Objective To determine the effectiveness of the tensionfree vaginal tape (TVT) in obese women with genuine stress incontinence (GSI), in whom obesity is often considered a relative contraindication to surgical treatment by traditional approaches, e.g. Burch colposuspension and slings (which are dif®cult and carry increased morbidity) or injectable agents (which although simple, are unpredictable and expensive). Patients and methods Data on 242 consecutive women with urodynamically proven GSI were collected prospectively. The women were subdivided into three groups with a body mass index (BMI) of <25, 25±29 and o30; obesity was de®ned as a BMI of o30. All procedures were performed under spinal anaesthesia. The King's validated quality of life (QoL) questionnaires (version 7) were completed before and 6 months after surgery. The subjective results were de®ned as a cure, signi®cant improvement or failure. Results Almost 90% of the obese women with GSI were cured, while the remaining 10% noted a considerable improvement in their symptoms. There was no signi®cant difference in cure rates among the three groups. There was a highly signi®cant (P<0.001) improvement in QoL in all groups. Conclusion The TVT is at least as effective in obese women as in those with a lower BMI. The TVT is a simple and minimally invasive procedure, with low morbidity even in the obese group. TVT can be offered con®dently to all obese women with GSI.

Blood was taken from 100 consecutive asymptomatic women at 17 to 18 weeks of pregnancy for Kleihauer testing. When a proportion of these slides were assessed at a different hospital there was agreement in only 46%. When the number of fetal cells were quantified there were differences of over 500%. These results show a large inter-observer and inter-hospital variation in interpreting Kleihauer slides. If these investigations are to be performed, it is essential that clinicians can rely on the results. There is a need for quality control measures and audit so that laboratories can rectify any deficiencies in their techniques.Acid elution techniques quantifying fetomaternal haemorrhage have traditionally been used in obstetrics for rhesus negative women to determine the required dose of anti-D gammaglobulin needed after a possible sensitising event. These tests have also been used as a diagnostic aid in pregnant women with abdominal pain or vaginal bleeding and after stillbirth. Whilst using the Kleihauer technique to quantify fetomaternal haemorrhage at the time of amniocentesis, a high proportion of positive results were detected. Initially the percentage of positive tests was determined. We then went on to see if the same slides would be reported as positive for fetal cells at a different laboratory. Having discovered a wide variation in the reporting from different laboratories, we set up this study to quantify the difference in reporting slides between different technicians. MethodsBlood was taken from 100 consecutive women attending at 17 to 18 weeks of gestation for an alpha-fetoprotein test. Verbal consent was obtained from each woman. None of the women had abdominal pain or vaginal bleeding. The acid elution technique described by Kleihauer was used to demonstrate fetal cells'. Blood films were fixed in 80% ethanol and slides were then allowed to stand at 37OC in a citric phosphate buffer for 5 min. This had the effect of lysing the maternal haemoglobin A and leaving behind haemoglobin F. When the slides are stained with haematoxylin and eosin, adult cells show as faint ghosts whilst fetal cells remain darkly stained. The slides were examined in three different ways: 1. 2. 3.All 100 slides were read by unspecified medical laboratory scientific officers at Laboratory A. Then the first batch of 28 slides were read by unspecified medical laboratory scientific officers at Laboratory B. Both positive and negative slides were sent to Laboratory B as it was not known whether slides read as negative by Laboratory A would also be read as negative by Laboratory B. The results from each laboratory were compared. Finally, the number of fetal cells was quantified in 18 slides, by eight specified medical laboratory scientific officers (four at each laboratory).The number of cells per 50 low power fields was counted. The slides were reported as positive when any fetal cells were seen. Bleeds of 1 5 mL were quantified using the formula: ResultsOf the 100 slides screened at Laboratory A, 63 stained positively for fetal c...

During 1988 and 1989, 3565 women booked under consultants who performed an ultrasound scan at booking, whilst 4984 booked under consultants who performed a formal mid-trimester scan between 16 and 18 weeks. All significant anomalies diagnosed prenatally and in the neonatal period were recorded, the incidence in each group being 12.9/1000 and 9.83/1000, respectively (NS). The sensitivity of diagnosis before 20 weeks was 45 percent in the 'mid-trimester' group (kappa 0.62) compared with 30 percent in the 'booking' group (kappa 0.46), overall sensitivity of prenatal diagnosis, however, being similar in both groups (63 vs. 65 percent, kappa 0.77 vs. 0.79). Cardiac anomalies were the single largest group which were not detected equally prenatally in both groups. This study shows that formal mid-trimester scanning leads to anomalies being detected significantly earlier in the antenatal period. Although not statistically significant, three lethal anomalies were missed prenatally in the 'booking' group which we would have expected to diagnose on a mid-trimester scan. These figures are discussed in the light of previous reports.

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The simplicity and high efficacy of the TVT makes it the first choice for the treatment of women with SUI, including those with more complex problems or coexisting risk factors.