MAVRIC: a multicenter randomized controlled trial of transabdominal vs transvaginal cervical cerclage.

Background: Vaginal cerclage (a suture around the cervix) commonly is placed in women with recurrent pregnancy loss. These women may experience late miscarriage or extreme preterm delivery, despite being treated with cerclage. Transabdominal cerclage has been advocated after failed cerclage, although its efficacy is unproved by randomized controlled trial.

Recertification and continuing professional development: The way ahead.

The arguments in favour of recertification have been made cogently. Doctors in the UK on the whole continue to enjoy the trust and respect of their patients and the general public, but the Shipman enquiry led by Dame Janet Smith questioned the validity of the existing system. Following a lengthy discussion, the Chief Medical Officer of England published his proposal for professional regulation: Trust, assurance and safety - the regulation of health professionals in the 21st century¹ was published in February 2007.

Awareness of emergency contraception: a follow-up report.

Background And Methodology: This study aimed to ascertain whether recent campaigns aimed at increasing awareness and use of progestogen-only emergency contraception (POEC) have been effective, by comparing the understanding and awareness of POEC in those attending the termination of pregnancy (TOP) clinic in 2006 to an earlier cohort studied in 2003. Questionnaires were handed to all women attending the TOP clinic during a 4-week period in September/October 2006. Questionnaires were collected before women left the clinic.

Percutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates.

Background: Parenteral nutrition for neonates may be delivered via a short peripheral cannula or a central venous catheter. The latter may either be inserted via the umbilicus or percutaneously. Because of the complications associated with umbilical venous catheter use, many neonatal units prefer to use percutaneously inserted catheters following the initial stabilisation period.

Pathophysiology of neonatal respiratory distress syndrome: implications for early treatment strategies.

Neonatal respiratory distress syndrome (RDS) remains one of the major causes of neonatal mortality and morbidity despite advances in perinatal care. The initial management of infants with RDS has almost become 'too routine' with little thought about the pathophysiological processes that lead to the disease and how the clinician can use the existing therapeutic interventions to optimize care. The transition from fetus to infant involves many complex adaptations at birth; the most important is the function of the lungs as a gas exchange organ.

Awareness of emergency contraception.

Objective: To study the level of awareness and use of emergency contraception (EC) in women attending a pregnancy termination clinic.

Method: A questionnaire was handed to all women attending the clinic for termination of pregnancy and related advice during the month of February 2003. Completed questionnaires were collected before the women left the clinic and the data analysed.

Tension free vaginal tape: a procedure for all ages.

Objective: To assess the success and complications of the tension free vaginal tape (TVT) procedure in different age groups.

Patients And Methods: This prospective long-term study of 179 consecutive cases of urodynamically confirmed urinary incontinence that had had the TVT procedure was conducted from March 1999 to December 2002 at a District General Hospital. To assess whether outcome was influenced by the patient's age, the patients were divided into three age groups: group A (30-49 years old), group B (50-69 years old) and group C (70-90 years old).

Tension-free vaginal tape: 162 cases in a district general hospital.

From March 1999 to July 2002 a prospective study was carried out of 162 consecutive cases of urodynamically confirmed stress and mixed incontinence who underwent the tension-free vaginal tape (TVT) procedure. Patients were followed up at 6 weeks and 6 months and with a quality of life questionnaire at 1 year. The intraoperative complication rate was 7.

Percutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates.

Background: Parenteral nutrition for newborn infants may be delivered via short peripheral cannulae or central venous catheters, which are usually sited percutaneously. The method of delivery may affect nutrient input, and consequently growth and development. Although potentially more difficult to site, percutaneous central venous catheters may be more stable than peripheral cannulae, and need less frequent replacement.

Current knowledge of risks and benefits of prophylactic oophorectomy at hysterectomy for benign disease in United Kingdom and Republic of Ireland.

Objective: To estimate current practice of prophylactic oophorectomy at hysterectomy for benign disease and also define the role of the variables considered prior to making the decision of prophylactic oophorectomy among consultant obstetricians and gynaecologists in UK and Republic of Ireland.

Design: A postal questionnaire was sent to all 1536 practising consultant gynaecologists in UK and Republic of Ireland. METHODS AND MAIN OUTCOMES MEASURED: Of the 809 replies received, 21% of the respondents routinely performed prophylactic oophorectomy.

Evaluation of an experimental midwife-led unit in Scotland.

This paper reports on the outcome of pregnancy among 3322 low-risk women managed in an 'experimental midwife-led unit' at Forth Park Hospital, Kirkcaldy, Scotland. All women were allocated to receive midwife-led antenatal and intrapartum care. Of the 3322 women, 1786 were nulliparous and 1536 were parous.

Understanding factors influencing request for a repeat termination of pregnancy.

Objective: To assess factors influencing request for a termination of pregnancy (TOP).

Design: A questionnaire based, prospective study of 150 women requesting a TOP. This questionnaire contained a modified version of the Edinburgh Postnatal Depression Scale (EPDS).

Current practice of hysterectomy and oophorectomy in the United Kingdom and Republic of Ireland.

The purpose of this study was to estimate current surgical practice of hysterectomy and prophylactic oophorectomy of UK and Irish consultant gynaecologists. Individual and regional variation in surgical practice and factors influencing surgical practice were assessed. A postal questionnaire was sent to all 1536 consultants in obstetrics and gynaecology currently practising in the United Kingdom and Ireland, with a 52.

Scottish female obstetricians' views on elective caesarean section and personal choice for delivery.

We have been reminded many times in the medical and lay press about the views of London female obstetricians choosing elective caesarean section for non-medical reasons. This paper asked Scottish female obstetricians for their personal choice regarding delivery and showed that only 15.5% would choose elective caesarean section compared with 31% and 21% in two surveys of London female obstetricians.

Medium-term follow-up of women with menorrhagia treated by rollerball endometrial ablation.

Background: To assess medium-term efficacy of rollerball endometrial ablation in a district general hospital.

Method: From March 1992 to June 1997, 91 women underwent rollerball endometrial ablation for uncontrolled menorrhagia unresponsive to medical treatment. Each was sent a detailed questionnaire after at least 18 months (range 18-55).

Do practice guidelines guide practice? A prospective audit of induction of labor three years experience.

Background: To examine the effect of implementation of guidelines for induction of labor on the process of care and outcome measures.

Method: Guidelines for induction of labor were implemented in January 1996 following an audit report identifying inconsistency in clinical practice. A prospective audit was carried out following the implementation of a new strategy directed towards pre-induction cervical ripening in nulliparae with unfavorable cervices and the use of low dosages of vaginal prostaglandin E2 for induction of labor.