Review: optical micrometer resolution scanning for non-invasive grading of precancer in the human uterine cervix.

Management of cervical precancer is archetypal for other cancer prevention programmes but has to consider diagnostic and logistic challenges. Numerous optical tools are emerging for non-destructive near real-time early diagnosis of precancerous lesions of the cervix. Non-destructive, real-time imaging modalities have reached pre-commercial status, but high resolution mapping tools are not yet introduced in clinical settings. The NCBI PubMed web page was searched using the keywords 'CIN diagnosis' and the combinations of 'cervix {confocal, optical coherence tomography, ftir, infrared, Raman, vibrational, spectroscopy}'. Suitable titles were identified and their relevant references followed. Challenges in precancer management are discussed. The following tools capable of non-destructive high resolution mapping in a clinical environment were selected: confocal microscopy, optical coherence tomography, IR spectroscopy, and Raman spectroscopy. Findings on the clinical performance of these techniques are put into context in order to assist the reader in judging the likely performance of these methods as diagnostic tools. Rationale for carrying out research under the prospect of the HPV vaccine is given.

Neonatal jaundice--a comparison between intravenous oxytocin and oral prostaglandin E2.

The total serum bilirubin levels at two and occasionally five days after birth were studied in 162 infants whose mothers received either intravenous oxytocin or oral Prostaglandin te2 during labour, and the results were compared with those obtained in forty-two control patients. Following labour of spontaneous onset, whether the mother received intravenous oxytocin or oral Prostaglandin E2, neonatal total serum bilirubin levels were not different from those in controls. After induction by amniotomy and an active agent, higher mean total serum bilirubin levels were found in infants whose mothers received intravenous oxytocin than in those given oral prostaglandin E2; a significant rise in the total serum bilirubin level appeared to occur when mothers received a total of more than 12,000 milliunits of oxytocin or more than 4,000 milliunits per kg birthweight of the infant.

Induction of labour in the presence of ruptured membranes with prostaglandin E2 gel.

The study shows the safety and the efficacy of labour induction with prostaglandin E2 gel. By combining an initially conservative approach with later induction by PGE2 a vaginal delivery rate of 96.8% was achieved.

Induction of labour with prostaglandin gel in patients with unfavourable cervices.

151 primigravid patients with Bishop scores of 4 or less were induced with prostaglandin E2 gel using an initial dose of 2 mg followed by 1 mg or 2 mg at 6 hours. Eighty one patients (53.6 per cent) were in established labour or had delivered by 12 hours, and a further 31 (20.5 per cent) had achieved successful ripening of the cervix. Ninety per cent and 64.5 per cent respectively achieved vaginal delivery and although 39 patients failed to respond to this regime, 72 per cent delivered vaginally after augmentation. No case of hypertonus was recorded and only one patient had abdominal delivery for "failed induction". This regime provides an effective means of induction of labour for a difficult group of patients with little worry of overstimulation and low "failed induction" rates.

Management of women referred to early pregnancy assessment unit: care and cost effectiveness.

OBJECTIVE: To assess the efficiency of an early pregnancy assessment unit in the care of women with bleeding or pain in early pregnancy. DESIGN: Analysis of women attending in the first year of the unit's operation and in the six months immediately before its introduction. SETTING: Early pregnancy assessment unit in a district general hospital serving a population of 310,000. PATIENTS: 1141 women referred with bleeding or pain in early pregnancy. MAIN OUTCOME MEASURES: Length of stay in hospital required for diagnosis and treatment. RESULTS: Before the unit was established the mean admission time was one and a half (range half to three) days for women who required no treatment and three (one and a half to five) days in women requiring evacuation of uterus. These times were reduced to two hours as an outpatient and one day respectively for most women after the unit was established. Between 318 and 505 women were estimated to have been saved from unnecessary admission, and 233 had their stay reduced; the associated saving was between pounds 95,000 and pounds 120,000 in one year. CONCLUSIONS: The early pregnancy assessment unit improved the quality of care and also produced considerable savings in financial and staff resources.

Outpatient endometrial assessment.

Over the past 10 years, outpatient endometrial assessment has largely replaced traditional dilatation and curettage, offering a quick, reliable and cost-effective alternative which avoids the need for general anaesthesia. The techniques available and their scope are discussed in detail.

The use of a calcium antagonist (nifedipine) to suppress preterm labour.

The efficacy of an orally administered calcium antagonist, nifedipine, in suppressing premature uterine activity, was compared with intravenous ritodrine and no treatment. Nifedipine was found to be significantly more effective than ritodrine or withholding therapy, and was almost devoid of side-effects.

Characteristic fetal heart rate changes in severe rhesus isoimmunization.

A case of pregnancy complicated by severe rhesus isoimmunization is described. The finding of a sequence of fetal heart pattern changes on daily cardiotocography offers a simple method of detecting the severely compromised fetus, which appears to be related to the underlying pathological process, and is more sensitive than other tests of fetal well-being currently used.

Epidural pethidine for relief of episiotomy pain.

Epidural pethidine was compared with epidural saline for relief of pain from episiotomy wounds. Pethidine 25 mg administered by the lumbar epidural route produced significant analgesia. However, the incidence and severity of episiotomy pain are so variable that routine use of the technique is not recommended.

Radioisotope dilution technique for measurement of blood loss associated with lower segment caesarean section.

Using a 51Cr-labelled red cell dilution technique, the blood loss associated with elective lower segment Caesarean section was measured in 30 patients, half of whom had a previous history of Caesarean section. The blood loss (mean +/- SD) was 1290 +/- 240 ml for first Caesarean sections and 1012 +/- 380 ml for repeat operations.

Variations in sperm count in oligozoospermic or asthenozoospermic patients.

Using a Coulter Counter, sperm density and total sperm population per ejaculate has been measured repeatedly in a series of oligozoospermic and asthenozoospermic patients. Marked variations in these parameters were found with repeated sampling from the same patient. The implications of such findings are discussed.

Current practice for induction of labour in the United Kingdom: time for a review?

This paper presents the results of postal survey of protocols for induction of labour. The drug regimes used for the induction of labour in NHS hospitals in England and Wales have been compared to both RCOG guidelines and to the drug manufacturer's recommendations. A wide variation in practice was found, with many units using dosages that are different from those recommended. The implications of such departures from the norm are discussed in terms of the importance of evidence-based practice and the role of national guidelines in ensuring optimum care.

Can an advanced nurse practitioner take on the role of senior house officer within a specialised area of practice: an evaluation.

This study looked at the impact of advanced nurse practitioners (ANPs) taking on the role of senior house officer (SHO) within obstetrics and gynaecology. It was anticipated that such a change would have benefits for patients and for service delivery. The project took place in the gynaecology department of a district general hospital. All patients who would normally be under the care of the SHOs with one medical team received this care from one or other of two ANPs. Focus groups were used to look at the impact of the changes on other staff within the unit. Patient questionnaires were used to assess the opinions of patients about the care they received. Length of stay, readmissions and cancellations were used to assess the impact on patient care. The change in role of the ANPs has had lasting benefits in terms of better communication and multidisciplinary working and the development of an informal referral system that allowed patients to be seen more quickly and appropriately. There were no ill effects on patient care.

Iron prophylaxis in pregnancy--is it useful?

Iron deficiency anaemia in pregnancy is not a common problem among Black patients in the Durban area, and prophylactic iron supplements do not lead to an increase in haemoglobin values. Prophylactic iron therapy should give way to investigation and appropriate treatment of patients with low haemoglobin values.

A comparison of the efficacy of gemeprost vaginal pessaries and extra-amniotic prostaglandin E2 gel in the induction of middle trimester abortion.

In an open random allocation trial of 50 patients, 25 had abortion induced vaginally with gemeprost (16.16-dimethyl-trans-delta squared- prostaglandin E1 methyl ester; PGE) 1 mg pessaries inserted into the posterior fornix. The remainder received 7.5 mg PGE2 in a gel inserted into the extraamniotic space. Following the administration of 2 doses of PGE2 gel, abortion was achieved in 100% of the cases within 24 hours, whereas the group treated with a maximum of 3 gemeprost pessaries administered at 3-hour intervals only achieved abortion within 24 hours in 76% of the cases. 3 doses of gemeprost pessaries are the cost equivalent of 2 doses of PGE2 gel.

Influence of early discharge after hysterectomy on patient outcome and GP workloads.

This paper examines the impact of early discharge following hysterectomy on patient outcome and GP workload. Results are presented from a survey of patient attitudes on care and recovery, pain relief and contacts overall with their general practitioner (GP) surgery. The findings are compared with those of a previous study where a policy of early discharge had been shown to increase GP workloads. The paper discusses the importance of preparing patients adequately for their surgery and postoperative recovery, and highlights the beneficial effects on patient attitudes of the introduction of patient information leaflets, a preadmission clinic and a telephone advice service following discharge.