Showing papers by "Wishaw General Hospital published in 2001"
TL;DR: Case reports suggest that the combined oral contraceptive pill or gonadotrophin-releasing hormone analogues may be effective in patients with asthma, although substantiation by randomised controlled trials is needed.
Abstract: The exacerbation of asthma in the premenstrual period has long been of interest. Premenstrual asthma has been estimated to affect up to 40% of females with asthma, although the exact prevalence of this phenomenon is unclear as studies have involved small numbers in hospital clinics. Large-scale community-based studies are required to estimate its true prevalence. Researchers are slowly piecing together clues as to the aetiology and pathogenesis of the disorder. Female sex-steroid hormones play an important role but the exact mechanism is still unknown. Recent evidence suggests that increased airway hyperresponsiveness, an indicator of underlying airway inflammation, during the luteal phase of the menstrual cycle may account for premenstrual exacerbations. In addition, there is now evidence of impaired or altered beta2-adrenoceptor function and regulation in females with asthma, which may have a part to play. Accurate diagnosis is dependent on a detailed history and the demonstration of premenstrual dip in peak expiratory flow. Exacerbations in the majority of women will respond to the usual treatment of bronchial asthma. However, a few women will experience significant morbidity or treatment-related adverse effects. Case reports suggest that the combined oral contraceptive pill or gonadotrophin-releasing hormone analogues may be effective in these patients. This requires substantiation by randomised controlled trials.
52 citations
TL;DR: The screening tests that are currently available for Down syndrome have been discussed and it is important that women understand that not all affected pregnancies will have a ‘high-risk’ screening result and that a proportion will therefore remain undetected by screening alone.
Abstract: own syndrome is the most common chromosomal defect, with a live birth incidence of approximately D 1 in 670. It is associated with a spectrum of mental and physical handicap and in view of this some couples will elect to terminate an affected pregnancy. Various strategies have been developed to identdj those pregnancies that are at higher risk of the condition and this article aims to discuss the screening tests that are currently available. It is important to make the distinction between screening and diagnostic testing. A screening test will give the woman an estimate o f risk, either high or low, of the pregnancy being affected; there is no such thing as a ‘no-risk’ result on the basis of screening. Therefore, a screening test for Down syndrome cannot answer the question ‘is my baby affected?, it can only estimate the risk of the condition being present, and this concept of risk may not easily be understood. For those women who wish to be certain that their baby does not have trisomy 21, the only option is a diagnostic test i.e. amniocentesis or chorionic villus sampling (CVS). The aim of screening is to identify ‘high-risk’ pregnancies; invasive diagnostic testing would then be offered to confirm whether or not the condition is present. Invasive testing is associated with a risk of miscarriage. Therefore, one important feature of a screening test is a low risk of loss of a karyotypically normal pregnancy per case of Down syndrome detected. It is also important that women understand that not all affected pregnancies will have a ‘high-risk’ screening result and that a proportion will therefore remain undetected by screening alone. The risk of aneuploidy increases with advancing maternal age and in view of this initial strategies to detect pregnancies affected by Down syndrome offered invasive testing to women aged 37 years and older. This group of women constituted 5% of the pregnant population and such a policy AD Cameron MRCOG
2 citations