Influence of physical exercise on baroreceptor sensitivity during pregnancy.

BACKGROUND: Baroreceptor sensitivity (BRS) refers to the magnitude of change in the heart rate in response to change in blood pressure (e.g. upon standing). The impact of regular antenatal exercise on maternal BRS is unclear. AIMS: To determine whether supervised weekly exercise influences BRS, and to determine if posture and calculation method are important in antenatal BRS measurement. STUDY DESIGN AND SUBJECTS: Eighty-one healthy pregnant women were randomly assigned to an exercise or control group. The exercise group attended weekly classes from the 20th week of pregnancy onwards. OUTCOME MEASURES: Cardiovascular assessments (beat-to-beat blood pressure, heart rate) were performed at 12-16, 26-28, 34-36 weeks and 12 weeks following birth. BRS was calculated using two methods ("sequence" and "beat-to-beat"). RESULTS: Fifty-one women (63%) completed the study. Mean BRS reduced progressively in all women (p < 0.025) and was lowest in those who exercised (0.046 < p < 0.002). Postnatal increases in BRS were independent of posture. Training-induced BRS (beat-to-beat) reduction occurred earlier than BRS (sequence), and only BRS (sequence) was affected by posture. Heart rate variability reduced with advancing gestation (p < 0.002) and was more pronounced in the exercise group (p < 0.029). CONCLUSIONS: Weekly exercise exaggerated the reductions in BRS and HRV during pregnancy and is likely linked to diminished parasympathetic activity.

Influence of antenatal physical exercise on heart rate variability and QT variability.

OBJECTIVE: We sought to characterise the influence of an antenatal exercise programme on ECG-derived cardiac variables. METHODS: Fifity-one healthy pregnant women were recruited and randomly assigned (2 × 2×2 design) to an exercise group or a control group. Exercising groups attended weekly classes from the 20th week of pregnancy onwards. Cardiovascular assessments (heart rate variabiliy (HRV), QT, and the QT variability index (QTVI)) were performed at 12-16, 26-28, 34-36 weeks and 12 weeks following birth, during supine rest and exercise conditions. RESULTS: Advancing gestation was associated with an increased maternal heart rate (p = 0.001), shorter QT interval (p = 0.003), diminished HRV (p = 0.002) and increased QTVI (p = 0.002). Each of these changes was reversed within 12 weeks postpartum (p < 0.004). The Exercise group displayed exaggerated changes for all variables (except QT) but only during supine rest in the third trimester (p < 0.029). CONCLUSION: Advancing gestation is associated with a shift in HRV/QTVI towards values that have been associated with an elevated risk of arrhythmia. A 20-week exercise programme undertaken between mid and late pregnancy exaggerated these changes during rest in the third trimester of pregnancy.

Recruitment of pregnant women to an exercise-intervention study.

We share here our experience of recruiting pregnant women into an exercise intervention study. Recruitment challenges were anticipated owing to the study design, which required four hospital visits for cardiovascular assessment, a long-term (nine-month) commitment, and adherence to a 20-week exercise programme. Fifty-three women were assigned to one of three groups (no-exercise, land exercise or water exercise) using a 2 × 2 × 2 flexible randomisation design. Seven hundred forty-four women were screened at an antenatal clinic, of whom 501 were eligible to participate in the study. One hundred forty-five women were subsequently approached: 46 (32%) of whom agreed to participate, 42 (29%) were interested but then declined and 57 (39%) declined outright. Our study design helped recruit pregnant women as it allowed them some choice of group membership. We also noted that the participant-researcher relationship is important in reducing attrition. Our experience provides indications of likely recruitment and attrition rates for future randomised controlled trials of this type.

Changes in heart rate variability and QT variability during the first trimester of pregnancy.

The risk of new-onset arrhythmia during pregnancy is high, presumably relating to changes in both haemodynamic and cardiac autonomic function. The ability to non-invasively assess an individual's risk of developing arrhythmia during pregnancy would therefore be clinically significant. We aimed to quantify electrocardiographic temporal characteristics during the first trimester of pregnancy and to compare these with non-pregnant controls. Ninety-nine pregnant women and sixty-three non-pregnant women underwent non-invasive cardiovascular and haemodynamic assessment during a protocol consisting of various physiological states (postural manoeurvres, light exercise and metronomic breathing). Variables measured included stroke volume, cardiac output, heart rate, heart rate variability, QT and QT variability and QTVI (a measure of the variability of QT relative to that of RR). Heart rate (p < 0.0005, p < 0.0005, p < 0.0005) and cardiac output (p = 0.043, p < 0.0005, p < 0.0005) were greater in pregnant women in all physiological states (respectively for the supine position, light exercise and metronomic breathing state), whilst stroke volume was lower in pregnancy only during the supine position (p < 0.0005). QTe (Q wave onset to T wave end) and QTa (T wave apex) were significantly shortened (p < 0.05) and QTeVI and QTaVI were increased in pregnancy in all physiological states (p < 0.0005). QT variability (p < 0.002) was greater in pregnant women during the supine position, whilst heart rate variability was reduced in pregnancy in all states (p < 0.0005). Early pregnancy is associated with substantial changes in heart rate variability, reflecting a reduction in parasympathetic tone and an increase in sympathetic activity. QTVI shifted to a less favourable value, reflecting a greater than normal amount of QT variability. QTVI appears to be a useful method for quantifying changes in QT variability relative to RR (or heart rate) variability, being sensitive not only to physiological state but also to gestational age. We support the use of non-invasive markers of cardiac electrical variability to evaluate the risk of arrhythmic events in pregnancy, and we recommend the use of multiple physiological states during the assessment protocol.

Patient awareness and acceptability of antenatal perineal massage.

Antenatal perineal massage is recommended to reduce perineal trauma at the time of delivery. The practice has been shown to be acceptable to pregnant women taking part in research studies. The aim of this study was to establish its acceptability to pregnant women in day-to-day clinical practice, as well as their awareness of its technique. An anonymous self-construct questionnaire was given to mothers after their first delivery. A total of 113 questionnaires were returned over a 4-month period. With regard to acceptability, 61.4% of respondents indicated that the practice was acceptable, only 25.7% felt the practice was embarrassing and 56.7% were happy for their husband/partner to perform it for them. With respect to awareness, 37.2% of the respondents had heard about the practice, 9.7% knew it should be practised from 34 weeks onwards, 11.5% knew it should be maintained for 5-10 min and 30.1% knew it ought to be performed daily. This showed first time mothers' awareness of antenatal perineal massage to be low, despite the idea being acceptable to them, which calls for action to improve awareness and provide more instruction and encouragement to take up the practice.

Quality and quantity: an audit of urodynamics practice in relation to newly published National Standards.

OBJECTIVE: To document urodynamic practice in Wales in relation to newly released National Minimum Standards with a view to influencing organisational change. METHODS: Three questionnaires, evaluating respectively, departmental practice, individual practice and the last 10 studies performed in that department, were sent to all departments performing urodynamics in Wales. Results 19/20 departments responded. Approximately 4,000 studies are performed annually in Wales. Three departments do not perform enough studies annually to meet minimum standards. The minimum standard of 30 studies annually is not met by most centers evaluating neuropathic patients or performing ambulatory tests. Eighty four percent of departments have a clinical lead, one quarter discuss urodynamics in the context of a multi-disciplinary team meeting and occasional audits are performed. Fifty-four staff perform urodynamics, of which 35 (65%) have attended a course. Ability to describe zeroing a transducer was scored out of 6 and respondents scored a median of 3/6. One hundred twenty two out of 168 (72%) of the studies audited asked a clear urodynamics question, but, in 22/168 (13%) this question was not answered. The urodynamics report was written immediately 85% of the time. CONCLUSION: Centers failing to meet the minimum standards for workload should consider their position in relation to standards and NICE guidance (UKCS, NICE). In particular, departments should give attention to standards described in "Good Urodynamic Practice," establish multi-disciplinary teams for continence management and consider greater centralization of investigations for patients with neuropathies and for ambulatory studies. Most staff attended a course, yet few can describe how to zero transducers. This raises questions about the quality of reporting of some urodynamic studies. Those that are involved in urodynamics should take part in regular CME, relevant audit and consider certification and revalidation. This audit has highlighted significant variations in practice and lends support to the application of nationally agreed standards.

A randomised controlled trial comparing TVT, Pelvicol and autologous fascial slings for the treatment of stress urinary incontinence in women.

OBJECTIVE: To compare TVT(TM) , Pelvicol(TM) and autologous fascial slings (AFSs). DESIGN: A multicentre randomised control trial. SETTING: Four units in the UK. POPULATION: Women requiring primary surgery for stress urinary incontinence (SUI). METHODS: A total of 201 women with urodynamically proven stress incontinence were randomised into three groups and assessed at baseline, 6 weeks, 6 months and 1 year. MAIN OUTCOME MEASURE: The primary outcome was patient-reported improvement rates. Secondary outcomes included operative complications/time, intermittent self-catheterisation (ISC) and re-operation rates. The quality-of-life tools used were the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) and EuroQoL. RESULTS: Fifty women had a Pelvicol(TM) sling, 79 had AFSs and 72 had TVT(TM). At 6 months the Pelvicol(TM) arm had poorer improvement rates (73%) than TVT(TM) (92%)/AFS (95%); P=0.003. At 1 year only 61% of the Pelvicol(TM) slings remained as improved, versus 93% of TVTs and 90% of AFSs (P<0.001). Pelvicol(TM) has poorer dry rates (22%) than TVT(TM) (55%)/AFS (48%) (P=0.001) at 1 year; hence, the Pelvicol(TM) arm was suspended following interim analysis. There is no difference in the success rates between TVT(TM) and AFS. One in five women in the Pelvicol(TM) arm had further surgery for SUI by 1 year, but none required further surgery in the other arms. AFS took longer to do (54 minutes versus 35 minutes for TVT(TM) /36 minutes for Pelvicol(TM) ) and had higher ISC rates (9.9 versus 0% Pelvicol(TM) /TVT(TM) 1.5%). Hospital stay was shortest for TVT(TM) (2 days). Most BFLUTS domains showed improvement in all three arms. The improvement for women in the Pelvicol(TM) arm, however, was less than for women in the other arms in several key domains. CONCLUSIONS: Pelvicol(TM) cannot be recommended for the management of SUI. TVT(TM) does not have greater efficacy than AFS, but does utilise fewer resources.

Extracorporeal magnetic energy stimulation of pelvic floor muscles for urodynamic stress incontinence of urine in women.

The aim of this study was to assess the efficacy, side effects and drop out rate of extra-corporeal magnetic energy stimulation of pelvic floor muscles for urodynamic stress incontinence of urine in women. It was a prospective non-controlled study at 2 district general hospitals in South Wales. It included 48 female patients with urodynamic stress incontinence of urine, who had 16, twice weekly treatment sessions. Pad test was the primary outcome measure and continence diary, King's Health and EuroQol quality of life questionnaires, side effects and drop out were the secondary outcome measures. Assessment was made on recruitment, at the end of treatment sessions and at 3 months follow up. Thirty one patients completed treatment sessions and 27 attended for follow up at 3 months. There was no significant change in outcome measures at the end of treatment or at 3 months follow up. Side effects were encountered by 52.1% of patients and the drop out rate was 35.4%.

The prevalence of silent postpartum retention of urine in a heterogeneous cohort.

The aim of this study was to assess the prevalence of silent postpartum retention of urine. It included 100 patients within 48 h from delivery or removal of indwelling catheters, when such catheters were inserted during labour. Residual urine was estimated using a portable bladder scan. A total of 37 patients (37%) had a post void residual bladder volume > 150 ml; the volume was between 151-200 ml in 26 patients (26%) and > 200 ml in 11 patients (11%). No association was found with time since delivery, or catheter removal in those catheterised at the time of delivery, catheterisation at the time of delivery, use of regional anaesthesia, or mode of delivery. This showed that silent retention of urine affects a significant proportion of various groups of patients after delivery, which calls for further research into this area.

Botulinum toxin B is not an effective treatment of refractory overactive bladder.

OBJECTIVES: To determine the efficacy and safety of botulinum toxin-B (BTX-B) in two groups of patients with urodynamically proven idiopathic detrusor overactivity (IDO) or neurogenic DO (NDO) refractory to conservative treatment. METHODS: This was a nonrandomized, prospective study. We diluted 5000 U of BTX-B in 20 mL of normal saline and injected it at 20 sites around the bladder, avoiding the trigone. The data collected at recruitment and 10 and 26 weeks postoperatively included number of incontinent episodes, frequency, and nocturia, King's Health Questionnaire score, and the urodynamic parameters of volume at the first overactive contraction and maximal cystometric capacity. RESULTS: A total of 25 patients were recruited, 20 with IDO and 5 with NDO. Only 7 patients, all with IDO, reported symptomatic improvement at the 10-week assessment. The symptoms had returned in these 7 patients at a median of 136 days (range 106 to 151) after injection. Of the remaining 20 patients, 16 (13 with IDO and 3 with NDO) thought an initial improvement had occurred but it had worn off or was wearing off by the first assessment. Two patients (both with NDO) reported no improvement. CONCLUSIONS: BTX-B had a limited duration of action, with most of its symptomatically beneficial effects wearing off by 10 weeks in most of our patients. The short duration of action for BTX-B suggests it is unlikely to gain widespread use in the treatment of DO.

Biomonitoring the human population exposed to pollution from the oil fires in Kuwait: analysis of placental tissue using (32)P-postlabeling.

The placenta is a readily available source of material for molecular epidemiological investigations. As such, DNA damage in this tissue can be indicative of maternal exposure to environmental pollutants such as polycyclic aromatic hydrocarbons (PAHs). Previous reports have demonstrated that (32)P-postlabeling (PPL) is able to detect the presence of aromatic adducts in human placenta that are associated with maternal smoking during pregnancy. Using PPL we have assayed the DNA damage in placental samples from Kuwaiti mothers who were exposed to environmental pollution during pregnancy. This pollution arose in the aftermath of the Iraqi invasion of Kuwait, which left hundreds of oil wells burning. For comparison, further Kuwaiti samples were obtained approximately 1 year after the oil well fires and, as such, are from individuals unexposed to the airborne pollution from the oil well fires during pregnancy. In addition, placental samples were obtained from subjects in the United Kingdom. Adduct levels were measured in all samples using both the nuclease P1 and butanol extraction enhancement procedures. No elevation of adduct levels was observed in the placenta of mothers exposed to the oil well fires (n = 40) with either procedure (144 +/- 30 attomol/microg DNA for nuclease P1 enrichment, 245 +/- 50 attomol/microg DNA for butanol extraction), when compared with the nonexposed Kuwaiti mothers (180 +/- 32 and 281 +/- 39 attomol/microg DNA, respectively, n = 24). Similar adduct levels were observed in UK mothers who smoked cigarettes (178 +/- 30 and 284 +/- 52 attomol/microg DNA, n = 30), which in turn were approximately twice those observed in nonsmoking mothers (90 +/- 14 and 141 +/- 15 attomol/microg DNA, n = 12), although there is no significant difference in the distribution of adduct levels when statistical analysis is performed. Comprehensive interpretation of the Kuwaiti data is difficult as precise information on PAH levels is unavailable, although the data do seem to indicate that exposure to PAHs was not biologically significant.

Universal prophylaxis for Chlamydia trachomatis and anaerobic vaginosis in women attending for suction termination of pregnancy: an audit of short-term health gains.

A previous study of infection and morbidity in 400 women attending for termination of pregnancy (TOP) had shown that 32 (8%) harboured cervical Chlamydia trachomatis and 112 (28%) had anaerobic (bacterial) vaginosis (AV). Fifty-three per cent of the women with preoperative C. trachomatis had AV. Thirty of the 32 women with chlamydial infection were followed up and 19 (63%) of these developed post-abortion upper genital tract infection, 7 of whom needed re-admission. In view of the high morbidity in women with chlamydial infection attending for TOP, anti-bacterial prophylaxis with metronidazole suppositories and oral oxytetracycline was introduced for women attending for suction termination of pregnancy (STOP). An audit of the clinical and financial benefits and/or losses was carried out. The audit of 1951 consecutive patients attending for STOP revealed that 132 (6.8%) had chlamydial infection with equivocal results reported in a further 2 patients. One hundred and eight of the 134 women responded to recall. Full genital tract infection screening was carried out in 105 of the 108 recalled patients of whom 5 had repeat positive cervical swabs for C. trachomatis, one had Trichomonas vaginalis, 24 had candidiasis and 17 had anaerobic vaginosis, none had gonorrhoea. Thirteen (12%) of the 108 women had pelvic infection as previously defined, none of whom required re-admission. At least pound sterling 20,000 has been saved each year in our Trust following the introduction of pre-abortion chlamydial screening and universal antichlamydial and anti-anaerobe prophylaxis. The introduction of universal prophylaxis against C. trachomatis and AV has profoundly reduced morbidity in patients attending for TOP and has also resulted in substantial financial savings.

PIP: This paper presents an audit of the clinical and financial benefits and/or losses of a new management protocol for Chlamydia trachomatis and anaerobic vaginosis (AV) in women requesting suction termination of pregnancy (STOP). This management protocol is known as the Singleton Regimen and involves the introduction of an antibacterial prophylaxis with metronidazole suppositories and oral oxytetracycline. The audit included 1951 patients requesting STOP at the Singleton Hospital between January 1992 and October 1993; 132 of them had chlamydial infection. A total of 108 women responded to recall. Full genital tract infection screening was carried out in 105 of the 108 recalled patients. Of the 105 patients, 5 had repeat positive cervical swabs for C. trachomatis, 1 had Trichomonas vaginalis, 24 had candidiasis, and 17 had anaerobic vaginosis. 13 of the 108 women had pelvic infection; none of them required readmission. In conclusion, the introduction of universal prophylaxis against C. trachomatis and AV has significantly reduced morbidity in patients obtaining a termination of pregnancy and has also resulted in substantial financial savings.

Mifepristone in combination with methotrexate for the medical treatment of tubal pregnancy: a randomized, controlled trial.

In the search for a more potent alternative to a single i.m. injection of methotrexate for ectopic pregnancy, a randomized trial was organized. The efficacy of a combination of methotrexate and mifepristone was compared with methotrexate alone in the treatment of unruptured tubal pregnancies. The diagnosis of an unruptured tubal pregnancy was confirmed laparoscopically in 50 patients during a 2 year period. Women were randomized to receive a single i.m. injection of 50 mg/m2 methotrexate alone or a single dose of 600 mg oral mifepristone in combination with the same dose of methotrexate. Both treatment protocols were successful in achieving the resolution of unruptured ectopic pregnancy (18/25 in the methotrexate group and 22/25 in the combination group) following the initial intervention. A second injection was needed in four (16%) cases in the methotrexate group and in one (4%) case in the combination group. Overall, a complete resolution was achieved in 22/25 and 23/25 cases respectively. Unruptured ectopic pregnancy resolved faster in women given the combination of methotrexate and mifepristone compared to women given methotrexate only (P = 0.01). The effect of the methotrexate and mifepristone combination was more pronounced in women with higher human chorionic gonadotrophin concentrations.

Intraumbilical oxytocin for the management of retained placenta: a randomized controlled trial.

OBJECTIVE: To evaluate the ability of intraumbilical oxytocin injection as a treatment for retained placenta after vaginal delivery to reduce the incidence of manual removal and postpartum hemorrhage. METHODS: A randomized controlled trial was set up in a university and a district general hospital. We recruited 81 women with singleton pregnancies who underwent vaginal delivery and who failed to deliver the placenta after 20 minutes of active management of the third stage of labor. Study subjects were randomized to receive either 1) an intraumbilical injection of oxytocin (20 IU in 20 mL of saline); 2) an intraumbilical injection of saline (20 mL); or 3) no treatment. Outcome measures were expulsion of the placenta within 45 minutes of delivery, need for manual removal of the placenta under anesthesia, and postpartum hemorrhage (defined as a blood loss greater than 500 mL). RESULTS: Women given an intraumbilical injection of oxytocin had a significant increase in spontaneous expulsion of the placenta within 45 minutes of delivery and fewer manual removals of the placenta, compared with women without treatment (odds ratio [OR] 11.6, 99% confidence interval [CI] 1.4, 272.8; and OR 7.4, 99% CI 1.1, 86.5; respectively). When women given intraumbilical oxytocin were compared with women given only intraumbilical saline, the difference was not statistically significant (OR 6.6, 99% CI 0.9, 77.2 for spontaneous expulsion of the placenta; and OR 4.7, 99% CI 0.8, 39.5 for manual removal). There was no significant difference in the incidence of spontaneous expulsion and manual removal of the placenta between women given intraumbilical saline injection and women without treatment (OR 1.8, 99% CI 0.1, 53.9; and OR 1.6, 99% CI 0.1, 22.4; respectively). CONCLUSION: The results of our study suggest a clinically important beneficial effect of intraumbilical oxytocin injection in the management of retained placenta.

Intraperitoneal Enterobius vermicularis infection: a case report.

BACKGROUND: Enterobius vermicularis in an ectopic location usually represents an incidental finding in tissue specimens in a patient without symptoms. However, the parasite can lead to inflammation and symptoms in rare cases. CASE: A 36-year-old woman had an abdominal hysterectomy for menorrhagia, dyspareunia, and lower abdominal pain. Two small nodules from the posterior aspect of the left broad ligament as well as the uterus were sent for histologic examination. The pathologic findings confirmed the diagnosis of "granulomatous peritoneal nodules due to E. vermicularis." Within the nodules were aggregates of ova of E. vermicularis. CONCLUSION: This case reminds us that such granulomatous lesions can simulate leiomyoma, fibroma, endometrioma, and tuberculous or malignant lesions. It is important to be aware of this resemblance to avoid unnecessary surgical intervention.

Sequential recording of the abdominal fetal electrocardiogram and magnetocardiogram.

The aim of this study was to demonstrate the acquisition of both the fetal magnetocardiogram (FMCG) and fetal electrocardiogram (FECG) from the abdomen of the same subject. This contrasts with previous reported studies which have generally recorded one or other of these signals but not the two together. Both signals were successfully recorded and averaged to produce a typical complex, thus allowing their direct comparison.

Health gains from screening for infection of the lower genital tract in women attending for termination of pregnancy.

Infection of the upper genital tract after abortion is well recognised, but routine screening for infection before termination is rare, and few centres are aware of the prevalence of post-abortion complications in their population. We undertook a study to assess the prevalence and sequelae of genital-tract infection in patients undergoing termination of pregnancy and to estimate the costs and potential benefits of introducing screening and prophylaxis for the most commonly found organisms. The study in Swansea, UK, was of 401 consecutive patients attending for termination of pregnancy; only 1 patient refused to take part. Immediately before the termination procedure vaginal and cervical swabs were taken for microscopic examination and culture of Trichomonas vaginalis, Neisseria gonorrhoeae, and candida species. We sought Chlamydia trachomatis by enzyme-linked immunosorbent assay. 112 (28%) women had the typical bacterial flora of anaerobic (bacterial) vaginosis, 95 (24%) had candidal infection, 32 (8%) chlamydial infection, 3 (0.75%) trichomonas infection, and 1 (0.25%) gonorrhoea. Postoperative follow-up of 30 of the women with chlamydial infection showed that pelvic infection developed in 19 (63%), of whom 7 were readmitted to hospital. 9 male partners of women with chlamydial (plus gonococcal in 1 case) infection were examined; 8 were symptom-free, 3 had C trachomatis infection, and 1 N gonorrhoeae. Estimated costs of hospital admissions for complications of chlamydial infection were more than double the costs of providing a routine chlamydia screening programme and prophylactic treatment. Screening for chlamydial infection before termination of pregnancy is essential. Prophylactic treatment for both chlamydial infection and anaerobic vaginosis should also be considered. Male partners of women infected with chlamydia are often symptom-free, but they must be traced to avoid reinfections.

PIP: Between October 1990 and March 1991, 401 women at Hill House Hospital in Swansea, Wales, undergoing an abortion enrolled in a study to determine the prevalence and sequelae of lower genital tract infection and to assess the costs and potential benefits of screening and of prophylaxis for the most common pathogens. The physicians administered 500 mg oxytetracycline for 10 days for women with uncomplicated chlamydia infection and for 14=21 days for those with chlamydia-related pelvic inflammatory disease (PID). A 5-day course of oral metronidazole (400 mg/2/times/day) treated anaerobic vaginosis and trichomonas infections. 51.7% had at least 1 lower genital tract infection, 28% had anaerobic vaginosis, 24% had candida infection and 32 women (8%) were infected with Chlamydia trachomatis. Some of these women also had anaerobic vaginosis, anaerobic vaginosis and candidosis, Escherichia coli infection, and candidosis (15, 1, 1, and 6 women, respectively). Anaerobic vaginosis was more likely to be present in women with chlamydia infection than in those without chlamydia infection (53% vs. 26%; p .05). 19 of 30 women (63%) with chlamydia infection who could be followed postoperatively developed PID. 7 women had to be readmitted to the hospital. 9 males partners of 26 women also attended the Genito-Urinary Medicine clinic. 8 had not symptoms, but 3 had C. trachomatis infection and 1 had Neisseria gonorrhoea infection. The physicians estimated the costs of hospital admissions for pelvic infection to be 2.4 times more costly than providing routine prophylactic screening and treatment (16,800 vs. 6960 UK pounds). These results showed the need to be screen for chlamydia infection before termination of pregnancy and to provide prophylactic treatment for chlamydia infection and anaerobic vaginosis. The physicians also recommended tracing the male partners of chlamydia-infected women to prevent reinfections.