bluuebunny/crossref_metadata_2025 huggingface dataset:
Histopathological findings in women with postmenopausal bleeding
Authors: Gredmark Thomas , Kvint Sonja , Havel Guillaume , Mattsson Lars‐Åke
Published: August 2005

Objective To investigate endometrial histopathology in a geographically defined population of women presenting with postmenopausal bleeding.

Design Prospective study with collection of data during an 18–month period.

Setting The health care county of Skaraborg, Sweden.

Subjects Dilatation and curettage using general anaesthesia was performed on 457 postmenopausal women suffering from uterine bleeding. Women using hormone replacement therapy for climacteric complaints were not included in the investigation.

Main outcome measures The frequency of bleeding was correlated to endometrial histopathology, and in relevant cases to pathological conditions in cervix and ovaries in a defined population of postmenopausal women.

Results The incidence of postmenopausal bleeding decreased with increasing age while the probability of cancer as the underlying cause increased. The peak incidence of endometrial carcinoma was found in women between 65 and 69 years of age. Endometrial histopathology showed: atrophy (50%); proliferation (4%); secretion (1 %); polyps (9%); different degrees of hyperplasia (10 %); adenocarcinoma (8 %); not representative (14 %); other disorders (3 %). In six women a squamous carcinoma of the cervix was found, and eight proved to have ovarian tumours.

Conclusions The histopathological finding of endometrial adenomatous hyperplasia or cancer in about 15% of the postmenopausal women with bleeding justifies a thorough examination. The probability of cancer as the underlying cause increased with age. The endometrium was atrophic in 50%. Eight women had ovarian tumours. These findings may imply that transvaginal ultrasound examination should be included in the evaluation of postmenopausal bleeding as occasionally endometrial biopsies of atrophic endometrium could be avoided and ovarian pathology detected.
Does early growth delay occur in diabetic pregnancy?
Authors: Steel Judith M. , Wu Patricia S. , Johnstone Frank D. , Muir Berenice B. , Sweeting Vicky M. , Hillier Stephen G.
Published: August 2005

Objective To identify the date of ovulation in pregnant women with Type 1 diabetes in order to assess the validity of the concept of early growth delay.

Design Identification of ovulation by measurement of urinary luteinising hormone and assessment of fetal growth using ultrasound scan.

Setting Diabetic pre‐pregnancy and antenatal clinic in a teaching hospital.

Subjects Twenty women with Type 1 diabetes who had attended a pre‐pregnancy clinic.

Measures Urinary LH, by laboratory and kit methods, during conception cycles. Human chorionic gonadotrophin measured in early pregnancy. Early ultrasound scans by a single observer blind to menstrual and ovulation dates.

Outcome Gestation calculated from ovulation date and gestation estimated from menstrual dates, compared with gestation at age indicated by early ultrasound scan.

Results When the date of ovulation was identified in 20 women with Type 1 diabetes there was no evidence of growth delay in any pregnancy. When gestation was estimated from menstrual dates there was apparent early growth delay in six pregnancies.

Conclusion This study, together with others discussed, indicates that early growth delay is probably an artefact of incorrectly estimated ovulation date.
A dose‐ranging study of the use of cyclical dydrogesterone with continuous 17β oestradiol
Authors: Burch D. J. , Spowart K. J. M. , Jesinger D. K. , Randall S. , Smith S. K.
Published: August 2005

Objective To establish the lowest dose of cyclical dydrogesterone that protects against endometrial hyperplasia induced by continuous 2 mg 17β oestradiol, and to study the dose effect on vaginal bleeding and side effects.

Design Double‐blind, prospectively randomised dose‐ranging study.

Setting Menopause clinics in the UK and The Netherlands.

Subjects Three hundred and seventy‐one postmenopausal women with intact uteri, aged 40 to 60.

Interventions Administration of six 28‐day treatment cycles of continuous daily micronised 178 oestradiol with a randomly allocated dose of 5 to 20 mg of dydrogesterone added for the last 14 days of each.

Main outcome measures Histological assessment of adequate progestational endometrial response, bleeding patterns and adverse effects.

Results The study was completed by 320 subjects (86 %). Endometrial transformation occurred in over 94 % of those talung 5 mg of dydrogesterone, and in over 97 % of those on hgher doses, without significant differences between the 10, 15 and 20 mg groups. Acceptable bleeding patterns were found at all doses, with the incidence of withdrawal bleeding rising with increasing dose. The day of onset of bleeding was predictable from cycle to cycle, and occurred later in the 20 mg group than in the others. The incidence of noncyclic bleeding was about 6 % at all doses. Withdrawal occurred in 3‐3% due to unacceptable bleeding and in 5‐4% due to side effects. There was no relation with dose.

Conclusions A dydrogesterone‐17p oestradiol combination hormone replacement therapy confers endometrial protection with an acceptable bleeding pattern and few side effects. At least 10 mg of dydrogesterone for 14 days is required for acceptable endometrial protection.
Measuring sexual functioning in premenopausal women
Authors: Garratt Andrew M. , Torgerson David J. , Wyness Jjulie , Hall Marion H. , Reid David M.
Published: August 2005

Objective To assess the validity and reliability of a measure of sexual function for premenopausal women.

Design A self‐administered sexual function questionnaire, derived from the Sabbatsberg Sexual Self‐Rating Scale, and other health measures were given to women who were randomly sampled from the community health index.

Subjects One hundred and forty‐eight premenopausal women aged between 45 and 49 years.

Main outcome measures The content validity, internal consistency and construct validity of the revised sexual rating scale.

Results One hundred and thirty‐seven women (92 %) responded to the main questionnaire and 89 (60%) completed the sexual rating scale, which possessed a high level of internal consistency; scores on the sexual ratings scale had small to moderate correlations with the measures of health, two of which (depression and role limitations attributable to emotional problems) were sufficient to explain 25 % of the variation in the sexual functioning scores.

Conclusion Questions derived from the Sabbatsberg sexual self‐rating scale have been used to construct a simple, acceptable, valid and reliable measure of sexual functioning for women in the 45 to 49 years of age group. Such a measure could be widely used as an adjunct to clinical and more general measures of health in order to assess the impact of interventions on sexual functioning within clinical trials.
The effect of cryopreservation in prevention of ovarian hyperstimulation syndrome
Authors: Thtinen Aila , Husa Lhsa‐Mari , Tulppala Maija , Simberg Niklas , Seppälä Markku
Published: August 2005

Objective To evaluate the effect of elective cryopreservation of all embryos in the prevention of severe ovarian hyperstimulation syndrome in women at increased risk, following superovula‐tion for in vitro fertilisation.

Design Three hundred and ninety women undergoing superovulation for in vitro fertilisation between September 1991 and December 1992.

Setting University Infertility Clinic, Helsinki, Finland.

Interventions Twenty‐three women were considered to have an increased risk of developing ovarian hyperstimulation syndrome. They were characterised by more than 20 retrieved oocytes and/or by serum oestradiol levels exceeding 10000 pmol/l on the day of administration of human chorionic gonadotrophin. Instead of cancelling the cycle the oocytes were harvested and fertilised, and all good quality embryos were cryopreserved. The embryos were thawed and replaced during subsequent natural cycles.

Main outcome measures Occurrence of ovarian hyperstimulation syndrome and pregnancy rate.

Results One out of the 23 patients at increased risk developed a moderate degree ovarian hyperstimulation syndrome, while the others had only mild symptoms. Two of the remaining 367 women with no risk developed ovarian hyperstimulation syndrome, both during early pregnancy. Among the 23 patients at increased risk there have been 15 clinical pregnancies after transfer of two to three frozen‐thawed embryos in natural cycles, with a 32.6 % pregnancy rate.

Conclusions Withholding embryo replacement and elective cryopreservation of the embryos is effective in preventing severe ovarian hyperstimulation syndrome. After subsequent replacement in natural cycles the implantation rate per embryo is good (22.7%).
Updating the clinical experience in endometriosis – the European perspective
Authors: Bromham D. R. , Booker M. W. , Rose G. L. , Wardle P. G. , Newton J. R.
Published: August 2005

In a large, double‐blind, multicentre study, 269 patients with confirmed endometriosis were randomly allocated to receive either danazol (200 mg twice daily; n= 137) or gestrinone (2.5 mg twice weekly; n= 132) for 6 months. The two groups were comparable in terms of the staging of endometriosis by the American Fertility Society (1979) score. After the sixth month of treatment, repeat laparoscopy was performed. Clinical assessment, haematological and biochemical investigations were carried out during the 6 months of treatment and for a further 12 months' follow‐up and are compared between the two groups. A total of 15 patients from the gestrinone group, including four patients with hirsutism, and 17 patients from the danazol group, including six patients with headache, withdrew because of adverse symptoms. An additional 22 patients, including 10 from the gestrinone group and 12 from the danazol group withdrew because of lack of efficacy, pregnancy, elevated hepatic function tests or for reasons unrelated to the trial. Total American Fertility Society scoring showed an improvement of 73.3% in 101 patients receiving gestrinone and 72.7% in 99 patients receiving danazol. The results showed a significant reduction in the severity of dysmenorrhoea by the third month in the danazol group and at 6 months in both groups. There was a significant (P < 0.001) increase in weight observed in both groups during treatment. Overall, the tolerability of danazol and gestrinone was good; however, significantly more patients with gestrinone complained of hirsutism while significantly more with danazol complained of leg cramps. During the 12 months of follow‐up, mild, moderate or severe degrees of lower abdominal pain, dysmenorrhoea and deep dyspareunia all fluctuated, with no statistically significant increase in frequency in either group.
Updating the clinical experience in endometriosis – the Brazilian perspective
Authors: Halbe H. W. , Nakamura M. S. , Da Silveira G. P. G. , Carvalho W. P. C.
Published: August 2005

In an open‐label, multicentre, randomized, parallel group study, 164 women with endometriosis were assigned to treatment. Out of these women, 81 received danazol (600 mg daily for 8 weeks, then 400 mg for 16 weeks) and 83 were given gestrinone (2.5 mg twice a week for 24 weeks). Five weeks before the start of treatment clinical evaluation and diagnostic laparoscopy were performed during the screening visit. Drug assignment and laboratory data assessment were carried out within 3 days of the estimated onset of the menstrual cycle at baseline visit. The response to treatment was assessed during visits at weeks 2, 4, 8, 12, 16, 20 and 24; at the last visit a second laparoscopy was performed. Therapeutic efficacy was evaluated by analysis of the laparoscopic scores assessed according to the revised American Fertility Society classification. Symptomatic response was measured by clinical scores and laboratory data. In one centre, bone mineral density was also recorded. One patient in the danazol group discontinued treatment due to a cutaneous rash as a probable adverse reaction at the beginning of the study. The therapeutic efficacy of danazol and gestrinone did not differ significantly when the revised American Fertility Society scores were compared. The symptomatic response also showed no statistical difference when clinical examination scores were analysed. There was no significant difference between the drugs in laboratory data, including bone mineral density, with respect to adverse events. Analysis of clinical scores showed that danazol was superior to gestrinone with respect to acne and irregular bleeding. Based on these data, we conclude that both danazol and gestrinone are reliable in the treatment of endometriosis and offer similar results.
Low dose aspirin in pregnancy and early childhood development: follow up of the collaborative low dose aspirin study in pregnancy
Authors:   CLASP Collaborative Group CLASP Coordinating Centre, Radcliffe Infirmary, Oxford
Published: August 2005

ObjectiveTo determine any benefits or risks, expressed in early childhood, of low dose aspirin treatment in pregnancies at high risk of complications due to pre‐eclampsia or intrauterine growth retardation.

DesignA questionnaire‐based follow‐up at 12 and 18 months of age of cohorts of surviving children whose mothers participated in a large randomised, double‐blind placebo‐controlled trial of 60 mg aspirin.

SettingUnited Kingdom and Ottawa, Canada.

Subjects4168 children assessed at 12 months through information provided by general practitioners, and 4365 assessed at 18 months through a questionnaire to parents.

Main outcome measuresHospital visits in the first 18 months for congenital malformations, motor deficit, developmental delay, respiratory problems or bleeding problems; height or weight below the third centile; and delayed acquisition of certain developmental skills.

ResultsThere were no clear differences in any of the main outcome measures, although some confidence intervals were wide.

ConclusionsAlthough an adverse effect can not be ruled out, these findings are reassuring about the safety of low dose aspirin started after the first trimester, at least in respect of congenital malformations, major motor deficit, and severe neuromotor or developmental delay identifiable in early childhood. They provide no clear evidence of benefit. Taking into account evidence from large randomised controlled trials, the place of low‐dose aspirin in pregnancy appears to be limited, although it may be beneficial for women at high risk of early onset pre‐eclampsia; for them, evidence suggesting that it is not harmful is important.
Blood pressure and renal function seven years after pregnancy complicated by hypertension
Authors: Nisell H. , Lintu H. , Lunell N. O. , Möllerström G. , Pettersson E.
Published: August 2005

Objective
To assess the occurrence of chronic hypertension and renal disorder after gestations complicated by pregnancy induced hypertension or pre‐eclampsia and to define background factors and laboratory analyses at follow up examination which discriminate between women who remain normotensive and those who develop hypertension.

Setting
Swedish university hospital.

Subjects
Women with pregnancy induced hypertension (PIH) (n= 49), pre‐eclampsia (n= 45) or a normotensive pregnancy (n= 44) during 1986.

Design
Subjects were reviewed in 1993 with regard to chronic hypertension and renal disorder. Plasma concentrations of creatinine, urea, uric acid, calcium and albumin were measured, and urine was examined for the presence of microalbuminuria and erythrocyte excretion rate. Those with and without hypertension at follow up were compared with regard to the renal function tests and possible features in the history which might predict chronic hypertension.

Results
Women with a history of pregnancy induced hypertension or pre‐eclampsia had an increased risk, relative to controls, for hypertension at follow up (37% and 20%vs 2%; P < 0.001), microalbuminuria (14% and 20%vs 2%; P < 0.05) and demonstrated increased plasma levels of albumin corrected calcium (2.41 [SE 0.021 and 2.40 [0.01] vs 2.32 [0.01] mmol/l; P < 0.001). The only factors significantly associated with hypertension at follow up were the presence of microalbuminuria (P= 0.0008) and having had a delivery prior to the index pregnancy (P= 0.0017).

Conclusions
The risk for chronic hypertension seven years after a pregnancy complicated with pregnancy induced hypertension or pre‐eclampsia is considerably increased. The presence of hypertension at follow up is closely related to residual renal disorder.
Effect of preterm premature rupture of membranes on neurodevelopmental outcome: follow up at two years of age
Authors: Spinillo Arsenio , Capuzzo Ezio , Stronati Mauro , Ometto Alessandra , Orcesi Simona , Fazzi Elisa
Published: August 2005

Objective
To evaluate the impact of preterm premature rupture of membranes on the neurodevelopmental outcome of infants, assessed at two years of age.

Design
A prospective observational study of surviving preterm infants born after premature rupture of membranes and of infants born after spontaneous preterm labour with intact membranes. The study was carried out in the period 1986 to 1991.

Setting
Pavia, Italy.

Subjects
One hundred and forty singleton infants born prematurely after premature rupture of membranes between 24 and 34 weeks of gestation and 120 controls of similar gestational age born after spontaneous preterm labour with intact membranes.

Main outcome measures
Infant neurodevelopmental outcome at two‐year follow up.

Results
After adjustment, by logistic analysis for the effect of gestational age and birthweight, infants born after premature rupture of membranes were more likely to have severe neurodevelopmental impairment (spastic tetraplegia and/or Bayley mental developmental index < 71) than controls (adjusted OR 5.75, 95% CI 1.22–27.18). Multivariate analysis of linear trend showed a statistically significant relation of duration of membrane rupture to occurrence of severe intraventricular haemorrhage, cystic periventricular leucomalacia and moderate to severe infant neurodevelopmental impairment.

Conclusion
Infants born after prolonged premature rupture of membranes are at higher risk of subsequent moderate to severe neurodevelopmental impairment than those born after spontaneous labour with intact membranes.
Receptor‐mediated uterine effects of vasopressin and oxytocin in nonpregnant women
Authors: Bossmar Thomas , ÅKerlund Mats , Szamatowicz Jacek , Laudanski Tadeusz , Fantoni Guido , Maggi Mario
Published: August 2005

Objective
To study in nonpregnant women myometrial actions of vasopressin and oxytocin and the involvement in these effects of specific uterine receptors.

Subjects
Twenty‐eight women undergoing hysterectomy for benign gynaecological disorders.

Interventions
Intrauterine pressure recordings. Intravenous bolus injections of 10 pmol/kg body weight of vasopressin and oxytocin. Repeated blood sampling for measurement of vasopressin and oxytocin concentrations in plasma. Recording of effects of vasopressin and oxytocin on isolated myometrium. Estimation of myometrial concentrations of vasopressin V1a and oxytocin receptors. Measurement of plasma oestradiol and progesterone.

Main outcome measures
Vasopressin‐ and oxytocin‐induced increases of the area under the in vivo recording curve over 10 minutes and EC50 concentrations of dose‐responses in vitro. Concentrations of vasopressin V1a and oxytocin receptors.

Results
Vasopressin was on average four times more potent than oxytocin in vivo. The effect of vasopressin premenstrually was more pronounced than in women under oestrogen influence only (proliferative phase‐hyperproliferation; P= 0.02), and tended to be more marked than in those in the luteal phase (P = 0.07). No significant variation in oxytocin response with the hormonal state was observed. EC50 concentrations of vasopressin were more than 20 times lower than those of oxytocin. The median concentration of the vasopressin V1a receptor was 208 (range 139–343) fmol/mg protein and that of the oxytocin receptor 49 (38–87) fmol/mg protein. Vasopressin receptor concentrations and in vivo effects of this peptide did not correlate, whereas for those of oxytocin a significant correlation was observed (P= 0.02).

Conclusion
The high potency of vasopressin in nonpregnant women, particularly premenstrually, firmly supports an aetiological importance of this peptide in the uterine hyperactivity of primary dysmenorrhoea. Oxytocin seems to be less important in this condition in view of its much smaller potency and the absence of increase in effect premenstrually. Vasopressin appears to influence both the oxytocin and the vasopressin Vla receptor sites in the uterus, whereas oxytocin acts specifically on its own receptor.
The sensitivity of ultrasound and serum alpha‐fetoprotein in population‐based antenatal screening for neural tube defects, South Australia 1986–1991
Authors: Chan Annabelle , Robertson Evelyn F. , Haan ERIC A. , Ranieri Enzo , Keane Rosemary J.
Published: August 2005

Objective
To determine the sensitivity of antenatal screening methods for neural tube defects in population‐based screening in South Australia in 1986–1991, and whether ultrasound can replace serum alpha‐fetoprotein screening in terms of achieving an equivalent level of sensitivity.

Design and setting
Ascertainment of all births and terminations of pregnancy with neural tube defects from multiple sources for 1986–1991 in South Australia. Serum and amniotic fluid alpha‐fetoprotein results were obtained from the only laboratory performing the tests as a Statewide antenatal screening programme, and information on ultrasound screening from case notifications, hospital case records and medical practitioners who cared for the women.

Subjects
All 243 births and terminations of pregnancy with neural tube defects in South Australia in 1986–1991.

Main outcome measures
The sensitivity of individual screening methods and of all methods used, particularly for spina bifida.

Results
For pregnancies with neural tube defects screened by any method (serum alpha‐fetoprotein, ultrasound or amniocentesis), 86YO sensitivity was achieved. Ultrasound screening for anencephaly achieved 100 % sensitivity even in low risk pregnancies, compared with 92 % for serum alpha‐fetoprotein. For spina bifida, the sensitivity of ultrasound screening increased with the level of risk in pregnancy: it was 60% in low risk pregnancies, which was equivalent to that of serum alpha‐fetoprotein screening (64%); 89% in high risk pregnancies and 100% for women referred for confirmation of a suspected spina bifida by another ultrasonographer (×12 for trend = 23.49, P < 0.0001). Ultrasound screening in high risk pregnancies for spina bifida achieved higher sensitivity in teaching hospitals compared with other ultrasound services in the State (97%vs 65%), but sensitivity was equivalent for low risk pregnancies. It is estimated that, had the serum screening programme not been in place, the level of sensitivity achieved for spina bifida by ultrasound and amniocentesis would have been 62% compared with the actual situation of 76% with the programme in existence, a difference of nearly 15% (95% CI 2.5 to 267) (×12= 5.45, P= 0.02).

Conclusions
Antenatal screening for neural tube defects in South Australia achieved a higher level of sensitivity with the maternal serum alpha–fetoprotein programme in place. We conclude that the serum screening programme should continue in South Australia pending a significant improvement in the sensitivity of routine ultrasound screening for spina bifida.
Limb reduction defects in South America
Authors: Castilla Eduardo E. , Cavalcanti Denise P. , Dutra Maria G. , Lopez‐Camelo Jorge S. , Paz Joaquin E. , Gadow Enrique C.
Published: August 2005

Objective
Limb reduction defects were considered as possible indicators of environmental teratogenesis; it was suggested that also invasive prenatal procedures could increase the risk for limb reduction defects. The purpose of this work is to give a baseline frequency for limb reduction defects, using data from a population not exposed to prenatal diagnosis procedures.

Design
Using data collected in the period 1967 to 1992 within the frame of the Latin American Collaborative Study of Congenital Malformations which clinically examined 2,917,074 newborn infants, a total of 1715 with limb reduction defects were found. All cases were classified and analysed in 25 categories. Geographic differences in recorded rates were tested by χ2 for homogeneity. Secular trends were analysed using χ2 test for linear trends.

Results
The overall birth prevalence rate of limb reduction defects among liveborn infants was 4.91 (per 10,000 births) (3.05 for isolated and 1.85 for associated cases). For stillbirths, the total prevalence was 2673/10,000 (553 for isolated and 21.20 for associated cases). The inclusion of the brachydactylies increased those figures to 5.55110,000 (3.39 for isolated and 2.16 for associated cases), and 27.42, respectively, (5.53 for isolated and 21.89 for associated cases). When isolated and associated cases were considered together, a geographic heterogeneity was found in pre‐axial limb reduction defects; there was also some heterogeneity for amputations. A maternal age effect was found for the isolated hypoplasias. Standardising by maternal age, the overall prevalence of limb reduction in liveborn infants was 5.66 per 10,000 (95% CI = 5.38–5.93). An increasing trend was suggested by the isolated form of distal amputations which involved hands, feet, or digits.

Conclusions
Our data suggest that clustering limb reduction defects in wide groups as transverse and longitudinal may lead to heterogeneous entities. When a possible association is suspected, it would be preferable to present and analyse data in the most discriminant form available. Due to the maternal age effect, it would be advisable to standardise the rates of transversal limb reduction defects by this variable.
Single pre‐delivery symphysis‐fundal height measurement as a predictor of birthweight and multiple pregnancy
Authors: Walraven G. E. L. , Mkanje R. J. B. , van Roosmalen J. , van Dongen P. W. J. , van Asten H. A. G. H. , Dolmans W. M. V.
Published: August 2005

Objective
To compare the value of different pre‐delivery maternal indices for predicting birth‐weight, and to examine the usefulness of a single pre‐delivery symphysis‐fundal height measurement for the detection of low birthweight and twin pregnancy or macrosomia.

Design
Symphysis‐fundal height measurements were gathered from 1509 women who had both a singleton delivery and available data of pre‐delivery weight, height and mid‐upper arm circumference, and from 73 women who had a twin delivery.

Setting
A district hospital in rural Tanzania.

Results
Symphysis‐fundal height, pre‐delivery weight and mid‐upper arm circumference, respectively, explain 41%, 13% and 4% of the observed variation in birthweight. At a cut‐off level of 30 cm for symphysis‐fundal height, the detection rate for birthweight below 2500 g and 2000 g was 66% and 68%, respectively, and the false positive rate was 9% and 14%, respectively. At a cut‐off level of 38 cm for symphysis‐fundal height the detection rate for twin pregnancy or birthweight > 4000 g was 76%, and the false positive rate was 4%.

Conclusion
Symphysis‐fundal height was a better predictor of birthweight than maternal height, pre‐delivery weight or mid‐upper arm circumference. It seems justified to investigate the value of a simple tricoloured symphysis‐fundal height measuring tape for use in antenatal care in developing countries at village level.
Fatty acid pattern of esterified and free fatty acids in sera of women with normal and pre‐eclamptic pregnancy
Authors: Lorentzen Bjørg , Drevon Christian A. , Endresen Marit J. , Henriksen Tore
Published: August 2005

Objective
To determine the composition of esterified and free fatty acids in sera of women with normal and pre‐eclamptic pregnancy.

Setting
Department of Obstetrics and Gynaecology, Aker Hospital, Oslo, Norway.

Subjects
Blood samples were taken from 510 healthy nulliparae at a gestational age of 17–19 weeks. Nineteen of these subsequently developed pre‐eclampsia. Seventeen of these, for whom blood samples were still available, and a control group of 17 women taken from the same population and matched for age, body mass index, gestational age and parity, were later studied in detail. A further group of 29 women admitted to the hospital with pre‐eclampsia were also studied, as was a matched control group of 29 women with normal pregnancies recruited from the antenatal clinic.

Methods
Blood samples were drawn after 8 to 10 h fasting. The patterns of serum free fatty acids and esterified fatty acids were determined by thin‐layer chromatography combined with gas‐liquid chromatography. Free fatty acids were also determined enzymatically.

Results
Among the circulating free fatty acids, the levels of palmitic (16:0), oleic (18:1 12–9) and linoleic acids (18:2 n‐6) were significantly higher early in pregnancy in women who later developed pre‐eclampsia. The same free fatty acids were also significantly increased in women with pre‐eclampsia. The level and composition of the esterified fatty acids in phospholipids, triglycerides and cholesteryl esters did not, however, differ between the two groups early in pregnancy. In contrast, in women with pre‐eclampsia, the relative content of oleic acid was increased in the phospholipid fraction, whereas linoleic acid was decreased in the phospholipid and triglyceride fractions.

Conclusions
We observed that the level and composition of circulating free fatty acids were already altered 10–20 weeks before the clinical onset of pre‐eclampsia. When the disease became overt there were changes in both esterified and free fatty acids.
Incidence of cervical smears indicating dysplasia among Austrian women during the 1980s
Authors: Kainz Christian , Gitsch Gerald , Heinzl Harald , Breitenecker Gerhard
Published: August 2005

Objective
To determine the incidence of cervical smears indicating cervical intraepithelial neoplasia during the 1980s and to compare two quinquennia.

Design
A retrospective epidemiologic analysis was performed, based on a large collection of 238261 cervical smears obtained from Austrian women screened between 1980 and 1989. After application of strict epidemiologic criteria to avoid bias of changes in socio‐economic status and methodological changes in cytology, 12604 women were eligible for further analysis. We calculated incidences and relative risks of cytologically indicated cervical intraepithelial neoplasia, comparing the time periods of 1980 to 1984 and 1985 to 1989 for different age cohorts.

Results
We found a statistically significant increase in the incidence of cervical cytology indicating cervical intraepithelial neoplasia in the second time period for patients between 21 and 40 years of age. Women older than 40 years showed a significant decrease of this incidence.

Conclusions
In Austrian women between the ages of 21 and 40 years an unidentified risk factor or a pattern of risk factors during the period prior to 1985 resulted in an increase of cervical intraepithelial neoplasia during the last years studied. This increasing incidence of cervical intraepithelial neoplasia indicates the importance of regular cytological screening. The significant decrease of the cervical intraepithelial neoplasia incidence in women older than 40 years provides an argument for increasing screening intervals in these women.
Obstetric outcome of Bangladeshi women in East London
Authors: Versi Eboo , Liu Ka Lai , Chia Patrick , Seddon Gaynor
Published: August 2005

Objective
To study the obstetric outcome of women of Bangladeshi origin in comparison with the white Caucasian population in East London.

Design
A retrospective study of 16718 pregnancies over a five year period (1987–1991). Setting An East London teaching hospital district.

Subjects
Six thousand four hundred and sixty Bangladeshi women compared with 7592 white Caucasian women.

Main outcome measures
Maternal: antenatal complications; induction and augmentation rates; analgesia and anaesthesia; instrumental delivery and caesarean section rates; third stage complications. Fetal: gestation and weight at birth; perinatal mortality rates.

Results
The following statistically significant findings were noted: Bangladeshi women had a longer reproductive age span and were of greater parity including grand multiparity. They suffered fewer antenatal complications except for gestational diabetes. They had lower induction rates and, among the parous group, lower augmentation rates. During labour they required less analgesia but more commonly had general anaesthesia for caesarean section deliveries. They required instrumental delivery less often but there was no difference in overall caesarean section rate for the two groups. However, overall Bangladeshi women had a lower elective caesarean section rate, although parous Bangladeshi women had a higher emergency section rate. In the third stage there were no differences in the complication rates for the nulliparous women, however the parous Bangladeshi women had a higher postpartum haemorrhage rate and a lower perineal repair rate consistent with their higher parity. Whilst preterm births were more common in Bangladeshi women, significant prematurity (less than 28 weeks gestation) was less common. Similarly, although Bangladeshi babies weighed less at birth, they had fewer babies weighing less than 1500 grammes. There was no statistically significant difference in the perinatal mortality rate between the two groups, being 8.1 per thousand births overall. Whilst there was a statistically insignificant decline in death rates over the five‐year period, between the groups there was no consistent difference.

Conclusion Pregnant Bangladeshi women in East London constitute a relatively high parity, low risk population who have less obstetric intervention and yet manage an equivalent (or better) perinatal outcome compared to their white Caucasian neighbours.
Perineoplasty compared with vestibuloplasty for severe vulvar vestibulitis
Authors: Bornstein Jacob , Zarfati Doron , Goldik Zeev , Abramovici Haim
Published: August 2005

Objective
To evaluate the efficacy of vestibuloplasty (vestibular undercutting without excision) to treat severe vulvar vestibulitis.

Design
Prospective randomisation of patients scheduled for surgery to undergo either perineoplasty or vestibuloplasty. Differences in outcome between groups were analysed using Fisher's exact test.

Setting
The Vulvar Clinic and referral centre for vestibulitis, Kupath Holim Health System, Department of Obstetrics and Gynaecology, Carmel Medical Centre, Rapapport Faculty of Medicine, Hatechnion, Haifa, Israel.

Subjects
Twenty‐one women with vulvar vestibulitis.

Results
Vestibuloplasty failed to relieve symptoms in 10 women, while perineoplasty resulted in complete resolution of symptoms in 9/11 women (P < 0–002).

Conclusions
The poor outcome of vestibuloplasty, if also reported by other centres, may render it an unacceptable treatment for vulvar vestibulitis. Vestibuloplasty aims to denervate sensitive vestibular tissue, and its failure may suggest that innervation disturbances are not the main cause of the syndrome.
A longitudinal study of the cervix in pregnancy using transvaginal ultrasound
Authors: Cook C‐M. , Ellwood D. A.
Published: August 2005

Objective
To study longitudinal changes in the cervix during pregnancy using transvaginal ultrasound and secondly, to determine whether the measures used change with gestational age, and whether there are differences between nulliparous and primiparous women.

Design
A longitudinal study involving five transvaginal ultrasound examinations of each woman at specified gestational ages from 18 to 30 weeks.

Participants
Twenty‐one nulliparous and 20 primiparous women completed the study and were delivered at term. Cervical length, diameter and dilatation were assessed at each examination.

Results
In both nulliparous and primiparous women there is no significant change in either cervical length or diameter over the time period studied. In primiparous women the cervix is significantly longer than in nulliparous women (44.4 (5.1) mm versus 40.6 (4.7) mm [mean (SD)]; P 0.001). The cervical diameter in primiparous women is also significantly greater (31.8 (4.0) mm versus 29.0 (3.7) mm; P < 0.001).

Conclusions
Cervical length and diameter are constant in both nulliparous and primiparous women throughout this gestational period. The cervix in primiparous women is both longer and thicker than in nulliparous women.
Platelet sensitivity to prostaglandin E1 inhibition is reduced in pre‐eclampsia but not in nonproteinuric gestational hypertension
Authors: Torres Pere Joan , Escolar Ginés , Palacio Montse , Gratacós Eduard , Alonso Pedro L. , Ordinas Antonio
Published: August 2005

Objective
Platelet aggregometry was used to discriminate platelet sensitivity to prostaglandin E, (PGE.) inhibition, to evaluate whether platelet behaviour in pre‐eclamptic women was different in this respect than from that in nonproteinuric hypertensive women.

Methods
The amount of PGE1 required to inhibit in vitro platelet aggregation induced by arachidonic acid was determined in samples from 60 women: 20 nonpregnant controls, 20 women with normal pregnancies, 10 women with gestational hypertension and 10 with pre‐eclampsia.

Results
The response to arachidonic acid was similar among the four groups. Amounts of PGE1 necessary to inhibit platelet aggregation were significantly higher in normal pregnant women compared with nonpregnant controls (P < 0.001). Platelets from pre‐eclamptic women required significantly higher concentrations of PGE, to inhibit aggregation than the other groups studied (P < 0.001). However, there was no significant difference between normal and nonproteinuric hypertensive pregnant women.

Conclusions
Our findings support the notion that increased platelet reactivity during late pregnancy is exacerbated in pre‐eclamptic women but not in nonproteinuric hypertensive women. This is in agreement with the hypothesis that pre‐eclampsia and gestational hypertension are different conditions. Prospective studies are required to confirm if this simple test may be useful in the early identification of pregnant women at risk for pre‐eclampsia.
Laser doppler‐recorded reactive hyperaemia in the forearm skin during the menstrual cycle
Authors: Bungum Leif , Kvernebo Knut , Øian Pål , Maltau Jan Martin
Published: August 2005

Objective
By means of laser Doppler flowmetry to describe the changes in resting microvascular perfusion and post‐occlusive reactive hyperaemia in skin of the forearm and finger pulp throughout the menstrual cycle.

Design
Prospective descriptive study.

Setting
University Hospital of Tromss, Norway.

Sample
Fifteen nonsmoking healthy women were studied in the follicular (days 2 to 7) and the luteal (days 19 to 24) phase of the menstrual cycle.

Results
Resting perfusion in forearm and finger pulp as well as post‐occlusive reactive hyperaemia in finger pulp were unchanged from the follicular to the luteal phase. The peak perfusion value of the reactive hyperaemic response after 1 min of arterial occlusion was significantly reduced from the follicular to the luteal phase (P < 0.01) in forearm skin. The repayment for the blood flow debt, which is the hyperaemic response in percentage of the ischaemic build‐up, was also reduced (P < 0.01). After 3 min of arterial occlusion, significant reductions in peak post‐occlusive flow (P < 0.01), recovery time, which is the total duration of the hyperaemic response (P < 0.01), and the repayment (P < 001) were observed. A significant correlation was found between the ratio serum oestradiol/progesterone and repayment after 3 min of arterial occlusion in forearm skin (r= 0.71, P < 0.001).

Conclusions
Vascular reactivity is altered during the menstrual cycle. In the luteal phase, significant reductions in peak perfusion, repayment and recovery time were seen. The mechanisms behind these findings are unclear, but probably involve changes in both serum oestradiol and progesterone levels.
Women's involvement with the decision preceding their caesarean section and their degree of satisfaction
Authors: Mould T. A. J. , Chong S. , Spencer J. A. D. , Gallivan S.
Published: August 2005

Objective
To assess the extent to which women contribute to1 the decision for caesarean section and their satisfaction with the decision and procedure.

Design
Observational study of women undergoing caesarean section who were interviewed using a standard proforma.

Setting
University College Hospital, London.

Participants
One hundred and two consecutive women Undergoing caesarean section.

Results
The women's perceived reason for the caesarean section agreed with the doctors' reason in 91 cases (89.2%). Only 2/29 women having elective sections stated they had no contribution, compared with 22/73 women having emergency sections (P= 0.018, two‐tailed Fisher's exact test). Twenty out of 29 women (69%) having elective procedures and 37/73 women (51%) having emergency sections recorded medium or more contribution. All women except one were 50% or more satisfied with the decision. Women's satisfaction with the operation was high in the immediate post‐operative period and remained so over the following six weeks. Forty‐three women (49%) said they would prefer an elective section in the next pregnancy given the choice.

Conclusions
Women undergoing caesarean section were well informed and took a considerable part in the decision‐making process. This suggests that women's wishes may be playing a role in increasing caesarean section rates. High levels of satisfaction with both the decision and the procedure itself indicate that caesarean section is an acceptable method of delivery, particularly when an elective procedure.
Acid accumulation during end‐stage bradycardia in term fetuses: how long is too long?
Authors: Gull Ilan , Jaffa Ariel J. , Oren Mary , Grisaru Dan , Peyser M. Reuben , Lessing Joseph B.
Published: August 2005

Objective
To estimate the existence and degree of fetal accumulation of acid during end‐stage bradycardia as reflected by the base deficit. This may set a criterion for proper intervention during labour.

Setting
Maternity unit of the Tel Aviv Medical Centre.

Subjects
Forty‐three consecutively born term infants whose mothers were delivered by vacuum extraction were analysed 27 because of end‐stage bradycardia and 16 controls whose mothers were delivered electively because of maternal indications.

Main outcome measures
Analysis of umbilical arterial cord blood for pH, Pco2, and base deficit. The base deficit was compared between the groups using the two‐tailed Student's t test, and was correlated with variables of fetal heart rate monitoring using the Pearson correlation coefficient.

Results
The base deficit was greater in newborns who had end‐stage bradycardia than in controls (11.02 vs 5.01, P < 0.0001). The duration of loss of short term variability in fetal heart rate during end‐stage bradycardia correlated positively with the base deficit (r= 0.8, P < 0.0005). Conversely, the time until the loss of short term variability during end‐stage bradycardia correlated negatively with the base deficit. The length and the depth of the bradycardia and their product, had a weaker correlation with the base deficit.

Conclusions
End‐stage bradycardia, which presumably reflects fetal hypoxia, is associated with acidaemia in the umbilical artery at birth in some fetuses. The fetuses who are predisposed to acidaemia, as reflected by an increased base deficit, are those who lost their fetal heart rate variability during end‐stage bradycardia for more than 4 min or started to lose this in less than 3 min from the beginning of the end‐stage bradycardia. Operative vaginal delivery should be reserved for these indications.
A longitudinal study of risk factors for the occurrence, duration and severity of menstrual cramps in a cohort of college women
Authors: Harlow Siobán D. , Park Meekyong
Published: August 2005

Objective
To describe how menstrual cramps vary from cycle to cycle within a woman over time. To examine the influence of weight and lifestyle factors on occurrence, duration, and severity of menstrual pain.

Design
A one‐year prospective menstrual diary study.

Participants
One hundred and sixty‐five women aged 17 to 19 years entering a local university in 1985.

Main outcome measures
The occurrence, length, and maximum severity of pain during a menstrual period.

Results
Menstrual pain occurred during 71.6% of observed menstrual bleeds, most commonly beginning the first day of menses. The median duration was two days. Sixty percent of women reported at least one episode of severe pain, while 13% reported severe pain more than half the time. Earlier age at menarche and long menstrual periods increased the occurrence, duration and severity of pain. In smokers, cramps tended to last longer. Being overweight was an important risk factor for menstrual cramps and doubled the odds of having a long pain episode. Frequent alcohol consumption decreased the probability of having menstrual cramps, but in women who had pain it increased duration and severity. Physical activity was not associated with any pain parameter.

Conclusions
Women who have pain lasting three days are an important target group for prophylactic therapy. The occurrence and severity of menstrual cramps is influenced by potentially modifiable characteristics including weight, smoking, and alcohol consumption. Doctors may wish to counsel women presenting with dysmenorrhoea about the importance of healthy lifestyles and about the inefficacy of alcohol consumption as a treatment for dysmenorrhoea.
Nuchal translucency measurements: frequency distribution and changes with gestation in a general population
Authors: Braithwaite Jeffrey M. , Morris Richard W. , Economides Demetrios L.
Published: August 2005

Objective
To investigate nuchal translucency variation with crown‐rump length (CRL) in the first trimester in normal fetuses.

Design
A prospective observational study

Setting
Department of obstetrics in a London teaching hospital.

Participants
One thousand seven hundred and seven pregnant women (1685 singleton and 22 twin pregnancies) with chromosomally normal fetuses between 9+0 and 14+6 weeks of gestation were recruited sequentially from a dating scan clinic. Nuchal translucency was measured in 94.9% by transabdominal sonography (TAS) and by transvaginal sonography (TVS) if difficulty was encountered with TAS (5.1%). Nuchal translucency measurement was repeated in 136 fetuses: the first scan between between 9+0‐11+6 weeks and the second over 12 weeks of gestation.

Results
Of this general population, 4.2% had a nuchal translucency (NT) measurement 2 2–5 mm, but this proportion varied significantly between gestational age groups (P= 0.011). The repeatability coefficients for NT measurements were 0.44 mm and 0.23 mm for TAS and TVS, respectively. The cross‐sectional data demonstrate an increase in nuchal translucency measurement between 9 and 12 weeks of gestation and then a decrease at 13–14 weeks. This relation is best modelled using the quadratic equation: log, (NT) =−1.03 + (0.0314 × CRL) − (2.20 × 10−4× CRL). Longitudinal data confirmed an increase of nuchal translucency measurements with increasing gestation.

Conclusion
Nuchal translucency measurements increase significantly with increasing gestation. The use of a single threshold nuchal translucency measurement throughout the first trimester is inappropriate. We propose reference ranges of nuchal translucency measurements with gestation, aiming to improve the performance of nuchal translucency screening for chromosomal abnormalities.