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Objective To investigate the impact of maternal body mass index (BMI, kg/m 2 ) on clinical complications, inpatient admissions, and additional short-term costs to the National Health Service (NHS) in Scotland.Design Retrospective cohort study using an unselected population database.Setting Obstetric units in Scotland, 2003 Population A total of 124 280 singleton deliveries in 109 592 women with a maternal BMI recorded prior to 16 weeks of gestation.Methods Population-based retrospective cohort study of singleton deliveries, with multivariable analysis used to assess short-term morbidity and health service costs. Conclusions Maternal BMI influences maternal and neonatal morbidity, the number and duration of maternal and neonatal admissions, and health service costs.

Objective To identify the trajectories of anxiety and depression in women and in their partners over 13 months after miscarriage.Design A prospective study with follow up at 6 and 13 months after miscarriage.Setting Three Scottish Early Pregnancy Assessment Units.Sample Of the 1443 eligible individuals approached, 686 (48.3%) consented to participate (432 women; 254 men). Complete data were obtained from 273 women and 133 men at baseline, 6, and 13 months.Methods On completion of the management of the index miscarriage, eligible and consenting women and men underwent an initial assessment comprising a semi-structured interview and a standardised self-report questionnaire. The latter was readministered at the follow-up assessments.Main outcome measures The hospital anxiety and depression scale (HADS), a reliable and valid measure of general psychopathology for use in nonpsychiatric samples.Results Compared with depression, anxiety was overall the greater clinical burden. Over the 13-month period, women reported higher levels of anxiety and depression than men. Over time, a significantly greater level of adjustment was reported by women particularly with regards to the resolution of anxiety symptoms. The effect of time on HADS scores in either gender was similar between subgroups of socio-demographic and clinical factors.Conclusions These findings verify that early pregnancy loss represents a significant emotional burden for women, and to some extent for men, especially with regards to anxiety. For many, the detrimental effects of miscarriage are enduring and display a complex course of resolution. These findings are discussed in terms of their clinical implications for early identification and management.

Clinical lmpre@oui of bleedingNanber of @eatsBleedlag presmire (cm of sailne) heavy228â€"36 A review of the world literature on cemented total hip arthroplasty reveals that there is almost a twenty-fold variation in the re-operation rate for aseptic loosening of the components at 10 years (Bosch, Kristen and Zweymüller 1980; Collis 1982; Sutherland et al. 1982; Johnstone and Crowninshield 1983; Older 1984). The lowest re-operation rates vary between 1.5% (Johnstone and Crowninshield 1983) and 7.4% (Stauffer 1982), and were achieved using very basic cementing techniques and implants that would now be considered obsolete. Indeed, advances in materials and in stem design have virtually eliminated the problem of stem fracture, which had been responsible for a significant number of the revisions due to aseptic loosening in the two series cited. If stem fractures are excluded, the revision rates for aseptic loosening only in these same two series varies between 0.88% and 5.7%, the latter being amongst the lowest published results from an institutional series as distinct from those reported by individual surgeons.Thus, by using up-to-date implants but the same cementing techniques as were used more than a decade ago, re-operation ratesof between 1%and 5% for aseptic loosening could reasonably be anticipated at 10 years.Further improvement might alsobe achieved by the more refined cementing techniques introduced in the past 10 years. Most of these, including intramedullary plugging, bone cleaning, retrograde insertion and pres surisation of cement, as well as the use of cement of Princess Elizabeth Orthopaedic Hospital, Wonford Road, Exeter, Devon, EX2 4LE, England. A. J. C. Lee, PhD, Reader in Engineering ScienceUniversity of Exeter, Northpark Road, Exeter, Devon EX4 4QF, England. Request for reprints should be sent to Mr R S M Ling.©1987BritishEditorialSocietyof Boneand Joint Surgery 030lâ€"620X/87/4l20$2.00 Table I. Saline manometry after preparation and plugging of the femoral cavity (after Heyse-Moore and Ling 1982) reduced viscosity, evolved from post-mortem studies and laboratory models Ling 1974, 1981; Markolf and Amstutz 1976;Oh et al. 1978; Miller et al. 1978a; Miller et al. l978b ; Wroblewski and van der RIjt 1984).The conclusionsfrom such studies may realistically be applied to the knee where the use of a tourniquet is common practice. The hip, however, presents a chal lenge in that cementing usually is performed in the presence of active bleeding from the bone surface. Although bleeding may be controlled by the use of hypotensive anaesthesia and by packing the acetabulum and femoral canal before cementing, there is no completely effective way of preventing it. A recent study (Heyse-Moore and Ling 1983) demonstrated significant femoral medullary bleeding pressuresduring total hip arthroplasty. In this work, the proximal end of the femur was sealed with a cement-and-rubber dam after the canal had been reamed and plugged. Attached to the rubber dam was a saline manometer that measured the intrafemoral ...

Objective To determine the risk of further gynaecological surgery and gynaecological cancer following hysterectomy and endometrial ablation in women with heavy menstrual bleeding.Design Population-based retrospective cohort study. Methods Anonymised data collected by the Scottish Information Services Division were analysed using appropriate methods across the hysterectomy and endometrial ablation groups. Cox proportional hazards regression analysis was used to examine the survival experience for different surgical outcomes after adjustment for age, year of primary operation and Carstairs quintile.Main outcome measures Further gynaecological surgery and gynaecological cancer in women.Results A total of 37 120 women had a hysterectomy, 11 299 women underwent endometrial ablation without a subsequent hysterectomy and 2779 women underwent endometrial ablation followed by a subsequent hysterectomy. The median (interquartile range) duration of follow-up was 11.6 years (7.9, 14.8) and 6.2 years (2.7, 10.8) in the hysterectomy and endometrial ablation (without hysterectomy) cohorts, respectively. Compared with women who underwent hysterectomy, those who underwent ablation were less likely to need pelvic floor repair [adjusted hazards ratio, 0.62; 95% confidence interval (95% CI), 0.50, 0.77] or tension-free vaginal tape surgery for stress urinary incontinence (adjusted hazards ratio, 0.55; 95% CI, 0.41, 0.74). Abdominal hysterectomy was associated with a lower chance than vaginal hysterectomy of pelvic floor repair surgery (hazards ratio, 0.54; 95% CI, 0.45, 0.64). Overall, the number of women diagnosed with cancer was small, the largest group being breast cancer (n = 584, 1.57% and n = 130, 1.15% in the hysterectomy and endometrial ablation groups respectively; adjusted hazards ratio, 1.14; 95% CI, 0.93-1.39).Conclusions Hysterectomy is associated with a higher risk than endometrial ablation of surgery for pelvic floor repair and stress urinary incontinence. Surgery for pelvic floor prolapse is more common after vaginal than abdominal hysterectomy.Keywords Endometrial ablation, endometrial cancer, heavy menstrual bleeding, hysterectomy, pelvic floor repair, stress urinary incontinence.Please cite this paper as: Cooper K, Lee A, Chien P, Raja E, Timmaraju V, Bhattacharya S. Outcomes following hysterectomy or endometrial ablation for heavy menstrual bleeding: retrospective analysis of hospital episode statistics in Scotland.