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Notes: Objectives 1. To produce a list of evidence-based criteria for good quality care relating to female laparoscopic sterilisation. 2. To assess the level of agreement with each criterion among gynaecologists in Scotland. 3. To obtain an overview of current sterilisation practice for comparison with the agreed criteria.Design 1. Agreement with criteria assessed by questionnaire survey; 2. Overview of current practice obtained by questionnaire survey and by casenote review.Setting Scotland.Sample 1. Questionnaire survey: all 132 consultant gynaecologists in NHS practice. 2. casenote review: 988 consecutive women sterilised in 12 representative hospitals.Results The response rate to the questionnaire survey was 94%. A list of 15 evidence-based criteria was produced, covering patient selection, information and counselling, techniques of tubal occlusion and timing of sterilisation. All 15 suggested criteria gained an overall balance of support among responding gynaecologists. Similar impressions of current practice were gained from the questionnaire survey and from the casenote review. Aspects of practice which measured up well to the agreed criteria included: only 6% of women sterilised were younger than 25 years of age; over 85% of casenotes included clear documentation that women had been counselled regarding failure rate and intended permanency; 88% of sterilisations were performed, or directly supervised by, a gynaecologist of consultant or senior registrar status; and only 2% of sterilisations were undertaken in combination with induced abortion. Aspects of practice which compared poorly with the agreed criteria, and for which recommendations for change have been made, included: only 22% of casenotes mentioned that the option of vasectomy had been discussed; only 30% of gynaecologists indicated that they provide locally produced information leaflets as an adjunct to counselling; four methods of tubal occlusion (including unipolar diathermy) were in use; and there were wide variations among hospitals in the use of day-case care, ranging from 19% to 99%.Conclusions A list of criteria for good quality care in relation to sterilisation has been validated by agreement among Scottish gynaecologists. Current practice (as assessed by questionnaire survey and casenote review) has been compared with the criteria and some recommendations for change in practice have been made. Following dissemination of these results and recommendations, re-audit will be undertaken in order to identify any changes.

Notes: Objective To describe and compare health outcomes two years after medical abortion or vacuum aspiration in women recruited into a patient preference trial during 1990 to 1991.Design Women recruited to the original, partially randomised study were contacted for assessment using a structured interview.Setting Grampian region of Scotland, UK.Participants One hundred and forty women who had participated in a partially randomised study of first trimester abortion two years previously.Intervention Vacuum aspiration or medical abortion using mifepristone and gemeprost.Main outcome measures Long-term general, reproductive and psychological health; acceptability of procedure; perceived value of choice of method of termination.Results There were no significant differences between women who had undergone medical abortion or vacuum aspiration two years previously in general, reproductive or psychological health. Almost all women placed a high value on the provision of choice of method of termination. There was a significant difference in perception of long term procedure acceptability among women who had been randomised to a method of termination.Conclusions Women should have the opportunity to choose the method of termination. This opportunity will result in high levels of acceptability, particularly at gestations under 50 days of amenorrhoea.

Notes: An in-vitro penetration assay, which incorporates measurements of sperm motility and forward velocity, was used to investigate sperm-cervical mucus interaction in 20 couples with unexplained infertility. Evidence of impaired cervical mucus penetration was found in this group of patients and in seven couples the results correlated with previous assessment by laparoscopic sperm recovery. The impairment of cervical mucus penetration was found to be due to defective sperm function rather than to the quality of the cervical mucus itself. Of the criteria of semen quality measured in this study, sperm motility and the zona-free hamster egg penetration test showed significant correlations with cervical mucus penetration.

Notes: Summary. The results of a cervical mucus scoring system and of basal body temperature (BBT) chart interpretation were compared with those of a short-incubation radioimmunoassay for luteinizing hormone (LH) in 198 ovulatory menstrual cycles. The timing of the maximal cervical mucus score was similar to that of the LH peak in all but 7% of assessable cycles. In contrast, the timing of the nadir of the BBT differed widely from that of the LH peak in 45% of cycles with interpretable charts. These findings suggest that cervical mucus scoring might be useful for identifying the time of ovulation where LH assays are unavailable or where speed and economy are at a premium.

Notes: A rapid luteinizing hormone (LH) radioimmunoassay (total time 4 h) has been developed and used to measure the preovulatory LH surge in 22 patients. Ovulation, assessed by laparoscopy or mini laparotomy, did not occur until at least 32 h after the start of the LH surge. This rapid LH radioimmunoassay provides a simple method of predicting ovulation for the correct timing of oocyte collection or artificial insemination.

Notes: Summary. Using record linkage data derived from Scottish hospital discharge summaries, admissions to gynaecological units and hysterectomy rates have been studied following sterilization. The average annual gynaecological admission rate per 1000 women was 43·7 in the group of sterilized women and 21·5 in the control subjects. The average annual hysterectomy rate was 9·3 in the sterilized women and 2·5 in the control subjects. Although there were differences in age and pregnancy number between cases and controls, these did not account for the observed differences. This study was not able to determine whether the increase in gynaecological morbidity was due to the sterilization procedure or to the characteristics of the women sterilized.

Notes: A total of 530 patients was reviewed six months after laparoscopic sterilisation by diathermy (235 patients) or silastic bands (295 patients). In the immediate post-operative period severe lower abdominal pain was more common in the patients who had silastic bands. There was one failure with diathermy and two with silastic bands. There were no differences in the nature or incidence of menstrual problems when the two methods were compared. In all, 40 per cent of patients reported an increase in menstrual blood loss and 26 per cent of patients an increase in menstrual pain, and this could not be attributed entirely to stopping oral contraception; 42 per cent of patients reported improvement in their sex lives after sterilisation, while 6.6 per cent reported deterioration mainly due to lack of libido. There was some regret about the operation in 5.1 per cent of patients.

Notes: Our experience with laparoscopy as the primary means of assessment of the female genital tract is described in 279 women attending a subfertility clinic. Thirty-two per cent of patients with primary infertility and 60 per cent of patients with secondary infertility had significant pelvic disease. We feel that laparoscopy should replace other methods for the routine primary assessment of the genital tract in subfertile women.

Notes: Arterial blood gases, physiological dead space and percentage pulmonary venous admixture (physiological shunt) were measured in 31 patients with proteinuric pre-eclampsia. There was no difference in pulmonary function in 22 patients with moderate pre-eclampsia when compared with normal pregnancy, but in 9 patients with severe pre-eclampsia, there was a significant increase in alveolar-to-arterial Po2 difference and physiological shunt, indicating a degree of pulmonary ventilation/perfusion imbalance. There was no accompanying hypoxaemia, suggesting that the impairment was of no clinical importance.

Notes: Objective— To investigate menstrual symptoms in relation to pelvic pathology.Design— A prospective questionnaire-based study.Setting— Aberdeen Royal Infirmary, Scotland.Subjects— 1250 questionnaires were sent out prior to planned admission and 1200 women (96%) brought the completed questionnaires. They comprised 598 women undergoing laparoscopic sterilization, 312 having laparoscopy because of infertility, 156 having laparoscopy because of chronic pelvic pain and 134 women undergoing abdominal hysterectomy for dysfunctional uterine bleeding.Main outcome measures— The occurrence of dysmenorrhoea, menorrhagia, menstrual regularity, premenstrual spotting, deep dyspareunia and pelvic pain in women with either endometriosis and post infective pelvic adhesions or a normal pelvis.Results— Menorrhagia, menstrual irregularity and premenstrual spotting occurred with equal frequency in all groups. Deep dyspareunia, pain after intercourse and recurrent pain unrelated to menstruation or coitus was more common in women with endometriosis and those with post infective pelvic adhesions than in those with a normal pelvis. Dysmenorrhoea appears to be more prevalent among women having endometriosis.Conclusions— Menstrual symptoms, while raising a high index of suspicion for endometriosis, are not entirely reliable as indicators of disease. Dysmenorrhoea is the most common reported symptom in endometriosis sufferers. Diagnostic laparoscopy should be considered before institution of treatment in women complaining of pelvic pain and menstrual symptoms.