Cardiovascular risk assessment in women - an update.

Cardiovascular disease is the leading cause of morbidity and mortality in postmenopausal women. Although it is a disease of aging, vascular disease initiates much earlier in life. Thus, there is a need to be aware of the potential to prevent the development of the disease from an early age and continue this surveillance throughout life. The menopausal period and early menopause present an ideal opportunity to assess cardiovascular risk and plan accordingly. Generally in this period, women will be seen by primary health-care professionals and non-cardiovascular specialists. This review addresses female-specific risk factors that may contribute to the potential development of cardiovascular disease. It is important for all health-care professionals dealing with women in midlife and beyond to be cognisant of these risk factors and to initiate female-specific preventative measures or to refer to a cardiovascular specialist.

East is east and West is west: perspectives on the menopause in Asia and The West.

There is a school of thought that believes that menopausal symptoms are a peculiarly 'Western' phenomenon, not experienced by women from other regions and particularly not from Asia where, it has been claimed, dietary, social and cultural factors afforded protection for women living in that region. More recently, studies conducted in multi-ethnic communities living in Western countries as well as in Asian communities have found that the menopause and its consequences are similar world-wide. Ethnic differences within Asia account for small differences in endogenous hormone levels and age at menopause between Asian and Western women, and the type of menopause symptoms and their prevalence also differ between those two communities. However, like in the West and perhaps because of a Western influence, the long-term health problems of postmenopausal women including cardiovascular disease, osteoporosis and breast cancer are of major importance to Asian women and health services in the 21st century.

Transvaginal pulsed Doppler ultrasound assessment of blood flow to the corpus luteum in IVF patients following embryo transfer.

The waveforms of vessels supplying the ovaries of women on an in-vitro fertilization (IVF) programme were studied using transvaginal B-mode and Doppler ultrasound. There were 125 scans recorded in 65 women at weekly intervals from 3 days after embryo transfer or 5 days after gamete intrafallopian transfer (GIFT) until confirmation of pregnancy or onset of menses. At each examination the signals obtained from vessels supplying the ovaries were recorded and quantified using a resistance index (RI). Fifteen patients became pregnant of whom one has subsequently miscarried. There was a highly significant difference in the RI values between patients who became pregnant and those who did not; no patient who became pregnant had a RI greater than 0.5. Oestrogen to progesterone ratios were calculated in the subgroup of non-pregnant patients and there was no correlation between these values and the RI values. This new technique enables prediction of IVF treatment failure earlier than has been reported previously and may reflect the inadequacy of the corpus luteum.

The impact of an instant pregnancy test kit on the operations of a major hospital casualty department.

The records of all patients on whom a casualty department pregnancy test was performed during the first 4 months of 1986 were retrospectively examined and compared with the records of all patients who in the first 4 months of 1987 had had an instant pregnancy test performed in the same casualty department, to determine the impact of such a kit on diagnostic accuracy, operative procedures and related economic factors. It was demonstrated that instant pregnancy testing significantly improved the accuracy of provisional diagnoses and appeared to help in reducing the number of surgical procedures performed. Furthermore, it was shown that a combination of careful clinical assessment plus the appropriate application of an instant pregnancy test kit could result in a cost saving to the hospital of over $41,000 per annum.

PIP: To assess the impact of an instant pregnancy test kit on hospital admissions for suspected ectopic pregnancy, the records of 100 patients from a Sydney, Australia hospital were examined. All records of patients of patients whom a pregnancy test was performed during 4 months of 1986 were compared with records of patients who had had an instant pregnancy test performed in the same hospital during 4 months of 1987. 2 test methods were used, the Tandem B HCG RIA which takes 2 hours, and the instant Test Pack HCG serum test kit, which takes 3 minutes. There was a 100% accuracy correlation between the 2 tests. Costs were compared on the basis of how many patients were admitted to the hospital who might not have required admission had a test result been available. Instant pregnancy testing significantly improved the accuracy of provisional diagnosis and seemed to contribute to a reduction in the number of surgical procedures performed. Calculations using the number of hospital admissions that would not have been made had a test result been available, revealed estimated savings of $41,000/per year to the hospital. It was concluded that the Test Pack was cheap, easy to use, provided instantaneous results, and resulted in significant savings in hospital operating costs.