Medical dilatation of the non-pregnant cervix: the effect of ethinyl oestradiol on the visibility of the transformation zone

Summary. The cervical transformation zone (TZ) was not fully visible in 25 women referred to the colposcopy clinic with cytological suspicion of cervical intraepithelial neoplasia (CIN). Each was given a 5-day course of oral ethinyl oestradiol during the follicular phase of the menstrual cycle, and colposcopy was then repeated. The transformation zone was visible at this second examination in 16 of the 25 patients. Of these patients, 11 were treated with a local destructive technique, nine by laser, two by cryocautery; one patient had a cone biopsy, and four patients did not require treatment. Although cone biopsy was necessary in 8 of the remaining 9 patients it is encouraging that the use of a simple medical regimen allowed us to avoid conisation and its morbidity in almost two thirds of these patients.     

Comparing Attitudes of Male and Female University Students before and after a Semester Course on Human Sexuality

The attitudes of 3 different classes of students who attended a semester class in human sexuality at the University of New Mexico were tested prior to and at completion of the course. The course and the testing questions are described. Male and female attitudes differed, but not widely, in several course areas. Pretest attitudes were liberal and posttest attitudes were found to be somewhat more liberal. Males, slightly more conservative in their pretest answers, changed to more closely resemble the female responses in the postcourse testing. For the following areas, there was the greatest pre- and posttest unanimity: sex education, venereal disease, masturbation, sexual response discussion, sex laws, and abortion. The highest percentage of change for both male and female responses occurred on the natural childbirth question. Limitations of the study include the difficulty of isolating the influence exerted by the course separately from exterior influences, the difficulty with analyzing "undecided" answers, and the subjective nature of such responses as "strongly agree" and "disagree." Findings of this study may be useful in the formulation of college level human sexuality courses.     

Elevated mid-trimester maternal corticotrophin-releasing hormone levels in pregnancies that delivered before 34 weeks

Objective To test whether maternal corticotrophin-releasing hormone levels are elevated in the mid–trimester for those women who subsequently had spontaneous preterm delivery and to assess the clinical utility of the measurement in the prediction of preterm delivery.
Design A prospective observational study.
Setting Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong.
Population 1047 low risk pregnant women recruited at 15–20 weeks of gestation.
Methods Venous samples were assayed for levels of corticotrophin-releasing hormone. The investigators responsible for the laboratory assay were blinded to the obstetric outcome.
Main outcome measures Incidence of preterm, term and post-term pregnancies.
Results Those who were delivered spontaneously at a preterm gestational age (before 34 weeks) had significantly higher corticotrophin–releasing hormone levels in the mid–trimester, compared with those who were delivered at term or post–term. There was a trend towards lower corticotrophm–releasing hormone levels with more advanced gestational age at delivery. When the measurement of corticotrophin–releasing hormone was used to predict delivery before 34 weeks, the best cut off was 1.9 MoM, which produced a sensitivity of 72.7% and specificity of 78.4%. This translated to a positive predictive value of 3.6%, negative predlctive value of 99.6% and relative risk of 9.4 when the background prevalence of spontaneous preterm delivery before 34 weeks was 1.1%. The likelihood ratio was 3.4.
Conclusions Mid-trimester maternal corticotrophin-releasing hormone levels are elevated in pregnancies destined to deliver preterm before 34 weeks. When used alone in a low risk population, the measurement has a low predictive power for preterm delivery. However, the likelihood ratio of 3.4 implies that in high risk populations the test may be considerably more valuable.