bluuebunny/crossref_metadata_2025 huggingface dataset:
A new treatment for endometrial cancer with gonadotrophin releasing‐hormone analogue
Authors: GALLAGHER C. J. , OLIVER R. T. D. , ORAM D. H. , FOWLER C. G. , BLAKE P. R. , MANTELL B. S. , SLEVIN M. L. , HOPE‐STONE H. F.
Published: August 2005

Objective— To test the antitumour effect of gonadotrophin releasing‐hormone (GnRH) analogues in women with recurrent endometrial cancer.

Design— An open phase II observational trial of GnRH analogues. Serial measurements of gonadotrophins, sex hormones and tumour dimensions were made together with repeat biopsy when possible to assess the response to treatment.

Setting— The outpatient clinics of the Department of Medical Oncology at The Royal London, Royal Marsden and St Bartholomew's hospitals.

Subjects— 17 patients with endometrial cancer which had recurred after surgery, radiotherapy and progesterone treatment and was symptomatic, progressive and assessable for response.

Intervention— Monthly subcutaneous injection of GnRH analogue.

Main outcome measures— Reduction in serum gonadotrophins and reduction in tumour dimensions.

Results— Six out of 17 patients (35%, 95% CI 12.6–58%) achieved a complete or partial remission which continues for a median of 20 months with no adverse effects.

Conclusion— GnRH analogues have a significant antitumour effect in recurrent endometrial cancer which warrants further examination in comparison with progestogens.
Patient acceptability of laser and cold coagulation therapy for pre‐malignant disease of the uterine cervix
Authors: GOODMAN J. D. S. , SUMNER D.
Published: August 2005

Objective— To determine patient acceptability of cold coagulation and laser treatment for cervical intraepithelial neoplasia (CIN).

Design— A prospective study with alternate allocation.

Setting— Teaching hospital in London.

Subjects— 155 women requiring treatment for CIN.

Main outcome measures— Time taken to complete the treatment; visual analogue scores for pain experienced, anxiety felt and acceptability of the procedure; post treatment bleeding and discharge, and follow‐up smear.

Results— Cold coagulation treatment was found to be quicker and less painful than laser treatment, there were no other significant differences between the two methods of treatment.

Conclusion— Cold coagulation is a more acceptable form of treatment for CIN than laser.
Presence of an oestradiol receptor‐related protein in the skin: changes during the normal menstrual cycle
Authors: FRASER DAVID , PADWICK MALCOLM L. , WHITEHEAD MALCOLM , COFFER ARNOLD , KING ROGER J. B.
Published: August 2005

Objective— To investigate the presence of an oestradiol receptor‐related protein (P29) in skin and skin oraganelles, and to assess changes in its content during the normal menstrual cycle.

Design— An observational study.

Setting— King's College School of Medicine and Dentistry, London.

Subjects— Twenty‐one premenopausal women with regular menstrual cycles undergoing gynaecological surgery. They were allocated to proliferative or secretory phases of the menstrual cycle on the basis of menstrual dating and histological examination of an endometrial sample.

Interventions— Small full thickness sections of skin (about 5 mm in depth) taken from the anterior abdominal wall at hysterectomy or laparoscopic sterilization.

Main outcome measures— The concentration of the oestradiol receptor‐related protein in skin and its organelles was assessed semi‐quantitatively, using a monoclonal antibody technique. The intensity of staining was compared between the proliferative and secretory phases of the cycle.

Results— The receptor‐related protein was consistently observed in epidermis, sebaceous glands, hair follicles and sweat ducts; there was no significant difference in its concentration between the proliferative and secretory phases of the menstrual cycle. The protein was not present in dermis and sweat ducts.

Conclusions— Epidermis and some skin organelles contain an oestradiol receptor‐related protein and must be considered as oestrogen target tissues. However, the content of this protein does not appear to change significantly during the normal menstrual cycle.
Histological incomplete excision of CIN after large loop excision of the transformation zone (LLETZ) merits careful follow up, not retreatment
Authors: MURDOCH JOHN B. , MORGAN PHILIP R. , LOPES ALBERTO , MONAGHAN JOHN M.
Published: August 2005

Objective
To quantify and analyse the influence of a histological report of incomplete excision of CIN after LLETZ on frequency of detection of residual CIN.

Design
Review of a computerised database of sequential women treated by LLETZ. Initial follow‐up was three months post‐treatment.

Setting
The Colposcopy Clinic, Regional Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK.

Subjects
721 women with CIN diagnosed histologically on LLETZ specimens.

Results
In spite of a first time treatment success rate of 95% at 3 months, only 56% of the women were reported to have complete histological excision of CIN. A report suggesting incomplete excision was more likely with more severe CIN, extensive lesions and involvement of the endocervical canal. Furthermore, 21 % with residual CIN had apparent complete excision of CIN at LLETZ.

Conclusions
A histological report of incomplete excision of CIN at LLETZ does not equate with residual disease. The high treatment success rate of LLETZ means that a report of incomplete excision should stimulate close colposcopic and cyt‐ologic follow‐up to identify the small number of women with residual CIN after therapy.
The effect of intrauterine growth retardation on the development of renal nephrons
Authors: HINCHLIFFE S. A. , LYNCH M. R. J. , SARGENT P. H. , HOWARD C. V. , VAN VELZEN D.
Published: August 2005

Objective
To investigate the effect of Type II (asymmetrical) intrauterine growth retardation (IUGR) on renal development.

Design
A prospective descriptive study.

Setting Department of Fetal and Infant Pathology, Liverpool Children's Hospital.

Subjects
Six (severely) affected IUGR stillbirths of known gestational age with a control group of stillbirths with birthweight > 10th centile, and eight liveborn IUGR infants who died within a year of birth with a control group of appropriately grown infants who died within a year of birth (postnatal groups).

Techniques
The kidneys from all the groups studied were analysed using unbiased, reproducible and objective design‐based stereological techniques.

Main outcome measures
Total renal nephron (glomerular) numbers and average volumes of total nephron and cortical and medullary nephron segments.

Results
Nephron number estimates lay below the control group's 5% prediction limit in five out of the six growth‐retarded stillbirths, and were significantly (P<0.005, IUGR at 65% of the control mean) reduced in the postnatal group. Estimates of nephron (segment) volume did not differ between control and IUGR groups.

Conclusions
Type II intrauterine growth retardation may exert a profound effect on renal development. The reduced nephron number at birth, together with the lack of any early postnatal compensation in either nephron number or nephron size, emphasizes the need for vigorous antenatal surveillance for IUGR and consideration of elective preterm delivery of affected fetuses. A systematic review of other organs, which develop in a similarly rapid fashion during the late intrauterine period, is indicated by this work. With one exception, all birthweights in the growth‐retarded groups were below the third centile, thus the precise quantitative relation between progressive IUGR and renal function requires further assessment.
Endometrial responses in artificial cycles: a prospective, randomized study comparing three different progesterone dosages
Authors: LI T. C. , RAMSEWAK S. S. , LENTON E. A. , COOKE I. D. , WARREN M. A. , DOCKERY P.
Published: August 2005

Objective
To examine the endometrial response to three different regimens of progesterone.

Design
A prospective, randomized study.

Setting
The Jessop Hospital for Women, Sheffield.

Subjects
14 women with premature ovarian failure divided into two equal groups.

Interventions
Three different regimens of hormone replacement therapy containing standard, high and low progesterone dosages. One group received the standard regimen in one cycle and high dosage regimen in another cycle. The second group received the standard regimen in one cycle and low dosage regimen in another cycle. The order of the two dosage regimens was randomized by lottery.

Main outcome measures
Ultrasonographic measurement of endometrial thickness and morphological study of endometrial biopsy specimens taken on day 19 of the cycle using the traditional dating criteria and morphometric techniques.

Results
Compared with standard regimen cycles, the endometrial response in cycles treated with the low dosage regimen showed significant retardation of overall endometrial development and changes in a number of morphometric measurements. The response of endometrial glands to the high dosage regimen was similar to that of the standard regimen, although the stromal cell diameter was increased.

Conclusions
In women receiving hormone replacement therapy normal endometrial development depends on an adequate dosage of progesterone, but increased dosage above our standard regimen does not produce any further change in the glandular component of the endometrium.
Intra‐operative blood loss during elective lower segment caesarean section
Authors: DUTHIE S. J. , GHOSH A. , NG A. , HO P. C.
Published: August 2005

Objective
To measure intra‐operative blood loss at elective lower segment caesarean section and to compare estimated wtih measured blood loss.

Design
Prospective observational study. Blood loss was measured in patients who underwent lower segment caesarean section in the course of routine hospital activity.

Setting
Tsan Yuk Hospital (Hong Kong), which is affiliated to the University of Hong Kong, 1990–1991.

Subjects
Forty women (mean age 29 years) with singleton pregnancies (mean gestation 38 weeks) delivered by elective lower segment caesarean section under general anaesthesia (mean birthweight 3177 g).

Main outcome measure
Intra‐operative blood loss measured by the alkaline haematin method (intra‐assay co‐efficient of Variation 2.2%).

Results
The mean measured blood loss was 487 ml (SE 40, range 164–1438). The mean estimated blood loss was 425 ml (SE 31) range 100–1300; mode 400). Observer error in estimating blood loss was higher if measured blood loss >600 ml. One patient received a blood transfusion and another had a post‐operative haemoglobin level <10.0g/dl.

Conclusion
Blood loss at elective lower segment caesarean section was usually <500 ml and was estimated with reasonable accuracy. However, there was a tendency to under‐estimate blood loss when the measured loss exceeded 600 ml.
Thyroxine dosage during pregnancy in women with primary hypothyroidism
Authors: GIRLING JOANNA C. , de SWIET MICHAEL
Published: August 2005

Objective
To assess whether pregnancy changes the thyroxine requirements of hypothyroid women.

Design
A retrospective, longitudinal study.

Setting
Queen Charlotte's and Chelsea Hospital for Women.

Subjects
32 women referred for antenatal care during 35 pregnancies.

Main outcome measures
Changes in thyroid stimulating hormone (TSH) and free thyroxine (fT4) levels as pregnancy progresses.

Results
In most of the pregnancies (80%), no change in thyroxine dose was required (mean dose 129 μg). The mean TSH levels in early (1.8 mU/1) and in late pregnancy (1.5 mU/1) were unchanged (P >0.5). In the remaining pregnancies, thyroxine dose was increased after the first antenatal clinic appointment, on the basis of thyroid function test results, from a mean of 104 μg to a mean of 172 μg (P<0.01). These women had a mean early pregnancy TSH of 12.3 mU/1, which decreased by 95% to 1.3mU/1(P<0.01).

Conclusions
Most of the hypothyroid patients presenting to an antenatal booking clinic are well controlled in early pregnancy and will remain so throughout pregnancy. The dose of thyroxine does not need to be changed, and further assessments of thyroid function should not be necessary. It is unlikely that the patients were all ‘over‐treated’ before conception, since they were referred to us by a large number of independent doctors. Women who are under‐treated before the pregnancy are likely to require both increased thyroxine dose and further thyroid function assays. They can generally be easily detected, biochemically, at the first hospital visit.
Vaginosonographic velocimetry in uterine arteries before and after administration of beta‐mimetics
Authors: DEUTINGER JOSEF , RUDELSTORFER RUDOLF , PATTERMANN ANDREAS , BERNASCHEK GERHARD
Published: August 2005

Objective
To investigate the effect of surgical procedures at 15 weeks gestation (amniocentesis or cervical cerclage), with or without post‐operative ritodrine prophylaxis, on uterine blood flow velocity waveforms and maternal heart rate.

Design
A quasi‐randomized observational study.

Setting
University Department of Obstetrics and Gynaecology, Vienna.

Subjects
Sixty women having a genetic amniocentesis for advanced maternal age and 57 women having elective cervical cerclage for previous preterm labour or recurrent miscarriage.

Interventions
The women in each group were allocated either to receive prophylactic ritodrine postoperatively or to receive no ritodrine treatment. Allocation used the year of birth of the woman (odd years received ritodrine, even years received no treatment). All the women had vaginal ultrasound velocimetry studies in both mainstem uterine arteries through the parametrium before the surgical procedure and again after the procedure. The ritodrine‐treated women in the cerclage group received intraveneous ritodrine hydrochloride (0.2 mg/min) and those in the amniocentesis group received 60 mg ritodrine/day orally.

Main outcome measures
Uterine artery blood flow velocity waveform indices: A/B ratio and pulsatility index (PI) and maternal heart rate before and after the surgical procedure.

Results
The only statistically significant difference in haemodynamic values between those obtained before the procedure and those obtained after the procedure with or without prophylactic ritodrine was seen in the women who had cervical cerclage with postoperative intravenous ritodrine. The mean A/B ratio decreased from 2.69 (SD 1.17) to 2.11 (SD 0.44), and the mean PI from 1.62 (SD 0.47) to 1.21 (SD 0.3) and the mean maternal heart rate increased from 82.6 (SD 11.1) to 99.4 (SD 15.7). There were no other statistically significant differences between before and after haemodynamic values.

Conclusions
There are no clinically relevant effects of amniocentesis and cervical cerclage on uterine blood flow velocity waveforms.
A double‐blind randomized study of the effect of erythromycin in preventing pelvic inflammatory disease after first trimester abortion
Authors: SØRENSEN JETTE L. , THRANOV INGRID , HOFF GERDI , DIRACH JøRGEN , DAMSGAARD MOGEN T.
Published: August 2005

Objective
To assess the prophylactic use of erythromycin in prevention of post‐abortal pelvic inflammation disease (PID) in first trimester abortion.

Design
Double‐blind, randomized controlled trial.

Setting
Department of Surgery, County Hospital, Denmark.

Subjects
Four hundred and thirty two women who were to undergo induced abortion before 12 weeks gestation were randomized to be treated either with prophylactic erythromycin or a placebo.

Intervention
The women were randomized to receive a placebo or erythromycin, 500 mg twice a day for 71/2 days starting the evening before the abortion. All the women were investigated for Chlamydia trachomatis and Neisseria gonorrhoea before the abortion.

Main outcome measures
Frequency of cervical C. trachomatis and N. gonorrhoea and frequency of PID after abortion.

Results
Fifty four women were excluded after randomization. The frequency of PID was 11% (20/189) in the erythromycin group and 16% (30/189) in the placebo group (P= 0.13, χ2‐test). The prevalence of C. trachomatis was 19% (15/78) in women ≤ 20 years of age, 13% (14/109) in women between 21 and 25 years and 2% (5/241) in women ≤ 26 years of age. In women positive for C. trachomatis erythromycin prophylaxis significantly reduced the frequency of PID to 8% (l/13) compared with 43% (6/14) in the placebo group (P= 0.051, logistic regression analysis). Erythromycin had no effect on other potential high risk groups (first pregnancy, nulliparous, <20 years of age, and women with previous PID).

Conclusion
Prophylactic erythromycin is not warranted for all women having an abortion. Cervical C. trachomatis is a risk factor for postabortal PID, and prophylaxis with erythromycin significantly reduces the frequency of PID. However, only a few women with PID had cervical C. trachomatis, and the prevention of post‐abortal PID remains a major challenge requiring further studies.
Detection of fetal DNA in trans‐cervical swabs from first trimester pregnancies by gene amplification: a new route to prenatal diagnosis?
Authors: GRIFFITH‐JONES MARTIN D. , MILLER DAVID , LILFORD RICHARD J. , SCOTT JANETTE , BULMER JUDITH
Published: August 2005

Objective
To determine whether fetal sex can be predicted from fetal DNA retrieved transcervically from the lower part of the uterine cavity in the first trimester of pregnancy.

Design
Prospective observational study.

Setting
St James's University Hospital, Leeds.

Subjects
33 women undergoing legal termination of pregnancy at 9 to 13 weeks gestational age.

Interventions
Before termination of pregnancy samples for DNA analysis were obtained with cotton wool swabs from the vagina, cervix and transcervically in 26 women. In the other seven women samples were obtained using a transcervical cell retrieval (TraCeR) procedure involving flushing the lower uterine cavity with 5 ml saline.

Main outcome measures
Detection of Y‐chromosome specific DNA sequences by the polymerase chain reaction (PCR) in cotton wool swabs taken from the lower uterus in the first trimester of pregnancy to predict fetal sex in comparison with standard cytogenetic analysis. Histological and immunohistochemical analysis of samples obtained by flushing of the lower uterine cavity (TraCeR) to confirm the presence of trophoblast.

Results
Fetal sex was predicted accurately in 25 of the 26 pregnancies investigated. Immunohistochemical analysis identified syncytial trophoblast fragments in all seven pregnancies investigated by TraCeR.

Conclusion
Trophoblast may be retrieved from the lower uterus in the first trimester by swabs or TraCeR. When purification of these syncytial fragments can be achieved using immuno‐magnetic technology, this test will enable prenatal diagnosis of single gene defects in the fetus by the polymerase chain reaction.
Clinical and histopathological features of parvovirus B19 infection in the human fetus
Authors: MOREY A. L. , KEELING J. W. , PORTER H. J. , FLEMING K. A.
Published: August 2005

Objective
To provide a comprehensive description of the clinical and histopathological features associated with parvovirus B19 infection of the human fetus.

Subjects
All cases of parvovirus B19‐related fetal death presenting to the John Radcliffe Hospital, Oxford, over a 16 year period. Diagnosis was confirmed retrospectively by non‐isotopic in situ hybridization for parvovirus B19 DNA.

Results
The ten cases occurred in two clusters (1979–80 and 1988–89) and presented between 15 and 29 weeks gestation. In at least three cases maternal infection was asymptomatic. Nine fetuses were grossly hydropic at necropsy. Histological features common to all cases included the presence of typical intranuclear inclusions in erythroid precursor cells and evidence of vasculitis within placental villi. Inflammatory changes were also present in the myocardium of four cases, with evidence of sub‐endocardial fibroelastosis in three.

Conclusions
Histological features of fetal parvovirus B19 infection are similar across a range of gestational ages. The heart failure and hydropic state associated with fetal parvovirus infection may be of multifactorial aetiology, and not due to fetal anaemia alone.
In‐vivo studies of uterine electrosurgery
Authors: DUFFY S. , REID P. C. , SHARP F.
Published: August 2005

Objective
To study the effects of electrosurgery on the living human uterus.

Design
Prospective observational study.

Subjects
Nine women with recurrent refractory dysfunctional uterine bleeding, listed for hysterectomy.

Intervention
Experimental endometrial resection on patients immediately prior to hysterectomy.

Main outcome
measures The influence of power output, duration of exposure and repetition of consecutive surgical applications on the size of the zone of thermal necrosis in uterine tissue.

Results
Resection of the endometrium was associated with a narrow zone of thermal necrosis of between 0.69 and 0.76 mm which was not dependent on power output. Duration of exposure, however, was directly related to tissue necrosis (1.44 vs 1.88 mm for Is and 5s, respectively). Coagulation by pin‐point desiccation caused a zone of thermal necrosis of 3.30–3.77 mm that was independent of either power or duration of exposure to electrical energy. Thermal transmission through the uterus in situ, during electrosurgery was minimal, the maximum recorded rise in temperature from the baseline was 0.4°C. The differences between the in vitro and in vivo effects of electrosurgery are highlighted and the possible reasons for these differences explored.

Conclusions
The potential for unwanted thermally‐induced damage to the uterus is small.
Laparoscopic treatment of infiltrative rectosigmoid colon and rectovaginal septum endometriosis by the technique of videolaparoscopy and the CO2 laser
Authors: NEZHAT CAMRAN , NEZHAT FARR , PENNINGTON EARL
Published: August 2005

Objective
To present the technique and results of videolaparoscopy and the CO, laser as a treatment for deep, infiltrative endometriosis of the rectovaginal septum, uterosacral ligaments, pouch of Douglas and anterior wall of the rectosigmoid colon.

Design
Observational study with 1–5 year follow up.

Setting
Sub‐specialty practice: Endometriosis clinic and centre for special pelvic surgery.

Subjects
185 women, ages 25–41 years. All had pelvic endometriosis and were referred because of the failure of previous medical and/or surgical treatment.

Interventions
Vaporization and excision of endometriotic implants and nodules, ureterolysis, ureteric stents, laparoscopic anterior rectal wall resection and reanastomosis, presacral neurectomy, laparoscopic hysterectomy, salpingo‐oophorectomy and appendicectomy using the CO2 laser.

Main outcome measures
174 patients were followed for 1–5 years after surgery by office visit questionnaire or telephone interview. Eleven were lost to follow‐up.

Results
175 patients were discharged within 24 h. Nine with bowel perforations and one with a partial bowel resection were discharged 2–4 days postoperatively. Two patients required ureteric stents, which were removed 6 weeks postoperatively without sequelae. 162 women reported moderate to complete pain relief (145 after one procedure, 13 after two and four after three). 12 reported persistent or worse pain following the surgery. Seven eventually underwent total hysterectomy, four had bowel resections and one had a salpingo‐oophorectomy. Of 61 with infertility, 25 achieved pregnancy. Postoperative complications included shoulder pain, anterior abdominal wall ecchymosis, urine retention and dyschezia for one to two weeks.

Conclusions
Our experience suggests that rectosigmoid colon and infiltrative rectovaginal septum endometriosis can be effectively treated via videolaparoscopy in the hands of experienced endoscopic gynaecologists.
Stimulation of vasopressin release in women with primary dysmenorrhoea and after oral contraceptive treatment—effect on uterine contractility
Authors: EKSTRÖM PER , ÅKERLUND MATS , FORSLING MARY , KINDAHL HANS , LAUDANSKI TADEUSZ , MRUGACZ GRZEGORZ
Published: August 2005

Objective
To study aspects of the aetiology of primary dysmenorrhoea and mechanisms underlying the therapeutic effect in this condition of an oral contraceptive.

Intervention
Intrauterine pressure was recorded before and during infusion of hypertonic saline (5% NaCl, 0.06 ml/kg/min) over 75 min on the first day of bleeding in women with dysmenorrhoea and after 3 weeks of oral contraceptive treatment. Plasma sampling every 15 min of ongoing infusion for the estimation of osmolality, arginine vasopressin, oxytocin and the prostaglandin (PG) F‐metabolito, 15‐keto‐13, 14‐dihydro‐PGF2α.

Subjects
Ten healthy nulliparous women with moderate to severe primary dysmenorrhoea.

Main outcome measures
Plasma levels of posterior pituitary hormones and the PGF‐metabolite. Total pressure area (TPA) of the recording curve.

Results
In dysmenorrhoea before infusion the plasma concentration of vasopressin was in mean 2.18, oxytocin 5.05 and the PGF‐metabolite 321.5 pmol/1, and the TPA 3.8 kPa ≥ 10 min. After oral contraceptive treatment the vasopressin level and the TPA were significantly reduced. At both sessions apart from intensifying the pain, the saline infusion increased vasopressin and oxytocin levels as well as the TPA, whereas the concentration of the PGF‐metabolite at both sessions decreased.

Conclusion
Confirmation is provided of the elevated secretion of arginine vasopressin and PGF2α, as well as increased uterine activity in primary dysmenorrhoea. The observations are in agreement with the concept that a lowered level of vasopressin and a decreased uterine activity contributes to the beneficial effect of OCs in the condition. Stimulation of the secretion of vasopressin increases the uterine activity and symptoms of primary dysmenorrhoea, but results suggest that this effect does not involve a mechanism of increased PGF‐synthesis. The role of oxytocin in dysmenorrhoea can not yet be defined.
A four‐year follow‐up of hearing and development in children exposed in utero to vibro‐acoustic stimulation
Authors: NYMAN MARGARETA , BARR MATS , WESTGREN MAGNUS
Published: August 2005

Objective
To obtain information of hearing and neuro‐development in children exposed to vibro‐acoustic stimulation in utero.

Design
Information collected from Swedish child care programmes.

Setting
Department of Obstetrics and Gynaecology, Karolinska Institutet, Danderyd University Hospital, Sweden.

Subjects
Children of 460 mothers exposed to vibro‐acoustic stimulation for the assessment of fetal well‐being during high‐ and low‐risk pregnancies during 1985–1987.

Main outcome measures
Auditory test (20–25 dB at eight frequencies between 500 and 8000 Hz) and general neurological examination at four years of age.

Results
No hearing damage or neuro‐developmental abnormalities that could be connected to the vibro‐acoustic stimulation were found.

Conclusions
Vibro‐acoustic stimulation, as applied in clinical practice, did not endanger either neurological developement or hearing in children exposed in utero.
A comparative study of the use of epoprostenol and dihydralazine in severe hypertension in pregnancy
Authors: MOODLEY J. , GOUWS E.
Published: August 2005

Objective
To compare the antihypertensive effects of epoprostenol sodium (pros‐tacyclin) with that of dihydralazine in acute hypertensive crises of pregnancy.

Design
A prospective randomized study. A minimum of 20 patients per group was considered statistically acceptable (alpha = 0.05, power = 0.9).

Setting
A large urban tertiary hospital.

Subjects
Forty‐seven pregnant patients with diastolic blood pressures of >100 mmmHg were studied.

Intervention
Lowering of high blood pressure with either dihydralazine (n= 25), the standard drug for this purpose, or epoprostenol (n= 22).

Main outcome measure
A significant drop in high blood pressure was regarded as a fall of 15 mmHg diastolic and 30 mmHg systolic blood pressure.

Results
There were no statistically significant differences in the antihypertensive effects between the two treatment groups. Epoprostenol infusion caused less tachycardia; the mean pulse rate changed from 81.77 beats/min, before treatment to 88.36 at stabilization, compared with a change from 80.96 beats/min to 102.68 in the group treated with dihydralazine (P= 0.0024).

Conclusion
The place of epoprostenol in pregnancy might be in patients with severe hypertension and tachycardia and in those requiring acute control of severe hypertension on the operating table before general anaesthesia.
Determinants of pregnancy heartburn
Authors: MARRERO J. M. , GOGGIN P. M. , de CAESTECKER J. S. , PEARCE J. M. , MAXWELL J. D.
Published: August 2005

Objective
To study the prevalence and severity of reflux symptoms in pregnancy.

Design
Self‐administered questionnaire detailing age, race, gestational age, parity, weight, height, symptoms and severity of gastro‐oesophageal reflux.

Setting
An antenatal clinic in a teaching hospital.

Subjects
607 consecutive women at various stages of pregnancy were recruited during attendance at antenatal clinic.

Results
The prevalence of heartburn increased with gestational age (22% in the first, 39% in the second, and 72% in the third trimester; P<0.0001), as did severity of heartburn (P<0.0001). Pharyngeal regurgitation as a symptom showed little increase during advancing pregnancy. Symptoms of heartburn rapidly increased towards the end of the second trimester. The decrease in heartburn traditionally expected during the last three weeks of pregnancy (fetal head descent) was not observed. Logistic regression analysis showed increased risk of suffering heartburn with increasing gestational age (P<0.0001), pre‐pregnancy heartburn (P<0.0001), parity (P<0.0001) and inversely with maternal age (P<0.05) but not with body mass index before pregnancy, race, or weight gain in pregnancy.

Conclusion
Heartburn, but less so pharyngeal regurgitation, increases in prevalence and severity with gestational age and parity. We speculate that hormone‐related impairment of distal oesophageal clearance mechanisms may have a crucial bearing on whether heartburn develops in those individuals at greatest risk.
The prognosis of adenosquamous carcinomas of the uterine cervix
Authors: BETHWAITE PETER , YEONG MEE LING , HOLLOWAY LINDA , ROBSON BRIDGET , DUNCAN GRAEME , LAMB DAVID
Published: August 2005

ObjectivesFirstly, to identify a cohort of women with invasive adenosquamous carcinomas of the uterine cervix, including mucin‐producing squamous cell carcinomas. Secondly, to compare the biological characteristics and behaviour of a cohort of adenosquamous carcinomas with a cohort of non‐mucin‐producing squamous cell carcinomas.

DesignHistological review, retrospective survival analysis.

SettingRegional multidisciplinary gynaecological oncology service.

Subjects161 cases of stage 1B and above invasive cervical carcinoma presenting between 1 January 1980 and 31 July 1987. Thirty nine women with adenosquamous carcinomas were compared with 103 women with non‐mucin‐producing squamous cell tumours.

ResultsInclusion of routine stains for mucin in the assessment of histological material resulted in the reclassification of 38 (24%) of the cases, including the identification of 31 mucin‐producing squamous cell carcinomas. The survival with adenosquamous tumours was significantly worse than with squamous cell cancers (P= 0.006), 5‐year survival rates being 52% and 75% respectively. Multivariate analysis showed that this effect was explained by differences in clinical stage, pelvic lymph node metastasis and vascular invasion by tumour.

ConclusionsThe application of routine mucin stains to cervical tumours identifies a group of previously unrecognized adenosquamous cancers. Tumours so identified are likely to pursue a more aggressive clinical course associated with a poorer survial when compared to non‐mucin‐producing squamous carcinomas.
Changes in decidual stromal cell function associated with labour
Authors: KHAN HAROON , ISHIHARA OSAMU , SULLIVAN MARK H. F. , ELDER MURDOCH G.
Published: August 2005

Objective
To determine whether decidual cells produce altered levels of prostaglandins after labour.

Design
Decidual stromal cells and macrophages were isolated before and after labour, and the production of prostaglandins E2 and F2α measured. Changes in the numbers of cyclooxygenase enzyme positive cells were assessed by immunocytochemistry.

Results
Decidual stromal cells obtained after labour produced 30 times more prostaglandins E2 and F2α in culture than cells obtained before labour. The increased production persisted for up to 72 h of culture, and was associated with an increase in the numbers of cyclooxygenase‐positive cells from <5% to >95%. No changes in macrophage function were observed.

Conclusion
Increased levels of prostaglandins E2 and F, a were released from decidual stromal cells after labour, suggesting that these cells may be an important source of prostaglandins in labour.
A randomized clinical trial on the benefit of adhesiolysis in patients with intraperitoneal adhesions and chronic pelvic pain
Authors: PETERS A. A. W. , TRIMBOS‐KEMPER G. C. M. , ADMIRAAL C. , TRIMBOS J. B. , HERMANS J.
Published: August 2005

Objective
To see whether surgical adhesiolysis would improve pelvic pain in women with pelvic adhesions.

Design
Randomized clinical trial comparing surgery (adhesiolysis) with no surgery with final analysis of results after 9–12 months.

Setting
Department of Gynecology, Leiden University Medical Center, the Netherlands.

Subjects
48 women known by laparoscopy to have stage II‐IV pelvic adhesions.

Interventions
Midline laparotomy and surgical adhesiolysis.

Main outcome results
Pelvic pain assessed by the McGill pain score, subjective pain assessment and disturbance of daily activities.

Results
24 women were randomly allocated to undergo surgical adhesiolysis and 24 to a control group who did not have surgery. After 9–12 months there were no significant differences between the two groups overall with regard to pelvic pain. A subgroup of women with severe, vascularized and dense adhesions involving bowel (stage IV) had significantly less pelvic pain after adhesiolysis for two of the three methods of assessment.

Conclusions
Adhesiolysis for the treatment of pelvic pain is not indicated in women with light or moderate degree pelvic adhesions. It may be beneficial in those with severe adhesions involving the intestinal tract.
The effect of pH on release of PGE2 from vaginal and endocervical preparations for induction of labour: an in‐vitro study
Authors: JOHNSON T. A. , GREER I. A. , KELLY R. W. , CALDER A. A.
Published: August 2005

Objective To study the effect of pH and precoating with obstetric cream on the release of prostaglandin E2 (PGE2) from commercially available triacetin and starch based gels, lactose based vaginal tables and sustained release hydrogel polymer pessaries in‐vitro.

Design
A prospective observational study.

Methods PGE2 preparations held in dialysis bags were placed in Ringers lactate buffer and release of PGE2 into the buffer was measured over 8–12 h by radio‐immunoassay. The hydrogel polymer pessary was also assessed after precoating with obstetric cream.

Main outcome measures
In‐vitro PGE2 release at pH 7.4, pH 5.4 and pH 3.4.

Results The gel preparations provided rapid and reliable release, while the lactose based vaginal tablet provided much lower release of PGE2 with sudden and variable release occurring after 5–8 h, an effect which was enhanced at low pH. With the triacetin gel preparation, release of PGE2 was reduced at lower pH, while the starch based gel appeared to provide optimal release at pH 5.4. The hydrogel polymer pessaries provided linear release in‐vitro and this was reduced at pH 3.4. In addition, precoating the sustained release hydrogel polymer pessaries with obstetric cream virtually abolished release of PGE2.

Conclusions As the vagina is normally acid, these results suggest that vaginal pH could influence PGE2 release and this may result in variable clinical responses. In view of this, pH should be taken into account in the development of preparations for clinical use. Furthermore, the use of obstetric cream should be avoided when administering PGE2 preparations for induction of labour.
The prognostic value of fetal ultrasonography before induction of labour
Authors: SAUNDERS NIGEL , AMIS SHAMIM , MARSH MICHAEL
Published: August 2005

Objective
To investigate whether ultrasound examination of the fetus and amniotic fluid before induction of labour can provide useful prognostic information about the course of labour and mode of delivery.

Design
A prospective observational study.

Setting
The delivery suite of St Mary's Hospital, London.

Subjects
101 women undergoing induction of labour.

Measured variables
Biparietal diameter, head circumference, abdominal circumference, occipital position, amniotic fluid volume and umbilical artery Doppler velocimetry waveforms.

Main outcome measures
The outcome of labour was assessed in terms of the induction delivery interval, the mode of delivery and the incidence of abnormal cardiotocograms in labour.

Results
Seven women were delivered by emergency caesarean section early in the first stage of labour because of a significant abnormality of the fetal heart trace and these pregnancies were characterized by small fetal abdominal circumference measurements. Marked oligohydramnios was also noted in five of these seven subjects. Small or average size babies who were surrounded by an adequate volume of amniotic fluid tended to be born spontaneously, whereas the majority of operative deliveries for failure to progress in labour were associated with fetal abdominal circumference measurements ≥340 mm. The mean Bishop score of women before labour who delivered spontaneously was not significantly different from the scores of women who had a forceps delivery or caesarean section. Abnormal cord Doppler waveforms were observed in only one instance.

Conclusions
In women undergoing induction of labour, the measurement by ultrasonography of two variables (fetal abdominal circumference and amniotic fluid volume) may allow the prospective identification of pregnancies at increased risk of fetal distress or dystocia. If these findings can be replicated in early spontaneous labour than more rational utilization of resources may be possible in hospital based obstetric practice.
Association of moderate obesity with a poor pregnancy outcome in women with polycystic ovary syndrome treated with low dose gonadotrophin
Authors: HAMILTON‐FAIRLEY DIANA , KIDDY DEBORAH , WATSON HAZEL , PATERSON CATHERINE , FRANKS STEPHEN
Published: August 2005

Objective
To assess the effect of moderate obesity on the outcome of induction of ovulation with low dose gonadotrophin in women with polycystic ovary syndrome (PCOS).

Design
Retrospective analysis of women with PCOS treated consecutively. An analysis of the impact of obesity on outcome of pregnancy using data from the North West Thames Regional (NWTR) obstetric database was included for comparison. Setting Induction of ovulation clinic at the Samaritan Hospital for Women (St. Mary's Hospital Group).

Subjects
100 women with clomiphene‐resistant anovulation associated with PCOS. 75 were of normal weight (BMI 19–24. 9 kg/m2, lean group) and 25 were moderately overweight (BMI 25–27.9 kg/m2, obese group).

Interventions
Induction of ovulation using low doses of gonadotrophins with small, stepwise increments in dosage as required.

Main outcome measures
Rates of ovulation, pregnancy and miscarriage; daily and total doses of gonadotrophin required for induction of ovulation.

Results
The proportion of ovulatory cycles was significantly greater in the lean group (77%) compared with the obese group (57%) (χ2 9.8, P<0.001). Obese women required larger doses of gonadotrophin to achieve ovulation (P <0.001). The proportion of women who achieved at least one pregnancy was similar in the two groups (39%vs 48%) but miscarriage was more frequent in the obese group (60%vs 27%; P<0.05). This difference was independent of the baseline and/or mid‐follicular luteinizing hormone (LH) concentration either before or during treatment. Analysis of data from the North West Thames Health Region obstetric database confirmed an increased risk of miscarriage in moderately obese women which was independent of maternal age.

Conclusions
Moderate obesity in women with PCOS, treated with low dose gonadotrophin, is associated with an increased risk of miscarriage. This is reflected in the results of analysis of the effect of obesity on outcome of pregnancy in the general population. It is therefore important to encourage weight reduction in obese women with PCOS before considering therapy to induce ovulation.
Maternal serum screening for Down's syndrome: the effect of routine ultrasound scan determination of gestational age and adjustment for maternal weight
Authors: WALD N. J. , CUCKLE H. S. , DENSEM J. W. , KENNARD A. , SMITH D.
Published: August 2005

Objective
To investigate the effect of using a routine ultrasound estimate of gestational age and maternal weight adjustment on maternal serum alpha‐fetoprotein (AFP), unconjugated oestriol (uE3) and human chorionic gonadotrophin (hCG) levels in antenatal screening for Down's syndrome.

Design
Women with a singleton pregnancy without Down's syndrome were screened using the three serum markers and an estimate of gestational age based on ‘dates’ (time since first day of the last menstrual period) and one based on an ultrasound scan examination was recorded together with maternal weight.

Setting
Women attending the Homerton Hospital, Hackney, for their antenatal care between February 1989 and January 1990.

Subjects
2113 women with a singleton pregnancy without Down's syndrome.

Results
The use of ultrasound to estimate gestational age (usually based on the biparietal diameter of the fetal skull) led to a significant reduction in the variance of each marker at a given week of pregnancy. The level of each marker was negatively associated with maternal weight, so that adjustment for weight also led to a reduction in variance. These data on gestational age and maternal weight, taken together with published data on pregnancies associated with Down's syndrome, indicate that the routine use of ultrasound to estimate gestational age will increase the detection rate from 58% to 67% while maintaining the false‐positive rate at 5%, or reduce the false‐positive rate from 5.7% to 3.1% while maintaining the detection rate at 60%. Routine maternal weight adjustment for the serum marker levels was much less useful, increasing the detection rate by about 0.5% for a given false‐positive rate, or reducing the false‐positive rate about 0.1% for a given detection rate.

Conclusion
An ultrasound gestational age estimate available at the time of Down's syndrome screening confers a substantial advantage to screening performance with a further small benefit resulting from maternal weight adjustment, which is worth adopting if it can be done without difficulty or extra cost.
Doppler ultrasound monitoring technology
Authors: Docker M. F.
Published: August 2005

Developments in the signal processing of Doppler ultrasound used for the detection of fetal heart rate (FHR) have improved the operation of cardiotocographs. These developments are reviewed and the advantages and disadvantages of the various Doppler and signal processing methods are compared.
Measurement of uterine activity in labour—clinical aspects
Authors: Gibb D. M. F.
Published: August 2005

Intra‐uterine pressure measurement remains the most objective way of measuring uterine activity in labour, and in this respect is superior to clinical assessment or external tocography. However there is little evidence to show that improving the assessment of uterine activity in labour is associated with an improvement in the outcome of labour for mother or fetus. It seems logical that use of intra‐uterine pressure monitoring will provide additional safety in women with a scarred uterus, breech presentation, high parity, or apparent failure of response to induction or augmentation of labour with the usual dose rates of oxytocics, but this has not been established by appropriately sized clinical trials. Further research to establish the role of uterine activity measurement in labour is urgently needed.
Prostaglandin prophylaxis and bladder function after vaginal hysterectomy: a prospective randomised study
Authors: Bergman Arieh , Mushket Yaron , Gordon David , David Menahem P.
Published: August 2005

Objective
To assess the efficacy of prostaglandins in enhancing bladder function after vaginal hysterectomy.

Design
Prospective randomised study of women who underwent vaginal hysterectomy between November 1989 and August 1990.

Setting
Sackler School of Medicine Tel Aviv University Medical Center, Department of Obstetrics and Gynaecology ‘B’.

Subjects
24 women who underwent vaginal hysterectomy and anterior and posterior colporrhaphy for prolapse.

Intervention
Administration of prostaglandin F2α 5 mg intravesically or E2 3 mg intravaginally versus 100 ml saline intravesically (control) daily, starting on the first post operative day, until adequate spontaneous voiding was established.

Results
Women receiving either PGF2 or PGE2 resumed spontaneous bladder function earlier, required significantly fewer days catheterisation and had significantly less febrile morbidity compared to women in the control group.

Conclusions
Prostaglandins, either intravesical or intravaginal, are beneficial in enhancing bladder function after vaginal hysterectomy.
Psychosexual dysfunction in women with gynaecological cancer following radical pelvic surgery
Authors: Corney R. H. , Crowther M. E. , Everett H. , Howells A. , Shepherd J. H.
Published: August 2005

Objective
To assess the prevalence and severity of psychosexual dysfunction in women treated for cancer of the cervix and vulva by radical vulvectomy, Wertheim's hysterectomy and pelvic exenteration; and to identify the risk factors for sexual morbidity and ways in which it might be reduced.

Design
Retrospective study of patients by questionnaire and semistructured interview, 6 months to 5 years following surgery.

Setting
Gynaecology–Oncology Unit of a general hospital.

Patients
105 English speaking women with gynaecological cancer.

Results
90% of the women in relationships had been sexually active prior to surgery. Of this group, 24% had no sexual difficulties post‐operatively; 66% of the latter still had problems more than 6 months later, and 15% of the latter never resumed intercourse (excluding those with a colpectomy). 82% of those aged less than 50 years who had had radiotherapy suffered sexual dysfunction. Lack of desire was the commonest problem, and half the women felt that their sexual relationship had deteriorated, yet only 16% felt that their marriage had worsened. Younger women were more likely to attribute personal and marital distress to their sexual problems. More information on sexual matters would have been liked by 28% of the women.

Conclusions
Sexual dysfunction is common following radical pelvic surgery and tends to remain a chronic problem. As well as organic causes there is a strong psychogenie element brought about by loss of fertility, disfigurement, depression and anxiety about one's desirability as a sexual partner. The presence of a stable relationship before the diagnosis of cancer helps women cope better, and young single women are a very vulnerable group. Patients want more information on sexual matters and the provision of sexual counselling may improve outcome in the future.