British Journal of Obstetrics and Gynaecology (Br J Obstet Gynaecol)

Publications in this journal

• Article: Reduction of the use of antimicrobial drugs following the rapid detection of Streptococcus agalactiae in the vagina at delivery by real-time 1 PCR assay

  E Poncelet-Jasserand, F Forges, M–N Varlet, C Chauleur, P Seffert, C Siani, B Pozzetto, A Ros
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  ABSTRACT: Objective : To assess whether the determination of the presence of group B streptococci (GBS) in the vagina using a rapid polymerase chain reaction (PCR) assay at delivery was able to spare useless antimicrobial treatments, as compared with conventional culture at 34–38 weeks of gestation. Design : Practical evaluation and prospective cost-effectiveness analysis. Setting : A university hospital in France. Population A cohort of 225 women in labour at the University- Hospital of Saint-Etienne. Methods : Each woman had a conventional culture performed at 34–38 weeks of gestation. At the beginning of labour, two vaginal swabs were sampled for rapid PCR testing and culture. The decision to prescribe a prophylactic antimicrobial treatment or not was taken according to the result of the PCR test. A comparative cost-effectiveness analysis of the two diagnostic strategies was carried out. Main outcome measures : Number of women receiving inadequate prophylactic antimicrobial drugs following each testing strategy, costs of PCR testing and culture, frequency of vaginal GBS, and diagnostic performance of the PCR test at delivery. Results : The percentage of unnecessarily treated women was significantly reduced using the rapid test versus conventional culture (4.5 and 13.6%, respectively; P < 0.001). The rate of vaginal GBS at delivery was 12.5%. The incremental cost- effectiveness ratio (ICER) for each inadequate management avoided was €36 and €173 from the point of view of the healthcare system and hospital, respectively. 5 Conclusions : The PCR assay reduced the number of inadequate antimicrobial treatments aimed to prevent the early onset of GBS disease. However, this strategy generates extra costs that must be put into balance with its clinical benefits.
  British Journal of Obstetrics and Gynaecology 01/2013;
• Article: Glucose challenge test for detecting gestational diabetes mellitus: a systematic review.

  Ardilouze JL, Mahdavian M, Baillargeon JP, Hivert MF
  British Journal of Obstetrics and Gynaecology 09/2012; 119(10):1283.
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  British Journal of Obstetrics and Gynaecology 01/2011;
• Article: Biering K, Aagaard Nohr E, Olsen J, Nybo Andersen AM, Juhl M. Smoking and pregnancy-related pelvic pain. BJOG 2010 Jul;117(8):1019-1026.

  Biering K, Aagaard Nohr E, Olsen J, Nybo Andersen AM, Juhl M
  British Journal of Obstetrics and Gynaecology 07/2010; 117(8):1019-1026.
• Article: Multicentre randomised controlled trials in obstetrics and gynaecology: an analysis of trends over three decades. BJOG. 2009 Jul; 116(8): 1130-4.

  Raza A, Chein P, Khan KS
  British Journal of Obstetrics and Gynaecology 01/2009; 116(8-116):1130-4.
• Article: Danielsson, M. Eisemann, I. Sjöberg & M. Wikman. Vulvar Vestibulitis: a multi-factorial condition. British J Obstetrics & Gynaecology. 108: 456-461:2001

  Danielsson, M. Eisemann, I. Sjöberg, M. Wikman
  British Journal of Obstetrics and Gynaecology 01/2001;
• Article: A national survey of the complications of endometrial destruction for menstrual disorders: the MISTLETOE study. AZTEC study group.

  J Donnez
  British Journal of Obstetrics and Gynaecology 12/1999; 106(12):1329.
• Article: Photodynamic therapy and its applications in gynaecology.

  M J Gannon, S B Brown
  British Journal of Obstetrics and Gynaecology 12/1999; 106(12):1246-54.
• Article: Place of birth and shoulder dystocia.

  M Stewart
  British Journal of Obstetrics and Gynaecology 12/1999; 106(12):1332.
• Article: Second trimester prenatal screening for Down's syndrome using alpha-fetoprotein and free beta hCG: a seven year review.

  K Spencer
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  ABSTRACT: To determine the value and impact over a seven year period of a second trimester screening programme for trisomy 21 and trisomy 18, using the two maternal serum markers alpha-fetoprotein and free beta human chorionic gonadotrophin. Retrospective review. A biochemical screening laboratory serving three health districts with three antenatal clinics in both teaching and nonteaching hospitals. 67,904 pregnancies in women of all ages screened between 14 and 22 weeks of gestation between 1 April 1991 and 31 March 1998. All women booked into three major antenatal clinics were offered biochemical screening. Women at increased risk of trisomy 21 or trisomy 18 (> or =1 in 250 at term) were offered an invasive diagnostic procedure. Follow up of the outcome of all pregnancies was performed. Detection rate for trisomy 21 and trisomy 18, false positive rates, uptake of screening, uptake of amniocentesis in women identified at increased risk, prevalence of trisomy 21 at birth, detection and false positive rates by maternal age, fetal loss rate after amniocentesis, report turn around time, and identification of other anomalies. Overall, 87% (67,904/78,501) of women underwent screening. The rate of detection of trisomy 21 was 75% (80/107; 95% CI 66 to 83) with a 5.1% false positive rate (3466/67,904; CI 4.9 to 5.3%). In women under 30 years of age the detection rate was 60% (18/30; CI 41 to 77) with a 2.6% false positive rate (956/36,371; CI 2.5 to 2.8). The rate of detection of trisomy 18 was 57% (8/14; CI 29 to 82) with a 0.7% false positive rate (475/67,904; CI 0.64 to 0.76). Uptake of amniocentesis was 83% (2912/3508). Women were 3.3 times more likely to refuse amniocentesis if the risk was close to the cutoff (1 in 250) than if the risk was > or =1 in 50. Fetal loss within 28 days of amniocentesis was 0.9% (25/2912). Prenatal screening identified 84 other anomalies in addition to 41 cases of impending fetal death. Second trimester prenatal screening for trisomy 21 and trisomy 18 using a simple two marker approach incorporating free beta hCG can achieve high detection rates over a long period of time. Health authorities who still have not introduced trisomy 21 screening should be encouraged by what can be achieved and should consider making such screening available to all women. Established second trimester detection rates of 75% for a 5% false positive rate will be the benchmark by which first trimester screening using nuchal translucency, PAPP-A and free beta hCG will be judged.
  British Journal of Obstetrics and Gynaecology 12/1999; 106(12):1287-93.
• Article: Mothers and babies, pregnant women and fetuses.

  L de Crespigny, F Chervenak, L McCullough
  British Journal of Obstetrics and Gynaecology 12/1999; 106(12):1235-7.
• Article: A prospective study of maternal serum insulin-like growth factor-I in pregnancies with appropriately grown or growth restricted fetuses.

  S Paul
  British Journal of Obstetrics and Gynaecology 12/1999; 106(11):1232-3.
• Article: Bowel dysfunction following hysterectomy.

  S Radley, M R Keighley, S C Radley, C H Mann
  British Journal of Obstetrics and Gynaecology 12/1999; 106(11):1120-5.
• Article: 5,10 methylenetetrahydrofolate reductase polymorphism in black South African women with pre-eclampsia.

  A B Chikosi, J Moodley, R J Pegoraro, P A Lanning, L Rom
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  ABSTRACT: The polymorphic C677T mutation in the gene encoding 5,10 methylenetetrahydrofolate reductase has been shown to be a risk factor for pre-eclampsia in Japanese and European women when inherited as a homozygous trait. We attempted to verify these findings in a black African population with a high incidence of pre-eclampsia. No difference in frequency of the T-allele was observed in 105 women with pre-eclampsia, compared with 110 healthy pregnant normotensive women. Only one woman with pre-eclampsia was TT homozygous, suggesting that methylenetetrahydrofolate reductase polymorphism is not an important factor in the pathogenesis of pre-eclampsia in black South African women.
  British Journal of Obstetrics and Gynaecology 12/1999; 106(11):1219-20.
• Article: Congenital diaphragmatic hernia: prenatal diagnosis, outcome and continuing morbidity in survivors.

  C L Huddy, P A Boyd, A R Wilkinson, P Chamberlain
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  ABSTRACT: To improve counselling by investigating the prenatal diagnosis, outcome and morbidity in survivors of congenital diaphragmatic hernia. Prenatal Diagnosis Unit, Oxford Radcliffe Women's Centre, Oxford. Cohort study. Babies with congenital diaphragmatic hernia diagnosed postnatally and born to women scanned prenatally identified between January 1991 and December 1996. Associated anomalies, outcome of pregnancy and final diagnoses were determined from hospital records. A report from the general practitioner and paediatrician recorded health and development information. Accuracy of prenatal diagnosis, survival of cases of congenital diaphragmatic hernia and presence of ongoing morbidity in survivors. There were 35 pregnancies with congenital diaphragmatic hernia, nine of which were not diagnosed prenatally. In 22 pregnancies with isolated congenital diaphragmatic hernia, four were terminated, there were six perinatal deaths and two later deaths. Thirteen of 35 cases (37%) with congenital diaphragmatic hernia were associated with other abnormalities: four with abnormal karyotype and nine with other structural anomalies. Five of these women continued with their pregnancy; there were two neonatal deaths and three survivors. Thirteen of 35 infants (37%) survived, eight with chronic disorders requiring specialist intervention including respiratory problems (n = 6); developmental delay (n = 4); poor growth (n = 5); artificial feeding (n = 3); gastro-oesophageal reflux (n = 3); recurrent hospital admissions (n = 6); and further surgery (n = 4). The survival for infants born alive with congenital diaphragmatic hernia was 56% (13/23), 61% of whom have persistent disorders. Despite advances in neonatology there is a high mortality and morbidity with congenital diaphragmatic hernia. Prenatal counselling should reflect this.
  British Journal of Obstetrics and Gynaecology 12/1999; 106(11):1192-6.
• Article: What is natural? Deciding what to do and not to do in medicine and health care.

  S Wackerhausen
  British Journal of Obstetrics and Gynaecology 12/1999; 106(11):1109-12.
• Article: Is an ultrasound assessment of gestational age at the first antenatal visit of value? A randomised clinical trial.

  C A Crowther, L Kornman, S O'Callaghan, K George, M Furness, K Willson
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  ABSTRACT: To assess the efficacy of an ultrasound scan at the first antenatal visit. Randomised clinical trial. Women's and Children's tertiary level hospital, Adelaide, Australia. Six hundred and forty-eight women attending for their first antenatal visit at less than 17 weeks of gestation who had no previous ultrasound scan in the pregnancy, who were expected to give birth at the hospital, and for whom there was no indication for an ultrasound at their first visit. Eligible consenting women were enrolled by telephone randomisation into either the ultrasound at first visit group, who had an ultrasound at the time of their first antenatal visit, or the control group in whom no ultrasound assessment was done at their first antenatal visit. Both groups of women completed a questionnaire at the end of the first visit on their feelings towards the pregnancy and anxiety levels. Data were collected on details of any ultrasound assessments, including the 18 to 20 weeks morphology scan, and pregnancy outcome. All primary analyses were on an intention-to-treat basis. The number of women who needed adjustment in dates of 10 days or more on the basis of their 18 to 20 weeks ultrasound morphology scan, who were booked for their morphology scan at sub-optimal gestations, who had a repeat of their maternal serum screening test, or who felt worried about their pregnancy at the end of the first antenatal visit. Fewer women (9%) in the ultrasound at first visit group needed adjustment of their expected date of delivery as a result of the 18 to 20 week ultrasound, compared with 18% of women in the control group (RR 0.52, 95% CI 0.34-0.79; P = 0.002). The number of women who had the 18 to 20 week ultrasound assessment timed suboptimally was similar to that in the control group (16% vs. 21%), as was the number of women who had a repeat blood sample taken for maternal serum screening (6% vs. 6%). Fewer women in the ultrasound at first visit group reported feeling worried about their pregnancy (RR 0.80, 95% CI 0.65-0.99; P = 0.04) or not feeling relaxed about their pregnancy (RR 0.73, 95% CI 0.56-0.96; P = 0.02), compared with women in the control group. A routine ultrasound assessment for dating offered to women at the first antenatal visit provides more precise estimates of gestational age and reduces the need to adjust the estimate of the date of delivery in mid-gestation. Women who had an ultrasound at the first visit reported more positive feelings about their pregnancy, compared with women in the control group at that time.
  British Journal of Obstetrics and Gynaecology 12/1999; 106(12):1273-9.
• Article: The role of observer error in antenatal dipstick proteinuria analysis.

  S C Bell, A W Halligan, A Martin, J Ashmore, A H Shennan, P C Lambert, D J Taylor
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  ABSTRACT: To determine the role of inter-observer error and the influence of training upon dipstick urine analysis. A two phase observational and training study. Five standard solutions of serum albumin were used to test the accuracy of midwives and nursing auxiliaries involved in dipstick urine analysis at a maternity hospital. The standard solutions were chosen such that they should have resulted in negative (n = 2) and positive (n = 3) dipstick test results, respectively. A teaching maternity hospital and academic department of obstetrics and gynaecology. Twenty midwives, 20 nursing auxiliaries and nine laboratory technicians. For the two nonproteinuric solutions, a higher false positive rate was observed for nursing auxiliaries (40% and 55%), compared with midwives (5% and 30%) (P = 0.020 and P = 0.20, respectively). Before training, laboratory technicians recorded high false positive rates (67% and 89%), but after training these were reduced to 0% and 22% (P = 0.25 and P = 0.023, respectively). Both nursing auxiliaries and midwives recorded false negative rates of between 10% and 45% for the three proteinuric solutions. Observer error may be reduced by assigning midwives to urine dipstick analysis or by the implementation of directed training. Classification of pre-eclampsia or other hypertensive diseases of pregnancy on the basis of the presence and degree of proteinuria should be confirmed with a 24-hour quantitative protein collection.
  British Journal of Obstetrics and Gynaecology 12/1999; 106(11):1177-80.