The aim of this prospective study of the use of transvaginal power Doppler ultrasound was to assess the subjectivity of the grading system and to elucidate, on a much larger series (200) of treatment cycles, the findings of previous authors. Vascular perfusion was studied using a grading system based on the percentage of follicular circumference (grade 1 < 25%, grade 2 < 50%, grade 3 < 75% and grade 4 > 75%) that depicted an echo signal. Interobserver variation was low (k = 0.81 + 0.08). A total of 1285 follicles were studied, of which 64% were of high (grades 3 or 4) and 36% were of low (grades 1 or 2) grade vascularity. Mean follicular diameter, oocyte retrieval rate, number of mature oocytes recovered and fertilization rates were all significantly higher (P < 0.05) and triploidy rate significantly lower (P < 0.05) from the cohort of follicles with high grade vascularity. There was no correlation between embryo morphology and vascularity grade. The pregnancy rate for cycles where the embryos transferred were derived from follicles with uniformly high grade (3 or 4 only) vascularity was significantly higher than for those cycles where the embryos transferred were derived from mixed (1 to 4) or low (1 or 2 only) grade follicles [24/72 (34.7%) versus 22/122 (18%); P < 0.05]. There were no significant differences in uterine artery or intraovarian pulsatility index values between the pregnant and non-pregnant treatment cycles. This study suggests that follicles with high grade vascularity are associated with better outcome variables. Thus, follicular assessment may be used prospectively to improve the outcome in in-vitro fertilization treatment cycles.

These data would suggest that perifollicular vascularity has an important role to play in the outcome of IUI cycles, and that power Doppler has the potential to refine the management of assisted reproduction treatment cycles.

Denial of pregnancy has been implicated in potentially jeopardising prenatal care and subsequent safe planned deliveries. This population-based study of hospital deliveries over an 11-year period, reveals that concealed pregnancies have an incidence of one in 2,500 deliveries. Among this cohort, 12% were married and 58% were multiparous with 8% having had a previous caesarean section. Some 20% of women had a medical disorder complicating the antenatal period. There was a preponderance of concealed pregnancies in the winter months compared with booked deliveries (p = 0.02). Mode of delivery was similar between the booked and concealed pregnancies with a low incidence of maternal morbidity in the latter. Prematurity rates (p = 0.0002) were significantly higher in the concealed pregnancy cohort. A total of 20% of infants had depressed Apgar scores at 1 min and 8% at 5 min. There was no documentation of counselling or follow-up in this group. Despite the low incidence of maternal morbidity, these women should be regarded as high-risk labour due to the increased perinatal morbidity. Greater effort needs to be made towards ensuring these women have adequate counselling and follow-up during the postnatal period.

This study supports the notion of expectant management in suspected fetal macrosomia in low risk primigravid women until 40 weeks gestation. Thereafter, the safest mode of delivery is controversial, with some evidence pointing to elective cesarean section as a viable alternative in these women. A prospective RCT is needed to evaluate the best management option in terms of fetal and maternal outcome in cases of suspected macrosomia after 40 weeks' gestation.

The aim of this study was to determine the aspirations of women with endometriosis in terms of the management of their disease. We interviewed 32 women with confirmed endometriosis and asked them to discuss the potential benefits of the establishment of a specialist endometriosis clinic. Eighty-eight per cent of the participants agreed that a separate specialist clinic would be beneficial. The reasons they cited can be grouped under four main themes: information provision, quality and type of care, peer support and endometriosis awareness. On the basis of these responses we propose that a strategy utilised in the management of other chronic diseases, drop-in group medical appointments, may provide a way forward. In addition, on the basis of the range of symptoms reported by our participants, we would argue that a multidisciplinary approach is necessary if endometriosis management is to be effective.