Tubal disease and fertility outcome.

A consequence of assisted reproduction technology in infertility management has been a decline in tubal surgery. Microsurgery to correct localized damage has the advantage of long-standing restoration of fertility. A simple prognostic classification is lacking.

Learning from litigation. The role of claims analysis in patient safety.

Claims for malpractice and medical negligence are a potentially important source of information on the causes of harm to patients and have provided valuable lessons in the past. However today, with many additional sources of information and methods of analysis, the role of claims analysis needs to be reappraised. We consider the role of claims analysis in relation to other methods of studying adverse outcomes, review previous studies of claims and summarize the findings of four recent British specialty claims reviews.

Prospective semistructured observational study to identify risk attributable to staff deployment, training, and updating opportunities for midwives.

Objective: To identify potential risk or mishap in the system of intrapartum care, relating to the deployment of midwives.

Design: Prospective semistructured observational study.

Setting: Labour wards of seven maternity units in the north west of England.

Oestrogen therapy for prevention of reinfarction in postmenopausal women: a randomised placebo controlled trial.

Background: Results of observational studies suggest that hormone replacement therapy (HRT) could reduce the risk of coronary heart disease (CHD), but those of randomised trials do not indicate a lower risk in women who use oestrogen plus progestagen. The aim of this study was to ascertain whether or not unopposed oestrogen reduces the risk of further cardiac events in postmenopausal women who survive a first myocardial infarction.

Methods: The study was a randomised, blinded, placebo controlled, secondary prevention trial of postmenopausal women, age 50-69 years (n=1017) who had survived a first myocardial infarction.

Dose finding in a low-dose 21-day combined oral contraceptive containing gestodene.

An open label, non-comparative study was carried out in 22 women over a total of five cycles. After an untreated cycle, oral administration of 20 microg ethinyl estradiol (EE) with 50 microg gestodene (GST) (tablets taken daily for 21 days with a break of 7 days) was commenced, and three treatment cycles were followed by an untreated follow-up control cycle. The ability of this formulation to inhibit ovulation and suppress ovarian activity was assessed by using hormonal parameters and ultrasound.

Effect of 21-day and 24-day oral contraceptive regimens containing gestodene (60 microg) and ethinyl estradiol (15 microg) on ovarian activity.

Objective: To compare ovulation inhibition and ovarian activity with 21-day and 24-day regimens of a low-dose combined oral contraceptive (COC) containing 60 microg of gestodene and 15 microg of ethinyl estradiol.

Design: Interventional observational study.

Setting: Reproductive medicine unit.

Effect of age on the response of the hypothalamo-pituitary-ovarian axis to a combined oral contraceptive.

Objective: To examine the effect of age on the response to treatment with a combined oral contraceptive.

Design: Prospective, controlled clinical study.

Setting: Reproductive medicine unit in a tertiary care university medical center.

UK accident and emergency departments and emergency contraception: what do they think and do?

Objectives: A postal questionnaire survey was conducted to assess what staff in UK accident and emergency (A&E) departments thought of providing an emergency contraception service, the degree of enthusiasm in and level of provision of the service, and staff attitudes to the introduction or continuation of provision of the service.

Methods: A questionnaire was sent to all 560 departments providing A&E services in the UK.

Results: Of the 560 units sent questionnaires, 355 (63.

Human ovarian granulosa cells and follicular fluid indices: the relationship to oocyte maturity and fertilization in vitro.

The study investigates the correlation between oocyte maturity and fertilization and a variety of hormonal parameters in follicular fluid and ovarian granulosa cells. A methodology for purification of granulosa cells from contaminating blood cells is also established. A total of 63 follicular aspirates were collected at oocyte retrieval from 30 women superovulated using the long luteinizing hormone-releasing hormone (LHRH analogue)/human menopausal gonadotrophin regimen.

Zoonotic and viral infection in fetal loss after 12 weeks.

One hundred and thirty-six women from an urban, rural and farming community were recruited to a study of infectious causes of midtrimester miscarriage (n = 85), stillbirth (n = 32), or termination for developmental (n = 17) or chromosomal (n = 2) abnormalities. No woman had evidence of acute infection with toxoplasma, listeria, leptospira or Chlamydia psittaci (ovine enzootic abortion). One woman had midtrimester miscarriage associated with primary cytomegolovirus infection and five women had evidence of parvovirus B19 infection, although fetal infection was not proven.

Modulation of uterine artery resistance to blood flow by the oral contraceptive pill.

The changes in uterine artery resistance to blood flow were studied during a normal ovulatory cycle (control) and during a cycle on the combined oral contraceptive pill in 10 healthy women, aged 18-35 years, using transvaginal color Doppler imaging. Ovulation was monitored using ultrasound and hormonal assays during both cycles. The Pulsatility Index (PI) was used as a measure of uterine artery resistance, on days 8 (midproliferative) and 22 (midluteal) of the control cycle and on days 22 (maximal ovarian suppression) and 28 (minimal ovarian suppression) of the pill cycle.

Three successive pregnancies in a patient with Takayasu's arteritis.

Takayasu's arteritis is a rare non-specific obliterative panarteritis of unknown origin that occurs predominantly in young Asian and Oriental females of childbearing age and has been encountered in the UK. With the exception of a few large series from the Far East, much of the information on Takayasu's arteritis in pregnancy comes from isolated case reports with no long term follow-up after pregnancy. We report a patient with this condition who had three pregnancies during a 4-year follow-up period with no serious complications.

A multicenter European survey of the attitudes to contraception in women at high risk or with established cardiovascular disease.

Objectives: The survey was designed to study the attitudes of gynecologists from 11 European centers providing guidance in contraception to women at high risk and women with cardiovascular disease.

Methods: Attitudes were registered by means of a standard questionnaire.

Results: Most contributors reported that, in women with venous thrombosis (10/11), deep venous thrombosis (10/11), coagulation disorders (11/11) and stroke (8/11), they prefer to prescribe methods other than combined oral contraceptives (COCs).

Shorter pill-free interval in combined oral contraceptives decreases follicular development.

The objective of the study was to determine the suppressive effect on ovarian activity of 20 micrograms ethinylestradiol plus 75 micrograms gestodene administered for 21 or 23 days. The study was designed as a double-blind, randomized, multicenter trial in 60 women. A pre-treatment cycle, three treatment cycles and a post-treatment period were monitored by ovarian ultrasound and by LH, FSH, 17 beta-estradiol and progesterone measurements every other day.

Short communication: the effect of mode of delivery on contractile function of placental arteries in vitro.

This study was designed to determine the effect of the mode of delivery on the in vitro assessment of placental blood vessel function. Twenty-two subjects with uncomplicated pregnancies, normal antenatal Doppler flow velocity waveforms and normal birth weights were recruited for the study. The 11 subjects who were delivered by elective caesarean section were matched with 11 controls, who had uncomplicated labours and spontaneous vaginal delivery.

Human chorionic gonadotrophin and steroid concentrations in follicular fluid: the relationship to oocyte maturity and fertilization rates in stimulated and natural in-vitro fertilization cycles.

The study investigates the relationship of follicular fluid steroids and human chorionic gonadotrophin to oocyte maturity and fertilization rates in stimulated and natural cycles. Oestradiol, progesterone, testosterone and human chorionic gonadotrophin were quantified in 129 samples of follicular fluid and the progesterone:oestradiol ratio calculated. Both stimulated cycles (short and long luteinizing hormone-releasing hormone/human menopausal gonadotrophin regimens) and natural cycles were compared.

Review of the organized support network for infertility patients in licensed units in the UK.

In acknowledging that 'counselling is generally recognized as beneficial', the Human Fertilization and Embryology Authority (HFEA) Code of Practice requires that all infertility units provide counselling facilities to be available for patients. In this study, we intended to evaluate the support and counselling services made available by the licensed units in the UK. A questionnaire consisting of 30 questions was designed and sent to every licensed treatment unit in the UK.