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Objectives: To describe duration of symptoms and patterns of diagnosis and referral in women with chronic pelvic pain., Design: Retrospective cohort analysis of the MediPlus UK Primary Care Database., Setting: One hundred and thirty-six general practices in the UK., Study Group: A cohort of 5051 incident cases of chronic pelvic pain., Methods: The cohort was followed up from the start of their symptoms in 1992 until the end of the chronic pelvic pain episode or the end of 1995., Main Outcome Measures: Duration of symptoms, frequency of diagnoses and referral rates., Results: A third of women had symptoms persisting for more than two years. Duration of symptoms increased significantly with age (P < 0.001) from a median of 13.7 months in 13-20 year olds to 20.2 months in women over the age of 60. Irritable bowel syndrome and cystitis were the most common diagnoses at all ages. Twenty-eight percent of women never received a diagnosis during three to four years of follow up after first consultation, and 60% of women had no evidence of a specialist referral. Women aged 21-50 and women whose final diagnosis was endometriosis received the largest number of diagnoses and had the highest referral rates., Conclusions: The numbers and types of diagnosis given to a woman with chronic pelvic pain and the likelihood of specialist referral depend on her age, as well as on the duration of symptoms. Women seen in secondary care for chronic pelvic pain are a highly selected group and are likely to represent only the tip of the iceberg.

Objectives: To estimate the prevalence and incidence in primary care of chronic pelvic pain in women in the UK., Design: Cross-sectional analysis of MediPlus UK Primary Care Database., Setting: One hundred and thirty-six general practices in the UK., Population: From 284,162 women aged 12-70 who were registered on the database and who had a general practice contact in 1991, 24,053 chronic pelvic pain cases were identified between 1991 and 1995., Methods: Chronic pelvic pain was defined as pelvic pain lasting for at least six months, and cases were identified on the basis of contacts with general practice. Pain due to malignancy, chronic inflammatory bowel diseases or pregnancy, or which occurred only during menstruation or sexual intercourse, was excluded., Main Outcome Measures: Prevalence and incidence rates of chronic pelvic pain in primary care by age and region., Results: Monthly prevalence and incidence rates of chronic pelvic pain were 21.5/1000 and 1.58/1000, respectively, with an annual prevalence of 38.3/1000. Monthly prevalence rates increased significantly with age (P < 0.001) from 18.2/1000 in 15-20 year olds to 27.6/1000 in women older than 60, as symptoms persisted longer in older women. Prevalence and incidence rates varied significantly between regions (P < 0.001), with the lowest monthly prevalence in Scotland (16.0/1000) and the highest in Wales (29.4/1000)., Conclusions: Chronic pelvic pain is a common condition in the UK, with a prevalence in primary care comparable to migraine, back pain, and asthma. Its prevalence in the general population is likely to be considerably higher.

Objective: To examine the prevalence of folic acid supplementation prior to conception and in the first trimester of pregnancy, and to identify sociodemographic variables associated with the use of supplements., Design: Observational study., Setting: District general hospital in the south in England., Population: Nine hundred and sixty-three randomly selected pregnant nulliparous caucasian women recruited from May 1994 to February 1996 inclusive., Methods: Questionnaire administered at approximately 16 weeks gestation., Main Outcome Measures: Intakes of supplemental folic acid before conception and during pregnancy., Results: 31.5% (303/963) (95% CI 28.5-34.4) of pregnant women reported using supplements containing folic acid prior to conception. The proportion using pre-conceptional folic acid increased by approximately 1% per month during the 22 months of the study. 38.1% (367/962) (35 1 to 41.2) of women began taking folic acid only after the confirmation of pregnancy, and this proportion appeared constant over time. Young age, smoking and low educational attainment were statistically significant predictors of failure to use folic acid both before and during pregnancy., Conclusions: Use of folic acid before conception in nulliparous women is much higher than the 2% to 3% reported in earlier studies of all pregnant women, and appears to be increasing. However, many women still only begin taking folic acid after conception, despite current health education strategies. New approaches, focusing on women who are currently least likely to take folic acid those who are young, are of low educational backgrounds, and are smokers - may now be required. Given the inevitably of unplanned pregnancies, efforts must also be made to increase the currently static uptake of folic acid immediately after the confirmation of pregnancy.

The outcome at age 2 years of preterm babies recruited into a three-arm randomised controlled trial of prophylactic volume expansion was ascertained in two ways: from a neurodevelopmental assessment performed by a paediatrician and from responses on a brief questionnaire completed by the child's personal health visitor. Of 776 babies recruited into the trial, 604 survived to the age of 2 years and the findings of a paediatric assessment were available for all survivors. Questionnaires were sent to the health visitors of 601 of the survivors; 513 (85.4%) were returned. There was sufficient information on the returned questionnaires to categorise 449 of the children as normal, impaired, moderately disabled or severely disabled. We were unable to detect a response bias by severity of disability. Agreement on individual questions ranged between 86.3% and 98.4%. There was some mismatch in the reporting of vision (weighted kappa = 0.71) and hearing (weighted kappa = 0.73), with differences in perception of level of severity of sensory loss. Health visitors tended to underestimate the child's functional level compared with the paediatrician. However, of 56 children classified as severely disabled by the paediatrician, 48 were classified similarly and eight as moderately disabled on the basis of the questionnaire. The end point of the trial was death or severe disability at 2 years of age. There was close similarity in the trial results whether based on the paediatric assessment or on the questionnaire. Further refinement of the questionnaire is needed, but this methodology may be useful in ascertaining the frequency of severe disability in large cohorts of babies.

Objective: To obtain a prevalence estimate for chronic pelvic pain in women in the United Kingdom by analysing published data., Design: Systematic review of published papers., Setting: The general population or hospitals in the United Kingdom., Population: Women participating in relevant community surveys or control women participating in hospital-based studies., Methods: Papers were retrieved by systematically searching the databases MEDLINE, EMBASE and PsycLit, and by hand searching. Studies were included if they 1. were community-based and reported prevalence rates of chronic pelvic pain, dyspareunia, dysmenorrhoea, or abdominal pain, or 2. referred to a clinical population but reported prevalence rates in a disease-free control group., Main Outcome Measures: Prevalence rates for chronic pelvic pain including any overlap with dyspareunia, dysmenorrhoea and abdominal pain., Results: No community-based study has been performed that provides an estimate of the prevalence of chronic pelvic pain in the general UK population. A rate of 39% was reported in women undergoing laparoscopy for sterilisation or investigation of infertility in the single study from the United Kingdom investigating chronic pelvic pain unrelated to menstruation or intercourse. Prevalence rates for dyspareunia, dysmenorrhoea, and abdominal pain found in UK community-based studies were 8%, 45% to 97%, and 23% to 29%, respectively, but definitions used varied greatly., Conclusions: Because chronic pelvic pain can reduce the quality of life and general wellbeing, there is a need for a community-based study into the prevalence of chronic pelvic pain and its effect upon the lives of women in the UK.

In a geographically-based study, we investigated the risk of cerebral palsy following intrapartum asphyxia at term, and the contribution of intrapartum asphyxia at term to the overall rate of cerebral palsy. We used stringent criteria for identifying intrapartum asphyxia, while recognising that the initial hypoxial insult might have occurred in the antenatal period. In the first part of the investigation, a cohort of 160 term, singleton infants, with a low (< or = 3) 1-minute Apgar score, was followed to the age of 5 years. Six infants in the cohort had presumed intrapartum asphyxia, of whom two died in the neonatal period, three had spastic quadriparesis, profound developmental delay and visual impairment, and one was unimpaired. The frequency of cerebral palsy associated with birth asphyxia was estimated as one in 3700 full-term livebirths. To assess the impact of birth asphyxia on the overall rate of cerebral palsy, all cases of cerebral palsy born in the study period were identified. Of the 30 cases, the three identified in the follow-up study were the only ones whose impairment could be attributed to birth asphyxia in a full-term birth. Birth asphyxia at term therefore was associated with 10% [95% confidence interval (CI) 2.1, 26.5] of all cases of cerebral palsy and with 20% (95% CI 4.3, 48.1) of the 15 cases of cerebral palsy in children born at term.

Objectives: In a cohort of term infants with cerebral depression at delivery, to investigate the association of perinatal signs of birth asphyxia, particularly abnormal fetal heart rate patterns in labour, acidaemia, and serious neonatal encephalopathy, with neurodevelopmental outcome at age five years., Design: Five year follow up study of a birth cohort., Setting: Regional maternity hospital., Subjects: One hundred and eighty-four singleton infants with a 1 min Apgar score < or = 3, born at term between January 1984 and September 1985., Main Outcome Measures: Neonatal death, cerebral palsy, and scores on a battery of neurodevelopmental tests at age five., Results: Seven infants had a cluster of perinatal signs suggestive of birth asphyxia; all included serious neonatal encephalopathy. Three of these infants died neonatally, three had spastic quadriparesis with profound developmental delay, and one was unimpaired at the age of five. Among the remaining infants, no association was found between severely abnormal fetal heart rate patterns in labour and scores on neurodevelopmental tests, or between acid-base status at delivery and test scores., Conclusions: Birth asphyxia, identified by a cluster of abnormal perinatal signs, including serious neonatal encephalopathy, has a poor prognosis. If serious encephalopathy is not present, cerebral depression at birth preceded by abnormal fetal heart rate patterns in labour, or with acid-base derangement, is not predictive of later impairment.

The labour, delivery and state of the newborn were compared retrospectively in a group of women who had labour induced and a group who started labour spontaneously. There were 200 women at term in each group, individually matched for age, parity and social class and with no medical or obstetric complications prior to labour. The induced group showed a higher incidence of epidural anaesthesia, fetal monitoring and operative delivery. Sixty had forceps deliveries and five had Caesarean sections compared with two forceps deliveries and no Caesarean sections in the 'spontaneous onset' group. The higher incidence of operative deliveries in the induced group was not fully explained by the excess of epidurals and fetal monitoring received. More of the babies born after an induced labour had endotracheal intubation during resuscitation.

Analysis of 14 219 births in West Jerusalem showed that infants of North African origin had a higher birthweight than infants of other ethnic groups. The group of mothers of North African origin included a relatively high proportion from the lowest social classes. The observed excess birthweight was apparent after allowing for the effects of gestation, maternal body size, baby's sex, parity and smoking. Maternal age and season of birth also had a significant effect on birthweight. Birthweight was higher if the mother had immigrated to Israel after the age of 10 years than if she had immigrated at a younger age, or had been born in Israel.

Of 32735 singleton births in Oxford in the 6 years 1978-1983, 10% were by caesarean section. In contrast to the national data, no trend in this rate was observed. Repeat caesarean sections accounted for 30% of all sections and the proportion of women who had had a previous caesarean section rose gradually in the hospital population. The other main indications for section were dystocia, fetal distress in labour and breech presentation, which together accounted for a further 45% of all sections. Comparison with caesarean section rates reported from North America shows that repeat sections and sections for dystocia were less frequent in Oxford but the rates for other indications were similar. Dystocia is likely to be a key factor in determining future section rates. Dystocia occurred mainly in primiparae, and was more common with short stature and with increasing gestation and maternal age. For all height, age and gestation groups dystocia was more than twice as frequent in induced as in non-induced labour. This association does not imply a causal relationship, but neither is one excluded.

The pregnancy outcome of 196 primigravidae aged 35 years or over, with no history of involuntary infertility, was compared with that of 196 matched primigravidae aged 20-25 years, and also with 72 'elderly' primigravidae (greater than or equal to 35 years) whose pregnancies had followed a period of involuntary infertility of at least 1 year. The older primigravidae with no history of infertility had a four-fold risk of preterm (less than 37 weeks) delivery, a five-fold risk of caesarean section and significantly increased rates of vaginal operative delivery, chronic hypertension and fibroids, when compared with the primigravidae between 20 and 25 years of age. They also showed a greater tendency to severe preeclampsia and perinatal death, but these differences were not statistically significant. Elective caesarean section was twice as common in the older women with a history of infertility than in those without such a history (20.8% compared with 10.7%) although this difference was not statistically significant. No other differences in pregnancy outcome were found between the two 'elderly' groups.

Data on births in the Oxford area for 1965 and 1972 are examined, and a model presented for analysing some effects of induction of labour during this period. It is suggested that this model is generally useful in understanding the various possible explanations for an apparent improvement in perinatal mortality figures.