bluuebunny/crossref_metadata_2025 huggingface dataset:
Pudendal nerve damage during labour: prospective study before and after childbirth*
Authors: Sultan Abdul H. , Kamm Michael A. , Hudson Christopher N.
Published: August 2005

Objective
To establish the effect of childbirth on pudendal nerve function and identify obstetric factors associated with such damage.

Design
A prospective investigational study.

Setting
Antenatal clinic, St Bartholomew's (Homerton) Hospital.

Subjects
One hundred and twenty‐eight unselected pregnant women beyond 34 weeks’ gestation.

Intervention
Pudendal nerve terminal motor latencies (PNTML) and perineal plane were measured during pregnancy and six to eight weeks after delivery, and remeasured in a subgroup (n= 22) at six months.

Main outcome measures
Effect of mode of delivery on PNTML and the plane of the perineum.

Results
Vaginal delivery resulted in a significant (P < 0.0001) prolongation of the mean PNTML bilaterally in both primipara (n= 57) 1.91 ms (SD 0.19) vs 2.00 ms (SD 0.22), antenatal vs postnatal, right PNTML; 1.96 ms (SD 0.21) vs 2.06 ms (SD 0.24) left PNTML, and multipara (n= 32) (P < 0.01). Perineal descent during straining was also increased after vaginal delivery (P < 0.001). Greater damage to the pudendal nerve occurred on the left side (P= 0.03). PNTML were not altered after elective caesarean section (n= 7), but were increased on the left side when caesarean section was performed during labour (1.94 ms (SD 0.13) vs 2.08 ms (SD 0.29), P < 0.01). A heavier baby and a longer active second stage of labour were both associated with significant prolongation of PNTML. Eight out of 12 women with a prolonged PNTML at six weeks had normal measurements when restudied six months after delivery.

Conclusion
Vaginal delivery, particularly the first, results in significant pelvic floor tissue stretching and pudendal nerve damage. Women who have a caesarean section during labour may also be at risk of pudendal nerve damage. The process of labour and vaginal delivery can both cause pudendal nerve damage which may be asymmetrical in extent.
Chorionic villous haemorrhage is associated with retroplacental haemorrhage
Authors: Mooney E. E. , Al Shunnar A. , O'Regan M. , Gillan J. E.
Published: August 2005

Objective
To examine the frequency of occurrence of chorionic villous haemorrhage in placentas with retroplacental haemorrhage, and to discuss the pathogenesis of these conditions.

Design
A retrospective study using histological sections of formalin‐fixed, paraffin‐embedded placental tissue stained with haematoxylin and eosin.

Setting
Department of Histopathology, Rotunda Hospital, Dublin.

Subject
Sixty cases of retroplacental haemorrhage, 34 cases of chorioamnionitis, and 24 histologically normal placentas.

Main outcome measurement
Presence or absence of chorionic villous haemorrhage.

Results
Chorionic villous haemorrhage was present in 31 of 60 cases of retroplacental haemorrhage (51 %), one of 34 cases of chorioamnionitis (2.9 %) and in no normal placentas.

Conclusions
It is postulated that chorionic villous haemorrhage reflects a disturbance of fetal vascular dynamics and precedes retroplacental haemorrhage. Such a disturbance could trigger the events leading to abruption.
Chronic pelvic pain caused by residual ovaries and ovarian remnants
Authors: Siddall‐Allum J. , Rae T. , Rogers V. , Witherow R. , Flanagan A. , Beard R. W.
Published: August 2005

Objective
To determine the diagnostic effectiveness and treatment of women with chronic lower abdominal pain due to residual ovaries or ovarian remnants.

Design
A prospective observational study.

Setting
Tertiary referral pelvic pain clinic.

Subjects
Seventeen women complaining of chronic pelvic pain of up to 25 years’ duration, of whom seven had residual ovaries and 10 ovarian remnant(s).

Main outcome measures
Persistent lower abdominal pain, pelvic tenderness and quality of life one year post‐operatively.

Results
Six of the seven women with residual ovaries, and nine of the 10 women with presumed ovarian remnants experienced relief of the original pain, loss of pelvic tenderness and an improved quality of life.

Conclusions
Residual ovaries after hysterectomy and ovarian remnants are established causes of chronic pelvic pain. Diagnosis and surgical removal is frequently difficult. Management strategies are proposed for both conditions.
A population‐based, controlled study of the relation between HIV infection and cervical neoplasia
Authors: Johnstone Frank D. , McGoogan Euphemia , Smart George E. , Brettle Ray P. , Prescott Robin J.
Published: August 2005

Objective
To study a geographically defined population of women exposed to a drug‐related risk for human immunodeficiency virus (HIV), together with carefully matched neighbourhood controls, in order to examine (1) the proportion of different groups having cervical cytopathology screening; (2) the association between HIV infection and cervical intraepithelial neoplasia; (3) the independent effect of CD4+ lymphocyte count and duration of HIV infection; and (4) the correspondence between cervical cytopathology and colposcopically directed biopsy.

Design
A population‐based study.

Subjects
All women domiciled in Lothians with the following characteristics: between 1983 and 1987 they had a history of injection drug use or a seropositive partner with a history of injection drug use; they had a pregnancy after that exposure where their serostatus was known. In addition, neighbourhood controls were identified by computer matching for the following criteria—post‐code sector, housing deprivation score, age, parity, pregnancy outcome, ethnic group, year of pregnancy, smoking.

Main outcome measures
Search was carried out for the cervical smear nearest in time to the index pregnancy end date, providing serostatus was known at that time. All identified smears were assessed by a cytopathologist without knowledge of clinical information, study group or serostatus.

Results
Of 376 women, appropriate cervical smears were identified for 336. The proportions screened in the different groups were similar. There were more abnormal smears in the seropositive group than in the drug‐related seronegative (P < 0.01) or the neighbourhood control groups (P < 0.001). HIV‐infected women with abnormal smears had lower CD4+lymphocyte counts (P < 0.0005). There was a reasonable correspondence between cytopathological classification and histological grading, and this was of similar strength in cases and controls (weighted kappa 0.72, 0.74).

Conclusions
There is a definite relation between HIV infection and cervical intraepithelial neoplasia. This is related to immune depletion but whether this is the sole mechanism for the association is unclear.
Relative influence of serum follicle stimulating hormone, age and other factors on ovarian response to gonadotrophin stimulation
Authors: Cahill D. J. , Prosser C. J. , Wardle P. G. , Ford W. C. L. , Hull M. G. R.
Published: August 2005

Objective
To determine the relative value of the woman's age, basal follicle stimulating hormone (FSH), basal luteinising hormone (LH) and menstrual cycle pattern (all denned prior to treatment) in predicting the ovarian response to gonadotrophin stimulation for in vitro fertilisation.

Design
Open, descriptive cohort study.

Patients
One hundred and seventy‐one consecutive ovulatory women undergoing their first cycle of in vitro fertilisation with ovarian stimulation after pituitary desensitisation.

Interventions
Measurement of basal (early follicular phase) and down‐regulated concentrations of serum FSH and LH, and calculation of age at treatment and of median length of menstrual cycles and range of variation prior to treatment.

Main outcome measures
Duration and amount of gonadotrophin stimulation to achieve follicular maturity, number of mature follicles, peak serum oestradiol concentration and number of mature oocytes, were compared between banded values of variables studied.

Results
Increasing basal FSH concentrations were significantly associated with reducing oestradiol levels, numbers of mature follicles and oocyte yield even when the FSH levels were still within the normal range though above average (6 to 8.9 i.u./l). There were similar but weaker associations with FSH levels after down‐regulation. There were also significant differences between women over and under 40 years old in their oestradiol levels, numbers of follicles and of oocytes. Analysis of variance showed significant independent association of basal FSH with both oestradiol and numbers of oocytes, but not of age, menstrual pattern, or serum LH concentrations.

Conclusion
Serum FSH is more sensitive than the woman's age in determining her ovarian responsiveness to stimulation. LH concentrations and menstrual cycle patterns are unhelpful.
Perinatal findings in children born to HIV‐infected mothers
Authors:   The European Collaborative Study
Published: August 2005

Objective
To explore in children born to HIV‐infected women, the association between a child's HIV infection status and birthweight, gestational age, congenital abnormalities and other perinatal findings.

Design
A prospective study of children born to women known to be HIV‐infected at or before the time of delivery enrolled in the European Collaborative Study.

Setting
Nineteen European centres.

Subjects
A cohort of 853 children with known HIV infection status.

Results
There was no evidence for an HIV dysmorphic syndrome, and the frequency of congenital abnormalities was similar in infected and uninfected children with no consistent pattern of defects. Injecting drug use during pregnancy had the most marked effect on birthweight and gestational age. Multivariate analysis demonstrated a weak association between birthweight and the child's HIV infection status, but this could partly be explained by the confounding effect of maternal immunological HIV status. HIV infection in the infant was not associated with gestational age, and the mean and distribution of gestational age were similar for infected and noninfected children.

Conclusions
The finding that HIV‐infected and noninfected children are of similar birthweight, the absence of a dysmorphic syndrome and no evidence of associated congenital abnormalities suggest that a substantial proportion of infection occurs late in pregnancy or at the time of delivery.
Doppler colour flow imaging of fetal intracerebral arteries and umbilical artery in the small for gestation; age fetus
Authors: Noordam M. J. , Heydanus R. , Hop W. C. J. , Hoekstra F. M. E. , Wladimiroff J. W.
Published: August 2005

Objective
To assess with Doppler colour flow imaging whether a brain‐sparing effect is present in all cerebral arteries of the circle of Willis in the small for gestational age fetus, to determine which cerebral flow velocity parameter is most discriminating in this pathological condition, and to relate this parameter to the umbilical artery pulsatility index.

Design
Prospective, cross‐sectional, matched case‐control study.

Setting
Academic department of obstetrics and gynaecology.

Subjects
Twenty‐eight small for gestational age fetuses and 28 normal controls at 24 to 38 weeks of gestation.

Interventions
Blood flow velocity waveforms from the umbilical and fetal intracerebral arteries were studied with Doppler colour flow imaging for measurement of peak systolic, end‐diastolic and time averaged velocities, and calculation of the pulsatility index.

Main outcome measures
Comparison of intracerebral and umbilical artery waveform parameters between small for gestational age fetuses and controls.

Results
Acceptable flow velocity waveforms were obtained in the intracerebral circulation in more than 85%. In small for gestational age fetuses, all intracerebral arteries displayed reduced downstream impedance. The end‐diastolic velocities of the middle and anterior cerebral artery are the most discriminative factors between small for gestational age fetuses and controls. The highest sensitivity was reached for the umbilical artery pulsatility index.

Conclusions
Doppler colour flow imaging allows easy identification of fetal intracerebral arterial vasculature. Whereas for the intracranial vasculature, the end‐diastolic blood flow velocities in the anterior and middle cerebral artery are the most sensitive parameters discriminating between small for gestational age and controls, umbilical artery pulsatility index remains the best indicator for the small for gestational age fetus.
Sacrocolpopexy: a retrospective study of a clinician' experience
Authors: Valaitis Sandra R. , Stanton Stuart L.
Published: August 2005

Objective
To assess the factors that may predispose patients to the development of vaginal vault prolapse and enterocele, and to determine the success of sacrocolpopexy in correcting prolapse.

Design
A retrospective study of women with vault prolapse undergoing sacrocolpopexy over a 10 year period between 1983 and 1993, with analysis of postoperative complications and success.

Setting
St. George's Hospital in London, a university teaching hospital, and private practice.

Subjects
Forty‐one women, presenting with symptomatic vault prolapse, who desired preservation of sexual function.

Interventions
Forty‐one patients underwent 43 sacrocolpopexies. Of these, 39 were performed by the senior author. All but four were reviewed in the clinic within the last year.

Main outcome measures
Pre‐ and post‐operative data and any interim prolapse or incontinence surgery were recorded. Success was assessed subjectively and by clinical examination for recurrence of prolapse, associated post‐operative complications, subsequent voiding difficulties, and incidence of incontinence.

Results
Failure was denned as a symptomatic enterocele or evidence of a third degree enterocele on examination. The 41 patients were followed for a mean time of 21.2 months. The cure rate of vault prolapse was 88 %. The most common complications were stress incontinence, urinary tract infection, and persistent vaginal discharge. Using the unpaired t‐est and χ2 analysis, there was no significant difference between failures or successes in terms of weight, parity, age, previous surgery, pulmonary history, or difficulties with defaecation, although the number of patients studied was small.

Conclusions
Sacrocolpopexy is a successful operation for the correction of prolapse. Complications include the development of genuine stress incontinence, detrusor instability, voiding difficulty, and mesh infection.
Intermittent versus continuous electronic monitoring in labour: a randomised study
Authors: Herbst Andreas , Ingemarsson Ingemar
Published: August 2005

Objective
To compare the efficacy in detecting signs of fetal hypoxia in labour of intermittent (I‐group) versus continuous (C‐group) electronic fetal monitoring in women with low or moderate risk factors for fetal distress.

Design
A prospective, randomised study.

Setting
A tertiary referral centre.

Subjects
Four thousand and forty‐four parturients at low risk for obstetric complications with a reactive fetal heart rate admission test at arrival in labour. During the study period (October 5 1989 to May 31 1991), 5647 women were delivered in the labour ward. Of these, 1178 women (20.9%) were excluded because of high risk factors in pregnancy or at admission for labour, including women undergoing elective caesarean section. Of the remaining 4469 women 4044 (905 %) were randomised to either intermittent (n= 2015) or continuous monitoring (n= 2029) during the first stage of labour.

Methods
In the C‐group the fetal heart rate was recorded continuously with electronic fetal monitoring during the first stage of labour. In the I‐group the fetal heart rate was recorded with electronic fetal monitoring for 10 to 30 min every 2 to 2.5 h during the first stage of labour, and the fetal heart rate was auscultated every 15 to 30 min in between recording periods. If complications occurred, recording was changed to continuous. In the second stage of labour all the women were monitored continuously. Umbilical cord artery acid‐base status was assessed at birth.

Main outcome measures
Duration of electronic fetal monitoring, rates of abnormal fetal heart rate patterns, caesarean section for fetal distress, acidosis in umbilical cord arterial blood at birth, Apgar scores of less than 7 at 1 or 5 min, and referrals to the neonatal intensive care unit.

Results
There were no significant differences between the study groups in the incidence of ominous fetal heart rate recordings: 6.3 % (I‐group) versus 6.6% (C‐group), or the interval from arrival to first detected abnormal fetal heart rate, although the number of suspicious fetal heart rate patterns was higher in the C‐group (28.6%) than in the I‐group (24.6%). In the I‐group electronic fetal monitoring was performed for (median monitoring time) 38.8 % of the first stage of labour as compared with 78.6 % in the C‐group. The incidence of caesarean section for fetal distress was similarly low in both groups: 1.2%versus 1.0%. There were no significant differences in the immediate neonatal outcome in terms of umbilical artery pH, Apgar scores, or admissions to the neonatal care unit.

Conclusions
Intermittent use of electronic fetal monitoring at regular intervals (with stethoscopic auscultation in between) appears to be as safe as continuous electronic fetal monitoring in low risk labours.
Employment during pregnancy in relation to risk factors and pregnancy outcome
Authors: Henriksen Tine Brink , Savitz David A. , Hedegaard Morten , Secher Niels Jørgen
Published: August 2005

Objective
To describe the relation of employment status during pregnancy to potential demographic, behavioural and obstetrical risk factors for adverse late pregnancy outcome, as well as the risks of having a preterm delivery and a small for gestational age infant.

Design
Cohort study.

Setting
A university hospital.

Subject
Of 8711 women with singleton pregnancies (1989–91), 5875 returned questionnaires about risk factors and employment status at 16 and 30 weeks gestation. Of the respondents 5552 were analysed in five groups: (1) women working throughout pregnancy, (2) women working in the first, but unemployed during the second trimester, (3) women on sick leave in the first and second trimester, (4) women unemployed throughout pregnancy, and (5) students. The association between employment status and having a small for gestational age infant and preterm delivery was evaluated, accounting for other risk factors.

Results
Working women and students had the most and unemployed women the least favourable demographic risk factors. Women on sick leave had the least favourable obstetrical and medical history, followed by unemployed women. No clear pattern of the behavioural risk factors was found. Differences in risk of having a small for gestational age infant were a function of parity, smoking and maternal height. Adjustment for these factors plus education yielded a lower risk of preterm delivery in partially unemployed women and higher risk among women on sick leave compared to working women, accounted for by different risks of bleeding in the second and third trimester.

Conclusions
Comparison of pregnancy outcome among women with different work status should consider the differences in risk factor profile. Adjusting for such risk factors, we found no evidence that work per se had any detrimental or beneficial effects on the risk of having a small for gestational age infant or preterm delivery.
Serum albumin and CA125 are powerful predictors of survival in epithelial ovarian cancer
Authors: Parker D. , Bradley C. , Bogle S. M. , Lay J. , Masood M. , Hancock A. K. , Naylor B. , Price J. J.
Published: August 2005

Objective
To assess the prognostic significance of presentation serum albumin, clinical stage and CA125 levels in ovarian cancer.

Design
Retrospective analysis of data using a Cox proportional hazards model.

Setting
A district general hospital oncology unit.

Subject
One hundred and fourteen consecutive patients with epithelial ovarian cancer.

Interventions
Cytotoxic chemotherapy and surgery.

Main outcome measure
Survival.

Results
A linear increase in risk was observed with high log CA125 (P < 0.0001) and with low albumin (P < 0.0001). In late stage patients (III and IV) albumin is the best predictor of survival (P= 0.0006). The presence of ascites, blood transfusion, type of surgery or chemotherapy did not improve the predictive model.

Conclusions
CA125 and albumin can be used to identify prognostic subgroups independently of stage. Albumin alone can also be used as a predictor of survival. A simple classification of patients into three groups based on serum albumin of 41 g/l or more, 35 to 40 g/l and 34 g/l or less provides a clear separation of survival curves in the present group of patients.
A longitudinal study of bacterial vaginosis during pregnancy
Authors: Hay P. E. , Morgan D. J. , Ison C. A. , Bhide S. A. , Romney M. , McKenzie P. , Pearson J. , Lamont R. F. , Taylor‐Robinson D.
Published: August 2005

Objective
To determine the longitudinal changes in the incidence of bacterial vaginosis in pregnancy.

Design
A prospective study of women during pregnancy.

Setting
A District General Hospital in North‐West London.

Subject
Seven hundred and eighteen pregnant women attending antenatal clinics. At their first attendance and subsequently, Gram‐stained vaginal smears were examined and Mycoplasma hominis and Gardnerella vaginalis were sought by culture.

Results
Initially, 87 (12%) women had bacterial vaginosis diagnosed on Gram‐stained reading of the vaginal smears. Examination of further smears, obtained from 176 women at 36 weeks of gestation, showed that those whose vaginal flora was normal initially, and who went to term, rarely developed vaginosis (three of 127, 2.4%). Samples were obtained at 36 weeks gestation from 32 women who had bacterial vaginosis initially, and went to term. In almost 50% (15 of 32) of these a normal lactobacillus‐dominated flora had regenerated. Thirty‐five women (5%) had initial vaginal smears graded as intermediate. From this group, six of the 17 (35%) women from whom samples were obtained at 36 weeks gestation still had flora of an intermediate pattern; 10 (59%) now had normal flora and only one (6%) had developed bacterial vaginosis. Women with bacterial vaginosis were more likely to be culture‐positive for M. hominis than those with normal flora (34/78 versus 10/563, odds ratio 42.73 (18.9 to 102.3) P < 0.001), or to be culture‐positive for G. vaginalis than those with normal flora (35/78 versus 21/563, odds ratio 21.0 (10.75 to 41.2) P < 0.001).

Conclusion
Pregnant women do not commonly develop bacterial vaginosis after 16 weeks gestation, and if present, it remits spontaneously in approximately half of those who reach term. As bacterial vaginosis is associated with increased rates of second trimester miscarriage and preterm delivery, any treatment aimed at its eradication in pregnancy should be given no later than the beginning of the second trimester of pregnancy.
A randomised prospective study of laparoscopic vaginal hysterectomy versus abdominal hysterectomy each with bilateral salpingo‐oophorectomy
Authors: Raju Kankipati S. , Auld Barry J.
Published: August 2005

Objective
To identify differences in the peri‐operative outcome of women undergoing hysterectomy with bilateral salpingo‐oophorectomy performed either by abdominal hysterectomy and bilateral salpingo‐oophorectomy or by laparoscopic‐assisted salpingo‐oophorectomy and vaginal hysterectomy. To identify any potential management implications, including financial differences, between these two forms of operations.

Subjects and methods
Eighty women undergoing hysterectomy and bilateral salpingo‐oophorectomy for benign gynaecological conditions were prospectively randomised to have the procedure by laparoscopic‐assisted bilateral salpingo‐oophorectomy and vaginal hysterectomy or total abdominal hysterectomy and bilateral salpingo‐oophorectomy. The peri‐operative and post‐operative courses of both groups were compared.

Results
Although laparoscopic‐assisted bilateral salpingo‐oophorectomy and vaginal hysterectomy took longer (100 (SD 5.6) versus 57 (SD 4.7) min, P < 0.0001), the women undergoing this procedure had a shorter time in hospital (3.5 versus six days, P < 0.0001) quicker recovery (three versus six weeks, P < 0.0001) and returned to work earlier. There were minimal complications in both groups and they were not significantly different. The cost of the laparoscopic‐assisted procedure was greater during the operation with longer operating time and cost of disposable instruments. However, the total cost of treatment was less in this group because of shortened post‐operative stay.

Conclusion
The study shows laparoscopic‐assisted bilateral salpingo‐oophorectomy and vaginal hysterectomy is a safe and cost‐effective procedure for women requiring a hysterectomy and bilateral salpingo‐oophorectomy.
Expression of transforming growth factor‐α in the normal cervix and in benign and malignant lesions of the uterine cervix
Authors: Konishi Ikuo , Ishikawa Yukiyoshi , Wang Shu‐yu , Wang Da‐peng , Koshiyama Masafumi , Mandai Masaki , Komatsu Takayuki , Yamamoto Shinichi , Mori Takahide
Published: August 2005

Objective
To investigate the expression and distribution of transforming growth factor‐α (TGF‐α) in the normal cervix and in benign and malignant lesions of the uterine cervix.

Subjects and methods
Immuno‐histochemical reactivity with a monoclonal antibody against TGF‐α was examined in tissue specimens from 15 normal cervices, six cervical polyps, four cervical condylomata acuminata, 34 cervical intra‐epithelial neoplasias, 35 invasive squamous cell carcinomas, five adenocarcinomas, and three mixed adenosquamous carcinomas.

Results
Normal squamous cells of the exocervix were found to be negative for TGF‐α immuno‐reactivity, whereas reserve cells and metaplastic squamous cells in the transformation zone were positive for TGF‐α. Although TGF‐α immuno‐reactivity was variable in the cervical condylomas, most cases of cervical intra‐epithelial neoplasia with or without koilocytotic atypia were negative for TGF‐α. In the invasive carcinomas, however, TGF‐α immunoreactivity was observed in 17 out of the 35 cases of squamous carcinoma, and in all cases of adeno‐ and adenosquamous carcinomas. In addition, intense TGF‐α immuno‐reactivity was found in clinically advanced tumours.

Conclusion
These results suggest that the expression of TGF‐α is associated with squamous metaplasia in the normal cervix, and that TGF‐α may play an important role in cervical carcinogenesis, especially in its progression.
The definition of pre‐eclampsia
Authors: Perry Ivan J. , Beevers D. G.
Published: August 2005

Background
Redman and Jefferies have proposed a revised definition of pre‐eclampsia which is based on absolute blood pressure levels and an increment from the baseline in the first half of pregnancy. There is no requirement for proteinuria. This definition should facilitate the distinction between nonproteinuric pre‐eclampsia and other causes of nonproteinuric gestational hypertension, such as chronic essential hypertension.

Objectives
1. To determine whether the blood pressure criteria of Redman and Jefferies can select women with characteristics of pre‐eclampsia from the group of women with gestational hypertension by the current criteria of the International Society for the Study of Hypertension in Pregnancy (ISSHP). 2. To determine the level of agreement between the classification system proposed by Redman and Jefferies and that of the ISSHP.

Design
A prospective study.

Setting
Obstetric unit, Dudley Road Hospital, Birmingham, UK.

Subjects
Six hundred and ninety‐two healthy nulliparous women and 11 women with chronic hypertension antedating pregnancy.

Main outcome measures
1. Differences in maternal characteristics and obstetric outcome among women with gestational (nonproteinuric) hypertension by the ISSHP criteria, meeting (and failing to meet) the Redman and Jefferies' blood pressure criteria. 2. The proportion of women classified as normal, proteinuric pre‐eclampsia, and chronic hypertension on the basis of both Redman and Jefferies' criteria and the current ISSHP criteria.

Results
There were 55 women with gestational hypertension alone by the ISSHP criteria, of whom 33 met Redman and Jefferies' blood pressure criteria for pre‐eclampsia. This group of 33 women had characteristics of nonproteinuric pre‐eclampsia, compared with the remaining 22 women in the ISSHP gestational hypertension category who had characteristics of chronic hypertension. The group of 33 were significantly younger and less obese, had significantly lower blood pressure at their first antenatal visit and their obstetric outcome was poorer. The Redman and Jefferies' blood pressure criteria identified as normal 99.5% (95% CI, 98.6% to 99.9%) of women who were also characterised as normal on the basis of the ISSHP criteria (622/625). There were 12 women with proteinuric pre‐eclampsia by the ISSHP criteria of whom 11 (92%; 95% CI, 62% to 99.8%) met Redman and Jefferies' blood pressure criteria for pre‐eclampsia. None of the 11 women with chronic hypertension antedating pregnancy met these criteria.

Conclusions
In this population the blood pressure criteria for pre‐eclampsia proposed by Redman and Jefferies select women with features of pre‐eclampsia (i.e., proteinuria and relatively poor outcome) and, in particular, they enable a distinction to be made between nonproteinuric pre‐eclampsia and other causes of gestational hypertension.
Oligohydramnios sequence: the spectrum of renal malformations
Authors: Newbould M. J. , Lendon M. , Barson A. J.
Published: August 2005

Objective
To assess the value of the autopsy findings on a series of infants dying with features of the oligohydramnios sequence, with particular reference to anomalies of the renal tract.

Design
Retrospective review.

Setting
Pathology departments serving three maternity units in Manchester.

Subjects
Eighty‐nine infants having an autopsy examination between 1976 and 1990.

Results
Thirty‐two (34%) infants had bilateral renal agenesis, 30 (34%) had bilateral cystic dysplasia, eight (9%) had unilateral agenesis with unilateral cystic dysplasia, four (4%) had renal histology characteristic of a recessively inherited disorder (two cases of renal tubular dysgenesis and two cases of autosomal recessive (infantile) polycystic disease), nine (10%) had minor urinary tract anomalies, and three (3%) had morphologically normal renal tracts. Forty‐eight (54%) infants had congenital abnormalities other than those resulting from oligohydramnios sequence; most commonly, these were anomalies of the sporadic VATER association, but in four infants the extra renal anomalies present allowed recognition of a recessively inherited syndrome (Meckel's in three cases, Smith‐Lemli‐Opitz in one).

Conclusions
A detailed autopsy is vital in assessment of infants with oligohydramnios sequence resulting from a congenital abnormality of the kidneys or urinary tract. This applies equally to second trimester fetuses following miscarriage or therapeutic abortion, to stillborn infants, or to neonatal deaths.
The effects of 3g eicosapentaenoic acid daily on recurrence of intrauterine growth retardation and pregnancy induced hypertension
Authors: Bulstra‐Ramakers M. T. E. W. , Huisjes H. J. , Visser G. H. A.
Published: August 2005

Objective To study the effects of addition of 3 g eicosapentaenoic acid daily to the diet, on recurrence rate of intrauterine growth retardation and pregnancy induced hypertension in a high risk population.

Design Prospective, double blind, randomised multicentre study. Eicosapentaenoic acid or placebo were given from 12 to 14 weeks of gestation onwards.

Setting University Hospital and regional hospitals in the north of the Netherlands.

Subjects Sixty‐three women with a history of intrauterine growth retardation (birthweight < 10th centile) with or without pregnancy induced hypertension in the previous pregnancy.

Main outcome measures Birthweight centiles and signs of pregnancy induced hypertension in current pregnancy.

Results One‐third of the women developed pregnancy induced hypertension and one‐third of the infants had a birthweight below the 10th centile. There were no differences between eicosapentaenoic acid and placebo group.

Conclusion Addition of 3 g eicosapentaenoic acid daily does not prevent recurrence of intrauterine growth retardation or pregnancy induced hypertension in a high risk population.
Longitudinal study of fetal middle cerebral artery flow velocity waveforms preceding fetal death
Authors: Rowlands David J. , Vyas Sanjay K.
Published: August 2005

Objective
To assess longitudinally fetal cerebral vasodilatation in small‐for‐gestational age fetuses to investigate whether intrauterine death might be predictable.

Design
Prospective observational study.

Setting
Ultrasound department in a university hospital.

Subjects
Five pregnancies with ultrasonographically confirmed small fetuses (abdominal circumference less than the 3rd centile) monitored longitudinally until time of intrauterine death.

Main outcome measure
Time between last ultrasound examination and diagnosis of intrauterine death, and variation in middle cerebral artery pulsitility index prior to death.

Results
Two of the five fetuses showed a reversal of adaptation (as indicated by an elevation of the middle cerebral artery pulsitility index) within 48 hours of intrauterine death. The other three had their final ultrasound examination 3 to 7 days before death and showed no such reversal of adaptation.

Conclusion
Reversal of adaptation in fetal hypoxaemia as indicated by a rise in the middle cerebral artery pulsitility index may be a predictor of intrauterine death within 48 hours. Whether delivery after reversal of adaptation would result in salvage of neurologically intact babies needs to be investigated.
The value of fetal arterial, cardiac and venous flows in predicting pH and blood gases measured in umbilical blood at cordocentesis in growth retarded fetuses
Authors: Rizzo Giuseppe , Capponi Alessandra , Arduini Domenico , Romanini Carlo
Published: August 2005

Objective
To assess the value of Doppler indices, calculated from fetal arterial peripheral vessels, cardiac outflow tracts and venous vessels, in the identification of acidaemia, hypercapnia and hypoxaemia as determined by pH and gas analysis of fetal blood obtained by cordocentesis in growth retarded fetuses.

Design
Doppler measurements were taken from umbilical artery, thoracic descending aorta, renal artery, middle cerebral artery, cardiac outflow tracts, inferior vena cava and ductus venoms immediately before cordocentesis. Logistic regression and receiver‐operator characteristic curve analysis were performed to examine the relation between Doppler indices and acid‐base status.

Setting
Tertiary centre for fetal medicine.

Subjects
Forty‐eight growth retarded fetuses fulfilling these criteria for inclusion: 1. absence of chromosomal and structural anomalies; 2. an abdominal circumference or ultrasonographic estimated fetal weight less than the 5th centile; 3. presence of abnormal velocity waveforms in umbilical artery; and 4. postnatal confirmation of a birthweight below the 5th centile and absence of structural anomalies.

Results
The percentage of reverse flow in inferior vena cava was a more closely related variable for acidaemia (x2= 29.69; P≤ 0.001) and hypercapnia (x2= 12.86; P≤ 0.001) than the other Doppler indices. Hypoxaemia was better predicted by the pulsatility index from middle cerebral artery (χ2= 15.31; P ≤ 0.001).

Conclusion
The analysis of velocity waveforms from inferior vena cava and middle cerebral artery can be used to predict acid‐base status in growth retarded fetuses secondary to placental insufficiency. This may lead to a more accurate antepartum monitoring of such fetuses.
Endovaginal ultrasonography in the diagnosis of adenomyosis uteri: identifying the predictive characteristics
Authors: Brosens J. , de Souza Nandita M. , Barker Fred G. , Paraschos Thanos , Winston Robert M. L.
Published: August 2005

Objective
To evaluate prospectively the role of endovaginal ultrasonography in the diagnosis of adenomyosis and to identify predictive characteristics.

Setting
In Vitro Fertilisation Unit, Hammersmith Hospital.

Subjects
Fifty‐six women with menorrhagia and dysmenorrhea.

Design
Endovaginal sonography was performed and uterine body morphometry and myometrial echogenicity were assessed. The sonographic suspicion of adenomyosis was scored high or low depending on the degree of uterine enlargement, uterine asymmetry not due to fibroids and heterogenicity of myometrial echoes. The sonographic diagnosis was compared either with the histological findings after hysterectomy (n= 34) or to the appearances on magnetic resonance imaging (n= 22).

Results
Adenomyosis was diagnosed in 28 patients: 15 by histology and 13 by magnetic resonance imaging. Endovaginal ultrasound demonstrated a sensitivity of 86%, a specificity of 50%, a positive predictive value of 86%, and a negative predictive value of 77%. Uterine morphometry alone did not predict adenomyosis: although the mean length of the longitudinal, antero‐posterior and transverse axis was larger in uteri with, compared with those without, adenomyosis, this did not reach statistical significance. The uterine asymmetry ratio was 1.43 (SD 0.6) and 1.34 (SD 0.4) (P= 0.26) in uteri with and without adenomyosis, respectively, but in the presence of adenomyosis the mean posterior wall was significantly thicker than the mean anterior wall: 25.6 (SD 66) mm compared with 21.8 (SD 5.0) mm, P= 0.02. Therefore, adenomyosis was best predicted on the basis of ill‐defined myometrial heterogeneity. However, leiomyomas and various echogenic shadows and artefacts often complicate subjective assessment of the myometrial echogenicity.

Conclusion Endovaginal sonography in symptomatic patients can be a sensitive but not a specific procedure for the diagnosis of adenomyosis.
Effects of gemeprost and mifepristone on the mechanical properties of the cervix prior to first trimester termination of pregnancy
Authors: Carbonne B. , Brennand J. E. , Maria B. , Cabrol D. , Calder A. A.
Published: August 2005

Objective
To study the effects of oral mifepristone and vaginal gemeprost on the mechanical properties of the cervix prior to first trimester termination of pregnancy by vacuum aspiration.

Design
A comparative study. Each patient served as her own control.

Setting
The Royal Infirmary of Edinburgh, Scotland, UK.

Subjects
Forty nulliparous women at six to twelve weeks of pregnancy.

Interventions
The women received either gemeprost (1 mg) 3 h prior to termination of pregnancy or mifepristone (200 mg) 48 h before operation.

Main outcome measures
Two different objective methods of assessment of the mechanical properties of the cervix, one measuring the distensibility of the cervix before drug administration and immediately before the operation, and the other measuring the force necessary to dilate the cervix; incidence of new symptoms following drug intake; immediate complications and estimated blood loss.

Results
Both treatments significantly increased cervical distensibility. Baseline dilatation was greater in the mifepristone group. The force required to dilate the cervix was significantly reduced in mifepristone‐treated patients, There was a good correlation between the two different methods of assessment of the mechanical properties of the cervix only in the gemeprost group.

Conclusion
Cervagem and mifepristone can be used to increase cervical distensibility. Cervical dilatation is easier with a 48 h regimen of mifepristone than with gemeprost.
Application of ultrasonic transit time flowmetry to the measurement of umbilical vein blood flow at caesarean section
Authors: Konje Justin C. , Taylor David J. , Rennie Michael J.
Published: August 2005

Objective
To determine the applicability of ultrasonic transit time flowmetry to the measurement at caesarean section of umbilical vein blood flow rate and to examine the relationship between flow rates and birthweight for gestational age.

Design
Umbilical vein blood flow was measured at caesarean section using a transonic time flow probe on a loop of the umbilical cord in 33 appropriate and 21 small for gestational age fetuses.

Results
The mean (SD) umbilical vein blood flow in the 54 fetuses was 78.4 (23.1) ml kg−1 min−1. There was a linear relation between umbilical vein blood flow measured by ultrasonic transit time flowmetry and birthweight (r= 0.63, P < 0.0001). The mean umbilical vein blood flow in appropriate for gestational age fetuses [90 (18) ml kg−1 min−1] was greater than that in the small for gestational age group [66 (23) ml kg−1 min−1]; P < 0.04).

Conclusions
Umbilical vein blood flow measurements obtained by the ultrasonic transit time flowmetry technique are simple to perform and compare well with reported values obtained by the Doppler ultrasound technique (when vessel diameter is greater than 4 mm). Umbilical venous blood flow rate is significantly lower in small for gestational age fetuses.
Persistent ectopic pregnancy following conservative surgery for tubal pregnancy
Authors: Dwarakanath L. S. , Mascarenhas L. , Penketh R. J. A. , Newton J. R.
Published: August 2005

Objective
To audit the incidence and management of persistent ectopic pregnancy following conservative tubal surgery performed at laparotomy and via the laparoscope.

Design
A retrospective analysis of the case records. Setting The Birmingham and Midland Hospital for Women.

Participants
Two hundred and fourteen women who received surgical treatment for ectopic pregnancy between October 1991 and December 1994.

Results
Of the 85 women who underwent conservative tubal surgery, nine were diagnosed as having persistent ectopic pregnancy on the basis of hCG values. The incidence after laparoscopy was no higher than after laparotomy. A second surgical procedure was indicated in only four cases.

Conclusions
Post‐operative surveillance of serum hCG remains mandatory. Patients who remain symptom free may be managed conservatively The threshold for a second‐look laparoscopy should be relatively high and be based on the presence of symptoms rather than changes in hCG values.
A prospective cohort study of oxytocin plus ergometrine compared with oxytocin alone for prevention of postpartum haemorrhage
Authors: Soriano David , Dulitzki Mordechai , Schiff Eyal , Barkai Gad , Mashiach Shlomo , Seidman Daniel S.
Published: August 2005

Objective
To determine the safety and efficacy of intramuscular oxytocin plus ergometrine compared to intravenous oxytocin for prevention of postpartum haemorrhage, and the significance of administration at the end of the second stage of labour compared with that after the third stage.

Design
A prospective cohort study.

Setting
A university affiliated tertiary medical centre.

Participants
Two thousand one hundred and eighty–nine women delivering singletons during 40 consecutive weeks.

Main outcome measures
Postpartum haemorrhage (> 500 ml), prolonged third stage (> 30 min), retained placenta (>60min), elevated blood pressure (systolic > 150 mmHg, diastolic > 100 mmHg).

Results
The rate of postpartum haemorrhage was not significantly different for oxytocinergometrine compared with oxytocin, when administered at the end of the second stage of labour (odds ratio 1.10, 95% confidence interval (CI) 0.75–1.61) or after the third stage (odds ratio 0.95, 95% CI 0.68–1.34). The patients receiving oxytocics at the end of the second stage of labour had significantly lower rates of postparturn haemorrhage, for both oxytocinergometrine (odds ratio 0.69, 95% CI 0.49–0.98) and oxytocin (odds ratio 0.60, 95% CI 0.41–0.87), compared with those treated after the third stage.

Conclusion
Administration of oxytocin alone is as effective as the use of oxytocin plus ergometrine in the prevention of postpartum haemorrhage, but associated with a significantly lower rate of unpleasant maternal side effects. Oxytocics administered after delivery of the fetal head compared with after the placental expulsion are associated with a significantly lower rate of postpartum haemorrhage.
Oral misoprostol versus mifepristone for cervical dilatation before vacuum aspiration in first trimester nulliparous pregnancy: a double blind prospective randomised study
Authors: Ngai Suk Wai , Au Yeuug Kam Chuen , Lao Terence , Ho Pak Chung
Published: August 2005

Objective
To compare the effectiveness of oral misoprostol and mifepristone for cervical priming before first trimester termination of nulliparous pregnancy.

Design
Prospective double blind randomised study.

Setting
Department of Obstetrics and Gynaecology, University of Hong Kong.

Participants
One hundred nulliparous women undergoing termination of pregnancy between 8 and 12 weeks of gestation were recruited for this prospective randomised trial. The women were allocated to either the oral misoprostol or mifepristone group. Subjects in misoprostol group were given placebo and misoprosto1 400 pg 36 h and 12 h respectively before vacuum aspiration. Subjects in mifepristone group were given 200 mg mifepristone and placebo 36 h and 12 h respectively prior to operation.

Main outcome measures
Baseline pre‐operative cervical dilatation, the incidence of side‐effects, the amount of blood loss and duration of procedure.

Results
There were no significant differences in the baseline cervical dilatation, incidence of side‐effects, amount of blood loss and duration of procedure.

Conclusions
Misoprostol and mifepristone are of similar effectiveness for cervical priming prior to vacuum aspiration in nulliparous women. Misoprostol has additional advantages of being widely available and inexpensive.
Elective or selective caesarean delivery of the small baby? A systematic review of the controlled trials
Authors: Grant Adrian , Penn Zoe J. , Steer Philip J.
Published: August 2005

Objective
To compare a policy of elective caesarean delivery with a policy of selective caesarean delivery for women in spontaneous preterm labour.

Design
Systematic review of relevant randomised controlled trials.

Participants
One hundred and twenty‐two women from six trials.

Interventions
Random allocation to ‘intention to deliver by caesarean section’ (elective caesarean policy), compared with ‘intention to deliver vaginally’ (selective caesarean policy).

Main outcome measures
Actual use of caesarean delivery, low Apgar score, neonatal intubation, intracranial pathology, perinatal death, and major maternal complications.

Results
One in six women in both groups were not delivered as allocated. Typical odds ratios for all adverse neonatal outcomes tended to favour the elective group, but for all outcomes studied the confidence intervals were wide and did not exclude clinically important hazards of the policy. The odds of serious maternal morbidity were increased in the caesarean section group (OR 6–2; 95% CI 1.3–30.1).

Conclusion
A policy of elective caesarean delivery increases the risks of maternal morbidity, but it remains unclear whether these are offset by benefits for the infant.