No description available.

No description available.

No description available.

No description available.

This thesis is based on work performed in the Department of Gynaecology of Aberdeen Royal Infirmary. Chapter 1 outlines and reviews the current literature on the aetiology, epidemiology and treatment of menstrual disorders. A detailed review of the Microwave Endometrial Ablation is made. The evidence based is reviewed and discussed with a focus on randomised trials. Chapter 2 describes the 5 year follow up of an original trial comparing women initially referred to a gynaecologist with excessive menses who were randomised to either standard medical treatment or endometrial ablation in the form of Transcervical Resection of the Endometrium (TCRE). Chapter 3 describes a multi-centre international randomised controlled trial comparing the first generation technique of Rollerball Endometrial Ablation (RBEA) with the second generation technique of Microwave Endometrial Ablation (MEA). Chapter 4 describes a randomised controlled trial of MEA performed in a outpatient setting in the early post menstrual phase to standard treatment performed in a day case theatre after endometrial preparation. <br> Chapter 5 reviews the rates of surgery for excessive menstrual bleeding in Scotland and the Grampian region from 1998 – 2004. Chapter 6 reviews the conclusions made from the work described in this thesis and there relevance to medical practice. Suggestions are made for areas of future research.

The work in this thesis is mainly focused on the role of conservative management of women with retained products of conception following a spontaneous miscarriage in the first trimester in comparison to the ‘gold standard’ surgical evacuation of the uterine cavity under general anaesthesia. A self-administered questionnaire based study was conducted to investigate the impact of seeing and handling the products of conception on the incidence of psychological adverse reactions in women managed conservatively as compared to the control group (women managed by surgical uterine evacuation). Women managed conservatively seemed to recover psychologically quicker than women managed by surgical evacuation. The impact of conservative management on the reproductive potential of women with retained products of conception was assessed in the fourth chapter. The first part of the fourth chapter studied the return of ovulation in a subgroup of women (n = 30) randomised to conservative management as compared to women (n = 30) randomised to surgical evacuation. The return of normal ovulation was examined by assessing the daily urinary excretion of luteinizing hormone (LH), pregnanediol (P₄) and total urinary oestrogen (E₂), follicular and endometrial development using transvaginal ultrasound. The second part of this chapter concentrated on following up women who desired to become pregnant from the two management groups. Conservative management had similar outcomes to surgical evacuation in relation to the reproductive performance. Finally, a systematic assessment of the cost-effective of conservative management was carried out in comparison with surgical evacuation in the last chapter of the thesis, which revealed a potential for substantial cost savings in NHS resources with the widespread use of conservative management.

Haemolytic disease of the fetus and newborn (HDFN) is, without preventive action, a common cause of fetal morbidity and mortality. The condition is caused by maternal antibody to red cell antigens crossing the placenta and mediating the destruction of fetal red cells. This results in fetal anaemia, jaundice, and in severe cases, death. In western populations the commonest causative antibody is anti-D. For forty years the incidence of alloimmunisation to the RhD antigen, and hence HDFN, has been moderated by the administration of anti-D immunoglobulin to RhD- mothers. The treatment is extremely effective but the mechanism of action remains unresolved. The aim of this quasi-experimental study is to test the hypothesis that there is a significant difference in maternal plasma cytokine expression before and after anti-D administration, thereby increasing the understanding of the mechanism of action. To recruit a participant cohort, RhD- women called to anti-D prophylaxis clinics at 28 weeks gestation were sent a leaflet describing the study 3-6 weeks before their appointment, and invited to participate. Blood samples were collected from 24 women receiving anti-D at 28 weeks gestation, before, and at 1, and 24 hours after administration. The concentration of plasma cytokines was measured by flow cytometry, and/or by enzyme linked immunosorbant assay (ELISA). Participants were allocated to test and control groups by the RhD group of their babies, determined at delivery. Changes in cytokine concentration greater than 50% (1.5 fold) were detected by ELISA for IL-1 ra and TGF-beta1. mRNA of white blood cells of these two cytokines was measured by quantitative polymerase chain reaction. When combined, the difference in TGF-beta1 responses in RhD+ and RhD- fetus arms were found to be statistically significant (p=0.047). When ELISA and PCR results were considered separately, no significant difference was noted in fold changes in test and control groups (p > 0.05). TGF-beta1 is a powerful immunosuppressant acting on the key cellular elements of the humoral immune response. The results of this study suggest that the mechanism by which anti-D prevents alloimmunisation includes the induction of TGF-?i secretion. Monoclonal anti-D selected for trials to replace human products have focussed on antibodies capable of causing clearance of fetal red cells from the maternal circulation, and have to date had poor results. The knowledge that anti-D prophylaxis has additional biological effects which may contribute to immunosuppression should inform the selection of monoclonal antibodies for future trials.

No description available.

No description available.

No description available.