bluuebunny/crossref_metadata_2025 huggingface dataset:
Chorionic villus sampling in a high‐risk population— 4 years' experience
Authors: WARD R. H. T. , PETROU M. , MODELL B. M. , KNOTT P. D. , MAXWELL D. , HOOKER J. G.
Published: August 2005

Summary. Between August 1982 and July 1986 a total of 163 pregnancies in 136 patients with a high genetic risk have had prenatal diagnosis by chorionic villus sampling. Villi were not obtained in five pregnancies (two of which subsequently miscarried), and 11 fetal losses followed successful sampling (four in pregnancies in which the fetus was shown to be affected). The rate of fetal loss fell with increasing experience of the team. Three sets of twins were all sampled successfully.
Occult biochemical pregnancy: fact or fiction?
Authors: WALKER E. M. , LEWIS M. , COOPER W. , MARNIE M. , HOWIE P. W.
Published: August 2005

Summary. Daily urine samples were obtained from 38 women of proven fertility, who were attempting to conceive, to assess the frequency of clinically unsuspected ‘biochemical pregnancies’ on the basis of late luteal phase rises of hCG. In 25 clinically confirmed conception cycles, the earliest pregnancy‐induced hCG rises from baseline occurred 8 days after the endocrinologically defined date of ovulation (mean 11·1 days, SD 1·3). Urine samples obtained throughout 50 non‐conception ovulatory cycles provided no evidence of any ‘biochemical pregnancies’ on the basis of late luteal phase rises of hCG occurring 8 or more days after the endocrinologically defined date of ovulation. If, as in previous studies, the date of ovulation had been estimated on the basis of menstrual cycle length and only the relatively non‐specific NIH antiserum had been used in RIAs, 7 of the 50 (14%) cycles would have been classified as resulting in biochemical pregnancies on the basis of hCG >50 m‐i.u./ml on one occasion or >20 m‐i.u./ml on two or more occasions after day 20 of the cycle. These levels of ‘hCG’ occurred at or soon after ovulation and could be explained by LH cross‐reacting in the RIA. The rises of ‘hCG’ were not confirmed when the urine samples were retested with an antiserum (Wellcome 895) of very high specificity for hCG. These results raise the possibility that the frequency of clinically unsuspected ‘biochemical pregnancy’ may have been substantially overestimated.
A double‐blind randomized controlled trial on the use of prophylactic antibiotics in patients undergoing elective caesarean section
Authors: MAHOMED KASSAM
Published: August 2005

Summary. In a double‐blind randomized controlled study 232 patients undergoing elective lower segment caesarean section were randomly allocated to receive a pre‐operative prophylactic dose of a combination of crystalline penicillin and chloramphenicol or a placebo. The two groups were comparable in terms of patient characteristics and operation variables. The group receiving antibiotics had significantly fewer febrile and infectious morbid events and thus spent fewer days in hospital than the group receiving the placebo.
The value of bladder filling in the clinical detection of urine loss and selection of patients for urodynamic testing
Authors: KADAR NICHOLAS
Published: August 2005

Summary. Bladder filling was used to enhance the clinical detection of urine loss in 37 women who attended a general gynaecological outpatient clinic with lower urinary tract symptoms and incontinence. Videocystourethrography was performed subsequently in all women, and the clinical and fluoroscopic detection of urine loss compared. The two methods of detecting urine loss agreed in all but four women with very slight genuine stress urinary incontinence, two being detected by one but not by the other of the two tests. In only 5 of 25 patients was incontinence demonstrable clinically without bladder filling, and in only 13 of 25 was it demonstrable in the supine position. These proportions were 5 of 21 and 10 of 21, respectively, for those with genuine stress incontinence, with or without coexistent detrusor instability. Bladder filling provoked uncontrollable voiding in five women, two had detrusor instability on cystometry, and two had low peak urinary now rates on uroflowmetry. The significance of these findings is discussed in the context of selecting patients for urodynamic testing.
Multiple caesarean sections: outcomes and complications
Authors: KIRKINEN P.
Published: August 2005

Summary. The outcome and complications of caesarean section were compared between 64 women who had had between three and eight previous sections (mean four) and 61 women sectioned for the first or second time. Gestational age was slightly less in the group with multiple operations. Of the women with three or more previous sections 27% had developed a fenestration in the transverse uterine scar; this was symptomless in half of them, and there was no associated severe ante‐ or intrapartum haemorrhage. Operation time was longer in women with multiple caesarean sections, and 13% required a caesarean hysterectomy. There were no other differences in the operative or postoperative courses between the two groups. In most women who have had multiple caesarean sections it is possible to wait for elective delivery until the fetus is mature. No absolute upper limit for the number of repeat caesarean sections can be given.
Inflammatory cell infiltration and survival in squamous cell carcinoma of the vulva
Authors: PRICE J. H. , HEATH A. B. , SUNTER J. P. , SINHA D. P. , MONAGHAN J. M.
Published: August 2005

Summary. The prognostic significance of tumour infiltration by inflammatory cells in squamous cell carcinoma of the vulva was examined in a cohort of 34 patients surviving without recurrence for at least 5 years after radical surgery, and a comparative cohort of 35 patients who died of their diseases. Overall, heavy inflammatory infiltration correlated with a good prognosis and light infiltration with a poor one, independent of other indices such as differentiation, tumour size and nodal status. IgA‐containing cell infiltration also correlated with a good prognosis but the presence of IgA‐containing cells did not alone account for all the inflammation in the good prognosis group. An immunological response to the tumour may be influencing prognosis. At a practical level, the extent of inflammation appears, at least in this material, to be as useful a prognostic index as many more conventional ones.
Perinatal data reliability in a large teaching obstetric unit
Authors: VILLAR J. , DORGAN J. , MENENDEZ R. , BOLAÑOS L. , PAREJA G. , KESTLER E.
Published: August 2005

Summary. In this inter‐rater agreement study of antenatal and neonatal variables collected in a large teaching obstetric unit, information routinely collected by hospital staff was compared with that collected by a specially trained physician and a social worker. Agreement between the two sources of data was evaluated using kappa statistics and intraclass correlation coefficients. Excellent agreement was observed for some variables such as maternal and newborn anthropometric measures, and previous birthweight, but there was poor agreement for others such as indicators of physical activity, work during pregnancy and blood pressure measures. Some of the limitations are due to problems in phrasing questions, patients' recall, interviewer bias and abstracting data. We recommend that epidemiological studies should always include a reliability component, proper standardization of personnel and instruments and include, when published, validity data and examples of questions used.
Thyroid function in pre‐eclampsia
Authors: LAO T. T. , CHIN R. K. H. , SWAMINATHAN R.
Published: August 2005

Summary. Thyroid function was studied in 24 proteinuric pre‐eclamptic patients and 24 gestation‐matched controls. The pre‐eclamptic patients had significantly lower mean total (TT4) and free thyroxine (FT4), and thyroxine‐binding globulin (TBG) concentrations, and the concentration of thyroid‐stimulating hormone was significantly higher. The mean total triiodothyronine (TT3) concentration, however, was similar to the controls. This is at variance with the classical low T3 syndrome reported previously for pre‐eclamptic patients. Compared to the controls, 33·3% and 29·2% of the pre‐eclamptic patients had low TT4 and TT3 concentrations respectively. Pre‐eclamptic patients with low TT4/ TT3 had significantly higher plasma urate concentrations. Thyroid hormone concentrations may reflect the severity of pre‐eclampsia.
Maternal serum unconjugated oestriol as an antenatal screening test for Down's syndrome
Authors: WALD N. J. , CUCKLE H. S. , DENSEM J. W. , NANCHAHAL K. , CANICK J. A. , HADDOW J. E. , KNIGHT G. J. , PALOMAKI G. E.
Published: August 2005

Summary. The median maternal serum unconjugated oestriol level between 13 and 27 weeks gestation in 77 pregnancies associated with Down's syndrome was lower than the median level in 385 unaffected control pregnancies matched for maternal age, gestational age, and duration of serum sample storage (P<0·001). The median level for the affected pregnancies was 73% of that in the controls. Low unconjugated oestriol levels can be used to detect fetal Down's syndrome; at cut‐off levels selected to detect at least 35% of affected pregnancies, unconjugated serum oestriol was a better screening test than either maternal age or serum alpha‐fetoprotein (AFP). The use of all three variables in combination to select women with a 1:250 or greater risk of a Down's syndrome term pregnancy would yield a 45% detection rate with a falsepositive rate of 5.2%. The same detection rate using maternal age alone or using age and serum AFP in combination would yield higher falsepositive rates, 15% and 9.8% respectively. The addition of unconjugated oestriol to a Down's syndrome screening programme would therefore be more efficient than the use of age and AFP alone; for a given detection rate fewer women would need an amniocentesis or, for a given percentage of women having an amniocentesis, more pregnancies with Down's syndrome would be detected.
The variation in cervical hydroxyproline and cervical water with age
Authors: ROBERTS A. D. G. , CORDINER J. W. , HART D. M. , BARLOW D. H. , MacRAE D. , LEGGATE I.
Published: August 2005

Summary. The squamocolumnar junction is frequently not visible in the postmenopausal patient. This study attempts to identify some of the changes in the cervix that may account for this observation. Twentyfour cervical biopsy samples taken at the squamocolumnar junction were analysed for hydroxyproline (collagen) and water content. There was significantly more hydroxyproline (collagen) in the premenopausal woman than the postmenopausal woman. Similarly, there was higher percentage of water in the biopsies in the premenopausal woman than the postmenopausal woman. Further samples obtained deeper in the cervical stroma did not confirm these differences. It appears likely that differences in cervical water and cervical collagen near the surface of the cervix account, at least in part, for the lack of visibility of the squamocolumnar junction in the older woman.
Transvaginal pulsed Doppler ultrasound assessment of blood flow to the corpus luteum in IVF patients following embryo transfer
Authors: BABER RODNEY J. , McSWEENEY MARJORIE B. , GILL ROBERT W. , PORTER RICHARD N. , PICKER RICHARD H. , WARREN PETER S. , KOSSOFF GEORGE , SAUNDERS DOUGLAS M.
Published: August 2005

Summary. The waveforms of vessels supplying the ovaries of women on an in‐vitro fertilization (IVF) programme were studied using transvaginal B‐mode and Doppler ultrasound. There were 125 scans recorded in 65 women at weekly intervals from 3 days after embryo transfer or 5 days after gamete intrafallopian transfer (GIFT) until confirmation of pregnancy or onset of menses. At each examination the signals obtained from vessels supplying the ovaries were recorded and quantified using a resistance index (RI). Fifteen patients became pregnant of whom one has subsequently miscarried. There was a highly significant difference in the RI values between patients who became pregnant and those who did not; no patient who became pregnant had a RI greater than 0.5. Oestrogen to progesterone ratios were calculated in the subgroup of non‐pregnant patients and there was no correlation between these values and the RI values. This new technique enables prediction of IVF treatment failure earlier than has been reported previously and may reflect the inadequacy of the corpus luteum.
Secular trend in the rate of small‐for‐gestational‐age infants: Haguenau Study 1971‐1985
Authors: MEYER L. , BOUYER J. , PAPIERNTK E. , LE LANN D. , MOUKENGUE L. , DREYFUS J.
Published: August 2005

Summary. Between 1971 and 1985, at the Haguenau Maternity Hospital, a 20% decrease was observed in the rate of small‐for‐gestationalage infants (birthweight <10th centile using figures from all the study births) among 20 101 births between 28 and 42 weeks. This decrease could not be explained by simultaneous changes in socio‐demographic and anthropometric characteristics of the pregnant women, nor a recruitment bias. The earliness of prenatal care at the Maternity Hospital may have played a role in the downward trend. Further research is needed to confirm the influence of prenatal care on the rate of small‐forgestational‐age babies.
The management of multiple pregnancy in women with a lower‐segment caesarean scar. Is a repeat caesarean section really the ‘safe’ option?
Authors: GILBERT LUCY , SAUNDERS NIGEL , SHARP FRANK
Published: August 2005

Summary. Multiple pregnancy occurring in a patient who has previously had a lower‐segment caesarean section is an unusual sequence of events. Retrospective analysis over an 11 ‐year period in Sheffield from 1975 to 1985, revealed 25 cases, a rate of 1 in 3300 deliveries. The caesarean section rate in this group of women rose from 20% (3/15) in the first six years to 70% (7/10) in the latter years for no obvious reason. This change in management did not produce any improvement in fetal outcome but there was an increase in maternal morbidity. This analysis and a review of available literature suggest that multiple pregnancy is not in itself an indication for elective repeat caesarean section.
Comparison of pregnancy‐specific β1‐glycoprotein (SP1) and ultrasound in predicting the date of delivery
Authors: NAIEM A. , BERSINGER N. A. , KELLER P. J. , SCHNEIDER H.
Published: August 2005

Summary. The accuracy of ultrasound measurements (crown‐rump length and gestational sac diameter) and the serum concentration of pregnancy‐specific β1‐glycoprotein (SP1) in the prediction of the date of birth was analysed in a study population of 94 patients. When measured before 8 weeks after the last menstrual period (LMP) the serum concentration of SP1, was found to be a good predictor of the expected date of delivery and a good alternative to ultrasound, but it was of limited use when determined at a later gestation.
The effect of vaginal delivery on the urethral sphincter
Authors: TAPP ANDREW , CARDOZO LINDA , VERSI EBOO , MONTGOMERY JULIA , STUDD JOHN
Published: August 2005

Summary. To investigate the actiological role of vaginal delivery in genuine stress incontinence we compared two groups of women who underwent full urodynamic assessment in our department. The women in the first group had competent urethral sphincter mechanisms and those in the second group had genuine stress incontinence. There were no differences between the two groups in respect of parity, number of vaginal deliveries or birthweight of the heaviest baby. The group with competent urethral sphincter mechanisms did show some evidence to implicate an increased number of vaginal deliveries in poor function of the distal part of the urethral sphincter mechanism.
Increased uterine prostaglandin E receptors in menorrhagic women
Authors: MACDONALD R. R. , THOROGOOD JANE , MASON M. K.
Published: August 2005

Summary. A randomized trial was arranged in Yorkshire to assess whether progestogens would improve survival as part of the primary treatment of endometrial carcinoma, in conjunction with surgery and radiotherapy. A total of 429 patients was randomized on diagnosis to the progestogen or control group and treated locally according to an agreed protocol. All the patients are now more than 1 year after operation and over half are more than 5 years after operation. The projected overall 5‐year survival rate is 76% but contrary to expectation there is no statistically significant difference in survival between the patients treated with progestogens and the control group even after statistical adjustment for known prognostic factors.
Amoxycillin‐clavulanic acid (Augmentin) versus metronidazole as prophylaxis in hysterectomy: a prospective, randomized clinical trial
Authors: BROWN E. M. , DEPARES J. , ROBERTSON A. A. , JONES S. , HUGHES A. B. , COLES E. C. , MORGAN J. R.
Published: August 2005

Summary. In order to determine the most effective regimen for the prevention of infection after elective hysterectomy, 300 patients were randomly assigned to receive three perioperativc doses of either amoxycillin‐clavulanic acid (1.2 g intravenous) or metronidazole (1 g suppository). Of the 280 patients who were assessable 138 were given amoxycillin‐clavulanic acid and 142 received metronidazole; 268 underwent abdominal hysterectomy and 12 had vaginal hysterectomy. Patients in the amoxycillin‐clavulanic acid group had significantly less infectious morbidity (13.8%) than those in the metronidazole group (33.1%). There were also statistically significant differences in favour of amoxycillin‐clavulanic acid with respect to operative site infection, duration of hospital stay, need for postoperative antimicrobials, and surgery for operative site infection. But for one isolate of Bacteroides fragilis, all pathogens isolated from wound infections in the metronidazole group were aerobes. No anaerobes were isolated from patients in the amoxycillin‐clavulanic acid group. The results suggest that prophylaxis for hysterectomy should consist of an agent, or combination of agents, with activity against both aerobic and anaerobic bacteria. Amoxycillin‐clavulanic acid fulfils this criterion and appears to be effective and safe.
Is routine antenatal booking vaginal examination necessary for reasons other than cervical cytology if ultrasound examination is planned?
Authors: O'DONOVAN PETER , GUPTA JANESH K. , SAVAGE JOHN , THORNTON JAMES G. , LILFORD RICHARD J.
Published: August 2005

Summary. Sixteen ovarian cysts, including one borderline ovarian malignancy, and ten trichomonal vaginal discharges but no cases of cervical incompetence or ectopic pregnancy had been detected at booking vaginal examination in 11 622 consecutive antenatal case records abstracted retrospectively. In an attitude survey of pregnant women 77% believed that vaginal examination was reassuring, 55% found it unpleasant, and 18% thought it could cause miscarriage. This, and a review of the literature, suggests that routine vaginal examination if ultrasound is planned has few advantages beyond the taking of a cervical smear.
Factors affecting the uptake of screening for neural tube defect
Authors: KYLE DOROTHY , CUMMINS CAROLE , EVANS STUART
Published: August 2005

Summary. A questionnaire concerning pregnant women's knowledge of, and attitudes to, serum alpha fetoprotein (AFP) screening for spina bifida was sent to all pregnant women receiving a health education leaflet on AFP screening who booked at the Birmingham Maternity Hospital in the first quarter of 1984. The majority said that they would accept the test, and subsequently did so. This suggests that low uptake of the test is not a result of patients' resistance, and the results indicated that the provision of early information about the test is likely to improve uptake and decrease anxiety. With the increasing clinical usefulness of the AFP test, routine screening of pregnant women with an ‘opt‐out’ system is becoming clinically desirable, and the survey suggests that it would be acceptable to the patients.
Daily variability of umbilical and lateral uterine wall artery blood velocity waveform measurements
Authors: HASTIE STEWART J. , HOWIE CATHERINE A. , WHITTLE MARTIN J. , RUBIN PETER C.
Published: August 2005

Summary. The daily variability of umbilical artery and lateral uterine wall artery velocity‐time waveforms recorded by continuous wave Doppler ultrasound was determined by making three observations in each of 97 women on different days within a 7‐day period. There were no significant changes in the maximal:minimal Doppler shift frequency (A/B ratio) or the pulsatility index in either artery over the period of study. Common pregnancy complications did not influence the variability of the recordings. The variability of uterine artery recordings was not affected by gestational age between 17 and 41 weeks but the degree of variability of the umbilical artery recordings was greater before 30 weeks. We conclude that after 30 weeks gestation this technique has an acceptable range of daily variability for clinical and research applications.
Is postoperative radiotherapy or maintenance chemotherapy necessary for carcinoma of the uterine cervix?
Authors: SHIROMIZU KENJI , MATSUZAWA MASUMI , TAKAHASHI MICHIKO , ISHIHARA OS AMU
Published: August 2005

Summary. The effectiveness of postoperative radiotherapy and adjuvant chemotherapy was examined for patients with uterine cervical squamous cell carcinoma. Whole pelvis irradiation is unnecessary for patients with less than 2/3 of depth of cervical local involvement without pelvic regional lymph node metastases. Adjuvant chemotherapy with tegafur [l‐(2‐tetrahydrofuryl)‐5‐fluorouracil] (600 mg/day) has failed to improve the survival of patients with positive lymph node metastases.
The role of pudendal nerve damage in the aetiology of genuine stress incontinence in women
Authors: SMITH A. R. B. , HOSKER G. L. , WARRELL D. W.
Published: August 2005

Summary. Conduction was studied in the terminal branches of the pudendal nerve in 42 women with normal urinary control and 87 women with stress incontinence of urine, genitourinary prolapse, or both. Women with stress incontinence of urine had delayed conduction to both the striated urethral muscle and the pelvic floor muscle, indicative of dcnervation injury. Women with normal urinary control and genitourinary prolapse had similar conduction times to the urethral sphincter striated muscle as normal women but clear evidence of denervation damage to the pelvic floor.
Leukotrienes in human umbilical plasma at birth
Authors: PASETTO N. , PICCIONE E. , TICCONI C. , PONTIERI G. , LENTI L. , ZICARI A.
Published: August 2005

Summary. The aim of this study was to see whether leukotrienes are present in human umbilical plasma at birth either before or after labour. Plasma concentrations of LTB4 (6·02 ng/ml) and LTD4 (6·11 ng/ml) were significantly higher (P<0·01) after spontaneous vaginal delivery than during elective caesarean section before labour (LTB4= 1·96 ng/ml, LTD4= 0·18 ng/ml). A possible involvement of leukotrienes in the biochemical and metabolic events of human labour is sugges
Cigarette smoking in pregnancy results in marked decrease in maternal hCG and oestradiol levels
Authors: BERNSTEIN LESLIE , PIKE MALCOLM C. , LOBO ROGERTO A. , DEPUE ROBERT H. , ROSS RONALD K. , HENDERSON BRIAN E.
Published: August 2005

Summary. We have examined serum levels of oestradiol (E2), sexhormone binding globulin (SHBG) and human chorionic gonadotrophin (hCG) during early pregnancy in relation to smoking status at the time of sampling in a series of 147 women. Smoking was associated with significantly depressed serum levels of E2, SHBG and hCG: in smokers, E2 levels were on average 17·6% lower (P=0·037), SHBG levels were 12·4% lower (P=0·15), and hCG levels were 21·5% lower (P=0·044). There appeared to be a steady decline in these values with increasing cigarette consumption. These lower hormone levels in smokers may explain certain adverse effects of smoking in pregnancy.
Umbilical artery flow velocity waveforms in labour
Authors: FAIRLIE F. M. , LANG G. D. , SHELDON C. D.
Published: August 2005

Summary. Doppler signals were recorded from the umbilical arteries in 103 women during labour. The pulsatility index (PI) did not alter with progress in labour. During uterine contractions the PI showed a change only if there was a deceleration in the fetal heart rate. Low birthweight (<10th centile) and delivery by caesarean section for fetal distress were significantly more frequent in patients with abnormal PI values (defined as >2 SD above the mean in normal labours). Fetal scalp blood pH was measured in 24 patients. The PI was abnormal in only one case, but none of the 24 had a pH <7·20.
Maternal and paternal alcohol consumption and miscarriage
Authors: HALMESMÄKl ERJA , ÄLIMÄKI MATTIV , ROTNE RISTO , YLIKAHRI REINO , YLIKORKALA OLAVl
Published: August 2005

Summary. To explore the role of parental alcohol consumption in miscarriage we interviewed 80 women who miscarried about their own and their partners' drinking habits. A control group of 81 gestational‐age‐matched women whose pregnancy ended in the delivery of a healthy infant at term were similarly questioned. The use of alcohol by women and men was equally frequent in both groups. Before pregnancy, the mean alcohol consumption per week had been about 1–2 drinks for the women and 4–5 drinks for the men. During the presumed day of conception, 13% of the women who miscarried and 11% of the women in the control group had drunk on average 3–4 drinks; the other women had been abstinent at this time. Of the partners, 13% and 15%, respectively, had taken a mean of 4–5 drinks. In both groups 58% of the subjects continued to consume alcohol during pregnancy. The mean consumption was about one drink a week by the women who miscarried and half a drink a week in the control group. Of women who miscarried, 36 had a blighted ovum and in this subgroup alcohol consumption in both women and men was similar to that in the other women who miscarried and their partners, suggesting that alcohol is not causally related to the development of a blighted ovum. These results suggest that moderate maternal or paternal alcohol consumption does not increase the risk of miscarriage.
An explanation for the problem of false‐negative cervical smears
Authors: BARTON S. E. , SINGER A. , JENKINS D. , HOLLINGWORTH A. , CUZICK J.
Published: August 2005

Summary. False‐negative cervical cytology due to sampling error is a well‐recognized problem. Forty‐seven women with histologically proven cervical intraepithelial neoplasia (CIN) were studied. All had two cervical smears performed at a mean interval of 3 months. At the time of the second smear, cervicography, colposcopy and biopsy were performed. The area of acctowhite cervical lesions and of the total visible atypical transformation zone (ATZ) were measurcd from the cervical photographs. The 17 women in whom one or both smears showed no dyskaryosis were found to have a significantly smaller proportion of their ATZ affected by CIN. It is suggested that this finding can account for the sampling error which causes false‐negative cervical cytology. New screening techniques, such as cervicography, may offer a method of detecting and assessing these relatively smaller cervical lesions.
Thrombocythaemia and recurrent miscarriage
Authors: Johnson P. M. , Davies J. M. , Rand J. , Murphy S. , Cowchock F. S.
Published: August 2005

The incidence of thrombocythaemia (a platelet count >600×l09/l) in a 10‐year survey was 7 per 106 population per year (R. M. Pettit, personal communication). It is generally a disease of late middle age, but a second population of young and mainly female patients has been described (Hoagland & Silverstein 1978). An increased platelet count can be secondary (after splenec‐tomy, associated with inflammation, malignancy or iron deficiency) or due to a primary myeloproliferative disorder. We describe four patients in whom a series of miscarriages before 20 weeks gestation appears associated with thrombocythaemia and estimate the prevalence of this association in patients with unexplained repeated miscarriage.
The Southmead perineal suture study. A randomized comparison of suture materials and suturing techniques for repair of perineal trauma
Authors: MAHOMED KASSAM , JAMES DAVID , GRANT ADRIAN , ASHURST HAZEL
Published: August 2005

Commonly used suture materials and techniques for perineal repair following vaginal delivery were compared in a randomized controlled trial involving 1574 women. Three comparisons were made using a modified factorial design. In the comparison of teflon‐coated polyglycolic acid (Dexon plus) with chromic catgut for repair of the vagina and deep perineal tissues there was no clear difference other than less short‐term analgesia being required in association with polyglycolic acid. Outcome was also similar after skin repair with either polyglycolic acid or chromic catgut or silk, although silk repair required more packets of material and was associated with delay in resuming sexual intercourse; polyglycolic acid was more likely to need removal than chromic catgut but it appeared to reduce the need for resuturing. There was no clear difference between continuous subcuticular and interrupted transcutaneous sutures for repair of perineal skin.
Mode of delivery and future fertility
Authors: HALL M. H. , CAMPBELL D. M. , FRASER C. , LEMON J.
Published: August 2005

A cohort of 22 948 women from a stable homogeneous population who gave birth for the first time between 1964 and 1983 were followed up prospectively. Analysis by mode of delivery showed that of those delivered by caesarean section 23·2% fewer had another pregnancy than those who had a spontaneous vaginal delivery. Women delivered by forceps were in an intermediate group. Miscarriage was more common in women who had been delivered by caesarean section. The relative infertility after caesarean section could not be accounted for by early sterilization, was not associated with maternal height or social status, and was only partly attributable to age.
Nausea and vomiting of early pregnancy and pregnancy outcome. An epidemiological study
Authors: WEIGEL M. MARGARET , WEIGEL RONALD M.
Published: August 2005

The association of nausea and vomiting in pregnancy with the outcome of pregnancy was investigated in a historical cohort of 903 women in Los Angeles, California, USA. Multivariahle statistical methods were employed to control for the potential confounding effects of age, ethnicity, occupation, and anti‐emetic use on pregnancy outcome. The analyses indicated that vomiting was associated with decreased risk of miscarriage (adjusted odds ratio 0·18, 95% CI 0·06 to 0·53); women with nausea but no vomiting had a miscarriage risk equal to that in the sample overall. Among the subsample of women with signs of threatened miscarriage, those who had experienced vomiting had a decreased risk of miscarriage (10·3%vs 31·7% in the subsample). No statistically significant association was observed between nausea and vomiting of pregnancy and other pregnancy outcomes (perinatal mortality, fetal anomalies, neonatal anthropometric measures).
Correlation of ultrasound findings and endometrial histopathology in postmenopausal women
Authors: NASRI M. N. , COAST G. J.
Published: August 2005

Comparison of ultrasound scan and histology of the endometrium was made in 90 postmenopausal women. Of these, 63 women had postmenopausal bleeding (group A) and 27 had had no bleeding (group B). Sensitivity of ultrasound to diagnose endometrial pathology was 91%, and all endometrial carcinomas, hyperplasias and pyometra were diagnosed by ultrasound. In 10 prcmenopausal women (group C), who had a hysterectomy for cervical intraepithelial neoplasia, the ultrasound measurements of the endometrial wall thickness were within 1 mm of the actual thickness, as measured in the fresh unfixed specimen with a ruler. This preliminary study has shown that a normal ultrasound appearance of the endometrium in postmenopausal women reliably excludes significant endometrial pathology. Also, changes in the thickness and texture of the endometrium detected by ultrasound correlated with subsequent pathological findings.
Intraperitoneal radioimmunotherapy for ovarian cancer
Authors: STEWART J. S. W. , HIRD V. , SULLIVAN M. , SNOOK D. , EPENETOS A. A.
Published: August 2005

Summary. Twenty‐eight patients with assessable residual ovarian cancer after cytoreductive surgery and chemotherapy received intraperitoneal 1–131 labelled monoclonal antibodies. There was no response in eight patients with tumour nodules >2 cm, a partial response in two of the 15 patients with tumour nodules <2 cm, and a complete response in three of the other five patients with positive peritoneal washings. A further six patients received Y‐90 labelled monoclonal antibodies for residual ovarian cancer. There was no response in one patient with nodules >2 cm, and a partial response in one of the other five patients with tumour nodules <2 cm. The non‐specific radiation dose in the peritoneal cavity from the infused isotope was measured by lithium fluoride thermoluminescent dosimetry (TLD). The radiation dose received by the peritoneal serosa was <500 cGy and was not sufficient to account for the observed tumour response. Significant bone marrow suppression was observed with 1–131 activities greater than 120 mCi and with Y‐90 activities greater than 13 mCi. The haemopoietic bone marrow is the dose‐limiting organ in patients receiving radioimmunotherapy.
A multicentre randomized trial comparing delivery with a silicone rubber cup and rigid metal vacuum extractor cups
Authors: COHN M. , BARCLAY C. , FRASER R. , ZAKLAMA M. , JOHANSON R. , ANDERSON D. , WALKER C.
Published: August 2005

Summary. A total of 258 women requiring assisted delivery where vacuum extraction was thought to be suitable were randomly allocated to delivery with a new silicone rubber cup or metal vacuum extractor cups. There was a tendency for the silicone rubber cup to effect delivery more quickly and to cause less scalp trauma, but to fail to effect delivery on more occasions than metal cups. However, none of these differences was statistically significant. There were no statistically significant differences in the rates of birth canal trauma, maternal blood loss, or neonatal jaundice. The silicone rubber cup produced a cosmetically more acceptable chignon than the metal cups. The introduction of vacuum extractors with silicone rubber cups into obstetric units should be encouraged.
Reactive fetal heart rate response to vibroacoustic stimulation in fetuses with low scalp blood pH
Authors: INGEMARSSON I. , ARULKUMARAN S.
Published: August 2005

Summary. Fetal vibroacoustic stimulation in fetuses with suspicious or ominous fetal heart rate traces in labour was followed by acid‐base balance determination on fetal scalp blood within 30 min of the test. The mean fetal scalp blood pH values were significantly higher in fetuses that showed reactive responses with fetal heart rate acceleration compared with those who had no response or responded with a deceleration to the vibroacoustic stimulation (pH 7·30 and 7·22 respectively). However, acidotic scalp blood pH values (7·16 and 7·18) were found in two fetuses which had shown reactive responses both to vibroacoustic stimulation and pain stimuli with scalp blood sampling.
Umbilical artery velocity waveforms: poor association with small‐for‐gestational‐age babies
Authors: DEMPSTER J. , MIRES G.J. , PATEL N. , TAYLOR D.J.
Published: August 2005

Summary. A total of 205 high‐risk pregnancies was studied using coninuous wave Doppler ultrasound examination of the umbilical artery to investigate the ability of the test to detect small‐for‐gestational‐age (SGA) infants. The waveforms were analysed by calculating a ratio of the peak systolic to end diastolic frequency (A/B ratio). An A/B ratio >95th centile from our derived normal values was classified as abnormal. Three outcome variables were examined: birthweight for gestational age, the standard deviation birthweight score and the ponderal index. Although of the 56 pregnancies with an abnormal Doppler result 34 (61 %) were associated with a SGA infant, only 41% of all the SGA infants had an abnormal Doppler result. Alternative measures of growth, the ponderal index and the SD birthweight score, showed that on average the babies in the Doppler abnormal group were smaller than those in the Doppler normal group, but the overlap between the normal and abnormal groups was large. Therefore although Doppler ultrasound appears to identify groups of smaller babies, it does not identify individual pregnancies where the baby will be small at birth.
The role of low‐dose methotrexate and folinic acid in gestational trophoblastic tumours (GTT)
Authors: BAGSHAWE K. D. , DENT J. , NEWLANDS E. S. , BEGENT R. H. J. , RUSTIN G. J. S.
Published: August 2005

Summary. Between 1964 and 1986, 487 patients with gestational trophoblastic tumour (GTT) were treated with methotrexate and folinic acid. The patients comprise two groups: between 1964 and 1974, 126 patients were treated but were not systematically stratified using a prognostic score before the start of treatment. These patients formed part of the 317 women who were analysed to identify a number of prognostic variables (Bagshawe 1976). Retrospective analysis of these 126 patients using these prognostic factors showed that in the true low‐risk group 85/88 (96%) are alive while 20/22 (91%) of the medium‐risk group and only 5/16 (31%) of the high‐risk group are alive. Overall the survival was 110/126 (87%) with a minimum follow‐up of 14 years. From 1974 all patients were stratified on admission into prognostic groups. Of the true low‐risk patients 347/348 survived (99·7%); 13 patients were underscored and treated as low risk when they should have been treated as medium risk, 12 (92%) of these are alive, but nine (69%) needed to change treatment because of drug resistance. While the overall survival in the 1974–1986 group was 359/361 (99%) with a minimum follow‐up of 16 months, the survival in all patients (1964–1986) was 469/487 (96%). Although the survival in these patients is excellent it should be noted that 69/348 (20%) low‐risk patients had to change treatment because of the development of drug resistance, and a further 23 (6%) needed to change treatment because of drug‐induced toxicity. Low‐dose methotrexate and folinic acid given in the schedule described remains the treatment of choice in patients with low‐risk GTT because of its effectiveness and minimal short‐ and long‐term toxicity. Patients presenting with medium‐ and high‐risk GTT need to start with combination chemotherapy from the outset to avoid the development of drug resistance.
Immunological heterogeneity of pregnancy‐associated plasma protein‐A (PAPP‐A). Effects on the radioimmunoassay of PAPP‐A
Authors: BISCHOF P. , MEISSER A.
Published: August 2005

Summary. Pregnancy‐associated plasma protein‐A (PAPP‐A) is a macromolecular glycoprotein produced by the trophoblast during pregnancy. Because the presence of PAPP‐A in non‐pregnant females is controversial, we re‐evaluated our own radioimmunoassay technique for PAPP‐A in the light of new observations about its immunological heterogeneity. Irrespective of the antibody (Geneva anti‐PAPP‐A or Dako anti‐PAPP‐A) the use of EDTA pregnancy plasma instead of pregnancy scrum as a standard yielded different slopes of the standard curves and estimated significantly different amounts of PAPP‐A in test samples. Moreover, highly purified tracers, isolated from maternal EDTA pregnancy plasma or pregnancy serum also produced significantly different results. So that the use of a tracer purified from EDTA plasma and EDTA pregnancy plasma as a standard will yield measurable levels of PAPP‐A in non‐pregnant female serum whereas the use of a tracer purified from maternal pregnancy serum and maternal pregnancy serum as a standard will not detect PAPP‐A in the same samples. We conclude that, irrespective of the antiserum used, but depending on the biological origin of the tracer and the standard, different results will be obtained. PAPP‐A is clearly immunologically heterogeneous, and the immunorecognition of PAPP‐A will depend on whether or not blood coagulation has taken place.
Oxytocin augmentation in dysfunctional labour after previous caesarean section
Authors: ARULKUMARAN S. , INGEMARSSON I. , RATNAM S. S.
Published: August 2005

Summary. Uterine activity was quantified in women with a previous caesarean scar and a slow progress of labour who needed oxytocin augmentation. Of the 63 women 49 (78%) progressed well (mean cervical dilatation rate of 1·5 cm/h) and were delivered vaginally. Fourteen women had slow progress of labour (0·3 cm/h) and were delivered by caesarean section despite adequate and similar augmented uterine activity to that in the women who were delivered vaginally. Those who were delivered by caesarean section had a significantly higher mean maximum dose of oxytocin and a longer period of augmentation. All caesarean sections were for cephalopelvic disproportion and the mean birthweight of babies born by caesarean section (3598 g) was significantly higher than that of babies born vaginally (3230g). Satisfactory rate of cervical dilatation in the presence of optimal uterine activity is predictive of favourable outcome when oxytocin is used for dysfunctional labour after previous caesarean section.
Amniotomy‐induced labour is not mediated by endogenous oxytocin
Authors: THORNTON S. , DAVISON J. M. , BAYLTS P. H.
Published: August 2005

Summary. A technique for complete oxytocinase inhibition has been combined with a rapid serial sampling strategy to determine the plasma oxytocin concentration in eight women undergoing amniotomy for the induction of labour at term and in eight control women. Amniotomy was not associated with an increase in plasma oxytocin concentration. Furthermore, the concentrations were not increased for 20 min following the procedure. Labour was not established in any patient by the end of the 30‐min study period.
A total of 250 136 laparoscopic sterilizations by a single operator
Authors: MEHTA PRAVIN V.
Published: August 2005

Summary. A total of 250 136 women was sterilized as outpatients by a single operator working with a team in ad hoc sterilization ‘camps’. Falope rings were applied by the laparocator under local anaesthesia, with premedication but without vaginal manipulation (in all but the first 10 100). Volunteers were recruited and the operation discussed in nearby villages. The women were numbered at registration and arranged in groups, each comprised of two rows (odd or even numbers) of 15 women, leading to two improvised operating tables or benches in a steep Trendelenbcrg position. With good teamwork the number of women sterilized was generally 40 to 50/h. There were 12 associated deaths, not all attributable to the procedure, a mortality rate of 4·8 per 100 000; 8 major complications (3·2 per 100 000) required laparotomy or admission to hospital. In a follow‐up survey of 84 940 responders to a questionnaire only 90 pregnancies (0·1%) were reported to have been conceived after the cycle of surgery. The results suggest that the rapid ‘no exposure’ technique as used in this series is safe and acceptable in an Indian context. If others could acquire this skill it could with appropriate adaptation make appreciable inroads into the unmet need for female sterilization in many other developing countries.
Reformatted computed tomography of the female pelvis: normal anatomy
Authors: CONSTANT O. , COOKE J. , PARSONS C. A.
Published: August 2005

Summary. Axial computed tomography (CT) of the pelvis provides useful information in patients with gynaecological malignancies, both for initial staging, to follow disease progression and to assess response to treatment. Additional useful information may be available from reformatted coronal and sagittal images. Knowledge of normal anatomy is essential for correct interpretation of pathology. The anatomy and technique used to acquire the images are described in this paper.
Induction of labour after fetal death: a randomized controlled trial of two prostaglandin regimens
Authors: KANHAI HUMPHREY H. H. , KEIRSE MARC J. N. C.
Published: August 2005

A total of 85 women with antepartum fetal death between 14 and 42 weeks gestation was randomly assigned to one of two regimens of intravenous infusion of the prostaglandin analogue 16‐phenoxy‐17, 18, 19, 20‐tetranor‐PGE2‐methylsulphonamide (sulprostone) for inducing labour. Women received either 1 μg/min until delivery or the commonly recommended treatment of 1500 μg in 8 h followed by another, identical course of treatment if delivery did not occur within 24 h. The 1 μg/min dose schedule used half the amount of prostaglandin and resulted in statistically significantly fewer gastrointestinal side‐effects compared with the conventional treatment. All women were delivered vaginally and there were no differences in induction‐to‐delivery intervals between the two treatments. Sulprostone infused at a rate of 1 μg/min resulted in a 50% chance of being delivered within 12 h and a 90% chance of being delivered within 24 h, with an overall frequency of side‐effects of 20%.
Progestogen administration in pregnancy may prevent preterm delivery
Authors: KEIRSE MARC J. N. C.
Published: August 2005

Summary. Two recently published metaanalyses of controlled trials of a wide variety of progestational agents, used in pregnancy (Daya 1989; Goldstein et al. 1989), prompted this third metaanalysis of placebocontrolled trials involving the prophylactic use of a single agent, 17αhydroxyprogesterone caproate. Of seven relevant published reports of controlled trials, six had involved women considered to be at high risk of miscarriage or preterm birth. This analysis provides no support for the view that 17ahydroxyprogesterone caproate protects against miscarriage, but suggests that it does reduce the occurrence of preterm birth. The latter effect was reflected in a reduced rate of low birthweight babies, but not in a statistically significant reduction in perinatal mortality and morbidity. The difference between this metaanalysis and the two earlier metaanalyses illustrates the problems both of selective subgrouping and of comprehensive pooling of data from small trials.
A histological and immunohistological study of cervical intraepithelial neoplasia in relation to recurrence after local treatment
Authors: RASBR1DGE S. A. , JENKINS D. , TAY S. K.
Published: August 2005

Summary. A retrospective histological study was performed on 23 patients who had presented with recurrent cervical intraepithelial neoplasia (CIN) 18 months or more after apparently adequate local destructive treatment and a comparable control group of 23 patients who had no recurrence at 18 months. All recurrences were in women with CIN 3. Detailed examination of pretreatment biopsies showed that there were significant differences in both the extent of crypt involvement (P<0.01) and maximum depth of CIN (P<0.01) between the recurrent groups and the comparison group of women without recurrence. There was also a significant difference in mitotic count between the two groups (P<0.01). Immunocytoehemical staining for Langerhans' cells or human papilloma virus common antigen showed no significant difference between the two groups. A mitotic count of 35 per ten high‐power fields or a depth of crypt involvement > 1.7 mm in the pretreatment biopsy was invariably associated with recurrence and identified 13/22 (59%) cases of recurrent disease. The histological reporting of these features may be of value in predicting a group of women at high risk of recurrence of CIN after local treatment.