John R. Newton

Effect of anti‐smoking health education on infant size at birth: a randomized controlled trial

The effects of anti‐smoking health education during pregnancy on smoking behaviour and the subsequent infants size at birth were investigated in a controlled trial. It was found that the planned educational intervention was incompletely carried out and was given more effectively to primigravidae in whom subsequent reduction of smoking was more evident. The effects of educative intervention on size at birth were therefore analysed for first and later pregnancies separately. The differences in birthweight and length between the intervention and control groups were concentrated almost entirely among the first born infants who were 68 g heavier and 0–75 cm longer in the intervention group than the first born infants in the control group.

Release characteristics, ovarian activity and menstrual bleeding pattern with a single contraceptive implant releasing 3-ketodesogestrel.

The properties of a single contraceptive subdermal implant releasing 3-ketodesogestrel were assessed in fifteen women over twelve months. Serum levels of 3-ketodesogestrel were monitored regularly following insertion and after removal. The mean serum level of 3-ketodesogestrel was 245 pg/ml after 72 h (steady state) and 176 pg/ml after twelve months. All volunteers demonstrated ovulation inhibition throughout the study. Transient oestradiol peaks occurred during the study. No luteal activity was noted. The cervical mucus was rapidly rendered hostile to sperm migration. Two women withdrew from the study during the first six months for medical reasons. Both volunteers cited bleeding irregularity as the main cause, one complaining of oligomenorrhoea, the other of prolonged bleeding/spotting episodes. A small but significant increase in weight was noted during the study period.

The effects of a combined contraceptive vaginal ring releasing ethinyloestradiol and 3-ketodesogestrel on vaginal flora.

Fifty nine women with documented normal ovulatory cycles and with no symptoms of vaginal infection were divided into four groups. Each group used a combined contraceptive vaginal ring (CCVR) with a mean daily release rate of 0.015 mg of ethinyloestradiol (EE) and 0.120 mg of 3-ketodesogestrel (3-KDG) per day, for one cycle of either 21, 28, 42, or 56 days. Cultures from the posterior vaginal fornix and from the endocervical canal were obtained immediately before insertion of the ring and on removal of the ring. Changes in the numbers of vaginal cells, aerobic and anaerobic bacteria, Chlamydia trachomatis, Gardnerella vaginalis, yeasts and Trichomonas vaginalis were documented at the end of each treatment. Intra- and inter- group changes in the vaginal flora were assessed at the end of each treatment. The comparison between the number and type of flora showed no significant change between the pre-treatment population and the post-treatment population. The results of this study suggest that the use of this CCVR for 21, 28, 42 and 56 days is not associated with an increase in inflammatory cells or pathogenic bacteria.

Characteristics and incidence of dysfunctional ovulation patterns detected by ultrasound.

The nature and incidence of normal and abnormal spontaneous ovarian cycles, identified with ultrasound and endocrine tracking, were examined in 45 regularly cycling infertile women with no definitive cause and 15 women who were apparently normal and were receiving donor insemination because of clearly infertile partners. In 136 cycles, four apparently distinct abnormal patterns were detected. The total incidence in the infertile group was 58% compared with 23% in the donor insemination group (P less than 0.005). Twelve of 26 subjects who had at least three cycles tracked showed two different abnormalities, and 1 subject had three different abnormalities in five abnormal cycles. These results suggest that abnormal cycles are a significant factor in unexplained infertility and that diagnosis and treatment cannot be based on the study of a single cycle.

Assessment of gestational age of the Asian fetus by the sonar measurement of crown‐rump length and biparietal diameter

Summary. Two populations of pregnant Asian and European women were scanned using linear array real‐time ultrasound machines. Measurements were made of fetal crown‐rump length (CRL) up to 14 weeks gestational age and of biparietal diameter (BPD) up to 20 weeks gestational age. Polynomial growth curves relating CRL and BPD measurements to their gestational ages were fitted to the data by the method of unweighted least squares. There were no significant differences between the Asian and European parameters for the CRL and BPD curves. European nomograms may be used to establish Asian fetal gestational age up to 20 weeks.

Scar rupture in labour after previous lower uterine segment caesarean section: the role of uterine activity measurement

Summary. A series of 12 trials of scar associated with scar rupture is reviewed. Uterine activity patterns were assessable in 10 of them. Clinical features and characteristics of the intrauterine pressure waveform and uterine activity are discussed in relation to the integrity of the scar.

Division of uterine adhesions (Asherman's syndrome) with the Nd‐YAG laser

Summary. Two women with Ashermans syndrome after postpartum curettage are presented. The diagnosis was confirmed by hysteroscopy. The adhesions were vaporized under hysteroscopic control, using a Nd‐YAG laser (neodymium‐yttrium‐aluminium‐garnet laser). The method was precise, casued minimal thermal injury and resulted in immediate return of regular menstrual cycles. The use of the Nd‐YAG laser for Ashermans syndrome warrants further study.

Ultrasound follicle diameter measurement: an assessment of interobserver and intraobserver variation

The intraobserver and interobserver variation of ultrasound measurement of Graafian follicles was assessed. Fourteen follicles from 10 to 30 mm in diameter were each measured three times in three orthogonal planes by three observers. The intraobserver standard deviation (SD) was 0.6 mm and interobserver SD, 1.2 mm, irrespective of follicle diameter. The pooled SD for both variables was 1.2 mm, giving 95% confidence limits of +/- 2.4 mm for any measurement.

The in vivo release characteristics of a multi-compariment vaginal ring releasing 3-keto-Desogestrel

The results of a stage I study of a new vaginal ring releasing 3-keto-Desogestrel [3kDOG] is reported. The study design consisted of one study cycle, where the ring was used continuously for 21 days and then removed. Twenty healthy volunteers were randomly allocated to each of two study groups. On day 5 of the menstrual cycle, group A used a vaginal ring releasing 30 micrograms 3kDOG per 24 hours and group B used a 15 micrograms 3kDOG per 24 hours ring. After initial absorption of the 3kDOG a plateau phase was reached in 46 hours [group A] and 49 hours [group B]. On reaching the plateau phase, the overall decline in plasma levels during the 21 days of use was 5.24% for group A and 5.27% for group B. This represents a daily decline in plasma levels of 0.27% and 0.28% for the 30 micrograms and 15 micrograms per 24 hours rings, respectively. The plasma levels achieved by the rings were significantly different throughout (p = 0.011). On removal after 21 days, the mean removal half-life for both ring types was similar at 20.9 hours for group A and 21.1 hours for group B. It is concluded that the characteristics of the delivery system are worthy of further study as a potential means of contraception using 3kDOG delivered from a vaginal ring.

A randomized study of three cannulas for transcervical chorionic villus sampling

A randomized trial involving 200 transcervical chorionic villus samples taken with three different cannulas was undertaken. In terms of karyotype recovery and ease of insertion the aluminum cannula performed best although the placental site influenced the ability to recover villi for all cannulas.