The effects of smoking on labour after uncomplicated pregnancy: a comparison between the progress and outcome of labour in 400 smokers and 400 matched non-smokers.

A comparison was made between the progress of labour and its outcome after an uncomplicated pregnancy, in 400 smokers and 400 non-smokers. Strict selection criteria were applied to eliminate, as far as possible, the variables which might have influenced labour in both groups and to ensure that the two groups of women were matched. The duration of labour was longer in smokers, who also had a higher incidence of caesarean sections. Smokers had a higher incidence of retained placenta and postpartum haemorrhage. The neonates of smokers had a higher incidence of problems in the immediate post-delivery period.

Results of an open one-year study with Diane-35 in women with polycystic ovarian syndrome.

To evaluate the effects of Diane-35 on androgenized oligomenorrheic women with polycystic ovarian syndrome, 32 women with PCOS were recruited to an open study of one-year duration. The effects of Diane-35 on signs of androgenization and on morphological and hormonal parameters were assessed in the pre- and posttreatment cycles and in the 3rd, 6th, 9th, and 12th treatment cycles. Twenty-two women completed the 12-month study period, five withdrew due to adverse events, two were lost to follow-up, and three stopped early because of a lack of efficacy. Ultrasound demonstrated significant reductions in ovarian volume, stromal density, and follicle number and size. Serum concentrations of LH, FSH, testosterone, androstenedione, and dehydroepiandrosterone sulfate decreased, and serum SHBG increased significantly. Mean Ferriman-Gallwey hirsutism scores declined from 14.3 before treatment to 5.7 at completion of therapy. Severe facial hirsutism, present in 23 (71.9%) of 32 women, disappeared in 6 women and improved in 6 women--a healing/improvement rate of 54.6% of 22 women who completed the study. Cycle control was good, amenorrhea occurred in 5 (1.6%) of 322 treatment cycles, while 94.8% of withdrawal bleeds were normal or scanty. Intermenstrual spotting occurred in 7.1% and break-through bleeding in 4.4% of all treatment cycles. The incidence of adverse events was similar to that of other gestagen-estrogen combinations. The results of the study demonstrate that Diane-35 provides an effective therapy for androgenized oligomenorrheic women with PCOS wishing simultaneous contraceptive protection.

Glucagon in women with polycystic ovary syndrome (PCO): relationship to abnormalities of insulin and androgens.

To investigate the glucagon status of women with polycystic ovary syndrome (PCO) and to relate this to serum concentrations of insulin, androgens and SHBG, 44 women with PCO and 23 control subjects underwent a 75-g oral glucose tolerance test. Although obese (body mass index greater than 30 kg/m2) women with PCO had higher concentrations of glucose and insulin than overweight (BMI 25-30 kg/m2) and non-obese (BMI less than 25 kg/m2) women with PCO and control subjects, fasting and summed values of glucagon in response to oral glucose were similar in all groups. The fasting and summed concentrations of glucagon were inversely related to those of testosterone and androstenedione in obese women with PCO, but no other relationships were demonstrated between hormone values and those of glucagon in the other groups. We conclude that glucagon is not implicated in peripheral insulin resistance in women with PCO.

Influence of danazol and goserelin on insulin and glucagon in non-obese women with endometriosis.

To investigate the effects of medical treatment of endometriosis on concentrations of insulin and glucagon in comparison with those of androgens, 12 non-obese women with minimal endometriosis were randomly allocated to receive treatment with either danazol or the gonadotropin-releasing hormone analogue, goserelin. In subjects treated with danazol, mean (SD) summed serum insulin (1.08 (0.22) nmol/l pretreatment; 3.00 (1.50) nmol/l after treatment, p less than 0.05) and summed plasma glucagon (94 (21) pmol/l pretreatment; 238 (113) pmol/l after treatment, p less than 0.05) responses to oral glucose administration increased significantly, but remained unchanged in subjects treated with goserelin. In the danazol-treated group, the mean free testosterone index increased from 3.3 (1.6) to 13.3 (4.2) (p less than 0.01), but there was no correlation between either glucagon or insulin and free testosterone index. In the goserelin-treated subjects, however, there was no change in mean free testosterone indices (pretreatment 3.6 (1.0), post-treatment 3.9 (1.8). Thus, the increase in free testosterone index induced by danazol treatment is not responsible for the concomitant development of hyperinsulinaemia and hyperglucagonaemia.

Lack of predictive value of HbA1 for impaired glucose tolerance in polycystic ovary syndrome.

Twenty-seven women with polycystic ovary syndrome (PCO) and 17 control women had a 75 g oral glucose tolerance test (oGTT) performed. Although glucose tolerance was impaired in the obese (body mass index greater than 25 kg/m2) women with PCO, glycosylated hemoglobin (HbA1) concentrations did not exceed the normal upper limit (7.2%). In all 44 women, there was no correlation between HbA1 and fasting glucose (r = 0.082, p = 0.63) but there was a significant correlation between HbA1 and summed glucose levels through the oGTT (r = 0.389, p = 0.02). HbA1 measurement does not predict the presence of impaired glucose tolerance in women with PCO.

A comparison of osmotic dilators, Lamicel and Dilapan, and a prostaglandin E1 analogue, gemeprost, for ripening the cervix before legal abortion.

66 primigravid women were allocated at random to receive either intravaginal application of the prostaglandin El analogue, gemeprost, or intracervical insertion of 1 of 2 osmotic dilators, Lamicel or Dilapan, 3 hours before legal abortion at 7-14 weeks gestation. Insertion of the dilators was not possible in 5 patients. All 3 methods were otherwise equally effective in achieving cervical dilatation and there was no difference in the need for or resistance to further dilatation between the 3 groups. Gemeprost was the most easily administered, and would be the most appropriate for routine preoperative use.

A fatal maternal outcome after delayed delivery in a midtrimester abdominal pregnancy.

Abdominal pregnancy has been reported to have a maternal mortality rate of 0% to 18%. Presence of the condition is difficult to diagnose, but such features as failure to induce labor after an apparent intrauterine fetal death should make one suspect it. Ultrasound examination may be misleading.