFUA F. , DANDONA P.
Published: August 2005

Summary. Atrial natriuretic peptide (ANP) concentrations were determined by radioimmunoassay technique in 23 women, 11 women with premenstrual syndrome (PMS) and 12 comparable asymptomatic women. The asymptomatic women showed no change in ANP concentration during the menstrual cycle. In the PMS group ANP levels showed a significant fall in the midluteal phase compared to levels in the follicular phase. Throughout the cycle ANP concentrations were lower in the PMS group than in the comparison group. This difference was statistically significant in the early, mid and late luteal phases of the cycle. The lower ANP concentration in the PMS group in the luteal phases may indicate either a lower plasma volume or a decrease in the total body sodium content or both. These findings are contrary to those expected.
A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer
Authors: JACOBS I. , ORAM D. , FAIRBANKS J. , TURNER J. , FROST C. , GRUDZINSKAS J. G.
Published: August 2005

Summary. Age, ultrasound score, menopausal status, a clinical impression score and serum CA 125 level were assessed to see how they could best distinguish between patients with benign (n = 101) and malignant (n – 42) pelvic masses. Each criteria used alone provided statistically significant discrimination. The most useful individual criteria were a serum CA 125 level of 30 U/ml (sensitivity 81 %, specificity 75%) and an ultrasound score of 2 (sensitivity 71%, specificity 83%). Three criteria could be combined in a risk of malignancy index (RMI) which is simply calculated using the product of the serum CA 125 level (U/ml), the ultrasound scan result (expressed as a score of 0, 1 or 3) and the menopausal status (1 if premenopausal and 3 if postmenopausal). This index was statistically virtually as effective a discriminant between cancer and benign lesions as more formal methods. Using an RMI cut‐off level of 200, the sensitivity was 85% and the specificity was 97%. Patients with an RMT score of greater than 200 had, on average, 42 times the background risk of cancer and those with a lower value 0.15 times the background risk.
Serum CA 125 levels during the menstrual cycle
Authors: LEHTOVIRTA P. , APTER D. , STENMAN U.‐H.
Published: August 2005

Summary. Serum concentrations of CA 125 were measured in different phases of the menstrual cycle in 16 women with ovulatory and 12 women with anovulatory cycles. CA 125 levels were significantly elevated during menstruation in both groups. In women with anovulatory cycles, but not in those with ovulatory cycles, CA 125 levels were already increased in the premenstrual phase. A negative correlation was found between serum CA 125 and progesterone concentrations in the premenstrual phase of the cycle. We suggest that premenstrual elevation of serum CA 125 in women with anovulatory cycles is related to premature endometrial vascular changes which are the result of the low serum progesterone concentration leading to insufficient endometrial control. Thus the effect of progesterone seems to be indirect rather than a direct effect on CA 125 synthesis. When the CA 125 assay is used for diagnosis of cancer, sampling should not be done immediately before or during menstruation because the physiological elevation of the CA 125 levels may give false positive results.
Effects of isradipine, a new calcium antagonist, on maternal cardiovascular system and uterine activity in labour
Authors: WIDE‐SWENSSON D. , TNGEMARSSON T. , ARULKUMARAN S. , ANDERSSON K‐E.
Published: August 2005

Summary. The effects of isradipine (a new calcium antagonist of the dihydropyridine type) on maternal blood pressure and heart rate, fetal heart rate, and uterine activity in labour were measured. Uterine activity was recorded by an intrauterine microtip transducer catheter connected to a fetal monitor. Isradipine was given as a slow injection in doses of 0.5 mg (10 women), 1 mg (11 women), and 1.5 mg (6 women). A reduction of systolic (6–16%) and diastolic (19‐22%) blood pressure was seen, and concomitantly there was an increase in maternal (29–34%) and fetal (3–10%) heart rates. Reduction in uterine activity was not dose‐related (maximum reduction 17%). Side effects (headache, palpitations) were minor and well tolerated. One woman in the highdose group had a shortlasting episode of hypotension. The results suggest that isradipine given as a bolus dose decreases blood pressure in pregnant women with little effects on uterine activity and fetal heart rate.
The perurethral technique for ultrasound directed follicle aspiration in an in‐vitro fertilization and embryo transfer programme: a report of 636 patient cycles
Authors: BOOKER MICHAEL , PARSONS JOHN
Published: August 2005

Summary. The data from 636 patient cycles from an outpatient‐based in‐vitro fertilization and embryo transfer programme are presented. Between 1984 and 1988, 545 women (86%) underwent ultrasound directed follicle aspiration (UDFA) exclusively by the perurethral route. The mean follicle aspiration rate was 93%, and the mean number of oocytes per procedure was 5.8. The complication rate was 6%, but none was major. From July 1985 the clinical pregnancy rate per UDFA was 17% and per embryo transfer 21%. The perurethral approach was used in combination with another UDFA route in 91 women (14%) but the need to change route decreased with increasing operator experience. Perurethral UDFA is an efficient and safe method for harvesting oocytes.
Factors influencing the prevalence and severity of dysmenorrhoea in young women
Authors: SUNDELL GUNILLA , MILSOM IAN , ANDERSCH BJÖRN
Published: August 2005

Summary. Factors influencing the prevalence and severity of dysmenorrhoea were assessed longitudinally in a representative sample of young women born in 1962. The prevalence of dysmenorrhoea was lower (P<0.01) at 24 years of age than at 19 years of age. At 24 years of age, 67% of the women still experienced dysmenorrhoea; 10% reported dysmenorrhoea which limited daily activity. The severity of dysmenorrhoea (linear analogue scale) was lower (P<0·001) at 24 years of age (3·4, SD 2.8) than at 19 years (4.1, SD 3.2). The prevalence and severity of dysmenorrhoea were reduced (P<0.05) in women who were parous in 1986 and nulliparous in 1981; but was unchanged in women who were still nulliparous or women who had had a miscarriage or abortion. Dysmenorrhoea was reduced (P<0.001) in oral contraceptive users. The severity of dysmenorrhoea was significantly associated with the duration of menstrual flow, menarcheal age and cigarette smoking. The severity of dysmenorrhoea was not associated with age as an isolated factor, nor with height, weight, length of menstrual cycle or frequency of physical exercise.
Genetic and familial predisposition to eclampsia and pre‐eclampsia in a defined population
Authors: ARNGRIMSSON REYNIR , BJÖRNSSON STEINGRIMUR , GEIRSSON REYNIR T. , BJÖRNSSON HÓLMGEIR , WALKER JAMES J. , SNAEDAL GUNNLAUGUR
Published: August 2005

Summary. Familial predisposition and patterns of genetic inheritance of eclampsia and pre‐eclampsia were investigated through three or four generations in 94 families from the homogenous island population of Iceland. The families descended from index women delivered in the years 1931–47 and who had either eclampsia (n = 38) or severe preeclampsia (n = 69). Inheritance was followed both through sons and daughters. The prevalence of pre‐eclampsia and eclampsia in daughters was significantly higher (23%) than that in daughters‐in‐law (10%). No difference was noted in the prevalence of these diseases by whether the daughter was born of an eclamptic or pre‐eclamptic mother or whether she was a first or later born daughter. There was a non‐significantly higher occurrence of pre‐eclampsia among grand‐daughters than in grand‐daughters‐in‐law. No difference was seen by whether granddaughters descended through sons or daughters. With increasing numbers of affected daughters or grand‐daughters the probability rose of finding more affected women in a family. Hypotheses of single recessive and dominant gene inheritance were compared and maximum likelihood estimates for gene frequency obtained. For a single recessive gene model this was 0.31 reflecting a population prevalence of 9.6%, whereas a dominant model with incomplete penetrance gave 0.14 at 48% gene penetrance, corresponding to a population prevalence of 0.9% homozygous expression of severe disease and 11% heterozygous expression of milder disease. Either genetic model could fit the data.
Epidemiology of pelvic inflammatory disease in parous women with special reference to intrauterine device use
Authors: BUCHAN HEATHER , VILLARD‐MACKINTOSH LAURENCE , VESSEY MARTIN , YEATES DAVID , MCPHERSON KLIM
Published: August 2005

Summary. Up to the end of 1989, 206 parous women in the Oxford Family Planning Association contraceptive study had been referred to hospital with a first episode of pelvic inflammatory disease. Of these, 65 suffered from definite disease described as acute, 81 from definite disease not described as acute and 60 from ‘other disease’. Considering all forms of disease together, referral was less common in those aged 25–29 and in those aged 45 or more than in those aged 30–44. Referral was more common in those of low social class, in those who smoked and in those who married young. All these factors were taken into account in analyses considering the effects of contraceptive methods. In these analyses, women currently using the contraceptive pill, the diaphragm, the sheath, female sterilization or an intrauterine device (IUCD) were compared with those currently using other methods or no method of contraception. IUCD ex‐users were, however, placed in a separate category, irrespective of their current method of contraception. The relative risks obtained in these analyses, with 95% CI, were as follows: contraceptive pill 0.5 (0.2‐0.9), diaphragm 0.6 (0.3‐1.2), sheath 1.2 (0.6‐2.4), female sterilization 0.7 (0.3‐1.5), non‐medicated IUCD 3.3 (2.3‐5.0), medicated IUCD 1.8 (0.8‐4.0), IUCD ex‐users 1.3 (0.7‐2.3). These data suggest that oral contraceptives, the diaphragm and female sterilization protect against pelvic inflammatory disease and that IUCDs increase the risk. Medicated devices, however, appear to carry only about half the risk of non‐medicated devices, and the elevation of risk in IUCD ex‐users appears to be small. Special analyses examined the risk associated with use of a Dalkon Shield. Among women currently using an IUCD (of any kind), those who had used a Dalkon Shield (at any time) had nearly five times as great a risk of hospital referral for pelvic inflammatory disease as those who had never used a Dalkon Shield (relative risk 4.7, 95% CI 2.1‐9.0).
Prediction of pregnancy‐induced hypertensive disorders by angiotensin II sensitivity and supine pressor test
Authors: DEKKER G. A. , MAKOVITZ J. W. , WALLENBURG H. C. S.
Published: August 2005

Summary. An angiotensin II sensitivity test and a supine pressor test were done consecutively at 28 weeks gestation in 90 healthy, normotensive nulliparous women. None of the supine pressor tests was positive, applying the predefined threshold of a rise of 20 mmHg in diastolic blood pressure after rolling over; nine tests were positive using a corrected 9 mmHg cut‐off level. Ten women had a positive angiotensin sensitivity test using a threshold of the effective pressor dose of 8 ng/kg/min; 22 women were positive using an effective pressor dose of 10 ng/kg/min. Later in pregnancy 12 women (13%) developed pregnancyinduced hypertensive disease (PIH). The specificity of both tests of predicting the development of PIH was about 90%. The sensitivity of the angiotensin sensitivity test at the 10 ng/kg/min level was 92%. Because of its low sensitivity of 25% the supine pressor test appears to have no value for the prediction of PIH. There was a significant positive association between angiotensin IT refractoriness and birthweight.
Dipalmitoylphosphatidylcholine (L‐α‐lecithin) stimulates prostaglandin E production in human amnion
Authors: OHTSUKA T. , LEE H. C. , YAMAGUCHI M. , MORI N.
Published: August 2005

Summary. The effect of dipalmitoylphosphatidylcholine (DPPC, L‐αlecithin), a substance not containing arachidonic acid, on prostaglandin E (PGE) production of amniotic membrane was studied. DPPC (3.125800 μg/ml) stimulated PGE production of amniotic membrane (150200%), suggesting that lecithin, the major surfactant component, is directly involved in the mechanism of human parturition as a stimulator of PGE production.
Vaginal epithelial abnormalities in patients with CIN: clinical and pathological features and management
Authors: NWABINELI N. J. , MONAGHAN J. M.
Published: August 2005

Summary. Of 4147 women who had CIN treated by laser at the Regional Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, 103 (2.5%) had co‐existing vaginal epithelial abnormalities. CIN 3 was the histological diagnosis most often associated with vaginal lesions. The upper vagina was almost always involved. In 67% the lesion in the cervix appeared to be confluent with that in the vagina. Even when the lesions were confluent, biopsies form the cervical and vaginal components did not always show the same grade of intraepithelial neoplasia and in some biopsies they showed different lesions. Laser treatment appears to be effective for the vaginal lesions and is therefore recommended although, in selected patients, careful follow up alone may suffice.
Ratio of immunochemically determined amniotic fluid acetylcholinesterase to butyrylcholinesterase in the differential diagnosis of fetal abnormalities
Authors: LOFT ANNE GITTE RASMUSSEN , MORTENSEN VIBEKE , HANGAARD JØ;RGEN , NØRGAARD‐PEDERSEN BENT
Published: August 2005

Summary. A total of 111 amniotic fluid samples, clear or blood stained, with elevated levels of alpha‐fetoprotein and acetylcholinesterase was analysed by immunoassays specific for acetylcholinesterase and butyrylcholinesterase and the acetylcholinesterase/butyrylcholinesterase‐ratios determined. Samples from 40 pregnancies associated with anen‐cephaly, 47 pregnancies associated with open spina bifida or encephalocele and six pregnancies with fetal intrauterine death or miscarriage all had ratios of >0.14. All 11 pregnancies with fetal ventral wall defects had ratios <0.14 as had four pregnancies with normal outcome and elevated levels of alpha‐fetoprotein and acetylcholinesterase. Three fetuses with both open spina bifida and ventral wall defects were associated with ratios above 0.14. These results suggest that immu‐nochemical determination of acetylcholinesterase and butyrylcholinesterase can be used to distinguish pregnancies complicated by anencephaly, open spina bifida, encephalocele and miscarriage from those with ventral wall defects and samples with false positive elevated levels of alpha‐fetoprotein and acetylcholinesterase. The procedure is accurate and simple to carry out and well suited to routine use in a clinical chemistry laboratory.
Intrauterine pressures in labours induced by amniotomy and oxytocin or vaginal prostaglandin gel compared with spontaneous labour
Authors: LAMONT R. F. , NEAVE S. , BAKER A. C. , STEER P. J.
Published: August 2005

Summary. Uterine activity during the first stage of labour was measured by an intrauterine transducer in 22 women induced with intravaginal PGE2 gel, in 37 induced by amniotomy and intravenous oxytocin, and in nine women in spontaneous labour. The nulliparous women in the PGE2 gel group had a significantly longer pre‐established phase of labour and a significantly shorter established phase than nulliparae induced by amniotomy and oxytocin. The mean levels of total uterine activity (kPas) during labour and the uterine activity integrals (kPas/15 min) were significantly lower in nulliparae induced with PGE2 gel than in those induced by amniotomy and oxytocin. These findings suggest that PGE2 gel has a positive, beneficial effect on cervical compliance during the pre‐established phase, resulting in less myometrial effort during established labour. These effects were less evident in parous women, probably because of an innate lower cervical resistance due to their previous labours. Uterine activity patterns during the 4 h leading to full cervical dilatation in nulliparae were similar in labours induced with PGE2 gel and spontaneous labours, whereas labours induced by amniotomy and oxytocin exhibited a significantly different pattern. Expulsion of the fetus during normal labour is a function of both uterine contractions and a decrease in the cervical resistance and the data suggest that induction by PGE2 gel more closely mimics spontaneous labour, whereas the predominant effect of oxytocin is to stimulate myometrial activity.
The tap test—a rapid bedside indicator of fetal lung maturity
Authors: GUIDOZZI F. , GOBETZ L.
Published: August 2005

Summary. The reliability of two rapid bedside tests of fetal lung maturity was investigated in 80 amniotic fluid samples. The results of the ‘tap’ test and those of the shake test were compared with the results of laboratory measurements of phospholipid profiles for fetal lung maturity. The tap test was found to be more reliable with a positive predictive value of 91% and a negative predictive value of 63%, whereas the shake test had a positive predictive value of 79% and a negative predictive value of 31%. The tap test was also more reliable in identifying fetuses with borderline lecithin/sphingomyelin ratios in the range 3.2–3.7:1.
Results with the EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) regimen in high risk gestational trophoblastic tumours, 1979 to 1989
Authors: NEWLANDS E. S. , BAGSHAWE K. D. , BEGENT R. H. J. , RUSTIN G. J. S. , HOLDEN L.
Published: August 2005

Objective— To assess the efficacy, toxicity and survival in patients with high risk GTT treated with the EMA/CO regimen (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine/oncovine).

Design— Open non‐randomized study of 148 consecutive patients referred to the Charing Cross Hospital between 1979 and 1989.

Setting— Trophoblastic disease centre in a London teaching hospital.

Subjects— 148 consecutive patients with high risk GTT were treated with the EMA/CO regimen. 76 patients had received no prior chemotherapy and 72 had received prior chemotherapy.

Main outcome measures— Survival, causes of treatment failure and toxicity were analysed.

Results— Of 76 patients who had received no prior chemotherapy, 62 (82%) are in remission, 72 patients had received prior chemotherapy and 64 (89%) are in remission; an overall survival of 85% for the 148 patients. Ten of the 76 patients without prior chemotherapy died from extensive disease within 3 weeks of starting chemotherapy. The complete and partial response rates to EMA/CO chemotherapy were 80% and 18% respectively. The addition of cisplatin salvaged 9 of 11 (82%) who developed drug resistance and did not require surgery. Salvage surgery alone resulted in 7 of 8 (87%) having complete remissions. Relapse after EMA/CO chemotherapy is uncommon (5.4%) but survival is still relatively good with further chemotherapy and/or surgery with 6 (75%) of 8 patients obtaining a further sustained remission. Complications from EMA/CO chemotherapy are acceptable with myelosuppression being dose‐limiting. Late sequelae are uncommon: menstruation usually returns with a few months, and no fetal abnormalities have been recorded in subsequent pregnancies. One patient developed what we presume to be a therapy‐induced acute myeloid leukaemia.

Conclusion— At present EMA/CO chemotherapy is our treatment of choice for patients with high risk GTT. Its toxicity is predictable and reversible. In patients developing drug resistance, salvage surgery is important. Future developments may include further dose intensification with the addition of haemopoietic growth factors, earlier diagnosis and the separation of gestational from non‐gestational trophoblastic tumours.
Oocyte and follicular fluid characteristics in women with mild endometriosis
Authors: MAHMOOD TAHIR A. , ARUMUGAM KULENTHRAM , TEMPLETON ALLAN A.
Published: August 2005

Summary. The follicular development, fertilization and cleavage rates and follicular fluid endocrinology were assessed in 20 women with mild endometriosis during a spontaneous menstrual cycle. Diagnostic lapa‐roscopy was performed 32 h after the onset of the endogenous luteinizing hormone (LH) surge in the 20 women with laparoscopically confirmed mild endometriosis and in a control group of ten women with tubal infertility. There was no significant difference in oocyte maturity or fertilization and cleavage rates between the women with mild endometriosis and those in the control group. The endocrine milieu of the pre‐ovulatory oocyte at the time of aspiration was similar in the two groups
Immunoreactive endometritis
Authors: SKENSVED H. , HANSEN A. , VETNER M.
Published: August 2005

Summary. A benign polyclonal lymphoid proliferation of the endometrium which bears morphological resemblance to the malignant lymphoma is found among women with bleeding disturbances. Seven previous cases have so far been reported in the literature. A retrospective examination of 11648 endometrial specimens revealed 287 examples of chronic endometritis (2–5%) of which 29 displayed lymphoid proliferation. We found no evidence of malignant haematologic disorder after a median observation of 68 months and no positive association with prior or present infectious disease. Histological follow‐up of ten patients showed that changes could persist for up to 12 months. We name this benign condition ‘immunoreactive endometritis’.
Anti‐Kell in pregnancy
Authors: LEGGAT H. M. , GIBSON J. M. , BARRON S. L. , REID M. M.
Published: August 2005

Summary. A review of data on haemolytic disease of the newborn (HDN) collected in Newcastle upon Tyne over 25 years revealed 194 pregnancies in which anti‐Kell was the only antibody detected. Sixteen affected babies were born. None was hydropic, three had very severe disease but all survived. There were also three stillbirths, none of which had post‐mortem appearances of HDN. The highest recorded anti‐Kell titres in individual patients ranged from 1/1 to 1/2048 and bore no relation to the severity of the disease. Of the eight pregnancies in which amniotic fluid examination predicted a high risk of stillbirth, half resulted in unaffected babies. We suggest that haemolytic disease caused by anti‐Kell is less severe than suggested by some workers. The use of guidelines developed from the study of Rhesus disease to determine the need for intervention in women with anti‐Kell may be inappropriate.
Controlling Rh haemolytic disease of the newborn in India
Authors: JOSEPH K. S.
Published: August 2005

Summary. The question whether India should institute a national programme of Rh screening and postpartum Rh immune globulin prophylaxis needs to be addressed, especially because of the recent emphasis on primary maternal and child health care. Given the absence of relevant community based data, decision analysis techniques were used to address these issues. The results reveal that the estimated cost per case of Rh HDN prevented through postpartum immune globulin prophylaxis is lower than the cost per case of Rh HDN treated through a curative strategy. However, the financial and infrastructural requirements of the preventive programme mean that such prevention may not be feasible at present. With the achievement of the Indian Government's stated objectives of population control, however, disease incidence should fall by 30% from 5–90/1000 births in 1981 to 4–13/1000 births by the year 2000, even in the absence of a prophylaxis programme.
Obstetric accidents: the patient's perspective
Authors: VINCENT C. A. , MARTIN T. , ENNIS M.
Published: August 2005

Summary Cases from the files of Action for Victims of Medical Accidents which had resulted in stillbirth, perinatal or neonatal death and long term mental or physical handicap were reviewed. In 41 cases there was both a detailed letter from the parents and an independent review by a senior obstetrician. The reviewer's main criticisms were of inadequate fetal heart monitoring, lack of involvement of senior staff and inadequate records. The fetal heart trace was missing in 7 cases and over half of the remaining 34 traces available were misinterpreted or not acted on. In 17 cases junior doctors failed to recognize fetal distress and managed a delivery that they did not have the experience to deal with. In a further 6 cases, senior staff were called but did not come. Records were criticized for being incomplete, illegible or missing. In a few cases unjustified alterations appeared to have been made. Women reported that on some occasions staff ignored their worries, were unsympathetic and gave too little information. Some parents also experienced considerable difficulty in obtaining a clear explanation of the nature and cause of their child's condition.
Placental bed spiral arteries in the hypertensive disorders of pregnancy
Authors: PIJNENBORG ROBERT , ANTHONY JOHN , DAVEY DENNIS A. , REES ALEXANDRA , TILTMAN ANDREW , VERCRUYSSE LISBETH , VAN ASSCHE ANDRE
Published: August 2005

Objective— The investigation of the histology of the placental bed spiral arteries in normal pregnancy and in pregnancies complicated by hypertension, with or without proteinura.

Design— An observational study, based on women having caesarean sections for clinical reasons.

Subjects— 17 normal pregnant women, 43 with gestational hypertension, of whom 39 had proteinuria, 17 with chronic hypertension, of whom 6 had proteinuria, and 5 with unclassified hypertension.

Interventions— Placental bed biopsies obtained during caesarean section.

Main outcome measures— Histological appearance of sections stained with haematoxylin and eosin PAS and Lendrum's MSB.

Results— Biopsies containing spiral arteries were obtained from 6 normotensive and 44 hypertensive women. Trophoblastic invasion was present in 5 of the 6 normotensive biopsies but absent in the majority of those with hypertension. Subintimal proliferation was seen in all the normotensive biopsies but in only 8 of 28 from those with gestational hypertension and proteinuria. Other features seen predominantly or only in the hypertensive biopsies, in order of frequency, were medial hyperplasia, fibrin deposits, acute atherosis, endothelial vacuolation and thrombosis.

Conclusion— Absence of physiological changes may not be peculiar to preeclampsia but may be associated or even a result of various forms of hypertension in pregnancy. Spiral arteries show a spectrum of changes in hypertensive pregnancies that do not appear to bear a clear‐cut relation to the clinical signs.
Partial placenta membranacea
Authors: WILKINS B. S. , BATCUP G. , VINALL P. S.
Published: August 2005

Summary. Seven pregnancies complicated by partial placenta membranacea occurring over a 2‐year period are described. The condition is encountered more frequently than the total or near‐total form, but is similarly associated with recurrent antepartum haemorrhage, miscarriage or preterm delivery. Diagnosis by ultrasound scan may prove difficult. Five pregnancies had histological evidence of chorioamnionitis, which may have helped to precipitate labour; three fetuses showed pulmonary inflammatory changes of at least 2 days' duration. No maternal predisposing factors could be elicited.
Maternal plasma corticotrophin‐releasing hormone—elevated in preterm labour but unaffected by indomethacin or nylidrin
Authors: KURKI TAPIO , LAATIKAINEN TIMO , SALMINEN‐LAPPALAINEN KATARIINA , LAVIYLIKORKALA O.
Published: August 2005

Summary. The role of corticotrophin‐releasing hormone (CRH) in preterm labour was studied in 23 women in preterm labour at between 26 and 33 weeks gestation who were randomly allocated to receive treatment with indomethacin (n=11) or with nylidrin a beta‐sympathomi‐metic agent (n=12). Maternal plasma CRH in the preterm group (median 70, range 9–597 pmol/1) before therapy was higher (P < 0.05) than that in 23 control pregnancies, without uterine contractions, matched for gestational age (median 51, range 4–127 pmol/1). CHR levels determined after 3 and 24 h of treatment showed a 10% decrease in the indomethacin group and 10–20% decrease in the nylidrin group, but these changes were not statistically significant. After cessation of uterine contractions during tocolysis, 12 women proceeded to give birth preterm (<37 weeks) and their pretreatment CRH levels (median 195, range 9–597 pmol/1) were higher (P < 0.05) than those in women whose pregnancy proceeded to term (median 52, range 16–207 pmol/1). In another group of women, full‐term labour was not accompanied by any changes in maternal CRH levels. Umbilical plasma CRH levels were 1.1–9.8% of the paired maternal levels and did not rise with advancing gestational age. Nor had the type of delivery (elective caesarean section before labour, or preterm or term vaginal delivery) any effect on fetal CRH levels. Neither maternal nor fetal CRH was related to maternal or fetal cortisol levels. We conclude that: (i) maternal CRH is elevated in preterm labour, (ii) maternal CRH is not affected by treatment with indomethacin or nylidrin and (iii) fetal CRH is of no significance in the initiation of preterm or term labour.
Increased plasma levels of vasoactive intestinal polypeptide in pre‐eclampsia
Authors: HOLST N. , ØIAN P. , AUNE B. , JENSSEN T. G. , BURHOL P. G.
Published: August 2005

Objective— To investigate the plasma vasoactive peptide (VIP) levels in pregnancies complicated by pre‐eclampsia.

Design— A prospective clinical study.

Setting— University Department of Obstetrics, Tromso, Norway.

Subjects— 18 women with untreated gestational proteinuric hypertension between 32 and 40 weeks gestation (13 primigravid) and 8 women with normal pregnancies of similar gestational age.

Interventions— Fasting blood samples on two occasions, 10 min apart.

Main outcome measures— Plasma VIP measured by radioimmunoassay.

Results— Mean maternal plasma VIP was 13–9 (SEM 1–7) pmol/l in those with pre‐eclampsia and 4–4 (SEM 0–5) pmol/l in normal pregnancies (P<0.0001).

Conclusion— The increased levels of VIP in pre‐eclampsia may represent a powerful compensatory mechanism to restore vascular perfusion of various organs, including the uterus and placenta.
Relation of fetal blood gases and data from computer‐assisted analysis of fetal heart rate patterns in small for gestation fetuses
Authors: RIBBERT LUCIA S. M. , SNIJDERS ROSALINDE J. M. , NICOLAIDES KYPROS H. , VISSER GERARD H. A.
Published: August 2005

Summary. Fetal heart rate (FHR) monitoring and computer‐assisted analysis were performed immediately before cordocentesis in 25 severely small‐for‐gestational age fetuses. There were significant associations between FHR variation and both umbilical vein blood Po2 (r= 0–66) and pH (r=0.69). However, the wide scatter of values around the regression lines prevented accurate prediction of fetal blood gases from FHR patterns. Nevertheless, FHR variation <20 ms was always associated with severe fetal hypoxaemia and acidaemia.
Thyrotrophin‐releasing hormone—a lactation‐promoting agent?
Authors: PETERS F. , SCHULZE‐TOLLERT J. , SCHUTH W.
Published: August 2005

Objective— To study the lactational and hormonal responses to nasal administration of thyrotrophin‐releasing hormone (TRH) in puerperal women with inadequate lactation.

Design— Prospective randomized double‐blind placebo‐controlled study.

Subjects— 19 puerperal women with inadequate lactation (<50% of normal milk yield) on the 5th day postpartum.

Interventions— 10 women were allocated to receive TRH administered by a nasal spray of 1 mg, four times daily, between suckling episodes, for 10 consecutive days starting on day 6 postpartum. Nine women were allocated to receive placebo sprays.

Main outcome measures— Daily milk yield, serum levels of prolactin and thyroid hormones.

Results— Before treatment all the women had significant prolactin responses to TRH and suckling stimuli. At the end of 10 days of treatment, milk yield increased significantly in the TRH group from a mean of 142–0 (SD 33.9) to 253–0 (SD 105.3) g/day (P = 0.014). There was no significant change in the placebo group. Basal prolactin levels increased from a mean of 117–4 μg/1(SD 45.2) to 173–3 μg/1 (SD 55.5) (P < 0.001) in the TRH group whereas in the placebo group prolactin levels decreased from 137–2 (SD 69.5) to 82–0 (SD 37.7) μg/1. A further rise in prolactin levels and milk yield was seen in seven women in the TRH group who received a second 10‐day course of TRH treatment at their own request. There was no significant change in levels of thyroid stimulating hormone, thyroxine and triiodothyronine during treatment in either of the two treatment groups and no signs of hyperthyroidism.

Conclusion— Repeated nasal TRH administration between suckling episodes may improve defective lactation.
Haemorrhagic problems in obstetrics and gynaecology in patients with congenital coagulopathies
Authors: GREER I. A. , LOWE G. D. O. , WALKER J. J. , FORBES C. D.
Published: August 2005

Objective— To review the obstetric and gynaecological problems in women with congenital coagulopathies.

Design— Retrospective review.

Setting— Regional Adult Haemophilia Unit, Glasgow Royal Infirmary.

Subjects— All women in contact with the Unit over a period of 30 years, comprising eight with von Willebrand's disease, 18 obligate carriers of haemophilia A and five obligate carriers of Christmas disease. Each woman was interviewed and details of their obstetric and gynaecological histories were obtained and their case records were reviewed.

Main outcome measures— Haemostatic changes associated with pregnancy and gynaecological problems.

Results— In 14 pregnancies in seven patients with von Willebrand's disease, there were four primary and four secondary post‐partum haemorrhages and a large perineal haematoma complicating an episiotomy. These problems arose despite the endogenous rise in factor VIIIc seen with pregnancy. All women seen with von Willebrand's disease complained of menorrhagia and had been referred to gynaecologists. Treatment included danazol, tranexamic acid and the contraceptive pill. Diagnostic curettagc resulted in severe haemorrhage in one woman and two women with pelvic pain and dyspareunia were found to have spontaneous broad ligament haematomas, one requiring surgery. In 43 pregnancies in obligate carriers of haemophilia A and Christmas disease there were five post‐partum haemorrhages and a large perineal haematoma.

Conclusion— In von Willebrand's disease it should be noted that adequate laboratory correction of factor VIIIc levels does not ensure clinical haemostasis; hence platelet function should also be measured. Patients with congenital coagulopathies pose particular problems for the obstetrician and gynaecologist and should be managed in close association with the local haemophilia centre.
Bilateral oophorectomy and hysterectomy in the treatment of intractable pelvic pain associated with pelvic congestion
Authors: BEARD R. W. , KENNEDY R. G. , GANGAR K. F. , STONES R. W. , ROGERS V. , REGINALD P. W. , ANDERSON M.
Published: August 2005

Objective— To determine whether bilateral oophorectomy combined with hysterectomy is an effective treatment for chronic pelvic pain due to congestion. Design—Prospective non‐randomized single centre study.

Setting— Tertiary referral centre to a specialist pelvic pain clinic in a teaching hospital.

Subjects— 36 women, 33 of whom had failed to obtain long term relief of pain on medical therapy.

Main outcome measures— Relief of pain, coital frequency, and effect on daily life. Histology of uterus and ovaries.

Results— Median pain score on visual analogue scale fell from a prc‐operativc value of 10 to 0 at one year. Twelve of the 36 women had some residual pain at one year postoperativcly, but in only one woman was the pain affecting her daily life. Thirty women were noted to have pelvic tenderness pre‐opcratively, at one year, 26 had no tenderness and four minimal tenderness on pelvic examination. The median frequency of sexual intercourse increased from once per month preoperatively to eight times per month one year postoperatively. The uterus was histologically normal in 25 women, adenomyosis was present in eight of whom two had ovarian endometriosis. Fibroids were present in three and endometriosis was found confined to the ovaries in one woman. Multiple peripheral cysts were present in the ovaries of 25 women.

Conclusion— Bilateral oophorectomy combined with hysterectomy and hormone replacement therapy is an effective treatment for chronic pelvic pain due to venous congestion, which has failed to respond to medical treatment and leads to restoration of normal coital function and daily life.
The management of prolonged pregnancy—an analysis of women's attitudes before and after term
Authors: ROBERTS LAWRENCE J. , YOUNG KEITH R.
Published: August 2005

Objective— To determine the attitude of pregnant women to a proposal of con‐servative management of prolonged pregnancy.

Design— A prospective questionnaire‐based survey.

Setting— Louis Margaret Maternity Wing, Cambridge Military Hospital, Aldershot.

Subjects— 500 pregnant women initially at 37 weeks gestation considered suitable for the potential conservative management of prolonged pregnancy.

Results— Despite a stated obstetric preference for conservative management, only 45% of the women at 37 weeks gestation were agreeable to conservative management; of those undelivered by 41 weeks gestation 31% still desired conservative management. This significant decrease was unaffected by parity or certainty of gestational age.

Conclusions— Most pregnant women are unwilling to accept the conservative management of prolonged pregnancy and become more reluctant to do so if undelivered by 41 weeks gestation. Women are not as favourably disposed towards the conservative management of pregnancy as has been suggested previously.
Episiotomy and perineal lesions in spontaneous vaginal deliveries
Authors: HENRIKSEN TINE BRINK , MØLLER BEK KARL , HEDEGAARD MORTEN , SECHER NIELS J.
Published: August 2005

Objective
To evaluate the influence of mediolateral episiotomy on the perineal state after spontaneous, singleton vaginal deliveries with fetus in the occiput anterior position.

Design
The study was a population based, observational study. Two approaches were used in the analyses. Initially, we considered the parturients as quasi‐randomised to one of three equally sized groups of midwives with different attitudes towards episiotomy. Secondly, we studied the effect of episiotomy on the state of the anal sphincter, controlling for birthweight, parity, and duration of second stage of labour.

Subjects
2188 pregnant women delivering consecutively.

Main outcome measures
Perineal lacerations and tear of the anal sphincter.

Results
Women allocated to the group of midwives with the lowest rate of episiotomy were more likely to have intact perineum after delivery (OR = l.8 (l.4–2.2)), had a slight tendency towards more perineal lacerations (OR = 1.3 (1.0–1.5)), but no increase risk of having tear of the anal sphincter, compared with the women allocated to the two groups of midwives with higher frequencies of episiotomy. The second approach showed that episiotomy was related to an increased risk of tear of the anal sphincter (OR = 2.3 (1.2–4.6)). However, this relation was not found among the group of parturients delivered by the midwives with the lowest rate of episiotomy (22%).

Conclusions
Our results encourage a conservative approach to the use of mediolateral episiotomy, and in the light of previous findings, it seems reasonable to suggest that episiotomy should ideally be used in about one in five spontaneous vaginal deliveries.
A longitudinal study of pelvic inflammatory disease
Authors: STAGEY CAROLYN M. , MUNDAY PATRICIA E. , TAYLOR‐ROBINSON DAVID , THOMAS BRENDA J. , GILCHRIST CLIVE , RUCK FIONA , ISDN CATHERINE A. , BEARD RICHARD W.
Published: August 2005

Objective
To study the microbiology and long term prognosis of pelvic inflammatory disease (PID).

Design
A prospective study of women with laparoscopically confirmed PID.

Setting
Teaching hospital in central London.

Subjects
23 women with PID.

Outcome measures
Microbiological investigations at the time of diagnosis and at follow up; subsequent fertility and the occurrence of pelvic pain.

Results
PID diagnosed by laparoscopy was regarded as moderate to severe in 15 cases. Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum or a combination of these micro‐organisms were detected most frequently in the cervix, less often in the endometrium and least in the tubes, C. trachomatis being the micro‐organism found most commonly in the tubes. There was serological evidence of acute chlamydial infection in 13 of 20 cases in which paired sera were available and a serological response to M. hominis in 9 of 12 cases in which it was possible to evaluate the results. On the basis of microbiological and serological results, C. trachomatis appeared to be the most important aetiological agent in 10 cases, N. gonorrhoeae in four cases, M. hominis in three cases and U. urealyticum in none; in five cases, two of these microrganisms appeared to be of equal importance. After 1 to 3 years, 33% of the women were having difficulty conceiving and 56% continued to complain of pelvic pain.

Conclusion
It is difficult to be certain of the infectious cause of PID in any given case. However, the evidence that N. gonorrhoeae and C. trachomatis are pathogens is very strong. M. hominis may be responsible for a few cases on its own or together with other micro‐organisms.
Induction of abortion with mifepristone and misoprostol in early pregnancy
Authors: THONG K. JOO , BAIRD DAVID T.
Published: August 2005

Objective
To investigate the clinical efficacy of the combination of mifepristone and an orally active prostaglandin, misoprostol, for early medical termination.

Design
Women with amenorrhoea ≤56 days were given 200 mg mifepristone. 48 h later, 600 μg misoprostol was given orally.

Setting
Medical Termination Unit, Simpson Memorial Maternity Pavilion, Edinburgh.

Subjects
100 women requesting medical termination of pregnancy.

Interventions
Evacuation of uterus for incomplete abortion or on‐going pregnancies.

Results
One woman had an incomplete abortion prior to administration of misoprostol. 92 (93%) out of 99 women had complete abortion following administration of misoprostol. There were three on‐going pregnancies (3.0%, 95% confidence limits (CL) 0.6‐8.6) and four incomplete abortions with this regimen (4.0%, 95% CL 1.1‐10.0). 24% women vomited and 7% had diarrrhoea following administration of misoprostol. 62% did not require any analgesia.

Conclusions
The combination of misoprostol with mifepristone is inexpensive, simple, effective, noninvasive and an acceptable alternative to current regimens for medical termination.
Compliance with hormone replacement therapy (HRT) after screening for post menopausal osteoporosis
Authors: RYAN P. J. , HARRISON R. , BLAKE G. M. , FOGELMAN I.
Published: August 2005

Objective
To assess compliance with recommendations for hormone replacement therapy (HRT) in postmenopausal women following screening for osteoporosis.

Design
A postal questionnaire sent to women an average of 8 months (range 6–12) following measurement of their bone mineral density (BMD), and recommendations regarding HRT given to the referring general practitioner.

Setting
Referrals from local general practitioners. Mixed social class.

Subjects
400 postmenopausal women aged 40–69 years (average age 52).

Main outcome measures
Compliance with advice and if failing to comply, reasons for not doing so.

Results
Replies were received from 352 women (88%) and 74% of respondents followed advice to start, continue, or refrain from starting or continuing HRT with regard to protecting their skeleton. Those who rejected advice to take HRT mostly had concern over side effects or the efficacy or safety of treatment. Of the women who started HRT 28% subsequently stopped, the principal reasons being withdrawal bleeding and weight gain. Of the women recommended to take HRT, 39% were not taking treatment by 8 months after referral, either because they ignored advice given (22%) or because of side effects (17%).

Conclusions
Screening leads to increased usage of HRT among women at most risk for osteoporosis. However, almost 40% of women with low bone mineral density were not taking HRT 8 months after referral, and therefore until improved compliance has ben demonstrated screening cannot be widely recommended.