Notes: Objective–To compare routine versus highly selective use of Doppler ultrasound and biophysical scoring in higher risk pregnancy. Design–A pragmatic randomized trial. Setting–St James's University Hospital, Leeds. Subjects–500 pregnant women at high risk of intrauterine growth retardation or still birth. Interventions–Regular monitoring with biophysical profile assessment and Doppler velocity waveform recording in umbilical and uteroplacental arteries. Results immediately available to clinicians. Main outcome measures–Gestational age al delivery, obstetric intervention rates and short-term neonatal morbidity. Results–Risk factors were distributed very evenly between the 250 patients in the study and control groups respectively. A total of 902 biophysical profile and Doppler assessments were done in the 250 study group patients and only in 12 patients in the control group. In the study group, absent end-diastolic flow was found in only 2.7% of all 902 measurements. A persistently abnormal biophysical score was always associated with absence of end-diastolic flow. The mean gestational age at induction of labour was statistically and clinically similar in the two groups and there was no overall statistically significant difference in intervention rates between the two groups. There was a statistically significant lower frequency of depressed 5-min Apgar scores in the study group. Serious neonatal morbidity was also statistically significantly more common in the control group than in the study group. Conclusions–The use of Doppler ultrasound in higher risk pregnancies does not lead to an increase in iatrogenic preterm delivery. The total rate of positive tests on Doppler ultrasound is very low and persistently abnormal biophysical scores are unlikely to be found in patients where umbilical end-diastolic blood flow is present. Surrogate measures for fetal damage seem to be improved when clinicians have access to Doppler ultrasound assessments.

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. The results of surgery for tubal damage, other than reversal of sterilization, were studied in two large hospitals. This is the first recent study from centres claiming no special expertise in this surgery. An unusually high follow-up rate was obtained. The term pregnancy rate for patients operated on for bilateral distal tubal occlusion was 4%. The success rate is lower than the lowest reported, overall success rates for each cycle of in vitro fertilization (IVF) and very much lower than cumulative term pregnancy rates for tubal surgery reported by most other authors. Patients with distal tubal occlusion but minimal adhesions had the best prognosis. Our results suggest that, provided in vitro fertilization is available, only those patients with good prognostic factors should undergo tubal surgery. These represent the minority of all patients with non-iatrogenic tubal blockage.

Notes: A substantive amendment to this systematic review was last made on 23 March 1999. Cochrane reviews are regularly checked and updated if necessary.〈section xml:id="abs1-1"〉〈title type="main"〉ABSTRACT Background: For centuries, there has been controversy around whether being upright (sitting, birthing stools, chairs, squatting) or lying down has advantages for women delivering their babies. Objectives: The objective of this review was to assess the benefits and risks of the use of different positions during the second stage of labour (i.e., from full dilatation of the cervix). Search strategy: Relevant trials are identified from the register of trials maintained by the Cochrane Pregnancy and Childbirth Group, and from the Cochrane Controlled Trials Register. Selection criteria: Trials were included which compared various positions assumed by pregnant women during the second stage of labour. Randomised and quasi-randomised trials with appropriate follow-up were included. Data collection and analysis: Trials were independently assessed for inclusion, and data extracted by the two authors. Disagreements would have been resolved by consensus with an editor. Meta-analysis of data is performed using the RevMan software. Main results: Results should be interpreted with caution as the methodological quality of the 18 trials was variable. Use of any upright or lateral position, compared with supine or lithotomy positions, was associated with:〈list style="custom"〉1Reduced duration of second stage of labour (12 trials—mean 5.4 minutes, 95% confidence interval (CI) 3.9–6.9 minutes). This was largely due to a considerable reduction in women allocated to use of the birth cushion.2A small reduction in assisted deliveries (17 trials—odds ratio (OR) 0.82, 95% CI 0.69–0.98).3A reduction in episiotomies (11 trials—OR 0.73, 95% CI 0.64–0.84).4A smaller increase in second degree perineal tears (10 trials—OR 1.30, 95% CI 1.09–1.54).5Increased estimated risk of blood loss 〉 500ml (10 trials—OR 1.76, 95% CI 1.34–3.32).6Reduced reporting of severe pain during second stage of labour (1 trial—OR 0.59, 95% CI 0.41–0.83).7Fewer abnormal fetal heart rate patterns (1 trial—OR 0.31, 95% CI 0.11–0.91). Reviewers' conclusions: The tentative findings of this review suggest several possible benefits for upright posture, with the possibility of increased risk of blood loss 〉 500 mL.Women should be encouraged to give birth in the position they find most comfortable. Until such time the benefits and risks of various delivery positions are estimated with greater certainty when methodologically stringent trials data are available, then women should be allowed to make informed choices about the birth positions in which they might wish to assume for delivery of their babies. Citation: Gupta JK, Nikodem VC. Women's position during second stage of labour (Cochrane Review). In: The Cochrane Library, Issue 4, 2000. Oxford: Update Software.

Notes: Zusammenfassung Die vorliegende Arbeit behandelt das polarographische Verhalten von Mn(II) in wäßriger und alkoholisch-wäßriger Lösung in Gegenwart verschiedener Leitsalze. Die Reduktion erweist sich als quasireversibel. Die Werte für α,E 1 2/r undk s wurden nach der Methode vonMatsuda und Ayabe 4 berechnet.

Notes: Abstract In the presence of glycolic, pyruvic, butyric or laevulinic acid In3+ at the dropping-mercury electrode behaves in a manner typical of „quasi-reversible” electrode processes.

Notes: Summary Sterility in males and females was observed in the resulting adults when 3–4-day-old pupae of solanaceous hadda,Epilachna vigintioctopunctata F. were exposed to gamma radiation doses of 2000 rad and 2500 rad. However, at 2500 rad longevity of treated insects was adversely affected.

Notes: Abstract Background: The abdominal route is the traditional method of performing hysterectomy with bilateral salpingo-oophorectomy. In a feasibility study, we compared a nonconventional (vaginal) route for bilateral salpingo-oophorectomy at the time of vaginal hysterectomy (VH + BSO) to similar forms of hysterectomy performed abdominally or with operative laparoscopy. Methods: Fifty-nine patients were subject to either total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO; n= 19), or laparoscopic-assisted vaginal hysterectomy and bilateral salpingo-oophorectomy (LAVH + BSO; n= 19) or VH + BSO (n= 21). Results: VH + BSO resulted in a shorter operating time compared to LAVH + BSO (p 〈 0.001), shorter hospital stay compared with TAH + BSO (p= 0.001), and quicker long-term recovery compared to the other two operations. Conclusion: This preliminary but significant study shows that the vaginal route for salpingo-oophorectomy at the time of vaginal hysterectomy is superior to other methods of hysterectomy. A randomized trial is needed to confirm these initial findings.