Proteinuria as a predictor of complications of pre-eclampsia

Proteinuria is a defining criterion for the diagnosis of pre-eclampsia. The amount of protein lost per day has been thought by some to predict both maternal and fetal outcome. The systematic review of 16 primary papers including over 6700 patients by Thangaratinam and colleagues published this month in BMC Medicine suggests otherwise. This finding may influence our management of pre-eclampsia.     

Recurrent spontaneous abortion--aetiological factors and subsequent reproductive performance in 76 couples

A diagnostic screening programme identified a possible aetiological factor in 32 of 76 couples (42%) evaluated for recurrent spontaneous abortion (three or more consecutive abortions). The abnormalities most commonly observed were endocervical infections (18%), cervical incompetence (11%) and uterine abnormality (9%). Hypothyroidism was present in 3 women and chromosomal abnormality in 2. None were positive for lupus anticoagulant. Treatment of uterine abnormality and cervical incompetence was associated with 75% and 86% success rates, respectively, whereas treatment of infective causes resulted in a 44% successful pregnancy rate, much the same as the 42% rate that occurred in women who had not been thus treated.     

Perineal management during childbirth and subsequent dyspareunia

Sexual function following childbirth was studied by means of a retrospective postal questionnaire. Dyspareunia measured on an analogue scale relative to pre-pregnancy values (mean values) was significantly greater three months after a mediolateral episiotomy (35%) than after vaginal delivery with intact perineum (9%) or Caesarean Section (16%) and similar to the value following second degree perineal laceration (29%). At 12 months the latter had returned to pre-pregnancy values, while that following episiotomy remained significantly elevated (17%).     

The influence of a vasectomy on the marital relationship and sexual satisfaction of the married man

The purpose of this study was to determine whether a vasectomy had any effect on important aspects of a marriage, such as sexual satisfaction, marital satisfaction, communication, and frequency of sexual intercourse. An experimental research design was used. We collected data by means of a biographical questionnaire, the Enriching & Nurturing Relationship Issues, Communications & Happiness questionnaire (Olson et al., 1985), and the Index of Sexual Satisfaction (Fischer & Corcoran, 1990), which were applied prior to and 5 months after the vasectomy. Results indicated no significant difference between the before and after measurements regarding sexual satisfaction, marital satisfaction, communication, and frequency of sexual intercourse.     

Titrated oral misoprostol solution for induction of labour: a multi-centre, randomised trial

Objectives To determine the effects of titrated oral misoprostol solution, compared with vaginal dinoprostone.
Study design Open, randomised clinical trial.
Setting Academic hospitals in South Africa and Liverpool, UK.
Methods Women undergoing induction of labour after 34 weeks of pregnancy were allocated by randomised, sealed opaque envelopes, to induction of labour with titrated oral misoprostol solution, or two doses of vaginal dinoprostone (2mg) administered six hours apart. Failure to deliver within 24 hours of randomisation was the primary outcome on which the sample size was based. The data were analysed by intention-to-treat.
Results Six hundred and ninety-five women were randomly allocated: 346 to oral misoprostol and 349 to vaginal dinoprostone. There were no significant differences in substantive outcomes. Vaginal delivery within 24 hours was not achieved in 38% of women in the oral misoprostol group and 36% in the vaginal dinoprostone group (RR 1.08; 95% CI 0.89-1.31). The caesarean section rates were 16% and 20%, respectively (RR 0.80; 95% CI 0.58-1.11). Hyperstimulation with fetal heart rate changes occurred in 4% of women in the oral misoprostol group and 3% after vaginal dinoprostone (RR 1.32, 95% CI 0.59–2.98). The response to induction of labour in women with unfavourable cervices was somewhat slower with misoprostol when membranes were intact, and with dinoprostone when membranes were ruptured. There were no differences in neonatal outcome between the two groups.
Conclusions This new approach to oral misoprostol administration was successful in minimising the risk of uterine hyperstimulation, which has been a feature of misoprostol use for induction of labour, at the expense of a somewhat slower response in women with intact membranes and unfavourable cervices. Misoprostol is not registered for use in pregnant women, and further research is needed to confirm optimal and safe dosages.