British journal of obstetrics and gynaecology最新文献

{"title":"Breast and pelvic examination in women taking hormone replacement therapy","authors":"Mira Harrison-Woolrych , David Purdie","doi":"10.1016/S0306-5456(01)00293-5","DOIUrl":"10.1016/S0306-5456(01)00293-5","url":null,"abstract":"","PeriodicalId":75620,"journal":{"name":"British journal of obstetrics and gynaecology","volume":"108 12","pages":"Pages 1201-1203"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0306-5456(01)00293-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56578393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mass closure: a new technique for closure of the vaginal vault at vaginal hysterectomy","authors":"Tariq Miskry,&nbsp;Adam Magos","doi":"10.1016/S0306-5456(01)00299-6","DOIUrl":"https://doi.org/10.1016/S0306-5456(01)00299-6","url":null,"abstract":"<div><p>A variety of methods of management of the vaginal vault have been described, all of which maintain certain principles. In techniques that advocate closure of the vault, the peritoneum and vaginal epithelium are treated with separate sutures. This leaves a potential space above the vaginal closure. We describe a simple technique of mass closure which obliterates this space and incorporates the pedicles to provide support for the vault. This method may hold potential advantages in terms of haemostasis, risk of vault haematoma, and post-operative vaginal cuff infections.</p></div>","PeriodicalId":75620,"journal":{"name":"British journal of obstetrics and gynaecology","volume":"108 12","pages":"Pages 1295-1297"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0306-5456(01)00299-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134663850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factor V Leiden and G20210A prothrombin mutations are risk factors for very early recurrent miscarriage","authors":"M.F. Reznikoff-Etiévant ,&nbsp;V. Cayol ,&nbsp;B. Carbonne ,&nbsp;A. Robert ,&nbsp;F. Coulet ,&nbsp;J. Milliez","doi":"10.1016/S0306-5456(01)00298-4","DOIUrl":"https://doi.org/10.1016/S0306-5456(01)00298-4","url":null,"abstract":"<div><p><strong>Objective</strong> To determine whether there is an association between early recurrent miscarriage (before 10 weeks of pregnancy) and Factor V Leiden and G20210A prothrombin mutations.</p><p><strong>Design</strong> A prospective study.</p><p><strong>Setting</strong> Department of Gynaecology and Obstetrics, Saint Antoine Hospital, Paris, France.</p><p><strong>Population</strong> Two groups of women: those with early unexplained recurrent miscarriage before 10 weeks of pregnancy (<em>n</em>=260) and control healthy women without a previous history of thromboembolism (<em>n</em>=240).</p><p><strong>Methods</strong> Screening for defects in the protein C anticoagulant pathway was performed using the anticoagulant response to agkistrodon confortrix venom (ACV test). Protein C and Factor V Leiden mutation testing was performed for each low ACV level. Each sample was tested for the G20210A prothrombin mutation.</p><p><strong>Results</strong> Factor V Leiden and G20210A mutations were found to be associated with early recurrent spontaneous miscarriage before 10 weeks of pregnancy, the odds ratios being 2.4 (95% CI 1–5) and 2.7 (95% CI 1–7), respectively. Similar results were found whether or not women had had a previous live birth.</p><p><strong>Conclusions</strong> Early recurrent miscarriage before 10 weeks of pregnancy is significantly associated with Factor V or G20210A prothrombin mutations. These results indicate a possible role for anticoagulant prevention in these early miscarriages.</p></div>","PeriodicalId":75620,"journal":{"name":"British journal of obstetrics and gynaecology","volume":"108 12","pages":"Pages 1251-1254"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0306-5456(01)00298-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134663877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body composition and energy metabolism in normotensive and hypertensive pregnancy","authors":"Allison Martin ,&nbsp;Anthony J O'Sullivan ,&nbsp;Mark A Brown","doi":"10.1016/S0306-5456(01)00289-3","DOIUrl":"https://doi.org/10.1016/S0306-5456(01)00289-3","url":null,"abstract":"<div><p><strong>Objective</strong> To determine whether the insulin resistance syndrome and altered body composition are features of hypertensive pregnancy.</p><p><strong>Design</strong> Women were recruited in the third trimester of pregnancy from the antenatal clinic, day assessment unit, and maternity ward of St George Hospital, Sydney.</p><p><strong>Population</strong> Women with pre-eclampsia (<em>n</em>=12), gestational hypertension (<em>n</em>=12), essential hypertension in pregnancy (<em>n</em>=11), and normotensive pregnancy (<em>n</em>=10).</p><p><strong>Methods</strong> Energy metabolism was assessed by indirect calorimetry to measure basal metabolic rate and diet-induced thermogenesis. Body composition was measured as lean body mass, total body water and fat mass by bio-electrical impedance. Blood was collected for measurement of glucose, insulin and lipid profiles. Insulin resistance was indirectly assessed by the insulin and glucose concentrations and diet-induced thermogenesis.</p><p><strong>Results</strong> Women with essential hypertension and gestational hypertension were heavier than women with normotensive pregnancies both pre-pregnancy and in the third trimester, whereas women with pre-eclampsia were similar to those with normotensive pregnancy. Women with essential hypertension were otherwise similar to normotensive pregnancy but women with gestational hypertension had a reduced diet-induced thermogenesis and almost double insulin levels. Women with pre-eclampsia had a similar body composition and insulin levels but reduced basal metabolic rate, diet-induced thermogenesis and glucose levels compared with normotensive pregnancy.</p><p><strong>Conclusions</strong> Women who develop gestational hypertension, but not pre-eclampsia, are more likely to be overweight. Women with essential hypertension are similar to women with normotensive pregnancy throughout pregnancy. Both gestational hypertension and pre-eclampsia appear to be associated with some degree of insulin resistance, greater than that occurring in normal pregnancy.</p></div>","PeriodicalId":75620,"journal":{"name":"British journal of obstetrics and gynaecology","volume":"108 12","pages":"Pages 1263-1271"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0306-5456(01)00289-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134663836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human papillomavirus and cervical cancer: where are we now?","authors":"John M.J Kirwan ,&nbsp;C.Simon Herrington","doi":"10.1016/S0306-5456(01)00263-7","DOIUrl":"https://doi.org/10.1016/S0306-5456(01)00263-7","url":null,"abstract":"","PeriodicalId":75620,"journal":{"name":"British journal of obstetrics and gynaecology","volume":"108 12","pages":"Pages 1204-1213"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0306-5456(01)00263-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134663879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Five-year follow up of women randomised to medical management or transcervical resection of the endometrium for heavy menstrual loss: clinical and quality of life outcomes","authors":"Kevin G Cooper ,&nbsp;Stuart A Jack ,&nbsp;David E Parkin ,&nbsp;Adrian M Grant","doi":"10.1016/S0306-5456(01)00275-3","DOIUrl":"https://doi.org/10.1016/S0306-5456(01)00275-3","url":null,"abstract":"<div><p><strong>Objective</strong> To assess clinical status, changes in health related quality of life, and subsequent management five years after medical management or transcervical resection of the endometrium for treatment of heavy menstrual loss.</p><p><strong>Design</strong> Five year follow up using postal questionnaires and operative databank review.</p><p><strong>Setting</strong> Gynaecology department of a large UK teaching hospital.</p><p><strong>Population</strong> Women referred to the gynaecologist for treatment of heavy menstrual loss.</p><p><strong>Methods</strong> Eligible women, without a treatment preference, were randomised equally to either medical treatment or transcervical resection of the endometrium.</p><p><strong>Main outcome measures</strong> Women's satisfaction with treatment, menstrual status, changes in health related quality of life, and additional treatments received at five years.</p><p><strong>Results</strong> One hundred and forty-four patients completed questionnaires, achieving 77% follow up (medical <em>n</em>=71/94; transcervical resection of the endometrium <em>n</em>=73/93). At five-year follow up, 7/71 (10%) of those randomised to the medical arm still used medical treatment, while 72/94 (77%) had undergone surgical treatment and 17/94 (18%) a hysterectomy. Twenty-five (27%) women allocated to transcervical resection of the endometrium had undergone further surgery, 18/93 (19%) a hysterectomy. At five years women initially randomised to medical treatment were significantly less likely to be totally satisfied (<em>P</em>&lt;0.01, difference 21%, 95% CI –37% to –4%), or to recommend their allocated treatment to a friend (<em>P</em>&lt;0.001, difference 59%, 95% CI –73% to –45%). Bleeding and pain scores were similar in both groups and highly significantly reduced. Significantly more women in the transcervical resection of the endometrium arm had no bleeding or very light bleeding (<em>P</em>&lt;0.02, difference -22%, CI –31% to –4%), and they had significantly less days heavy bleeding (<em>P</em>&lt;0.02). Short Form 36 health survey scores were significantly improved from baseline for all eight health scales in the transcervical resection of the endometrium arm, and four in the medical arm.</p><p><strong>Conclusions</strong> A policy of immediate transcervical resection of the endometrium for women referred to a gynaecologist for treatment of heavy menstrual loss achieves higher levels of satisfaction, better menstrual status, and greater improvements in health related quality of life than medical treatment. In addition, transcervical resection of the endometrium is safe and does not lead to an increase in the number of hysterectomies. An effective endometrial ablative technique should be offered to all eligible women seeking treatment of their heavy menses from a gynaecologist.</p></div>","PeriodicalId":75620,"journal":{"name":"British journal of obstetrics and gynaecology","volume":"108 12","pages":"Pages 1222-1228"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0306-5456(01)00275-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134663883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparability of published perinatal mortality rates in Western Europe: the quantitative impact of differences in gestational age and birthweight criteria","authors":"Wilco C. Graafmans ,&nbsp;Jan-Hendrik Richardus ,&nbsp;Alison Macfarlane ,&nbsp;Marisa Rebagliato ,&nbsp;Beatrice Blondel ,&nbsp;S. Pauline Verloove-Vanhorick ,&nbsp;Johan P. Mackenbach","doi":"10.1016/S0306-5456(01)00291-1","DOIUrl":"https://doi.org/10.1016/S0306-5456(01)00291-1","url":null,"abstract":"<div><p><strong>Objective</strong> <!-->To quantify the impact of publication criteria on differences in published national perinatal mortality rates among Western European countries.</p><p><strong>Design</strong> <!-->Descriptive study of perinatal mortality rates in Western European countries with adjustments for international differences in publication data.</p><p><strong>Population</strong> <!-->All live births and perinatal deaths in 1994 in Western European countries.</p><p><strong>Methods</strong> <!-->The 1994 perinatal mortality rates were obtained from national and Eurostat publications for Belgium, Denmark, Finland, France, Germany, Greece, The Netherlands, Norway, Portugal, Spain, Sweden, United Kingdom (England, Wales, Scotland, Northern Ireland). Two methods, one direct and one indirect, were used for adjusting these officially published rates for differences in registration laws or publication practices. For the indirect method adjustment factors were derived from an analysis of a large Finnish database using different cutoff points for gestational age and birthweight. For the direct method a common cutoff point was imposed for birthweight (1000g) and gestational age (28 completed weeks) on national perinatal mortality data, obtained from civil registration or hospital/obstetrics databases in each country.</p><p><strong>Results</strong> <!-->The published perinatal mortality rates ranged from 5.4 per 1000 total births in Sweden and Finland to 9.7 in Greece and Northern Ireland. The indirect adjustment method showed that some countries apply cutoff points for registration or publication of perinatal mortality which may raise the perinatal mortality rate by up to 17% above the most commonly used threshold for including live and stillbirths. The direct adjustment method showed that a common lower limit of 1000g for birthweight or 28 weeks for gestational age would reduce the perinatal mortality rate, but by a differing extent ranging from 14% to 40%. Both adjustment methods reduced the contrast between the countries’ perinatal mortality rates, and changed their rank order.</p><p><strong>Conclusion</strong> <!-->These quantitative results confirm that international differences in countries’ published perinatal mortality rates partly reflect differences between countries’ criteria for registration and publication of perinatal deaths.</p></div>","PeriodicalId":75620,"journal":{"name":"British journal of obstetrics and gynaecology","volume":"108 12","pages":"Pages 1237-1245"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0306-5456(01)00291-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134663885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The clinical application of a dual head gamma camera with coincidence detection in 20 women with suspected ovarian cancer","authors":"G. Lieberman ,&nbsp;A.B. MacLean ,&nbsp;J.R. Buscombe ,&nbsp;A.J.W. Hilson ,&nbsp;K. Adamson ,&nbsp;W.M. Reid ,&nbsp;A. Green ,&nbsp;R.H. Begent","doi":"10.1016/S0306-5456(01)00290-X","DOIUrl":"https://doi.org/10.1016/S0306-5456(01)00290-X","url":null,"abstract":"<div><p><strong>Objective</strong> To assess the effectiveness of a dual head coincidence gamma camera in identifying ovarian cancer as a less expensive alternative to the traditional 2-[¹⁸F] fluoro-2-deoxy-D-glucose (¹⁸FDG) system using positron emission tomography.</p><p><strong>Design</strong> Prospective study.</p><p><strong>Population</strong> Twenty consecutive women suspected of having ovarian carcinoma. Inclusion was based on abnormal serum CA125 (reference range is 0–35 units/L), ultrasound, computerised tomography or clinical findings.</p><p><strong>Methods</strong> Women underwent assessment before staging laparotomy. Two nuclear medicine physicians, who were blinded to the pre-operative assessment, reported on ¹⁸FDG- dual head coincidence gamma camera imaging.</p><p><strong>Main outcome</strong> <strong>measures</strong> The histology and operative staging were compared with the ¹⁸FDG- dual head coincidence gamma camera findings.</p><p><strong>Results</strong> Twelve women had pelvic malignancies (nine primary and three recurrences), seven women had benign pathology and one patient had a borderline malignancy. We were able to image accurately all malignant pelvic masses with dual head coincidence gamma camera, as well as accurately demonstrate disease spread. Two of the benign pelvic masses localised ¹⁸FDG. The positive predictive value for detecting malignancy was 86%.</p><p><strong>Conclusions</strong> Dual head coincidence gamma camera offers accurate and affordable imaging in suspected ovarian masses, with improved specificity over CA125, ultrasound and computerised tomography. These results are similar to those obtained on more expensive dedicated PET systems. We report on a series of patients believed to have primary or recurrent carcinoma and recognise the need to include patients more likely to have benign lesions to assess false positive results. However, we believe that dual head coincidence gamma camera is useful in the pre-operative assessment of women with suspected ovarian cancer.</p></div>","PeriodicalId":75620,"journal":{"name":"British journal of obstetrics and gynaecology","volume":"108 12","pages":"Pages 1229-1236"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0306-5456(01)00290-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134663884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resection of recurrent bulky gynaecological side wall malignancy with iliac vessel reconstruction","authors":"R.J. Gornall ,&nbsp;N. Standfield ,&nbsp;N.M. deSouza ,&nbsp;V.R. Aachi ,&nbsp;G.A.J. McIndoe","doi":"10.1016/S0306-5456(01)00271-6","DOIUrl":"10.1016/S0306-5456(01)00271-6","url":null,"abstract":"","PeriodicalId":75620,"journal":{"name":"British journal of obstetrics and gynaecology","volume":"108 12","pages":"Pages 1305-1308"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0306-5456(01)00271-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56578369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome for children born after in utero laser ablation therapy for severe twin-to-twin transfusion syndrome","authors":"A.G Sutcliffe ,&nbsp;N.J Sebire ,&nbsp;A.J Pigott ,&nbsp;B Taylor ,&nbsp;P.R Edwards ,&nbsp;K.H Nicolaides","doi":"10.1016/S0306-5456(01)00294-7","DOIUrl":"https://doi.org/10.1016/S0306-5456(01)00294-7","url":null,"abstract":"<div><p><strong>Objective</strong> To examine the postnatal development of a group of children born after <em>in utero</em> laser ablation therapy for severe twin-to-twin transfusion syndrome.</p><p><strong>Design</strong> <!-->Retrospective cohort outcome study involving assessment of neurodevelopment and physical well being.</p><p><strong>Setting</strong> <!-->Harris Birthright Centre, King’s College Hospital, London.</p><p><strong>Participants</strong> <!-->Twins and singleton survivors treated via laser ablation therapy for twin-to-twin transfusion syndrome over a four-year period.</p><p><strong>Methods</strong> Of 54 families contacted to participate in the study, who had been treated for twin-to-twin transfusion syndrome during a four-year period, 24 families attended for paediatric assessment; 12 pairs of twins and 12 singleton survivors were assessed for perinatal, neurological and neurodevelopmental outcome using the Griffiths scales of mental development. A further 20 families were assessed via a proforma after contact with their general practitioner. A comparison of these groups showed no significant differences in sociodemographic factors or severity of disease between responders (44 families, 81.5%) and non-responders (10 families).</p><p><strong>Results</strong> The group of children assessed by a paediatrician had low birthweight (1619g donor, 1814g recipient, 1877g singleton) and had been born preterm (33 weeks twins, 31.2 weeks singleton) with attendant increased resuscitation, neonatal unit admission (mean 40 days) and instrumental delivery. Mean Griffiths scores were within the normal range of ability (91.2 donor <em>vs</em> 97.7 recipient and 101.6 singletons) with the only significant difference being in the locomotor subscale where donor (82.6) and recipient (85.3) were less than singletons: -99.1 (<em>P</em>&lt;0.05). There was no cerebral palsy in the singleton survivors, but there were five cases in the twin group. All except one affected child (with quadriplegia) had mean Griffiths scores in the normal range. In the GP proforma group there was one case, in a twin, of cerebral palsy.</p><p><strong>Conclusion</strong> The overall cerebral palsy rate was 9%: 0% in the singleton survivors group and 13.3% in the twin survivors group. This pilot data highlights the need for careful long term follow up of children affected by twin-to-twin transfusion syndrome.</p></div>","PeriodicalId":75620,"journal":{"name":"British journal of obstetrics and gynaecology","volume":"108 12","pages":"Pages 1246-1250"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0306-5456(01)00294-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134663887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}