Notes: Objective To determine if pulse oximetry could detect any changes in fetal arteriolar oxygen saturation resulting from maternal administration of oxygen.Design A prospective study comparing study comparing the fetal pulse oximetry reading before and after giving 27% and 100% oxygen to the mother. The data were collected using an experimental pulse oximeter and a sensor specifically adapted to cope with the problems of fetal pulse oximetry.Setting Labour ward, St. James's University Hospital, Leeds University, UK.Subjects Twelve fetuses presenting by the vertex in normal uncomplicated labour.Main outcome measures The change in fetal arteriolar oxygen saturation recorded by the pulse oximeter in response to oxygen administration to the mother.Results Twenty-seven percent oxygen increased the average fetal arteriolar oxygen saturation by 7.5%, the effect being reversed when the oxygen was withdrawn. One hundred percent oxygen increased fetal arteriolar oxygen saturation by 11% and when the oxygen was withdrawn oxygen saturation dropped by 10%. One hundred percent inspired maternal oxygen was more effective than 27%. The gradient of the fetal oxygen regression slope is steeper with 100% oxygen than 27% and it is steeper when oxygen is given compared to when it is withdrawn. This suggests that the fetus responds to the new placental oxygen gradient by accepting oxygen more rapidly than it gives it up. Using a quadratic regression model, it took 9 min for fetal oxygen saturation to reach its maximum value after giving the mother oxygen.Conclusion This study confirms that a pulse oximeter is able to measure an increase in fetal arteriolar oxygen saturation when oxygen is administered to the mother.

Notes: Objective To compare the impact on use of resources in the management of small for gestational age babies using Doppler ultrasound versus cardiotocography.Design A randomised controlled trial.Setting A large district general hospital delivering 5500 to 6000 infants each year, 30% to 35% of which are to women of Pakistani origin.Population One hundred and fifty women delivered of small for gestational age infants.Main outcome measures Primary outcome measures were length of hospital inpatient stay and induction of labour rates. Secondary outcome measures included caesarean section rates and length of stay on neonatal unit.Results The use of Doppler reduced average hospital inpatient stay from 2.5 days to 1.1 days, compared with cardiotocography (P= 0.036). There was no effect on induction of labour rates or caesarean section rates. There was no significant difference in length of stay on the neonatal unit (P= 0.33). There was a reduction in monitoring frequency and fewer hospital antenatal clinic visits.Conclusion The use of Doppler ultrasound to manage small for gestational age infants reduces the use of resources, compared with cardiotocography.

Notes: Summary. X-ray pelvimetry was performed on 43 women in the squatting and erect positions within 1 week of delivery. The act of squatting increased the transverse and antero-posterior pelvic dimensions by 1 %. The theoretical mechanisms by which posture may affect dimensions are discussed.

Notes: Summary. Women with abnormal cervical cytology and an unsatisfactory colposcopic examination were offered Lamicel in an attempt to expose the entire transformation zone. The sponge, which softens, dilates and effaces the cervix, was passed intracervically in 41 patients in whom the entire squamocolumnar junction could not be seen. After 3–4 h the sponge was removed and colposcopy repeated. In 29 of the 41 patients the lesion and the squamocolumnar junction were now fully visible. Twenty-five of these patients were spared a cone biopsy.

Notes: In a prospective double-blind randomized placebo-controlled clinical trial the efficacy of paracervical lignocaine was compared with saline in reducing pain in 70 women undergoing laser ablation of the cervical transformation zone. Paracervical lignocaine had no significant measurable effect on reducing the pain experience during the laser procedure. The mean subjective visual linear analogue pain score in the lignocaine and saline groups was 27% (95% CI 17 to 38) and 30% (95% CI 24 to 41) respectively (t= 1·0; P = 0·35). The median (quartiles) objective pain scores for the same groups were 0 (0-2) and 0 (0-1) respectively (P= 0·58).

Notes: Objective To determine whether routine testing for serum Chlamydia trachomatis antibodies, considered in combination with a woman's clinical features, may avoid the need for diagnostic laparoscopy in routine investigation for infertility.Design Retrospective case notes analysis.Setting Secondary level care infertility clinic.Population Eighty women who had undergone both laparoscopy and serum Chlamydia trachomatis antibody testing.Methods Ascertainment of any history of suspected pelvic inflammatory disease, pelvic pain, cervical intraepithelial neoplasia, pelvic surgery or appendicectomy; any abnormality on clinical pelvic examination; the findings at laparoscopy; the result of serum Chlamydia trachomatis antibody testing by enzyme-linked immunosorbent assay (ELISA) screening with microimmunofluorescence (MIF) confirmatory diagnostic testing. The usefulness of clinical features, the serum Chlamydia trachomatis antibody test and these two variables combined in the detection of tubal disease and pelvic pathology of relevance to infertility were measured statistically.Main outcome measures Specificity, sensitivity, positive predictive value, negative predictive value and likelihood ratio for each of the tests.Results The combination of any positive clinical feature with a positive test for serum Chlamydia trachomatis antibodies detects tubal disease with sensitivity 92%, specificity 70%, positive predictive value 72%, negative predictive value 91% and likelihood ratio 3.1; it detects bilateral tubal obstruction with sensitivity 84%, specificity 51%, positive predictive value 35%, negative predictive value 91% and likelihood ratio 1.7; it detects pelvic pathology relevant to infertility with sensitivity 76%, specificity 71%, positive predictive value 80%, negative predictive value 65% and likelihood ratio 2.6. The negative predictive value for pelvic pathology from the use of clinical features in addition to the chlamydia antibody test is not significantly higher than that from the chlamydia antibody test alone (53%).Conclusions A policy of selective laparoscopy in routine investigation for infertility, based on the result of the test for serum Chlamydia trachomatis antibodies and a woman's clinical features, is not supported.