bluuebunny/crossref_metadata_2025 huggingface dataset:
Clotting factor VII during pregnancy, delivery and puerperium
Authors: DALAKER K.
Published: August 2005

Summary. During pregnancy the activity of coagulation factor VII in plasma increases up to 248% (SEM 16) (n=18) at 40 weeks even when all precautions to avoid cold activation are taken. This increase is at all times during pregnancy, delivery and puerperium entirely due to the presence in vivo of what is most likely a phospholipid‐factor VII complex. This complex is sensitive to phospholipase C, so that treatment with the enzyme reduces the activity of pregnant plasma down to that of non‐pregnant controls. When present in the complex factor VII has a higher specific activity and an altered conformation with a more accessible active site as demonstrated by increased susceptibility to inactivation by diisopropylfluorophosphate. Factors II and X are increased to 136% (SEM 4) and 171% (SEM 6) (n=18) without being sensitive to phospholipase C. The increase during pregnancy and the decrease after delivery of the phospholipase‐sensitive factor VII activity have been followed.
Urinary oestrogen levels and follicle ultrasound measurements in clomiphene induced cycles with an endogenous luteinizing hormone surge
Authors: MESSINIS IOANNIS E. , TEMPLETON ALLAN
Published: August 2005

Summary. Total oestrogen in urine and the ultrasonic size of the follicles were measured in relation to the onset of the endogenous luteinizing hormone (LH) surge (day 0) in 18 cycles induced with clomiphene citrate in an in‐vitro fertilization programme. Oestrogen values in urine (μg/24 h) increased progressively during the late follicular phase up to the day of the onset of the surge. The mean maximum follicle diameter (22·3, SD 4·7 mm) estimated by ultrasound was measured on day 0. At the onset of the LH surge, the values of urinary total oestrogen showed a better relation with the total volume of the first three follicles in order estimated by ultrasound (r= 0·71) than with the mean ultrasonic diameter of the leading follicle (r= 0·56). A wide range of individual values for both urinary oestrogen and follicle size was found. In another group of 32 women treated with clomiphene for recovery of oocytes used for research purposes, a good correlation was found between the mean ultrasonic follicle diameter 16 h before the laparoscopy and the follicle diameter calculated from the fluid volume at aspiration (r= 0·80). These results suggest that the decision when to give human chorionic gonadotrophin (hCG) in an in‐vitro fertilization programme remains arbitrary in many individual cases. Apart from the oestrogen levels, the calculation of the size of all follicles, instead of only the leading one, may give further help in timing the hCG.
Human amnion in the treatment of vaginal malformations
Authors: MORTON KAREN E. , DEWHURST C. J.
Published: August 2005

Summary. Vaginoplasty using human amnion has been performed in 27 patients aged from 13 to 28 years. Excellent epithelialization occurred with good functional results; the technique appears to be preferable to other surgical methods.
Should patients with mild atypia in a cervical smear be referred for colposcopy?
Authors: SOUTTER W. P. , WISDOM S. , BROUGH ANN K. , MONAGHAN J. M.
Published: August 2005

Summary. Significant premalignant disease of the cervix was found in 37% of women referred to a colposcopy clinic because of a smear that showed no more than mildly atypical cells, and in 49% of women whose smears showed mild dyskaryosis. This did not seem to be related to the number of times the abnormal smear had been repeated and was not confined to patients whose smears had been reported by only one laboratory. In another group of 102 women whose first abnormal smear was graded as atypical: 10 had cervical intraepithelial neoplasia; 9 still had abnormal smears and 27 had been lost to follow‐up, possibly because the potential importance of this finding was not recognised by the doctor to whom the smear report had been returned. Women with mildly atypical or mildly dyskaryotic smears are at considerable risk of having cervical intraepithelial neoplasia. All patients with a smear report showing dyskaryosis of any degree of severity should be referred for colposcopy. Those with atypical cytology should be referred for colposcopy if a second smear, repeated after 3 months, is not normal.
Co‐treatment of the male partner in vaginal candidosis: a double‐blind randomized control study
Authors: BISSCHOP M. P. J. M. , MERKUS J. M. W. M. , SCHEYGROND H. , VAN CUTSEM J.
Published: August 2005

Summary. In a double‐blind study, 117 non‐pregnant women with vaginal candidosis were treated for 3 days with 200 mg‐tablets of ket‐oconazole taken once, twice or three times daily. The incidence of predisposing factors or of a recurrence history did not differ between treatment groups. Their male partners were randomly assigned to receive ketoconazole, 200 mg twice daily or placebo for 3 consecutive days. Cure and recurrence rates were not different in the three treatment groups, with or without simultaneous treatment of the male partner. Treatment of the sexual partner in the three dose‐regimengroups proved not to have influenced the therapeutic effect.
A statistical examination of the accuracy of combining femoral length and biparietal diameter as an index of fetal gestational age
Authors: YAGEL S. , ADONI A. , OMAN S. , WAX Y. , HOCHNER‐CELNIKIER D.
Published: August 2005

Summary.The use of femur length (FL) and biparietal diameter (BPD) for estimation of gestational age (GA) was investigated using 1123 ultrasound measurements between the 14th and 41st week of gestation. Femur length was found to provide a more accurate index than BPD for the entire range of gestational age considered. If an interval of approximately ±2·5 weeks is considered ‘satisfactory’, the accuracy of FL past the 31st week is not sufficient to justify its use. Combining the FL and BPD measurements via the formula: GA = 9·565 + (0·0414) FL + (0·0024573) FL2+ (0·15209) BPD – (0·00015827) BPD2provides an index of gestational age accurate to approximately ± 2·5 weeks up to the 32nd week of gestation and accurate to approximately ± 2·75 weeks up to the 34th week of gestation. This is the first time that combining FL and BPD in a statistically rigorous manner has been proposed as an index of gestational age, and we suggest that this combination be used as a routine tool in its assessment.
Outcome of extremely‐low‐birthweight infants
Authors: YU V. Y. H. , WONG P. Y. , BAJUK B. , ORGILL A. A. , ASTBURY J.
Published: August 2005

Summary. The overall 1‐year survival rate of 261 infants born at 500 g–999 g over a 7‐year period was 46%. The survival rate of the 220 inborn infants, corrected for birth defects, would have increased from 47% to 57% if delivery room deaths were excluded and to 62% if postneonatal deaths had also been ignored. Survival improved progressively with increasing 100 g weight groups. The disability rate in the 108 survivors who were at least 2 years old corrected for prematurity was 28% with little variation between the 100 g weight groups. There were no significant trends in annual perinatal mortality, 1‐year survival and disability rate in survivors over the study period for the inborn population. The male infants had significantly lower normal‐survival rate than the female infants. Small‐for‐gestational‐age infants, comprising 11% of the inborn group, had significantly better survival but a higher disability rate. Multiple births had significantly lower survival and normal‐survival rates than had singleton births. Infants whose mothers were transferred for delivery at the perinatal centre before onset of labour had a significantly better survival rate than those whose mothers had ‘booked’ and those who were transferred in labour.
A comparison of fetal heart rate monitoring and umbilical artery waveforms in the recognition of fetal compromise
Authors: TRUDINGER B. J. , COOK C. M. , JONES L. , GILES W. B.
Published: August 2005

Summary. Antenatal fetal heart rate monitoring was compared with the study of umbilical artery flow velocity waveforms for the recognition of fetal compromise in 170 patients considered at high fetal risk. In 53 patients the infant had a 5‐min Apgar score of <7 and/or a birthweight < the 10th centile of weight for gestation. Fetal heart rate traces were classified as reactive or non‐reactive and also assessed with a modified Fischer score. The systolic/diastolic A/B ratio was measured in the umbilical artery waveform. Fetal compromise was more efficiently recognized by study of the umbilical artery waveforms. The sensitivity of assessment by umbilical artery waveforms was 60% compared with 17% and 36% respectively, for the two methods of scoring fetal heart rate traces. This was not associated with an increase in false‐positive results as the predictive value of both positive (64% compared with 69 and 58%) and negative (83% compared with 72 and 75%) results was similar when umbilical artery waveform analysis was compared with the two methods of scoring fetal heart rate traces. Specificity was also similar (85% compared with 97 and 88%).
Urinary albumin excretion in pregnancy
Authors: LOPEZ‐ESPINOZA I. , DHAR H. , HUMPHREYS S. , REDMAN C. W. G.
Published: August 2005

Summary. Urinary albumin excretion during pregnancy has been studied using a sensitive radioimmunoassay. One hundred pregnant women attending a high‐risk antenatal clinic and 14 normal pregnant women were investigated serially, during pregnancy and post‐partum. The normal subjects showed a small but significant rise in albumin excretion in the third trimester, which was sustained pre‐delivery and in the first postnatal week. Twenty‐six women were classified as having mild pre‐eclampsia and 44 as having chronic hypertension without evidence of superimposed pre‐eclampsia. In neither group was there evidence of proteinuria by conventional testing, nor was the median albumin excretion different from normal antenatally; in the first week after delivery a significant increase was observed, but this regressed to normal 6 weeks later. Eight patients developed severe pre‐eclampsia, of whom one had evidence of underlying renal disease. Three presented with proteinuria already established. In the remaining five patients, the shift from normal to high albumin excretion occurred rapidly, usually preceded by a rise in uric acid and a decrease in the platelet count. These data suggest that proteinuric pre‐eclampsia, as defined by relatively insensitive routine laboratory measurement, is not preceded by a phase of increasing albumin loss which can be detected by more sensitive assays.
The effect of maternal ethanol intoxication on fetal cardiotocography: a report of four cases
Authors: HALMESMÄKI ERJA , YLIKORKALA OLAVI
Published: August 2005

Summary. Fetal cardiotocography revealed no or poor variability and no reactivity to fetal movements and or external stimuli in four drunken women. This was taken as a sign of fetal hypoxia in one patient and led to emergency caesarean section although, the infant was not hypoxic. In the other three patients, cardiotocography normalized within 11–14 h when the mothers became sober.
Prediction of size of infants at birth by measurement of symphysis fundus height
Authors: PERSSON B. , STANGENBERG M. , LUNELL N. O. , BRODIN U. , HOLMBERG N. G. , VACLAVINKOVA V.
Published: August 2005

Summary. Symphysis fundus heights (SF) were measured approximately 15 times during pregnancy in a consecutive series of 2941 women with regular menstrual cycles and known last menstrual period. A reference SF chart from 17 to 40 weeks of pregnancy was derived from measurements in 1350 of these women who were healthy, and heights and pre‐pregnancy weights within the 10th and 90th centiles and were delivered vaginally of healthy infants with a birthweight/length ratio within ±2SD. The reference chart was used to predict fetal growth deviations in the unselected series of pregnancies. The effectiveness of SF measures to detect fetuses with an infant birthweight/length ratio below −2SD or a birthweight below the 10th centile was low; the sensitivity was only 16·7 and 26·6% and the predictive value of positive screening result was 1·8 and 18·0%, respectively. Corresponding values for fetuses with an infant birthweight/length ratio above +2 SD or a birthweight above the 90th centile were 31·8 and 37·5% and 3·3 and 24·5%, respectively. Symphysis fundus (SF) measurement has thus been found to be of limited value as a screening method to detect abnormal size at birth.
An audit of the detection and management of small‐for‐gestational age babies
Authors: HEPBURN MARY , ROSENBERG KATHRYN
Published: August 2005

Summary. The detection and management of small‐for‐gestational age babies (SGA) was assessed in a case record review of 1302 randomly selected pregnancies. Of the 129 babies with birthweights below the 10th centile for gestational age, 34 (26%) were identified antenatally. For every two correctly identified SGA babies there were three false positive predictions. In‐patient monitoring and early elective delivery occurred both in the correctly identified pregnancies (24%) and in the false positives (12%). The management of suspected pregnancies bore no apparent relation to test results and appeared arbitrary. Mortality and morbidity, as measured by nursery admission for >48 h and retention in the nursery after the mother's discharge, were higher in SGA babies than in the hospital population as a whole. The number of ill babies was small, however, reflecting the heterogeneous aetiology of small size for gestational age. Moreover, antenatal detection had little influence on these measures of outcome. It is concluded that tests for detection of SGA babies remain imprecise in practice, gestational weight alone correlates poorly with fetal well‐being, and the need remains for sensitive tests to detect babies with genuine morbidity.
Apgar score, meconium and acidaemia at birth in relation to neonatal neurological morbidity in term infants
Authors: DIJXHOORN M. J. , VISSER G. H. A. , FIDLER V. J. , TOUWEN B. C. L. , HUISJES H. J.
Published: August 2005

Summary. The relation between Apgar score, meconium and acidaemia at birth and neonatal neurological morbidity was investigated in 805 vaginally born term infants whose birthweight was appropriate‐for‐dates (AFD). Presence or absence of meconium stained amniotic fluid was not related to the neonatal neurological condition. The 1‐min and 3‐min Apgar scores and the umbilical artery pH were related, but the variances explained in neonatal neurological optimality score were very low (0·9 and 0·5% respectively). Combination of Apgar score and pH slightly increased these percentages to 1·5. The highest frequency of neurologically deviant infants was, on the other hand, found in the group with a normal pH but low Apgar score. It is concluded that in AFD term infants nowadays the predictive value of a low Apgar score, acidaemia at birth and/or presence of meconium for the neonatal neurological morbidity is poor. Most neonatal neurological abnormalities must be due to other factors.
Aetiology of non‐immune hydrops: the value of echocardiography
Authors: ALLAN LINDSEY D. , CRAWFORD DIANE C. , SHERIDAN RICHARD , CHAPMAN MICHAEL G.
Published: August 2005

Summary. Forty‐eight pregnancies, five of them multiple, were referred for fetal cardiac assessment following the detection of non‐immune hydrops fetalis; there were 52 hydropic fetuses in total. A cardiovascular aetiology was found in 21 of these 52 (40%); structural heart disease was present in 13, tachyarrhythmia in the remaining eight. The accurate delineation of these causes was possible using fetal echo‐cardiography, and enabled rational management to be instituted. This included termination of pregnancy, pharmacological control of arrhythmias and appropriate timing of delivery.
The obstetric management of non‐immunological hydrops
Authors: GOUGH J. D. , KEELING J. W. , CASTLE B. , ILIFF P. J.
Published: August 2005

Summary. During the past 8 years, non‐Rhesus hydrops has been observed in 31 pregnancies extending beyond 28 weeks gestation. Only three of the babies survived. Antenatal diagnosis is possible by ultrasound examination and although 27 of our patients had at least one indication for this procedure, only 22 were so investigated and in 13, fetal hydrops was demonstrated. Twenty‐three were delivered before 36 weeks gestation, 10 by caesarean section of whom none survived; 16 babies were stillborn. Fourteen infants had major cardiovascular anomalies and six had other major malformations. In five infants, infection was thought to be causally related to fetal hydrops and in only four could no cause for the hydrops be found. In five pregnancies the cause of hydrops was discovered antenatally; this influenced subsequent management and two of the five survived. The unexpected appearance of a very abnormal fetal heart rate pattern requires the exclusion of fetal anomaly and non:immunological hydrops. When a diagnosis of nonimmune hydrops is made its underlying cause should be sought without delay so that specific treatment may be instituted in the few cases where this is appropriate. A high incidence of complications of the third stage of labour should be anticipated. Subsequent pregnancies are likely to be normal.
Diagnosis of intrauterine infection by demonstration of antibody‐coated bacteria in the amniotic fluid
Authors: MØLLER MARGRETHE , WRENSEN J. , JEPSEN F. LØVE , THOMSEN A. C.
Published: August 2005

Summary. Immunofluorescence examination of amniotic fluid for the occurrence of antibody‐coated bacteria was carried out in 72 consecutive women with premature rupture of the fetal membranes to assess this method in the diagnosis of intrauterine infection. Antibody‐coated bacteria were demonstrated in 11 women with clinical signs of intrauterine infection, histological amnionitis and heavy growth of one bacterial species. The presence of intrauterine infection was considered possible in another 14 women. One patient had no clinical signs of infection, but positive histological and bacteriological evidence; anti‐body‐coated bacteria were demonstrated in this patient, but not in the remaining 13 women. In 47 women clinical, histological and bacteriological signs of intrauterine infection were absent, and examinations for antibody‐coated bacteria were negative in all of them. It is concluded that the demonstration of antibody‐coated bacteria in amniotic fluid indicates the presence of intrauterine infection, and the examination may in some cases be positive before the appearance of clinical signs of infection.
Screening for antibodies to HTLV‐III amongst the semen donors of an AID programme
Authors: BROMWICH P. D. , WALKER A. P. , GREGSON SUE H. , ROSS CAROLINE F. , EGLIN R. P. , MACEY JOYCE E. M.
Published: August 2005

Summary. This study suggests that, at the present time, AID is not likely to be a significant risk factor in the transmission of AIDS in Britain, particularly in centres which are already practising careful screening of semen donors. New facilities which are becoming available for HTLV‐III screening should help to provide reassurance that semen donations are free from the virus.
Episiotomy repair—immediate and long‐term sequelae. A prospective randomized study of three different methods of repair
Authors: ISAGER‐SALLY L. , LEGARTH J. , JACOBSEN B. , BOSTOFTE E.
Published: August 2005

Summary. Three methods of episiotomy repair were randomly assigned after 900 consecutive deliveries. The three procedures were: (1) continuous No. 00‐plain catgut in the vagina; No. 00‐plain catgut interrupted stiches in the perineal muscles and fascia, and No. 00‐nylon interrupted stiches in the skin. (2) The same technique as in (l), but with No. 0‐polyglycolic acid (Dexon) in all layers. (3) The suture material as in (2), but used with a subcuticular technique. The women treated with method 3 reported statistically significant less pain and disabilities in the early puerperium. Three months after delivery 262 women (33%) still had perineal complaints which could be directly related to the episiotomy in 25% (8% of total number). The group treated with method 3 had the best long‐term results and we conclude that the subcuticular technique using polyglycolic acid should be the method of choice.
Clinical aspects of LHRH analogues in gynaecology: a review
Authors: McLACHLAN ROBERT I. , HEALY DAVID L. , BURGER HENRY G.
Published: August 2005

Summary. LHRH agonists are synthetic peptide analogues of hypothalamic luteinizing hormone releasing hormone (LHRH) with superior potency and longer duration of gonadotrophin release. Paradoxically, repeated administration causes pituitary desensitization with diminished gonadotrophin and oestradiol secretion. A state of hypogonadotrophic hypogonadism is reversibly induced; plasma oestrogen can be reduced to castrate levels. LHRH agonists reliably induce anovulation but are unlikely to replace existing contraceptive methods in most normal women. By contrast these agents offer, for the first time, the prospect of inducing a reversible pseudomenopause essentially free of side‐effects. LHRH analogues promise to have a profound impact upon the management of a diverse range of oestrogen‐dependent gynaecological diseases both benign and malignant. In particular, they may shortly become the gynaecological treatment of choice in endometriosis, as well as becoming part of the management of common gynaecological disorders such as dysfunctional uterine bleeding and uterine fibroids.
Fertility and pregnancy after operation for a prolactinoma
Authors: RICHARDS AMANDA M. , BULLOCK M. R. R. , TEASDALE G. M. , THOMSON J. A. , KHAN M. I.
Published: August 2005

Summary. Pituitary exploration was performed in 40 women with hyperprolactinaemic infertility and a prolactinoma was found in 37. After operation 26 (65%) of the 40 patients had a normal serum prolactin concentration; 31 women have so far had 49 pregnancies; in seven of these patients bromocriptine therapy was used after surgery. Eight of the remaining nine women were shown to be ovulating, but four of these subsequently decided not to attempt a pregnancy. The course and outcome of the 49 pregnancies were similar to those in normal women and no visual or endocrine complications occurred. Surgical removal of a prolactinoma often restores fertility, and may secure a safer pregnancy.
Haemodynamic changes and left ventricular performance during high‐dose oestrogen administration to male transsexuals
Authors: SLATER ANTHONY J. , GUDE NEIL , CLARKE IAIN J. , WALTERS WILLIAM A. W.
Published: August 2005

Summary. Serial haemodynamic and systolic time interval measurements in 17 male transsexuals during high‐dose oestrogen administration were compared with control values obtained after oestrogen withdrawal. During oestrogen treatment, cardiac output, stroke volume, plasma volume and total blood volume increased while total peripheral resistance, diastolic blood pressure and red cell mass decreased significantly. Changes in heart rate and systolic blood pressure were not significant. Despite a much higher dose of oestrogen, the haemodynamic changes observed in this study are similar in magnitude to those occurring in women taking oral contraceptives. Significant changes in systolic time intervals during oestrogen treatment were a shortened pre‐ejection period (PEP) index, a prolonged left ventricular ejection time (LVET) index and a decreased PEP/LVET ratio indicating that left ventricular performance was augmented.
Active management of the unconscious eclamptic patient
Authors: RICHARDS A.M. , MOODLEY J. , GRAHAM D. I. , BULLOCK M. R. R.
Published: August 2005

Summary. Of the many complications which may develop after eclamptic seizures, prolonged unconsciousness is one of the most difficult for obstetricians to manage as the pathophysiology of this condition remains largely unknown. Computed axial tomography (CT scan) was performed on 20 unconscious eclamptic patients, and autopsy was obtained on an additional two patients. Changes compatable with cerebral oedema were demonstrated in 75% of patients; cerebral haemorrhage occurred in 9%. A programme of intensive neurological management aimed at optimizing cerebral perfusion and controlling intracranial pressure is outlined. We have reduced the mortality rate for unconscious eclamptic patients from 50% to 17% in our institution.
The impact of a rubella prevention policy on the outcome of rubella in pregnancy
Authors: EDMOND ELIZABETH , ZEALLEY HELEN
Published: August 2005

Summary. Surveillance of rubella vaccination in schoolgirls has continued intensively in Edinburgh since 1970. Screening for rubella antibody of all women attending antenatal clinics has been available since 1974. The analysis of cases of rubella occurring in pregnancy during an outbreak in 1979 confirmed the efficacy of schoolgirl vaccination in the city but indicated poor implementation of postnatal vaccination. Eighteen (67%) of 27 proven cases occurred in women who were screened in previous pregnancies and not immunized. Of the total of 13 liveborn infants the only two with congenital rubella defects were born to mothers in this group. Rubella immunization of schoolgirls and women of childbearing age must receive continued intensive effort if the problems of rubella in pregnancy are to be eradicated.
Parental age and risk of complete and partial hydatidiform mole
Authors: PARAZZINI F. , VECCHIA C. LA , PAMPALLONA S.
Published: August 2005

Summary. The relation between age of parents and the risk of complete and partial hydatidiform mole was examined using data from a casecontrol study conducted in Northern Italy of 149 histologically confirmed complete moles, 45 partial moles and 306 controls subjects who delivered normal babies. Compared to women aged 21 to 35, the relative risk (RR) of complete mole was elevated for teenage women (RR = 1·9) and for those aged 36–40 (RR = 1·9) or over 40 (RR = 7·5). There was no association between women's age and partial mole. Likewise, older paternal age (>45) was related with the risk of complete mole (RR = 4·9, though allowance for women's age reduced this point estimate to 2·9), but not of partial mole. The present findings indicate that there are important differences in the epidemiology of complete and partial hydatidiform mole.
Aetiological factors in placenta praevia a case controlled study
Authors: ROSE GILLIAN L. , CHAPMAN MICHAEL G.
Published: August 2005

Summary. The obstetric and gynaecological histories of 80 women with proven placenta praevia have been reviewed together with case controls matched for age and parity. There was a significant relation between placenta praevia and previous caesarean section (P<0·05), dilatation and curettage (P<O·Ol), spontaneous abortion (P<0·05) and evacuation of retained products of conception (P<Om05). Repeated uterine instrumentation was associated with increased risk of placenta praevia (P<O·OOl). We were unable to show any influence of previous termination of pregnancy. These findings are consistent with the hypothesis that endometrial/myometrium damage is a significant aetiological factor in low placental implantation.
Alpha‐fetoprotein, vaginal bleeding and pregnancy risk
Authors: HADDOW JAMES E. , KNIGHT GEORGE J. , KLOZA EDWARD M. , PALOMAKI GLENN E.
Published: August 2005

Summary. To assess the interrelation between maternal serum alphafetoprotein (MSAFP) levels and vaginal bleeding as a combined pregnancy risk factor, we studied 6829 singleton pregnancies without fetal malformations during the second trimester. The predictive powers of the two risk factors, analysed separately, are consistent with published reports in relation to fetal death and low birthweight. Until now, however, these two risk factors have not been analysed together. The present study demonstrates that MSAFP and vaginal bleeding are largely independent of each other as predictors of fetal death, relative risks being 0·7 (MSAFP <0·7 multiples of the median (MOM), vaginal bleeding absent), 3·5 (MSAFP <2·0 MOM vaginal bleeding present), 5·8 (MSAFP 2·0 MOM, vaginal bleeding absent), and 12·6 (MSAFP 2·0 MOM, vaginal bleeding present). Corresponding risks for low birthweight are: 0·7, 1·8, 2·5 and 1·6 (mean birthweights in the four categories are 3516 g, 3407 g, 3238 g, and 3176 g).
A comparison between the organization of obstetrics in Denmark and The Netherlands
Authors: SCHERJON SICCO
Published: August 2005

Summary. A comparison was made between two types of obstetric organization: total hospitalization as in Denmark, and a system that allows a choice between hospital and home delivery, provided there are no medical contra‐indications, as in The Netherlands. Until the end of the 1950s, the current Dutch view prevailed in Denmark; Denmark changed its organization in the late 1960s and followed the international preference for total hospitalization. This change was not caused by disappointing obstetric results, nor was it the result of strong pressure from pregnant women. The change was associated with a considerable increase in instrumental deliveries. In both countries the perinatal mortality rate decreased continuously but in Denmark the improvement in early neonatal mortality was slightly faster. This difference may have occurred because of insufficient referral in The Netherlands of high‐risk pregnancies and deliveries to the fully equipped obstetric departments. The Dutch acceptance of a high proportion of home‐confinements is unlikely to be the explanation.
Regional perinatal mortality and regional hospitalization at delivery in The Netherlands
Authors: TREFFERS P. E. , LAAN R.
Published: August 2005

Summary. In The Netherlands 34–35 % of all deliveries still take place at home, but with considerable regional differences. A study was made of the relation between the perinatal mortality rate and the percentage of hospital deliveries in the 11 provinces of The Netherlands, in municipalities divided into groups according to the number of inhabitants, and in the 17 cities with more than 100 000 inhabitants. No relation could be demonstrated between the regional percentage of hospital deliveries and the regional perinatal mortality rate. The proportion of hospital delivery appears not to be a major factor determining the regional perinatal mortality rate in the current system of obstetric care in The Netherlands.
Does father's unemployment put the fetus at risk?
Authors: GOLDING JEAN , THOMAS PETER , PETERS TIM
Published: August 2005

Summary. Information concerning 15037 singleton deliveries in 1970 showed that among the 3.5% where the male head of the household was unemployed there was no significant excess of low birthweight or pre‐term delivery, once social class had been taken into account. There were major differences, however, in maternal health behaviour. In order to ascertain whether the health behaviour might be a consequence of the unemployment, data were also analysed for the 658 pregnancies in women whose husbands, though employed at delivery, were subsequently unemployed. Almost identical patterns were found, implying that the association with health behaviour was not a time‐related consequence of unemployment.
Outcome of neonatal intensive care: obstetric implications for a regional service
Authors: WATKINSON MICHAEL , McINTOSH NEIL
Published: August 2005

Summary. Data from 634 newborn babies with birthweights ≤2000 g admitted to the South West Thames Regional Neonatal Unit in St George's Hospital since its opening in 1980 were analysed. Only 271 (43%) of the pregnancies were booked there; 200 (32%) of the babies were transferred in utero and 162 (26%) after delivery. Weight‐specific neonatal survival rates, calculated after exclusion of lethal abnormalities showed that between 1001 and 1500 g, 79 (96%) of the 82 babies transferred in utero survived in 1981–1984, compared with only 57 (79%) of the 72 postnatal transfers (P<0.02). Under 1000 g, no such differences were found, possibly because paediatricians transferred only the fitter babies in this weight range. The birth of very‐low‐birthweight babies of short gestation in units unable to provide immediate resuscitation, adequate stabilization and full neonatal intensive care is a major risk factor for increased neonatal mortality. These findings support the role of regional perinatal centres as service units for antenatal transfer and neonatal intensive care, and as teaching centres.
The duration of lochia
Authors: OPPENHEIMER L. W. , SHERRIFF ELIZABETH A. , GOODMAN J. D. S. , JAMES CATHERINE E. , SHAH DINA
Published: August 2005

Summary. The duration of lochia and its association with a number of obstetric variables was studied in 236 women. Each woman completed a diary sheet describing the colour and duration of her lochia for up to 60 days post partum. The phases of lochia were divided according to the classical description; lochia rubra, serosa and alba. The median total duration of lochia was 33 days, lochia rubra 4 days and lochia serosa 22 days. Lochia persisted to 60 days in 13% of women. The duration of lochia was shorter in parous women and women with smaller babies.
Cyclic changes in serum cholesterol and lipoproteins following different doses of combined postmenopausal hormone replacement therapy
Authors: JENSEN JYTTE , NILAS LISBETH , CHRISTIANSEN CLAUS
Published: August 2005

Summary. Cyclic changes in lipoproteins after sequential oestrogen‐progestogen therapy were studied in a group of healthy postmenopausal women treated with three different hormone doses, and followed up for two consecutive cycles by twice weekly examinations (a total of 17 examinations). There was a significant rise in high density lipoprotein (HDL) cholesterol and a significant fall in low density lipoprotein (LDL) cholesterol closely related to the dose of the oestrogen component. Addition of the progestogen, 1 mg of norethisterone acetate, decreased the oestrogen‐induced rise in HDL, but HDL levels remained higher than initial values in the high‐dose (4 mg) and medium dose (2 mg) groups. The average increases in HDL cholesterol were 13%, 9% and 2% in the high‐dose, medium‐dose and low‐dose (1 mg) groups, respectively, and the corresponding mean decreases in LDL cholesterol were 18%, 15% and 10% respectively. We conclude that postmenopausal treatment with sequentially combined oestrogen‐progestogen has no adverse effects on the lipoprotein status.
Oral contraceptive use modifies the manifestations of pelvic inflammatory disease
Authors: WØLNER‐HANSSEN PÅL
Published: August 2005

Summary. A case‐control study was performed on 94 women with acute salpingitis and 12 women with salpingitis and perihepatitis; all patients included in the study were infected with Chlamydia trachomatis and all had been subjected to diagnostic laparoscopy. None of the 12 patients with, but 38 (40%) of the 94 patients without, perihepatitis used oral contraceptives (P=0.002). The geometric mean titre of serum IgG antibodies to C. trachomatis was higher among patients with (1:1021) than among patients without (1:69) perihepatitis (P=0001). Oral contraceptive users had lower geometric mean titre of antibodies to the organism (1:25) than non‐users (1:109, P=0.001). The study suggests that oral contraceptive use may modify the clinical manifestations of chlamydial pelvic inflammatory disease.
Regional perinatal mortality and regional hospitalization at delivery in The Netherlands
Authors: Treffers P. E. , Laan R.
Published: August 2005

Summary. In The Netherlands 343.5 % of all deliveries still take place at home, but with considerable regional differences. A study was made of the relation between the perinatal mortality rate and the percentage of hospital deliveries in the 11 provinces of The Netherlands, in municipalities divided into groups according to the number of inhabitants, and in the 17 cities with more than 100 000 inhabitants. No relation could be demonstrated between the regional percentage of hospital deliveries and the regional perinatal mortality rate. The proportion of hospital delivery appears not to be a major factor determining the regional perinatal mortality rate in the current system of obstetric care in The Netherlands.
Perinatally related wastage–a proposed classification of primary obstetric factors
Authors: Whitfield C. R. , Smith N. C. , Cockburn F. , Gibson A. A. M.
Published: August 2005

Summary. Adapting Sir Dugald Bairďs concept of primary obstetric causes of perinatal mortality, a revised clinico‐pathological classification has been evolved to take account of new knowledge and developments, and to direct attention to potentially avoidable deaths and to where intensified efforts and investigation are needed. Categories highlighting the importance of intrauterine growth retardation, unexplained intrauterine death and spontaneous premature labour have been introduced, intrapartum hypoxia is separated from birth trauma, and infection again has its own category. Regular perinatal audit at one obstetric hospital, since 1979, has shown that the new system provides a workable and useful means for classifying not only perinatal deaths, but also late abortions, late neonatal deaths and perinatally related infant deaths. The rate of total perinatally related wastage, defined in this way, was almost twice that for perinatal mortality (22‐8 compared with 11·9 per 1000 births). The former is advocated as a more realistic index for the audit of perinatal care. The revised and extended system is put forward as a contribution to the current debate on classifying and reporting such wastage, in the hope that it may be tested as a model for regional as well as hospital surveys.
Does father's unemployment put the fetus at risk?
Authors: Golding Jean , Thomas Peter , Peters Tim
Published: August 2005

Summary. Information concerning 15037 singleton deliveries in 1970 showed that among the 3.5% where the male head of the household was unemployed there was no significant excess of low birthweight or pre‐term delivery, once social class had been taken into account. There were major differences, however, in maternal health behaviour. In order to ascertain whether the health behaviour might be a consequence of the unemployment, data were also analysed for the 658 pregnancies in women whose husbands, though employed at delivery, were subsequently unemployed. Almost identical patterns were found, implying that the association with health behaviour was not a time‐related consequence of unemployment.
Outcome of neonatal intensive care: obstetric implications for a regional service
Authors: Watkinson Michael , Mcintosh Neil
Published: August 2005

Summary. Data from 634 newborn babies with birthweights ≤2000 g admitted to the South West Thames Regional Neonatal Unit in St George's Hospital since its opening in 1980 were analysed. Only 271 (43%) of the pregnancies were booked there; 200 (32%) of the babies were transferred in utero and 162 (26%) after delivery. Weight‐specific neonatal survival rates, calculated after exclusion of lethal abnormalities showed that between 1001 and 1500 g, 79 (96%) of the 82 babies transferred in utero survived in 1981–1984, compared with only 57 (79%) of the 72 postnatal transfers (P<0·02). Under 1000 g, no such differences were found, possibly because paediatricians transferred only the fitter babies in this weight range. The birth of very‐low‐birthweight babies of short gestation in units unable to provide immediate resuscitation, adequate stabilization and full neonatal intensive care is a major risk factor for increased neonatal mortality. These findings support the role of regional perinatal centres as service units for antenatal transfer and neonatal intensive care, and as teaching centres.
Analysis of impedance cardiography longitudinally applied in pregnancy
Authors: Davies P. , Francis R. I. , Docker M. F. , Watt J. M. , Crawford J. Selwyn
Published: August 2005

Summary. Data gathered during a longitudinal study of cardiac output throughout pregnancy, measured by application of impedance cardiography, have been reassessed in respect to individual items of measurement. Examination of the pattern of change in these values did not reveal any flaw in the proposition that impedance cardiography, with the invocation of the Kubicek equation, can confidently be applied in such a study.
Umbilical cord whole blood viscosity and the umbilical artery flow velocity time waveforms: a correlation
Authors: GILES WARWICK B. , TRUDINGER BRIAN J. , PALMER ALLAN A.
Published: August 2005

Summary. The possibility was examined of an association between umbilical cord whole blood viscosity and umbilical artery flow velocity time waveforms obtained with continuous wave Doppler ultrasound. The cord blood viscosity was measured at both high (100 s‐l) and low (0·1 s‐I) shear rates with a concentric cylinder viscometer. Plasma viscosity and fibrinogen were also measured. An abnormal pattern in the umbilical artery flow velocity waveform (high A/B ratio) indicative of high resistance was associated with an increase in whole blood viscosity at high shear (which may reflect a change in red cell rigidity). Viscosity at low shear (reflecting red cell aggregation and rouleaux formation) did not differ. There was a significant association between the small‐for‐gestational age fetus and abnormal umbilical artery waveform study (P <0·002) but not abnormal whole blood viscosity at high (P=0·09) or low (P=0·08) shear.
Medical dilatation of the non‐pregnant cervix: the effect of ethinyl oestradiol on the visibility of the transformation zone
Authors: PRENDIVILLE W. J. , DAVIES W. A. R. , DAVIES J. O. , SHEPHERD A. M.
Published: August 2005

Summary. The cervical transformation zone (TZ) was not fully visible in 25 women referred to the colposcopy clinic with cytological suspicion of cervical intraepithelial neoplasia (CIN). Each was given a 5‐day course of oral ethinyl oestradiol during the follicular phase of the menstrual cycle, and colposcopy was then repeated. The transformation zone was visible at this second examination in 16 of the 25 patients. Of these patients, 11 were treated with a local destructive technique, nine by laser, two by cryocautery; one patient had a cone biopsy, and four patients did not require treatment. Although cone biopsy was necessary in 8 of the remaining 9 patients it is encouraging that the use of a simple medical regimen allowed us to avoid conisation and its morbidity in almost two thirds of these patients.
Evidence‐Based Medicine and the Challenge of Low Back Pain: Where Are We Now?
Authors: Chou Roger
Published: August 2005

Abstract:  Low back pain has long been described as a challenge for both primary care physicians and specialists. Management of low back pain has also been criticized as frequently arbitrary, inappropriate, or ineffective. Contributing factors have been an inadequate evidence base and a need for more rigorous appraisals of the available literature.

Evidence‐based medicine, an approach to clinical problem solving, is predicated on the premise that high‐quality health care will result from practices consistent with the best evidence. In contrast to the traditional medical paradigm that placed a heavy reliance on expert opinion, authority, and unsystematic clinical observations, evidence‐based medicine emphasizes the need for rigorous critical appraisals of the scientific literature to inform medical decision making. Evidence‐based medicine places strong weight on the requirement for valid studies, particularly randomized controlled trials, to appropriately evaluate the effectiveness of health care interventions. Because of the rapidly increasing volume of medical literature, however, most clinicians are unable to keep up‐to‐date with all the new data. Two types of preprocessed evidence that can aid busy clinicians in medical decision making are systematic reviews and evidence‐based clinical practice guidelines. Like primary studies, systematic reviews and clinical practice guidelines must adhere to high methodologic standards to reduce error and bias.

As in other areas of medicine, the approach to the management of low back pain has been positively affected by the availability of more clinical trials and better use of critical appraisal techniques to evaluate and apply research findings. In addition to more rigorous primary studies, an increasing number of high‐quality systematic reviews and evidence‐based clinical practice guidelines for low back pain are also available. Although some research gaps and methodologic shortcomings persist, the richer evidence base has greatly improved our understanding of what does and does not work for low back pain. Despite these advances, the best available evidence often does not inform everyday clinical decisions for low back pain. Nonetheless, there is widespread agreement that adherence to evidence‐based practice will help improve low back pain patient outcomes and reduce arbitrary variations in care. This article reviews basic principles of evidence‐based medicine, discusses evidence‐based medicine in the context of low back pain management, and summarizes some useful evidence‐based medicine resources.
Why It Is So Difficult to Form Effective Community Coalitions
Authors: Kadushin Charles , Lindholm Matthew , Ryan Dan , Brodsky Archie , Saxe Leonard
Published: August 2005

Reviews of large‐scale community coalition evaluations suggest that most have not been successful either in involving a broad array of institutions or in meeting their outcome goals. Informed by the literature and by insights from fieldwork, a social‐structural theoretical explanation is offered for this lack of success. To summarize: coalition structures and the concept of community are loosely defined; local structures attempt to cope with problems that have regional, state, national, and international roots; ethnic, class, and racial divisions lead to cooptation; the narrative of past failed interventions creates current problems; organizations with different sizes and institutional affiliations have problems in working together; and the presence of many organizations leads to confused decision‐making processes. In addition, drug and alcohol prevention program funding is dwarfed by the funds of the alcohol and illegal drug industries. Recognizing these issues in advance and focusing interventions can help to alleviate the effects of these structural problems.
Training effects of short bouts of stair climbing on cardiorespiratory fitness, blood lipids, and homocysteine in sedentary young women
Authors: Boreham C A G , Kennedy R A , Murphy M H , Tully M , Wallace W F M , Young I
Published: August 2005

Objectives:To study the training effects of eight weeks of stair climbing on Vo2max, blood lipids, and homocysteine in sedentary, but otherwise healthy young women.

Methods:Fifteen women (mean (SD) age 18.8 (0.7) years) were randomly assigned to control (n  =  7) or stair climbing (n  =  8) groups. Stair climbing was progressively increased from one ascent a day in week 1 to five ascents a day in weeks 7 and 8. Training took place five days a week on a public access staircase (199 steps), at a stepping rate of 90 steps a minute. Each ascent took about two minutes to complete. Subjects agreed not to change their diet or lifestyle over the experimental period.

Results:Relative to controls, the stair climbing group displayed a 17.1% increase in Vo2maxand a 7.7% reduction in low density lipoprotein cholesterol (p<0.05) over the training period. No change occurred in total cholesterol, high density lipoprotein cholesterol, triglycerides, or homocysteine.

Conclusions:The study confirms that accumulating short bouts of stair climbing activity throughout the day can favourably alter important cardiovascular risk factors in previously sedentary young women. Such exercise may be easily incorporated into the working day and therefore should be promoted by public health guidelines.