bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of gestational age of the Asian fetus by the sonar measurement of crown‐rump length and biparietal diameter
Authors: PARKER A. J. , DAVIES P. , NEWTON J. R.
Published: August 2005

Summary. Two populations of pregnant Asian and European women were scanned using linear array real‐time ultrasound machines. Measurements were made of fetal crown‐rump length (CRL) up to 14 weeks gestational age and of biparietal diameter (BPD) up to 20 weeks gestational age. Polynomial growth curves relating CRL and BPD measurements to their gestational ages were fitted to the data by the method of unweighted least squares. There were no significant differences between the Asian and European parameters for the CRL and BPD curves. European nomograms may be used to establish Asian fetal gestational age up to 20 weeks.
Normal cardiac ventricular geometry and function during the last trimester of pregnancy and early neonatal period
Authors: WLADIMIROFF J. W. , VOSTERS R. , McGHIE J. S.
Published: August 2005

Summary. Fetal and early neonatal left and right ventricular cardiac geometry and left ventricular cardiac function were studied by M‐mode technique in a cross‐sectional study between 28 and 40 weeks of gestation (n=227) and a longitudinal study from 24 h before until 48 h after delivery (n=15). Antenatally both ventricles were geometrically uniform; there was a 3·2–3·4‐fold increase in left ventricular volume and a nearly 3‐fold increase in left ventricular stroke volume and cardic output. During the early neonatal period the right ventricular transverse diameter reduced in size; there was a further 1·1‐fold rise in left ventricular volume and a further 1·2–1·3‐fold rise in left ventricular stroke volume and cardiac output.
Changed prognosis of breech‐presenting low birth weight infants
Authors: COX CHARLES , KENDALL A. C. , HOMMERS MARION
Published: August 2005

Summary. We have compared the mortality and morbidity of low birthweight breech‐presenting singleton infants born in the Coventry Maternity Hospital during the years 1973 and 1974 with those born during 1979 and 1980. During this period changes in management have included an increase in the caesarean section rate and the continuing development of methods of intensive care for the newborn infants. The neonatal mortality rate has fallen but the increased survival rate is accounted for largely by the survival of handicapped infants. The value of routine caesarean section in the absence of other obstetric pathology for low birthweight breeches is unproven and may be deleterious to mother and baby.
Results of heavy drinking in pregnancy
Authors: HALLIDAY HENRY L. , REID MARK McC. , McCLURE GARTH
Published: August 2005

Summary. The outcome of pregnancy is reported for 23 women who had been drinking alcohol heavily and who were delivered in Belfast maternity hospitals during the last 4 years. Twenty‐one (91%) of the babies were small‐for‐gestational age and many had head circumference measurements <5th centile. Ten babies (44%) had abnormal facies consistent with the ‘fetal alcohol syndrome’ and 10 babies had congenital malformations of the heart, palate, genitalia and kidneys. Perinatal problems which included breech presentation, birth asphyxia, hypoglycaemia, polycythaemia, hypocalcaemia and withdrawal symptoms were frequently present. Most of the babies have shown delayed postnatal growth and six of the ten who are aged over 1 year have delayed development.
Birthweight by gestational age and its effect on perinatal mortality in white and in Punjabi births: experience at a district general hospital in West London 1967–1975
Authors: DAWSON I. , GOLDER R. Y. , JONAS E. G.
Published: August 2005

Summary. At Hillingdon Hospital in West London two main ethnic groups: ‘UK’ (i.e., white European) and ‘Indian’ (i.e. Punjabi) account for the bulk of obstetric work load. Birthweight by gestational age graphs were calculated for some 6000 Indian and 18000 UK infants born between 1967 and 1975 inclusive. A mean weight difference at term favoured UK male babies by 240 g and UK female babies by 230 g. Though the crude perinatal results in the two populations were not significantly different, the perinatal mortality of infants <2500 g in birthweight was lower in the Indian than the UK population, particularly in the 1500–2400 g group. This is attributed to a levelling off in intrauterine growth from 36 to 37 weeks gestation onwards in Indian compared with UK pregnancies, so that they were more mature than UK births of the same weight. However light‐for‐dates births, defined as birth weights below the 10th centile of weight‐for‐gestational age on their own ethnic and sex specific standards pose problems, irrespective of ethnic background.
Intraventricular conduction time in fetuses born with growth retardation
Authors: BRAMBATI BRUNO , BONSIGNORE LUIGI
Published: August 2005

Summary. Averaged QRS complexes were studied in 26 pregnancies characterized by fetal growth retardation. A high correlation was found between QRS duration and infant birthweight and the QRS interval closely reflected the abnormal cardiovascular conditions that occur in the malnourished fetuses. QRS determination provides a complementary and accurate method to detect and assess an inappropriately growing fetus.
Forces required for surgical dilatation of the pregnant and non‐pregnant human cervix
Authors: ANTHONY G. S. , FISHER J. , COUTTS J. R. T. , CALDER A. A.
Published: August 2005

Summary. The force required to dilate the uterine cervix to a diameter of 8 mm has been measured in 200 non‐pregnant and 40 early pregnant patients. In general, the resistance offered by the cervix was lower in parous than in nulliparous subjects and in pregnant compared with nonpregnant subjects. The phase of the menstrual cycle did not appear to influence cervical resistance but the highest recordings were seen in postmenopausal subjects. Particularly low resistance was encountered in women receiving Depo‐Provera for contraceptive purposes.
Fetal crown‐rump length measurement by ultrasound in normal pregnancy
Authors: PEDERSEN JAN FOG
Published: August 2005

Summary. Fetal crown‐rump length (CRL) was determined by ultrasound in 105 healthy pregnant women. Each fetus was measured two to four times between the 7th and 14th week, giving a total of 300 observations. The descriptive curve of CRL as a function of age was very similar to those published by others. The longitudinally collected observations showed that CRL in female fetuses was significantly smaller compared with that in male fetuses (P<0·01). There was no demonstrable effect of maternal age, height or parity on fetal CRL. Measurement of CRL enables assessment of gestational age to within ±4–6 days (95% confidence interval), with greatest precision at CRL measurements of 31–40 mm. The discrepancy between ultrasound age as estimated from a CRL measurement and menstrual age may be a variable of prognostic significance in threatened abortion and maternal diabetes.
Ultrasonographic measurement of the yolk sac
Authors: CROOIJ M. J. , WESTHUIS M. , SCHOEMAKER J. , EXALTO N.
Published: August 2005

Summary. Ultrasonographic measurements of the yolk sac were made during first trimester in 100 pregnancies. The results were related to the crown‐rump length of the embryos and showed an increase in size from 7 to 11 weeks menstrual age. A possible relation between anomalies in yolk sac development and embryonic development was studied in six patients by means of serial weekly Ultrasonographic examinations. In one case with absence of the yolk sac embryonic death occurred at 10 weeks menstrual age; the embryo had spina bifida.
Reliability and accuracy of the zona‐free hamster ova assay in the assessment of male fertility
Authors: MARTIN RENEE H. , TAYLOR PATRICK J.
Published: August 2005

Summary. The efficacy of the zona‐free hamster ova assay in assessing male fertility was studied in 22 men of proven fertility, 16 of unproven fertility, and 31 who were members of infertile couples. The mean hamster ova penetration rates were significantly higher in males of proven fertility (34%) and unproven fertility (30%) than in infertile males (11%). Sperm from 21 of 22 men of proven fertility penetrated >15% of ova; one man had a zero penetration rate. Sperm from 8 of 16 men of unproven fertility and 24 of 31 men of infertile couples penetrated <15% of ova. There was no correlation between penetration rates and any of the traditional measures of semen analysis. Two assays were performed on every male and six assays were performed on six males. There was good interassay reliability in all 69 males (r=0·86) and in the six males with six tests (r=0·97). The mean interassay variation was 8·6%.
Predictive value of ultrasound measurement in early pregnancy: a randomized controlled trial
Authors: BENNETT MICHAEL J. , LITTLE GILLIAN , DEWHURST JOHN , CHAMBERLAIN GEOFFREY
Published: August 2005

Summary. Early fetal biparietal diameter (BPD) measurements were obtained with ultrasound in 1062 women attending for antenatal care; a random half had the results withheld from the obstetricians. Of the 1026 women who were sure of the dates of their last normal menstrual period, 829 (81%) were found to have appropriate biparietal diameter measurements, in 3% the pregnancy was more than 2 weeks further advanced and in 14% more than 2 weeks less than calculated. In 30% of the women whose results were intended to be withheld, the code had to be broken because of clinical concern. There were no differences in fetal outcome (birthweight centile, Apgar score at 1 min and perinatal mortality) in the women whose BPD results were known compared with those whose results were withheld from the obstetrician. But a significantly larger number of labours were induced for suspected growth retardation when the gestational age was known.
Oral contraceptives and venous thromboembolism
Authors: BERGQVIST AGNETA , BERGQVIST DAVID , HEDNER ULLA
Published: August 2005

Summary. In 58 patients with phlebographically diagnosed deep vein thrombosis during oral contraception the extension and localization of the thrombotic process was analysed in relation to the coagulation and fibrinolytic system 6 months after thrombosis. Left‐sided thrombi dominated and the thrombi were more extensive and proximal on the left side. This left‐sided dominance was more apparent with higher oestrogen content in the pills. The right‐sided thrombi more often were the source of pulmonary embolism. In 31% of the patients a defective fibrinolytic system was found; this defect was seen more often in patients with right‐sided thrombi. Only very few defects were found in the coagulation system. No patients had an antithrombin III deficiency.
Urinary incontinence and genital prolapse in the female: clinical, urodynamic and radiological examinations
Authors: WALTER STEEN , OLESEN KNUD P.
Published: August 2005

Summary. Clinical examination, cystometry, combined pressure–flow studies and colpocysto‐urethrography were used to investigate 369 consecutive patients referred with symptoms of genital prolapse or urinary incontinence. The incidence of urinary incontinence in women seeking hospital investigation and therapy was 240/100000 women per year. Three hundred and three complained of urinary incontinence, 21% of these had urge incontinence, 36% both urge and stress incontinence and 43% stress incontinence. There was no correlation between previous obstetric history and present symptoms, the severity and objective signs of incontinence or the urodynamic findings. Correlation was found between urge incontinence and the cystometric finding of overactive detrusor function. Stress incontinence as a symptom was well correlated with low‐pressure micturition. Pelvic examination did not differentiate between patients with different types of urinary incontinence. Cystometry was essential for the investigation of vesical dysfunction. Urodynamic studies and colpocysto‐urethrography were useful in the diagnosis of outlet disorders and suspension defects.
Outcome of spontaneous labour in multigravidae
Authors: GIBB D. M. F. , CARDOZO L. D. , STUDD J. W. W. , MAGOS A. L. , COOPER D. J.
Published: August 2005

Summary. From a study of 2000 consecutive labours, the outcome of 847 multigravid patients admitted in spontaneous labour was examined. Labour was classified according to the cervimetric pattern, and response to oxytocin given according to a strict protocol with the use of a nomogram and partogram. The mean ‘observed first stage’ was 3·4 h, and the caesarean section rate 1·4%. Normal labour occurred in 88·5%, with a vaginal delivery rate of 99·5% in this group. Stimulation was indicated in 98 patients (11·6%), augmentation improving the rate of progress in 86 (87·8%) of these, with vaginal delivery occurring in all but one. Successful accelerated labour was not associated with any increase in neonatal morbidity as judged by Apgar scores, intubation or transfer to the special care baby unit. Twelve patients did not have improvement following augmentation and seven were delivered by caesarean section, including one following a potentially preventable uterine rupture. The greatest neonatal morbidity was in the group with primary dysfunctional labour that did not improve with augmentation. It may be that this was related to the mode of delivery rather than augmentation, as there was no significant difference in neonatal condition between normal and abnormal labour if vaginal delivery occurred.
The value of antenatal cardiotocography in the management of high‐risk pregnancy: a randomized controlled trial
Authors: BROWN VALERIE A. , SAWERS R. S. , PARSONS R. J. , DUNCAN SHEILA L. B. , COOKE I. D.
Published: August 2005

Summary. The value of routine regular antenatal cardiotocography (CTG) in the management of high‐risk pregnancy was assessed in a prospective randomized controlled study of 353 patients. All patients had a weekly CTG trace during the last 6 weeks of pregnancy and according to random allocation the tracings were concealed from, or available to, the clinicians. Other methods of assessing fetal welfare were available to both groups. There was no significant difference between the concealed and revealed groups in the timing and mode of delivery, birthweights, Apgar score and neonatal morbidity. No apparent effect from the routine use of antenatal CTG in high‐risk pregnancy was shown.
Ritodrine in the management of fetal distress
Authors: SHEYBANY S. , MURPHY J. F. , EVANS D. , NEWCOMBE R. G. , PEARSON J. F.
Published: August 2005

Summary. The potential value of a bolus injection of ritodrine in the management of fetal distress was examined in 24 patients. Following the injection of ritodrine, uterine activity measured over a period of 14·7±6·3 (SD) min was reduced to 22 (±12·4 SD)% of the pre‐existing values. The cardiotocographic tracings showed a reversion to a normal or less ominous pattern in 14 of the 16 patients where this could be evaluated. The infants in the ritodrine group took less time to establish regular respirations. The perinatal neurobehaviour in the ritodrine and control groups did not differ. Two mothers who were given ritodrine and who received atropine premedication developed tachycardia and marked systolic hypertension. The administration of a bolus of ritodrine may have a place in the management of fetal distress when caesarean section is unavoidably delayed, but atropine premedication must be avoided as the combination can lead to potentially serious cardiovascular complications.
Aggregation of human platelets by amniotic fluid
Authors: SALEM HATEM H. , WALTERS WILLIAM A. , PERKIN JEAN L. , HANDLEYJ CHRISTOPHER J. , FIRKIN BARRY G.
Published: August 2005

Summary. Twenty‐four amniotic fluid samples were examined for their effects on human platelets. All samples caused irreversible platelet aggregation. The active material precipitated with high‐speed ultracentrifugation and was completely inhibited by prior incubation with purified collagenase. The presence of free collagen in amniotic fluid was further confirmed by polyacrylamide‐gel electrophoresis and hydroxyproline assays. Beside platelet‐aggregating activity, amniotic fluid samples were also shown to significantly shorten the recalcification time of normal plasma. This procoagulant activity appears to be related to the presence of thromboplastin, collagen and other as yet unidentified procoagulant material in amniotic fluid. The presence of activators of platelets and clotting factors in amniotic fluid would account for the strong clotpromoting activity of this fluid. These studies suggest that the ideal management of the coagulopathy of pregnancy should include a combination of anticoagulant and antiplatelet drugs.
Assessment of pituitary secretory capacity in women with hypogonadotrophic hypogonadism by using a long‐acting synthetic analogue of luteinizing hormone releasing factoi
Authors: WILLIAMS C. A. VAUGHAN , McNEILLY A. S. , BAIRD D. T.
Published: August 2005

Summary. The gonadotrophin responses to single and repeated injections of a long‐acting synthetic analogue of luteinizing hormone releasing factor (LRF), d‐Ser(TBU)6EA10LHRH, were investigated in 10 women with normoprolactinaemic hypogonadotrophic hypogonadism. Abnormal luteinizing hormone (LH) responses were observed in two of the five patients treated with 5μg of the analogue and in all five patients treated with three injections of 10, 20 and 10 uμg administered at intervals of 10‐14 h. However, the LH response to repeated injections of the analogue was of similar magnitude and duration to that observed in normal women in response to an oestrogen provocation test in the early‐to‐mid follicular phase of the cycle. Thus failure of the LH response to oestrogen provocation in women with hypogonadotrophism results from hypothalamic rather than primary pituitary dysfunction. This study confirms the usefulness of this analogue of LRF in the assessment of pituitary secretory function in women with abnormal responses to oestrogen positive feedback.
Outcome in patients with post‐pill amenorrhoea
Authors: SOLTAN M. H. , HANCOCK K. W.
Published: August 2005

Summary. Ninety‐six patients who developed amenorrhoea following the use of oral contraceptives were studied in two groups; one with a history of regular periods and the other with irregular periods prior to the use of oral contraceptives. Pregnancy rates were similar in patients with and without a previous history of menstrual dysfunction. Thirty‐nine of 47 patients who desired pregnancy and in whom there was no definable factor inhibiting pregnancy, succeeded in conceiving.
Cyclic GMP in urine to monitor the response of ovarian cancer to therapy
Authors: TURNER G. A. , ELLIS R. D. , GUTHRIE D. , LATNER A. L. , ROSS W. M. , SKILLEN A. W.
Published: August 2005

Summary. Guanosine 3′:5′‐phosphate (cyclic GMP) in urine has been used to monitor the response of patients with ovarian cancer to treatment. Changes in the cyclic GMP level appear to correlate well with clinical status in that the disappearance of clinically detectable tumour is associated with a drop in the level whereas a tumour recurrence is associated with an elevation. Serially measured cyclic GMP is valuable for detecting a recurrence of tumour growth in patients in clinical remission and can predate any clinical signs by as much as 10 months. In patients who show no response to treatment, cyclic GMP levels in urine are elevated in the majority of specimens collected.
Is the lecithin/sphingomyelin ratio outdated?
Authors: JAMES D. K. , TINDALL V. R. , RICHARDSON T.
Published: August 2005

Summary. The lecithin/sphingomyelin (L/S) ratio in amniotic fluid is an excellent predictor of fetal lung maturity in most pregnancies but today its value is limited. A review of the use of the L/S ratio service in Manchester from 1975 to 1981 (inclusive) shows a dramatic and consistent fall in the number of requests made over the last 18 months of this period resulting in inconvenience and inefficiency in the laboratory service. Possible explanations for the declining use of the L/S ratio service are discussed with particular reference to St Mary's Hospital, Manchester and a regional re‐organization of laboratory assessment of fetal lung maturity is proposed.
Twin pregnancy as a model for studies in fetal cortisol concentrations in labour: relation to prostaglandins, prolactin and ACTH
Authors: NORMAN R. J. , DEPPE W. M. , COUTTS P. C. , MARIVATE M. , JOUBERT S. M.
Published: August 2005

Summary. Cortisol and prostaglandins were measured in umbilical cord blood obtained from 50 twin pregnancies at caesarean section performed either before or during labour. Umbilical artery cortisol concentrations did not differ between twin I and II before labour or in the latent stage. During active labour cortisol levels were significantly higher in twin I than in twin II. Maternal cortisol levels did not correlate with cord blood cortisol levels in either twin before active labour, nor did the rise in maternal cortisol correlate with the cortisol level in twin I; maternal cortisol levels did, however, correlate with cortisol levels in twin II during active labour. Prostaglandins E(PGE), F2α(PGF2α), 13,14‐dihydro‐15‐keto F2αPGFM) and ACTH were measured in cord vein blood. PGE values did not differ between twin I and II before active labour. During active labour PGE levels were significantly greater in twin I and correlated with raised cortisol levels. No differences were seen at any stage in PGE and PGFM levels between twins I and II although PGFM levels increased in both twins during active labour. ACTH and prolactin levels did not increase during labour and were similar in twins I and II. The rise in fetal cortisol during active labour is primarily of fetal origin and PGE may be involved in stimulating cortisol production in the fetus.
Cervical dilatation by Lamicel—studies on the mechanism of action
Authors: NICOLAIDES K. H. , WELCH C. C. , KOULLAPIS E. N. , FILSHIE G. M.
Published: August 2005

Summary. Lamicel is a synthetic hydrophilic polymer tent which produces cervical softening and dilatation when inserted into the endocervical canal. To investigate the mechanism of action of Lamicel, the intrauterine pressure and levels of 6‐keto‐prostaglandin F1α, 13–14‐dihydro‐15‐keto‐prosta‐glandin F2α, oestradiol and progesterone in plasma and amniotic fluid were measured in patients undergoing second trimester abortion. There was no significant change in any of the measured hormones during a 2–h treatment with Lamicel, but uterine activity increased significantly for 10 min after insertion, then settled spontaneously to below pre‐treatment levels. Peripheral plasma levels of magnesium sulphate measured in patients undergoing first trimester abortion were not significantly raised after insertion of Lamicel. Light microscopic examination of cervical specimens, obtained at hysterectomy from patients pre‐treated with Lamicel for 24 h, revealed minimum increase in vascularity mast cell population and ground substance mucopolysaccharides.
Development of an improved technique for first‐trimester microsampling of chorion
Authors: RODECK C. H. , MORSMAN J. M. , GOSDEN CHRISTINE M. , GOSDEN JOHN R.
Published: August 2005

Summary. Six different methods of chorion biopsy were compared and assessed in 45 patients in the first trimester of pregnancy. A total of 103 biopsies was obtained; it was found that the most reliable, accurate and safe method combined direct transcervical endoscopy with real‐time ultrasound scanning, using an aspiration needle.
Trophoblast sampling by blind transcervical aspiration
Authors: LIU D. T. Y. , MITCHELL JOSEPHINE , JOHNSON JANE , WASS D. M.
Published: August 2005

Summary.Blind transcervical aspiration for trophoblast was carried out on 137 patients undergoing elective termination of early pregnancies. Trophoblast was obtained from 45 patients (33%) usually at the first attempt. Collection was not necessarily more successful between 8 and 11 weeks of gestation. In only 13 patients (9%) was trophoblast collected without contamination by maternal tissue, or blood. Perforation of the amniotic sac in one patient (1%), bleeding either observed, or detected histologically (34%) and introduction of infection (4%) constitutes a real threat to fetal survival. Maternal serum a‐fetoprotein estimation appears useful and may forewarn likelihood of fetal damage. Although transcervical aspiration should encounter ready acceptability as an outpatient procedure, modifications in the technique are essential before clinical application for detection of gene, or chromosome anomalies can be considered.
Primary dysmenorrhoea: the importance of both prostaglandins E2 and F2α
Authors: LUMSDEN M. A. , KELLY R. W. , BAIRD D. T.
Published: August 2005

Summary. Menstrual fluid was collected in a contraceptive diaphragm from 16 women with primary dysmenorrhoea and 12 matched control subjects without dysmenorrhoea. Prostaglandins F2α (PGF2α), E2 (PGE2) and 6‐oxo‐prostaglandin F1α (6‐oxo‐PGFlα) were extracted and measured using gas‐chromatography: mass spectrometry (GC:MS). The concentrations of both PGF2α and PGE2 were higher on days 1 and 2 in the dysmenorrhoea group than in the control group and the concentration of PGF2α was higher on day 1 than on day 2 in the dysmenorrhoea group. The concentrations of 6‐oxo‐PGF1α (the stable metabolite of PGI2) were low in both groups. These results confirm suggestions that PGF2α is important in the aetiology of dysmenorrhoea and also indicate that PGE2 may be involved.
Exclusion of the fetal brain as the main source of rat and human amniotic fluid oxytocin
Authors: SWAAB D. F. , OOSTERBAAN H. P.
Published: August 2005

Summary. At term relatively high oxytocin concentrations are found in maternal plasma and in rat and human amniotic fluid. To determine the contribution of the fetal brain to these oxytocin levels, the peptide was measured in maternal rat plasma and amniotic fluid 2 days after intrauterine removal of the fetal brains, and in the amniotic fluid of 16 human anencephalics. After removal of the fetal rat brains and in human anencephalic pregnancies normal maternal plasma concentrations and amniotic fluid oxytocin contents were found. Consequently, both maternal plasma oxytocin and amniotic fluid oxytocin are not determined to any substantial degree by the fetal brain.
Perceptions of labour: discrepancies between midwives' and patients' ratings
Authors: BRADLEY C. , BREWIN C. R. , DUNCAN S. L. B.
Published: August 2005

Summary. Women's ratings of their experience of childbirth were compared with midwives' ratings of the women's experience. The midwives' ratings were significantly different from those of their patients. Mid‐wives presented a more positive picture of the woman's experience than did the woman herself. Furthermore, the women reported using psycho‐prophylactic techniques for controlling discomfort for significantly more of the time than the midwives reported that the women used such techniques. The results are discussed in the context of similar findings reported in the literature.
Plasma renin substrate in the prediction of pregnancy outcome in threatened abortion
Authors: SIIMES ANJA S. I. , IMMONEN ILKKA , STENMAN ULF‐HÅKAN , KÄRKKÄINEN JORMA E. K. , PEKONEN FREDRIKA , FYHRQUIST FREJ Y.
Published: August 2005

Summary. Concentrations of plasma renin substrate, serum oestradiol‐17β, human chorionic gonadotrophin, sex‐hormone binding globulin and plasma renin activity were measured in 77 samples from 74 patients with uterine bleeding during the first and second trimesters of pregnancy and in a control group of 29 normal pregnant women (51 samples). Mean concentrations of these substances were lower than control values in patients with an abnormal outcome of pregnancy. In patients with a normal outcome after uterine bleeding, concentrations were mostly within the control range. Serum oestradiol‐17β concentration was superior to the other variables in predicting fetal outcome in the whole group. In patients with a live fetus at the time of blood sampling but who subsequently aborted, serum oestradiol‐17β concentration was mostly normal, whereas plasma renin substrate was decreased. Our results suggest that plasma renin substrate may provide additional prognostic information to that given by serum oestradiol‐17β measurement or ultrasonography in threatened abortion.
Fetal plasma catecholamine concentrations and fetal heart‐rate variability during first stage of labour
Authors: BISTOLETTI P. , LAGERCRANTZ H. , LUNELL N.‐O.
Published: August 2005

Summary. Fetal heart‐rate (FHR) variability was studied in 50 term fetuses during the first stage of labour. The variability was computed as an arbitrary index during a 20‐min period preceding a fetal scalp blood sample which was used for the measurement of pH, adrenaline and noradrenaline. None of the fetuses was found to have a scalp blood pH<7.2. The short‐term variability index was significantly correlated with the noradrenaline concentration in fetal blood, but the adrenaline levels which were generally very low showed no correlation with the variability values. There was no correlation between variability index and cervical dilatation or blood pH. We have shown previously high plasma catecholamine concentrations in the asphyxiated fetus with a decreased pH. In this study where fetal pH was normal a correlation between FHR variability and fetal scalp plasma noradrenaline levels was found. Thus an increased FHR variability might be an early sign of fetal distress when fetal pH is still normal.
Uteroplacental blood flow index in intrauterine growth retardation of fetal or maternal origin
Authors: NYLUND L. , LUNELL N.‐O. , LEWANDER R. , SARBY B.
Published: August 2005

Summary. Uteroplacental blood flow index was determined in 30 women with intrauterine growth retardation (IUGR group) and in 26 women without fetal growth retardation (control group) during the last trimester of pregnancy. After 1 mCi (37 MBq) of indium‐113m chloride had been injected intravenously the radiation was registered by a computer‐linked scintillation camera positioned above the placenta during 10 s‐intervals for 240 s. From the isotope accumulation curve a Uteroplacental blood flow index could be calculated for each patient. The median blood flow index in the IUGR group was less than half of that in the control group. In the IUGR group the index was as low in the six women who gave birth to infants with congenital malformations as in the other 24 women in whom fetal growth retardation was due to maternal factors.
Trophoblast alterations in the placental bed in relation to physiological changes in spiral arteries
Authors: GERRETSEN G. , HUISJES H. J. , HARDONKf M. J. , ELEMA J. D.
Published: August 2005

Summary. Ninety‐three placental bed biopsies containing a segment of a spiral artery at the level of the decidual–myometrial junction (53 with and 40 without physiological changes) were histologically investigated for depth of trophoblastic penetration of the uterine wall, formation of trophoblastic multinucleated giant cells and the enzyme histochemical characteristics of the interstitial (stromal) and vascular (intramural) trophoblast. The depth of trophoblastic penetration was not related to the presence or absence of the physiological changes. Conversely, in the absence of physiological changes, a significant accumulation of multi‐nucleated giant cells at the decidual–myometrial junction was found before 36 weeks of gestation. The enzyme histochemical characteristics of the placental bed trophoblast suggest a stromal migration of trophoblast to the proximal (decidual–myometrial) part of the spiral artery whereas the distal part might be invaded by intraluminal (upstream) invasion. The hypothesis is put forward that in the absence of physiological changes a disturbed stromal migration is caused by intrinsic (trophoblastic) or extrinsic (interstitial of vascular) factors expressed by the augmentation of the multinucleated cells at the decidual–myometrial junction.
The prediction of preterm labour by recording spontaneous antenatal uterine activity
Authors: BELL ROBIN
Published: August 2005

Summary. The recording of spontaneous antenatal uterine activity was assessed as a predictor of preterm labour in a group of patients considered at high risk on the basis of a past history of preterm delivery. The recording of individual uterine contractions ≥15 mmHg between 20 and 28 weeks gestation was found to be useful for the prediction of preterm labour in this high risk group.
Non‐consummation of marriage treated by members of the Institute of Psychosexual Medicine: a prospective study
Authors: BRAMLEY H. M. , BROWN J. , DRAPER K. C. , KILVINGTON J.
Published: August 2005

Summary. A prospective study of the treatment of unconsummated marriage was carried out by 16 doctors trained by the Institute of Psycho‐sexual Medicine. This training stresses the development of skills in using the doctor/patient interaction therapeutically, rather than in the acquisition of knowledge. The 159 couples admitted to the study had a mean duration of symptoms of 4.2 years; 60% of them had consummated by 6 months and 72% by 24 months. Other improvements in sexual function occurred even among those failing to consummate; 135 couples had previously consulted 253 other agents. The average cumulative length of treatment at the 6‐month review was 3 h. Partners attending alone did as well as couples who attended together.
Urethral pressure measurement by microtransducer: the results in symptom‐free women and in those with genuine stress incontinence
Authors: HILTON P. , STANTON S. L.
Published: August 2005

Summary. Urethral pressure measurements were recorded at rest and during stress by a microtransducer technique in 20 women without urinary symptoms and 120 women with urodynamically proven genuine stress in‐continence. In the symptom‐free women the resting profile values were largely maintained during stress, as a consequence of 100% transmission of intra‐abdominal pressure rises to the proximal three‐quarters of the functional urethral length. Whilst the majority maintained continence at the bladder neck level, 25% of these controls showed evidence of bladder neck opening during stress. The stress‐incontinent patients showed a deficiency of pressure transmission ratios which appeared to have an ‘all or none’ character in the determination of symptoms. The amplitude and stability of the maximum urethral closure pressure at rest, the extent of urethral closure pressure lost in response to stress, and the extent of intra‐abdominal pressure rises interact to determine the severity of symptoms or ‘margin to continence’.
A clinical and urodynamic assessment of the Burch colposuspension for genuine stress incontinence
Authors: HILTON P. , STANTON S. L.
Published: August 2005

Summary. Twenty‐five women having a Burch colposuspension operation were assessed before and after the operation by urodynamic investigations including urethral pressure measurements at rest and on stress. After 3 months, the objective cure rate was 88%. An increase in voiding difficulty and urodynamic evidence of outflow obstruction was seen after the operation. The operation does not induce any significant change in resting urethral profile variables. The stress profile showed accentuation in pressure transmission ratios, most marked in the proximal urethra. These changes are likely to be mechanical in origin and may be responsible for voiding difficulties in those women who initiate voiding by straining.
Increased decidual prostaglandin E concentration in human abortion
Authors: JASCHEVATZKY OSCAR E. , SHALIT AMOS , GRUNSTEIN STEPHAN , KAPLANSKI JACOB , DANON ABRAHAM
Published: August 2005

Summary. Prostaglandin E (PGE) concentration was measured in decidual tissue after spontaneous and missed abortion and compared with that obtained from induced abortion. Tissues were obtained by curettage from groups of 10 patients each and PGE was estimated by radioimmunoassay. After spontaneous and missed abortions decidual tissue contained significantly higher mean concentrations of PGE, (486.3 and 66.7 ng/g wet tissue respectively) than after induced abortion (18.6 ng PGE/g wet tissue). It is suggested that an increased rate of PGE biosynthesis or reduced breakdown, or both, may play a role in the mechanism of human abortion.
Excretion of oxprenolol and timolol in breast milk
Authors: FIDLER JACK , SMITH VALERIE , DE SWIET MICHAEL
Published: August 2005

Summary. The excretion of oxprenolol and timolol in breast milk was examined by comparing their concentrations in milk with those in plasma. The mean milk to plasma ratio of oxprenolol was 0.29 (SD 0.14; that for timolol was 0.80 (SD 0.21). The total quantity of either drug ingested by a fully breast‐fed infant is unlikely to be therapeutically significant.
Use of glucocorticoids in pregnancies complicated by severe hypertension and proteinuria
Authors: LAMONT R. F. , DUNLOP P. D. M. , LEVENE M. I. , ELDER M. G.
Published: August 2005

Summary. During a 2‐year period, 56 infants of 34 weeks gestation were delivered from 53 pregnancies complicated by severe hypertension and proteinuria. In the first part of the study 32 infants were delivered whose mothers did not receive antepartum glucocorticoids; subsequently 24 infants were born whose mothers did receive antepartum glucocorticoids. The severity of maternal disease, gestational age at delivery, birthweight and obstetric management was similar in both groups. In the group receiving glucocorticoids 88% of the infants were discharged live from the neonatal unit compared with 72% in the group who did not receive corti‐costeroids. It is concluded that in pregnancies complicated by severe hypertension and proteinuria requiring delivery before 34 completed weeks of pregnancy, the administration of antepartum glucocorticoids to the mother does not carry an increased risk to the fetus, and may be of benefit by reducing the risk of idiopathic respiratory distress syndrome and subsequent intraventricular haemorrhage.
Tubal sterilization: findings in a large prospective study
Authors: VESSEY MARTIN , HUGGINS GEORGE , LAWLESS MELANIE , McPHERSON KLIM , YEATES DAVID
Published: August 2005

Summary. Of the 17 032 women taking part in a large prospective study of the beneficial and harmful effects of different contraceptive methods, 2243 (13%) had undergone tubal sterilization by the end of 1981 while another 3551 (21%) had husbands who had undergone vasectomy. The most commonly used female sterilization procedure was laparoscopic tubal diathermy. About 19% of all operations were carried out at the time of a delivery or during the subsequent 4 weeks. In total, 16 accidental pregnancies have occurred in the sterilized women, the failure rate during the 12 months after surgery being 0.37 per 100 woman‐years and the rate during the subsequent months being 0.10 per 100 woman‐years. Of the 16 accidental pregnancies, seven were ectopic. In an analysis comparing women who had undergone tubal sterilization with those whose husbands had undergone vasectomy, there was little evidence of any excess occurrence of gynaecological or psychiatric disorders in the former group.
Fetal breathing movements and maternal hyperoxia in the growth retarded fetus
Authors: DORNAN J. C. , RITCHIE J. W. K.
Published: August 2005

Summary. The effect on fetal breathing movements (FBM) of maternal breathing of 50% oxygen was examined. The procedure caused a two‐fold rise in maternal arterial Po2 and did not alter FBM in normal pregnancy. In pregnancy complicated by intrauterine growth retardation (IUGR) a substantial increase in the incidence of FBM was recorded during hyperoxia (control 29.8.3.9%, hyperoxia 68.2+3.6). No such change was observed in pregnancies where IUGR was suspected but not proven at delivery.
Oxytocin deficiency at delivery with epidural analgesia
Authors: GOODFELLOW C. F. , HULL M. G. R. , SWAAB D. F. , DOGTEROM J. , BUIJS R. M.
Published: August 2005

Summary. The effect of epidural analgesia on oxytocin release during the second stage of normal labour was studied by comparing 10 primigravidae who had epidurals with 10 control subjects who did not have epidurals. A significant increment in oxytocin between paired peripheral blood samples taken at the onset of full cervical dilatation and crowning of the fetal head was found in the control subjects but not in those with epidurals. Forceps delivery was required more often in the group with epidural analgesia and was associated with lower oxytocin levels at crowning. Since distension of the lower birth canal and stimulation of pelvic autonomic nerves leads to oxytocin release, and the need for forceps associated with epidurals can be reduced by oxytocin, these differences are attributed to the lumbar epidural block.
Selection of an obstetric data base for a microcomputer and its use for on‐line production of birth notification forms, discharge summaries and perinatal audit
Authors: MARESH M. , BEARD R. W. , COMBE D. , DAWSON A. M. , GILLMER M. D. G. , SMITH G. , STEER P. J.
Published: August 2005

Summary. A microcomputer system is described which stores data for perinatal audit and produces‘on‐line’the statutory birth notification form and mother and baby discharge summary. The derivation of a minimum data‐base and the methods used to obtain reliable data are outlined. The results of a trial of the production of the birth notification form for 195 deliveries are reported together with those of a further trial of 86 deliveries in which the system was used to produce both the notification form and the discharge summary. A study of the accuracy of the handwritten birth notification forms revealed a high error rate which was markedly reduced by the use of the microcomputer system. The system is now in routine use and further developments are outlined.
Dihydrotestosterone levels at midpregnancy and term: a comparison with testosterone concentrations
Authors: ABRAMOVICH D. R. , HERRIOT R. , STOTT JACQUI
Published: August 2005

Summary. Dihydrotestosterone levels in maternal and fetal plasma were unchanged from midpregnancy to term whereas the values in amniotic fluid increased by 75%. There were no sex differences in fetal plasma or amniotic fluid values throughout pregnancy in contrast to the results reported for testosterone levels.
Short‐term variation in the level of α‐fetoprotein in maternal serum
Authors: HOUGHTON D. J. , NEWNHAM J. P. , KITAU MURIEL J. , CHARD T.
Published: August 2005

Summary. Serial serum levels of α‐fetoprotein (AFP) were examined over a 24‐h period in six subjects. A short‐term variation was demonstrated which was significantly greater than that due to the assay alone, but which showed no particular pattern. These findings may explain why an‘abnormal’AFP level frequently reverts to a‘normal’level on second sampling.
Effect of vacuum curettage on the concentrations of plasma 6‐keto‐prostaglandin Flα and serum thromboxane B2
Authors: YLIKORKALA O. , MÄKILÄ U.‐M. , VIINIKKA L.
Published: August 2005

Summary. Serial plasma samples collected before and after vacuum curettage followed by methylergometrine injection in 10 women were assayed for 6‐keto‐prostaglandin Flα (6‐keto‐PGF1α). The mean 6‐keto‐PGFlα concentration was 97.2 (SE 8.8) pg/ml before cervical dilatation. The concentration rose to 128.2 (SE 13.5) pg/ml (P < 0.10) immediately and to 133.3 (SE 17.8) pg/ml (P < 0.05) 1 h after curettage and returned to the initial value within 5 h. Neither methylergometrine nor anaesthesia, nor non‐gynaecological surgery, caused changes in the level of plasma 6‐keto‐PGFlα. The capacity of the platelets to produce thromboxane A2 during spontaneous clotting of blood did not change during vacuum curettage, anaesthesia and non‐gynaecological surgery, nor after methylergometrine. The evidence suggests that the pregnant myometrium and/or intrauterine tissues capable of generating prostacyclin (PGI2) in vitro may release PG12 also in vivo.
Treatment of menorrhagia with intrauterine release of progesterone
Authors: BERGQVIST A. , RYBO G.
Published: August 2005

Summary. In 12 women with menorrhagia 80 ml per menstrual period) a progesterone‐releasing device (Progestasert) was inserted. The women were followed by repeated measurements of the blood loss for 12 periods. The menstrual blood loss was significantly reduced after 1 month but the duration of bleeding was somewhat prolonged. Twelve months after insertion the menstrual blood loss amounted to 35% of the blood loss before the insertion. The Progestasert is a valuable treatment for menorrhagia.
Pregnancy in sickle cell disease in the UK
Authors: TUCK SUSAN M. , STUDD J. W. W. , WHITE J. M.
Published: August 2005

Summary. The complications and outcome of 125 pregnancies in women with sickle cell disease between 1975 and 1981 are reviewed. There were no maternal deaths, but a perinatal mortality rate of 48 per 1000. The main maternal complications were sickling crises (38%), anaemia (65%), infections (61%) and severe pregnancy‐induced hypertensive disease (5%). There were three patients with eclampsia. There was a 13% spontaneous preterm delivery rate, 25% of the babies were‘light‐for‐dates', fetal distress in labour was seen in 24% and 15% were delivered by caesarean section. There was an increased incidence of involuntary infertility and spontaneous abortion. The treatment by prophylactic blood transfusions is discussed.
A comparison of low‐risk pregnant women booked for delivery in two systems of care: shared‐care (consultant) and integrated general practice unit. II. Labour and delivery management and neonatal outcome
Authors: KLEIN MICHAEL , LLOYD IVOR , REDMAN CHRISTOPHER , BULL MICHAEL , TURNBULL A. C.
Published: August 2005

Summary. A random sample of low‐risk pregnant women were equally divided into four groups of 63 nulliparae and multiparae each booked for care in a integrated general practice unit (GPU) and a shared‐care (consultant) system. Selection criteria included only women who were admitted because they were in spontaneous labour or thought they were. Nulliparous women booked for shared‐care came into hospital at a less advanced state of cervical dilatation than those booked for the GPU andspent longer (11 compared with 8 h) in hospital before delivery; the comparable durations in multiparae were 6 and 4 h. Both the first and second stages of labour were longer in the GPU‐booked women but they received less pethidine and fewer had epidural analgesia; they received less electronic fetal monitoring, augmentation and forceps delivery, and fetal distress was diagnosed less often. The 1‐min Apgar score was < 6 in 17.5% of infants of nulliparae booked for the shared‐care system compared with 1.6% of those booked for the GPU. The intubation rate of infants of nulliparae was 11% in the shared‐care system compared with no intubations in the GPU. These comparisons demonstrate the simplicity and safety of delivery of low‐risk women in the GPU as compared with deliveries of similar women in a shared‐care (consultant) unit.
Amniotic fluid phosphatidylglycerol: an early indicator of fetal lung maturity
Authors: WHITTLE M. J. , WILSON A. I. , WHITFIELD C. R.
Published: August 2005

Summary. In a study of 766 amniotic fluids, collected from pregnancies between 26 weeks and term, phosphatidylglycerol (PG) was identified in a greater proportion than was a mature lecithin/sphingomyelin (L/S) ratio at all gestational ages between 28 and 38 weeks regardless of the underlying pregnancy complication. The early appearance of PG was particularly striking in amniotic fluids obtained after preterm rupture of membranes.

Since PG has been previously shown to be a useful indicator of the risk of neonatal respiratory distress syndrome, its appearance before a mature L/S ratio suggests that its detection offers a considerable advantage in the management of high‐risk obstetric problems in which the earliest possible indication that the fetal lungs are mature is required.