bluuebunny/crossref_metadata_2025 huggingface dataset:
The changing pattern of eclampsia over a 60‐year period
Authors: Leitch C. R. , Cameron A. D. , Walker J. J.
Published: August 2005

Objective
To determine changes in the incidence and pattern of eclampsia within the same geographical area over a 60‐year period.

Design
A retrospective, descriptive study of 1259 consecutive women classified, at the time, as having had an eclamptic convulsion between the years 1931 and 1990.

Setting
A large city centre teaching hospital and the surrounding catchment area.

Main outcome measures
The changes in the incidence and timing of the convulsion and the outcomes for the mother and baby.

Results
Over the study period, the incidence of eclampsia fell by more than 90%, from 74.1/10,000 in the 1930s to 7.2/10,000 in the 1980s. Most of the reduction occurred over the first four decades, with little change in the last 20 years. Overall, 44% of the cases of eclampsia occurred in the antenatal period, 33% intrapartum and 23% postpartum. Since the biggest decreases were seen in the incidence of antenatal and particularly intrapartum eclampsia, there has been a relative increase in the proportion of eclampsia occurring postpartum. Maternal death from eclampsia occurred in 15.1% of cases between 1931 and 1940, 13.4% between 1941 and 1950, but fell dramatically to 3.9% after 1950. There has been no maternal death since 1964. Apart from the first decade, postpartum eclampsia was associated with significantly less risk of death to the mother throughout the study period. Perinatal death rate has fallen steadily from 432.6/1000 cases of eclampsia between 1931 and 1940 over the first three decades, to 168.7/1000 between 1961 and 1970. There has been little change since, although a lower proportion of neonatal deaths occurred as stillbirths.

Conclusions
We found a significant reduction in both the incidence of eclampsia and associated morbidity in this population over the last 60 years. This has occurred in association with the introduction of the National Health Service, widespread antenatal care for all and a general improvement in health and welfare. Any further reduction in the incidence in the UK may be difficult to achieve. Since the incidence of eclampsia is now low, efforts should perhaps be directed at minimising the morbidity associated with severe pre‐eclampsia rather than prevention of convulsions.
A study of the quality of perinatal autopsy in the former Northern Region
Authors: Wright C. , Cameron H. , Lamb W. ,   on behalf of the Northern Perinatal Mortality Survey Steering Group
Published: August 2005

Objective
To assess the quality of perinatal autopsy.

Design
Review of all reports of post mortem examinations carried out following perinatal deaths from January 1994 to June 1994.

Population
Former Northern Region of England.

Methods
Assessment of post mortem reports concerning their content and interpretation, the assessment carried out by panel comprising a pathologist, obstetrician and paediatrician.

Results
Reports were available for all 104 cases where post mortem examinations had been undertaken, of which 53 (51%) met the minimum standards for such autopsies proposed by the Royal College of Pathologists. Interpretative comments were judged to be adequate in 51 (49%).

Conclusions
The quality of perinatal autopsies is frequently poor. Improvement requires increased awareness of the potential value of the autopsy, and more consultation between pathologists, obstetricians and paediatricians.
Lactate compared with pH analysis at fetal scalp blood sampling: a prospective randomised study
Authors: Westgren M. , Kruger K. , Ek S. , Grunevald C. , Kublickas M. , Naka K. , Wolff K. , Persson B.
Published: August 2005

Objective
Fetal scalp blood sampling is a widely used method for assessing fetal condition in the event of ominous fetal heart rate patterns. The purpose of this randomised trial was to compare the value of fetal scalp blood lactate and pH management in cases of abnormal intrapartum fetal heart rate tracings.

Methods
Of 341 cases of ominous fetal heart rate patterns, 169 were randomly assigned to pH analysis, and 172 to lactate measurements. Lactate was measured using a lactate card requiring 5 μL of blood and yielding the result within 60 seconds. pH analysis was performed with an ABL 510 acid‐base analyser requiring 35 μL of blood and yielding the results within 47 seconds.

Results
Unsuccessful fetal blood sampling procedures (no result or an unreliable result) occurred significantly more often in the pH subgroup than in the lactate subgroup (OR 16.1 with 95% CI 5.8‐44.7). In the pH subgroup the failure rate was inversely related to the degree of cervical dilatation. Compared with the pH subgroup, the lactate subgroup was characterised by fewer fetal scalp incisions per blood sampling attempt (median 1.0 [interquartile range (IQR) 1‐11 vs 2.0 [IQR 1‐21]), and significantly less time required for the sampling procedure (median 120 s [IQR 90‐147] vs 230 s [IQR 180‐3001). The groups did not differ in mode of delivery, neonatal outcome and umbilical artery acid–base balance and lactate levels.

Conclusion
This trial showed the levels of lactate and pH in fetal scalp blood to be comparable in predicting perinatal outcome, but the procedure to measuring lactate was more successful than that for pH. Owing to its simplicity of performance, lactate analysis is an attractive alternative for intrapartum fetal monitoring.
First trimester ultrasonographic diagnosis of fetal structural abnormalities in a low risk population
Authors: Economides Demetrios L. , Braithwaite Jeffrey M.
Published: August 2005

Objectives
Ultrasonographic screening between 12+01 and 13+6 weeks for fetal structural abnormalities using transab dominal sonography and, where necessary, transvaginal sonography in a low risk population.

Design
A prospective observational study

Setting
London teaching hospital

Methods
Pregnant women with a total of 1632 low risk viable fetuses between 12+0 and 13+6 weeks of gestation were scanned using transabdominal and, where necessary, transvaginal sonography (40%). If the anatomical survey was normal, the women underwent routine 18‐20 week anomaly scans. Pregnancy outcomes were obtained from radiological and neonatal computerised databases, and postal or telephone patient enquiry.

Results
Seventeen (1.0%) major structural abnormalities were diagnosed in the study group. Of these, 11 (64.7%) were diagnosed at the 12‐13 week scan, three diagnosed in the mid‐trimester and three postnatally. Of the fetal abnormalities diagnosed antenatally, 78.6% were diagnosed in the first trimester. The sensitivity of abnormality detection by the combination of both first and second trimester scans was 82.3%. In addition, a significant number of missed abortions (n= 36) were also diagnosed by the first trimester scan.

Conclusion
This study has demonstrated the potential of screening a low risk population for fetal abnormalities at 12‐13 weeks of gestation using transabdominal sonography and, where necessary, transvaginal sonography. Larger studies are required to establish the clinical value of the first trimester scan.
First trimester sonographic detection of chromosomal abnormalities in an unselected population
Authors: Economides Demetrios L. , Whitlow Barry J. , Kadir Rezan , Lazanakis Michael , Verdin Stuart M.
Published: August 2005

Objective
To investigate the role of first trimester sonography in detecting chromosomal abnormalities in an unselected obstetric population.

Methods
2281 women (mean maternal age 30 years [range 16‐47]; mean gestational age 12+3 weeks [range 11‐14]) underwent transabdominal scanning to assess fetal structure and, if anatomical survey was considered to be incomplete (31% of cases), transvaginal sonography was also performed. Measurement of nuchal translucency was included and karyotyping performed as considered appropriate.

Results
There were 16 chromosomal abnormalities; 13 (81%) were diagnosed at 11‐14 weeks either because of a nuchal translucency greater than or equal to the 99th centile for gestational age (7/16; 44% [95% CI 25‐63]) or due to the presence of structural abnormalities (6/16; 38% [95%CI 14.2–61.81). Seventy‐five percent of cases of trisomy 21 were also diagnosed either because of having a nuchal translucency greater than or equal to the 99th centile (5/8; 63%) or due to the presence of a structural abnormality (1/8; 13%).

Conclusions
A significant proportion of fetal chromosomal abnormalities can be detected by first trimester sonographic screening to assess fetal structural appearance. The sensitivity of detection can be improved by combining measurement of nuchal translucency with detailed examination of fetal anatomy.
The prevalence of chronic pelvic pain in women in the United Kingdom: a systematic review
Authors: Zondervan Krina T. , Yudkin Patricia L. , Vessey Martin P. , Dawes Martin G. , Barlow David H. , Kennedy Stephen H.
Published: August 2005

Objective
Toobtain a prevalence estimate for chronic pelvic pain in women in the United Kingdom by analysing published data.

Design
Systematic review of published papers.

Setting
The general population or hospitals in the United Kingdom.

Population
Women participating in relevant community surveys or control women participating in hospital‐based studies.

Methods
Papers were retrieved by systematically searching the databases MEDLINE, EMBASE and PsycLit, and by hand searching. Studies were included if they 1. were community‐based and reported prevalence rates of chronic pelvic pain, dyspareunia, dysmenorrhoea, or abdominal pain, or 2. referred to a clinical population but reported prevalence rates in a disease‐free control group.

Main outcome measures
Prevalence rates for chronic pelvic pain including any overlap with dyspareunia, dysmenorrhoea and abdominal pain.

Results
No community‐based study has been performed that provides an estimate of the prevalence of chronic pelvic pain in the general UK population. A rate of 39% was reported in women undergoing laparoscopy for sterilisation or investigation of infertility in the single study from the United Kingdom investigating chronic pelvic pain unrelated to menstruation or intercourse. Prevalence rates for dyspareunia, dysmenorrhoea, and abdominal pain found in UK community‐based studies were 8%, 45%, to 97%, and 23% to 29%, respectively, but definitions used varied greatly.

Conclusions
Because chronic pelvic pain can reduce the quality of life and general wellbeing, there is a need for a community‐based study into the prevalence of chronic pelvic pain and its effect upon the lives of women in the UK.
Insulin sensitivity in pre‐eclampsia
Authors: Roberts Ralph N. , Erik Henriksen Jan , Hadden David R.
Published: August 2005

Objective
To investigate whether pre‐eclampsia is associated with an exaggeration of the insulin resistance seen in normotensive pregnancy.

Design
Minimal model analysis of a frequently sampled intravenous glucose tolerance test to assess insulin sensitivity.

Setting
Royal Maternity Hospital, Belfast.

Participants
Eleven women with pre‐eclampsia and 11 matched normotensive pregnant women.

Results
Insulin sensitivity (SI) was increased in the group with pre‐eclampsia compared with the normotensive women (mean [±SEM]: 2.6 [0.4] vs 1.6 [0.2] 10−4 min−1 per mU/L; P= 0.028). This was accompanied by a decrease in glucose effectiveness (SG) (1*1 ±0.1 vs 1.7 ±0.1 10−2 mid, P= 0.006) in the pre‐eclamptic women. In the normotensive group there was a significant inverse correlation between S, and mean arterial blood pressure (Y=−0.65; P= 0.03), but no such relation existed in the group with pre‐eclampsia.

Conclusions
As with other forms of secondary hypertension, and unlike essential hypertension, the pathophysiology of pre‐eclampsia is not associated with insulin resistance.
The performance of screening tests for ovarian cancer: results of a systematic review
Authors: Bell Ruth , Petticrew Mark , Sheldon Trevor
Published: August 2005

Objective
To estimate the performance of currently available tests in detecting ovarian cancer in asymptomatic women.

Methods
Systematic review of prospective screening studies.

Results
Twenty‐five studies were identified: sixteen studied women at average risk and nine studied women at higher risk. Most studies evaluated only one screening method, were small, detecting few cancers, and gave few follow up details. Sensitivity estimates are therefore imprecise. In a typical larger study, reported sensitivity of ultrasound screening at one year was around 100% (95% CI 54%–100%), while the sensitivity of CA125 measurement followed by ultrasound (multimodal screening) was about 80% (95% CI 49%–95%). False positive rates ranged between 1.2% and 2.5% for grey scale ultrasound, between 0.3% and 0.7% for ultrasound with colour Doppler and between 0.1% and 0.6% for multimodal screening. This implies that, in annual screening of a population with an incidence of 40 per 100,000, and if no cancers were missed, between 2.5 and 60 women would undergo surgery for every primary ovarian cancer detected.

Conclusions
Ultrasound and multimodal screening can detect ovarian cancer in asymptomatic women, but there is currently no evidence on whether screening improves outcome for women in any risk group. On‐going randomised controlled trials should establish the magnitude of any benefit of screening. The low prevalence of ovarian cancer in the population, and its rate of progression, may limit the potential cost‐effectiveness of screening.
A prospective intervention study of stopping smoking in pregnancy in a routine antenatal care setting
Authors: Wisborg Kirsten , Brink Henriksen Tine , Jørgen Secher Niels
Published: August 2005

ObjectivesTo evaluate the effect of specific education of midwives on stopping smoking in pregnant women and to determine the effect of this programme on pregnancy outcome.

DesignA prospective intervention study.

SettingDepartment of Gynaecology and Obstetrics, Aarhus University Hospital, Denmark.

Population and methodsA group of midwives (9 out of 54) was taught the effects of smoking during pregnancy and instructed in various methods of educating women to stop smoking. All pregnant women who attended antenatal care from October 1994 to September 1995 were either in the intervention group (n = 527) or the control group (n = 2629). Pregnant women attending the specifically educated midwives were considered to be the intervention group. They were given individual advice about stopping smoking at the first antenatal visit at about 16 weeks of gestation and a leaflet on smoking and pregnancy.

ResultsAt the first antenatal visit at about 16 weeks of gestation, 22% of the pregnant women smoked. Between the first visit and the routine visit at 30 weeks of gestation 51 (2%) stopped smoking and 56 (2%) started smoking. No differences were found between the intervention group and the control group in the rate of stopping smoking, validated by cotinine measurements. Mean birthweight, mean gestational age and the proportion of preterm birth in the two groups were similar.

ConclusionEducation of midwives and integration of advice about smoking cessation at a low cost in routine antenatal care failed to affect smoking habits among pregnant women.
A randomised controlled trial of care of the perineum during second stage of normal labour
Authors: McCandlish Rona , Bowler Ursula , van Asten Hedwig , Berridge Georgina , Winter Cathy , Sames Lesley , Garcia Jo , Renfrew Mary , Elbourne Diana
Published: August 2005

Objective
To compare the effect of two methods of perineal management used during spontaneous vaginal delivery on the prevalence of perineal pain reported at 10 days after birth.

Design
Randomised controlled trial.

Setting
Two English maternity care units.

Sample
5471 women who gave birth between December 1994 and December 1996.

Methods
At the end of the second stage of labour women were allocated to either the ‘hands on’ method, in which the midwife's hands put pressure on the baby's head and support (‘guard’) the perineum; lateral flexion is then used to facilitate delivery of the shoulders, or the ‘hands poised’ method, in which the midwife keeps her hands poised, not touching the head or perineum, allowing spontaneous delivery of the shoulders.

Main outcome measure
Perineal pain in the previous 24 hours reported by women in self‐administered questionnaire 10 days after birth.

Results
Questionnaires were completed by 97% of women at 10 days after birth. 910 (34.1%) women in the ‘hands poised’ group reported pain in the previous 24 hours compared with 823 (31.1%) in the ‘hands on’ group (RR 1.10, 95% CI 1.01 to 1.18: absolute difference 3%, 0.5% to 5%, P = 0.02). The rate of episiotomy was significantly lower in the ‘hands poised’ group (RR 0.79, 99% C1 0.65 to 0.96, P= 0.008) but the rate of manual removal of placenta was significantly higher (RR 1.69, 99% CI 1.02 to 2.78; P= 0.008). There were no other statistically significant differences detected between the two methods.

Conclusion
The reduction in pain observed in the ‘hands on’ group was statistically significant and the difference detected potentially affects a substantial number of women. These results provide evidence to enable individual women and health professionals to decide which perineal management is preferable.
Increased large arterial stiffness and impaired acetylcholine induced skin vasodilatation in women with previous gestational diabetes mellitus
Authors: Hu Jie , Norman Mikael , Wallensteen Måna , Gennser Gerhard
Published: August 2005

Objective
Gestational diabetes is associated with increased risk of developing noninsulin‐dependent diabetes (NIDDM) later in life. By the time that a diagnosis of NIDDM is established, functional disturbances in the vascular system may be observed. This study was planned to assess macro‐ and microvascular function in nonpregnant women without signs of diabetes two to four years after a pregnancy complicated with gestational diabetes.

Design
Cross‐sectional study.

Setting
Vascular research laboratory in the obstetric unit of a university hospital.

Participants
Seventeen nonpregnant, healthy women with a history of gestational diabetes and 20 nonpregnant control women of similar age without previous diabetes.

Methods
For quantification of the mechanical properties in large arterial vessels the wall movements of the abdominal aorta and left common carotid artery were recorded with an ultrasonic tracking system. Microvascular perfusion in the skin of the hand and foot was recorded by a laser Doppler technique to assess the vasodilatory response induced by transcutaneous acetylcholine.

Results
Women in the gestational diabetes group showed evidence of increased wall stiffness in the common carotid artery and a lower maximum incremental velocity of the pulsatile vessel diameter change in both aorta and carotid artery compared with controls. Acetylcholine induced vasodilatation in both hand and foot was lower in women with previous gestational diabetes compared with controls.

Conclusion
Abnormal vascular function was found in asymptomatic women with a history of gestational diabetes. It is speculated that these abnormalities might be early evidence of vascular complications associated with subsequent NIDDM.
Outcome of very preterm small for gestational age infants: the first nine years of life
Authors: Kok Joke H. , Lya den Ouden A. , Verloove‐Vanhorick S. Pauline , Brand Ronald
Published: August 2005

Objective
To determine the influence of intrauterine growth retardation of preterm infants on mortality and cognitive development.

Design
A nationwide study cohort of very preterm and/or small for gestational age infants (< 32 weeks and/or < 1500 g) born alive in 1983 in the Netherlands. Assessment on neuromotor and cognitive development at five years, and a parental questionnaire on school performance at nine years. Cognitive outcome is defined as handicap for mental and speech‐language development, and need for special education.

Sample
134 small for gestational age infants (< 10th centile) and 410 appropriate for gestational age infants (between 25th and 75th centile) of all infants between 25 and 32 weeks of gestational age were identified; infants with congenital malformations and not of Caucasian race were excluded.

Main outcome measures
Neonatal mortality, in‐hospital and five years mortality; Cognitive outcome at five years; School performance at nine years.

Results
The mortality risk for small for gestational age compared with appropriate for gestational age infants was significantly higher, after adjustment for gestational age, sex, multiple pregnancy and mode of delivery (OR 2–56,95% CI 1.26–5.26). Small for gestational age infants showed more often gross motor and minor neurological dysfunction, but less cerebral palsy than appropriate for gestational age infants. Cognitive outcome at five years in small for gestational age infants was significantly worse than appropriate for gestational age infants stratified for mode of delivery OR 2.44 (95% CI 1.05–5.55). At nine years of age significantly more small for gestational age infants (1 6.4%) needed special education than appropriate for gestational age infants (11.9%).

Conclusion
Intrauterine growth retardation increases the risk of mortality and of cognitive disorders.
Prolonged pregnancy: evaluating gestation‐specific risks of fetal and infant mortality
Authors: Hilder Lisa , Costeloe Kate , Thilaganathan Baskaran
Published: August 2005

Objective
To evaluate gestation‐specific risks of stillbirth, neonatal and post‐neonatal mortality.

Design
Retrospective analysis of 171,527 notified births (1989–1991) and subsequent infant survival at one year, from community child health records.

Setting
Notifications from maternity units in the North East Thames Region, London.

Main outcome measures
The incidence of births, stillbirths, neonatal and post‐neonatal deaths at each gestation after 28 completed weeks. Mortality rates per 1000 total or live births and per 1000 ongoing pregnancies at each gestation were calculated.

Results
The rates of stillbirth at term (2.3 per 1000 total births) and post‐term (1.9 per 1000 total births) were similar. When calculated per 1000 ongoing pregnancies, the rate of stillbirth increased six‐fold from 0.35 per 1000 ongoing pregnancies at 37 weeks to 2.12 per 1000 ongoing pregnancies at 43 weeks of gestation. Neonatal and post‐neonatal mortality rates fell significantly with advancing gestation, from 15 1.4 and 31.7 per 1000 live births at 28 weeks, to reach a nadir at 41 weeks of gestation (0.7 and 1.3 per 1000 live births, respectively), increasing thereafter in prolonged gestation to 1.6 and 2.1 per 1000 live births at 43 weeks of gestation. When calculated per 1000 ongoing pregnancies, the overall risk of pregnancy loss (stillbirth + infant mortality) increased eight‐fold from 0.7 per 1000 ongoing pregnancies at 37 weeks to 5.8 per 1000 ongoing pregnancies at 43 weeks of gestation.

Conclusion
The risks of prolonged gestation on pregnancy are better reflected by calculating fetal and infant losses per 1000 ongoing pregnancies. There is a significant increase in the risk of stillbirth, neonatal and post‐neonatal mortality in prolonged pregnancy. This study provides accurate data on gestation‐specific risks of pregnancy loss, enabling pregnant women and their carers to judge the appropriateness of obstetric intervention.
Immediate and delayed pushing in the second stage of labour for nulliparous women with epidural analgesia: a randomised controlled trial
Authors: Vause S. , Congdon H. M. , Thornton J. G.
Published: August 2005

Objective
To test the hypothesis that a policy of delaying active pushing in nulliparous women with epidural analgesia in labour reduces operative vaginal deliveries.

Design
A randomised controlled trial.

Setting
The delivery suite at Leeds General Infirmary.

Sample
One hundred and thirty‐five nulliparous women with an effective epidural in labour.

Methods
The women were randomised to early pushing (commencement of pushing within one hour of the diagnosis of full dilatation) or delayed pushing (delaying pushing for a maximum of three hours from the time of diagnosis of full dilatation, unless the vertex was visible at the introitus sooner). epidural analgesia in labour reduces operative vaginal deliveries.

Main outcome measure
Rate of instrumental vaginal delivery.

Results
There was a nonsignificantly increased rate of instrumental vaginal delivery with early pushing (odds ratio 1.31,95% CI 0.62–2.78). No adverse effects were noted.

Conclusion
Although delayed pushing was associated with fewer instrumental vaginal deliveries, the size of the effect may have occurred by chance and the evidence does not, at present, justify a general recommendation towards either early or delayed pushing.
A randomised placebo controlled trial of suppressive acyclovir in late pregnancy in women with recurrent genital herpes infection
Authors: Brocklehurst P. , Kinghorn G. , Carney O. , Helsen K. , Ross E. , Ellis E. , Shen R. , Cowan F. , Mindel A.
Published: August 2005

Objective
To evaluate the efficacy and safety of a suppressive course of acyclovir in late pregnancy in women with recurrent genital herpes infection on the incidence of viral shedding, herpes lesion development and caesarean section for recurrent genital herpes.

Design
Double‐blind, randomised placebo controlled clinical trial.

Setting
Adepartment of genitourinary medicine in Sheffield and an antenatal clinic in London.

Population
Pregnant women with recurrent genital herpes infection at < 36 weeks of gestation.

Methods
Participating women were given acyclovir 200 mg four times a day (or matching placebo) from 36 weeks of gestation until the time of delivery. Women were seen weekly and viral cultures were obtained from the cervix and vulva. Decisions regarding mode of delivery were left to the discretion of the attending obstetrician.

Main outcome measures
Delivery by caesarean section for recurrent genital herpes infection. Number of episodes of recurrent genital herpes infection and number of episodes of asymptomatic viral shedding during the treatment period. In addition blood was taken at two weekly intervals to determine acyclovir levels.

Results
The total number of women recruited was 63 (3 1 received acyclovir and 32 received placebo). The number of women undergoing delivery by caesarean section for recurrent herpes at the time of delivery was 12 (19%). The odds ratio for delivery by caesarean section in women taking acyclovir, compared with those talung placebo, was 0.44 (95% CI 0.09–1.59). The odds ratio for clinical recurrences during treatment was 0.10 (95% confidence interval 0.00–0.86) and the odds ratio for clinical recurrence or asymptomatic shedding during treatment was 0.32 (95% CI 0.05–1.56).

Conclusion
This trial was unable to demonstrate that acyclovir can significantly decrease the number of caesarean section deliveries; however, the number of clinical recurrences was significantly reduced. Two episodes of asymptomatic virus shedding both occurred in women taking acyclovir. At the present time there is little evidence to suggest that acyclovir should be used outside randomised controlled trials for the suppression of recurrent genital herpes infection during pregnancy.
A population based case‐control teratologic study of oral metronidazole treatment during pregnancy
Authors: Czeizel Andrew E. , Rockenbauer Magda
Published: August 2005

Objective
To study human teratogenic risk of metronidazole.

Design
A case‐control analysis of congenital abnormalities after oral metronidazole treatment during pregnancy grouped by months of gestation. The source of information concerning the use of drugs during pregnancy was the prospective data of the women's prenatal logbook and the retrospective data of a questionnaire filled in by mothers.

Setting
The large population‐based dataset of the Hungarian Case‐Control Surveillance of Congenital Abnormalities, 1980–1991.

Participants
The control group involved 30,663 pregnant women who had healthy babies; the response rate was 65%. The index group consisted of 17,300 pregnant women who had offspring with congenital abnormalities from the study pregnancy; data were available for 82% of these women.

Results
Of 30,663 pregnant women in the control group, 1041 (3.4%) were treated with metronidazole, 162 (0.53%) in the second to third month of gestation. Of 17,300 pregnant women in the index group, 665 (3.8%) were treated with metronidazole, 104 (0.66%) in the second to third months. McNemar analysis for case‐matched control pairs indicated a somewhat higher maternal metronidazole treatment in the second‐third months of gestation in nine cases with cleft lip with or without cleft palate, but it was not possible to exclude the recall bias. In addition, this finding was not confirmed by the comparison of cases with cleft lip with or without cleft palate and the total control group.

Conclusion
Treatment with oral metronidazole during pregnancy presents no clinically important association with congenital abnormalities.
Obstetric outcome in 232 ovum donation pregnancies
Authors: Abdalla Hossam I. , Billett Anne , Kan Andrew K. S. , Baig Sabah , Wren Marie , Korea Lena , Studd John W. W.
Published: August 2005

Objective
To study the obstetric outcome of ovum donation pregnancies.

Design
A retrospective analysis of 232 ovum donation pregnancies in the six years from 1988 to 1993.

Setting
Infertility clinic in a private hospital.

Participants
All ovum donation recipients that achieved pregnancy in the clinic during the stated time period.

Main outcome measures
Percentages of live birth and miscarriages and ectopic pregnancies; number of sacs identified in the uterus at early (four weeks after transfer) and later scans; incidence of antepartum and postpartum haemorrhage; incidence of pregnancy‐induced hypertension; incidence of preterm, low birthweight and small‐for‐gestational age babies; and incidence of operative deliveries.

Results
Of 232 pregnancies, 151 babies were born (live birth rate of 20%); and 81 were lost (57 before eight weeks, 17 after eight weeks and seven ectopic pregnancies). In nine cases there were no intrauterine sacs at the early scan (two ‘chemical pregnancies’ and seven ectopic pregnancies). In 169 cases there was initially one intrauterine sac, ending with 102 singleton deliveries (60%); in 47 cases there were initially two intrauterine sacs, ending with 11 singleton deliveries (23%) and 32 twin deliveries (68%); in the seven cases where three sacs were identified initially, there were no singleton deliveries, three twin deliveries (one selective fetal reduction) and three triplet deliveries. Women with premature ovarian failures had a significantly higher pregnancy rate compared with those with functioning ovaries (P < 0.02). However, in the former group, the miscarriage rate was also significantly higher (P < 0.03) so that the number of term births was similar. The incidence of vaginal bleeding was 12% in the first trimester, 1.5% in the second trimester, and 2% in the third trimester. The incidence of postpartum haemorrhage was 12%. Thirty‐two women had pregnancy induced hypertension (23% of all deliveries). This occurred in 22/105 singletons (21%), 7/32 twins (22%) and in all three (100%) of the triplets. In the singleton group 13% of infants were preterm, 18% had a birthweight < 2.5 kg and 15% were < 3rd centile for birthweight at delivery (small‐for‐gestational age). Ovarian function was found to be the only factor that significantly influenced the incidence of small‐for‐gestational age babies (odds ratio 8.84; 95% confidence interval 1.1–70.0; P= 0.007). The overall operative delivery rate was 85% with the caesarean section rate being 69%.

Conclusions
Women who become pregnant following oocyte donation should be considered obstetrically as high risk, especially those with ovarian failure because of the increased incidence of small‐for‐gestational age infants in these pregnancies. They are also at higher risk of pregnancy induced hypertension and postpartum haemorrhage.
Progesterone resistance in women who have had breast cancer
Authors: Simpson H. W. , McArdle C. S. , Griffiths K. , Turkes A. , Beastall G. H.
Published: August 2005

Objective
To investigate whether certain physiological responses to luteal progesterone are normal in women previously treated for breast cancer.

Design
Salivary progesterone concentrations, basal body temperatures, and breast blood flow changes (surface temperature method) were all recorded daily for one natural menstrual cycle.

Setting
Participants in the study made saliva collections and temperature measurements at home under semi‐standardised conditions with supervisory visits by a project nurse.

Participants
Twenty‐five controls were compared with 30 women with previous breast cancer; all but three participants were parous and the average ages were 39 years (range 28–48) and 40 years (range 29–46), respectively. On average the women with previous breast cancer had had surgery 2.4 years previously; the operation was usually mastectomy, leaving the contralateral breast for study.

Results
Follicular phase (day 1–14) oral temperature averages were statistically indistinguishable between women in the control group and those with previous breast cancer. Luteal progesterone profiles were considered in the normal range for the controls and patients. However, the women with previous breast cancer, on average, exhibited a significantly smaller rise in the luteal phase basal body temperature. Follicular phase breast surface temperature was significantly higher in the breast cancer group (+0.30°C). This group showed a highly significant reduction of the luteal heat cycle in their breasts.

Conclusions
Two progesterone‐mediated physiological mechanisms have been found to be significantly less responsive in women with previous breast cancer than controls. The literature has been reviewed. Progesterone resistance could be a clinical entity and could be important in carcinogenesis.
The reliability of catheter‐tip transducers for the measurement of intrauterine pressure in the third stage of labour
Authors: Chua S. , Lee M. , Vanaja K. , Chong Y. S. , Nordstrom L. , Arulkumaran S.
Published: August 2005

In order to assess the reliability of intrauterine pressure measurements in the third stage of labour, catheter‐tip transducers were used in 20 women randomly allocated into two groups of 10. In each case in the first group two catheters were tied together and introduced transcervically into the uterine cavity after delivery of the placenta. In each case in the second group two catheters were inserted independently into the same uterine cavity. The active and cumulative active pressures recorded from the pairs of catheters within each uterine cavity were compared. Comparison of individual active pressure readings from separate transducers revealed good agreement whether the catheters were tied together or were seperate. Cumulative active pressure was very similar when assessed by each catheter in the same uterus. Intrauterine catheter‐tip transducers can be used reliably to measure uterine activity in the third stage of labour although there may be minor contraction by contraction differences in recordings of individual active pressures.
Induced abortion in the first trimester of pregnancy and risk of miscarriage
Authors: Parazzini Fabio , Chatenoud Liliane , Tozzi Luca , Di Cintio Elisabetta , Benzi Guido , Fedele Luigi
Published: August 2005

Objective
To analyse the relation between induced abortion and risk of subsequent miscarriage.

Design
Case‐control study conducted between February 1990 and May 1995.

Participants
Case group included 782 women (median age 32 years, range 1446) admitted for spontaneous abortion (within the 12th week of gestation) to a network of obstetric departments in the greater Milan area. The control group was recruited among women who gave birth at term (> 37 weeks of gestation) to healthy infants on randomly selected days at the hospitals where cases had been identified. A total of 1543 controls (median age 30 years, range 14–45) were interviewed.

Results
A total of 102 cases (13%) and 181 controls (12%) reported one or more induced abortions. No clear relation emerged between miscarriage and induced abortions. In comparison with women reporting no induced abortion the odds ratio (OR) for miscarriage were 1.1 (95% CI 0.8–1.4) in women reporting one induced abortion and 0.9 (95% CI 0.4–1.8) in women reporting two or more. Likewise, there was no association between time since last and age at first induced abortion and risk of miscarriage.

Conclusions
This study did not find any strong association between induced and spontaneous abortion.
Endoscopic laser coagulation in the management of severe twin‐to‐twin transfusion syndrome
Authors: Ville Yves , Hecher Kurt , Gagnon Alain , Sebire Neil , Hyett Jon , Nicolaides Kypros
Published: August 2005

Objective
To assess the clinical effectiveness of endoscopic laser coagulation of placental vessels in the

Design
Prospective study.

Setting
Three referral centres for the management of twin‐to‐twin transfusion syndrome.

Population
One hundred and thirty‐two pregnancies complicated by severe twin‐to‐twin transfusion syndrome, reflected by polyhydramnios and enlarged bladder of one twin and oligoanhydramnios and collapsed bladder of the other twin, presenting before 28 weeks of gestation.

Methods
Prospective collection of data on pre‐procedure assessment, the procedure and the follow up were collected prospectively. Laser coagulation of placental vessels crossing the intertwine membrane on the chorionic surface under sono‐endoscopic guidance, followed by amniodrainage.

Main outcome measures
Maternal and pregnancy complications, perinatal death and morbidity were assessed over the last five years with follow up of survivors.

Results
Endoscopic laser was carried out at a median gestation of 21 weeks. The total number of surviving infants was 144 (55%) and there was at least one survivor in 97 cases (73%). At a minimum age of one year neurological handicap was suspected in six survivors (4.2%).

Conclusions
The results of this multicentre study are similar to those in our original report on the first 45 cases. In comparison with serial amniodrainage, the survival rate may be similar, but the handicap rate in survivors appears much lower. This study stresses the need for a prospective study comparing treatment of severe transfusion syndrome threse two techniques.
A systematic review and meta‐analysis of family history and risk of ovarian cancer
Authors: Stratton John F. , Pharoah Paul , Smith Steven K. , Easton Doug , Ponder Bruce A. J.
Published: August 2005

Objective
To estimate the relative risk and lifetime risk of ovarian cancer in women with various categories of family history.

Design
A meta‐analysis of all published caseecontrol and cohort studies.

Methods
Pooled relative risk estimates were calculated for the caseecontrol studies, using the Mantel‐Haenzel method. These estimates were combined with the relative risks from the cohort studies. The pooled estimates of relative risk were used to estimate lifetime risks of ovarian cancer from age 15 Up to age 75, for various categories of family history.

Main outcome measures
Relative risks and lifetime risks of developing ovarian cancer were calculated for the categories of women with 1. an affected first degree relative; 2. an affected mother; 3. an affected sister; and 4. women with more than one affected relative.

Results
The relative risk to first degree relatives is 3.1 (95% CI 2.6–3.7). There is some evidence that this relative risk declines with age. The relative risk to mothers of cases 1.1 (95% CI 0.8–1.6) was lower than the relative risks to sisters: 3.8 (95% CI 2.9–5.1), and daughters: 6.0 (95% CI 3.0–11.9); the explanation of this difference is unclear.

Conclusions
Women with a family history of ovarian cancer have a substantially higher risk of developing ovarian cancer compared with women without such a history. However the risk is small for most categories of family history, except for the small number of individuals who have more than one affected relative.
Impact of surgery for stress incontinence on the social lives of women
Authors: Black N. A. , Bowling A. , Griffiths J. M. , Pope C. , Abel P. D.
Published: August 2005

Objective
To assess the feasibility of collecting disease‐specific and generic data on the impact of surgery on the social lives of women with stress incontinence; to describe the social impact of surgery in a representative group; and to determine the effect of timing on the assessment of outcome.

Design
Longitudinal study; questionnaires before and three, six, and twelve months after surgery.

Setting
Eighteen hospitals in North Thames region.

Participants
Four hundred and forty‐two women undergoing surgery for stress incontinence between January 1993 and June 1994.

Main outcome measures
Post‐operative recovery time, stress incontinence symptom impact index, activities of daily living, and cost of protection.

Results
Post‐operative recovery was uneventful for most women, but three months after surgery 24% of those in paid employment beforehand were still on sick or unpaid leave. Most women (75%) reported that stress incontinence had less adverse impact on their lives three months after surgery, though 18% reported no change, and 7% felt life was worse. The likelihood of improvement was similar regardless of whether pre‐operative urodynamic studies had been conducted. The extent of improvement was dependent on pre‐operative severity. Similar findings were obtained six and twelve months after surgery. After an initial slight but nonsignificant deterioration in their ability to carry out activities of daily living, women gained a slight benefit from surgery (proportion with no or only slight limitation rose from 72% to 82%; P= 0.0001). The mean cost of protection (pads and towels) fell from £8.59 a month before surgery to £2.99 a month one year after surgery, by which time 68% of women were not using protection. In contrast, 11% were still spending over £10 a month.

Conclusions
It is possible to collect standard data on the impact of surgery on social functioning and, thus, provide women with better information on likely outcomes. The benefits of pre‐operative urodynamic investigations need to be assessed. The stability of the outcome measures over the first post‐operative year suggest that outcomes need to be assessed only once and at any time from three to twelve months after the operation.
Shedding of syncytiotrophoblast microvilli into the maternal circulation in pre‐eclamptic pregnancies
Authors: Knight Marian , Redman Christopher W. G. , Linton Elizabeth A. , Sargent Ian L.
Published: August 2005

Objective
To investigate whether syncytiotrophoblast microvilli (STBM) are shed into the maternal circulation in increased amounts in pre‐eclamptic pregnancies as a possible cause of maternal vascular endothelial dysfunction.

Design
A time‐resolved fluoroimmunoassay was developed to measure STBM levels in peripheral and uterine venous plasma from normal pregnant and pre‐eclamptic women. Three colour flow cytometry was used to assess the microparticulate nature of the STBM in pregnancy plasma. The effects of these plasmas on endothelial cell proliferation was compared and a correlation with the levels of STBM detected was sought.

Setting
A laboratory investigation using clinical samples obtained from an obstetric practice in a teaching hospital.

Samples
Peripheral venous plasma from 20 women with established pre‐eclampsia, 20 normal pregnant women matched for age, gestation and parity, and 10 nonpregnant women of reproductive age. Paired uterine and peripheral venous plasma taken at caesarean section from 10 women with pre‐eclampsia and 10 unmatched normal pregnant women.

Results
STBM were detected in the plasma of pregnant women by both flow cytometry and time‐resolved fluoroimmunoassay. Significantly higher levels of STBM were found in women with established pre‐eclampsia (P= 0.01). STBM concentrations were higher in uterine venous plasma than in concurrently sampled peripheral venous plasma, confirming their placental origin. A significant correlation was found between the amount of STBM in the plasma and endothelial cell inhibitory activity.

Conclusions
STBM are shed into the maternal circulation (microvillous deportation) and are present in significantly increased amounts in pre‐eclamptic women. They may contribute to the endothelial dysfunction underlying the maternal syndrome of pre‐eclampsia.
The haemodynamic effects of ketanserin versus dihydralazine in severe early‐onset hypertension in pregnancy
Authors: Bolte Antionette C. , van Eyck Jim , Strack van Schijndel Rob J. M. , van Geijn Herman P. , Dekker Gustaaf A.
Published: August 2005

Objective
To compare the haemodynamic efficacy of ketanserin (a selective serotonin2‐receptor blocker) with dihydralazine in the management of severe early‐onset hypertension in pregnancy.

Design
Subgroup analysis within a randomised prospective multicentre trial to compare haemodynamic effects as measured by pulmonary artery catherization.

Setting
Departments of Obstetrics and Gynaecology and Intensive Care Medicine, Free University Hospital, Amsterdam and Sophia Hospital, Zwolle.

Participants
Thirty‐one women with a diastolic blood pressure > 110 mmHg and a gestational age between 26 and 32 weeks.

Results
The antihypertensive efficacy of both drugs was comparable. Dihydralazine significantly increased cardiac output (P < 0.01), while ketanserin induced only minor changes in cardiac output. Systemic vascular resistance decreased in both groups, but the decrease was significantly more pronounced with dihydralazine compared with ketanserin. Ketanserin induced a significant but not clinically relevant increase in heart rate (P < 0.01, while dihydralazine caused marked tachycardia (P < 0.005). Left ventricular stroke work index was reduced to similar values in both groups.

Conclusions
The antihypertensive profile of ketanserin is characterised by an early and gradual reduction of blood pressure in combination with a moderate decrease in systemic vascular resistance and no significant change in cardiac output. Dihydralazine causes market tachycardia resulting in a considerable increase in cardiac output.
Changes in the expression of the type‐2 but not the type‐1 cyclo‐oxygenase enzyme in chorion‐decidua with the onset of labour
Authors: Slater Donna , Allport Victoria , Bennett Phillip
Published: August 2005

Objective
To determine the relative expression of cyclo‐oxygenase (COX)‐1 and COX‐2 in the chorion‐decidual part of human fetal membranes following delivery at term and to identify any changes in expression associated with labour.

Methods
Fetal membranes were collected from 12 term pregnancies before labour following elective caesarean section and from 12 spontaneous vaginal deliveries. Expression of COX‐1 and COX‐2 mRNA was measured using a previously validated quantitative RT‐PCR assay.

Results
COX‐2 expression exceeded that of COX‐1 by approximately eight‐fold. COX1 expression did not change but COX‐2 expression was found to increase four‐fold with labour.

Conclusions
Chorion‐decidua has the capacity to contribute to the increase in prostaglandin synthesis within the uterus associated with labour. As in the amnion, it is COX‐2 and not COX‐1 which is upregulated with labour. COX‐2 selective anti‐prostaglandins should therefore be as effective as nonselective drugs in inhibition of fetal membrane prostaglandin synthesis.