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Objectives-To assess women's preferences for, and the acceptability of, medical abortion and vacuum aspiration in the early first trimester.Design-Patient centred, pardally randomised trial. Medical abortion was performed with mifepristone 600 mg followed 48 hours later by gemeprost 1 mg vaginal pessary. Vacuum aspiration was performed under general anaesthesia.Setting-Teaching hospital in Scotland.Patients-363 women undergoing legal induced abortion at less than nine weeks' gestation.Main outcome measures-Women's preferences for method ofabortion before abortion; acceptability judged two weeks after abortion by recording the method women would opt to undergo in future and by semantic differential rating technique.Results-73 (20%) women preferred to undergo medical abortion, and 95 (26%) vacuum aspiration; 195 (54%) were willing to undergo either method, and were allocated at random. Both procedures were highly acceptable to women with preferences. Gestation had a definite effect on acceptability in randomised women; at less than 50 days there were no differences, but between 50 and 63 days vacuum aspiration was significantly more acceptable.Conclusions-Women who wish to use a particular method should be allowed their choice, regardless of gestation. Women of 50-63 days' gestation without preferences for a particular method are likely to find vacuum aspiration more acceptable. A patient centred, partially randomised trial design may be a usefil tool in pragmatic research.

BackgroundThe increasing prevalence of obesity in women of child‐bearing age is of growing concern in the health community. Obesity is associated with sub‐optimal reproductive performance; therefore, it is understandable that the number of young women with elevated body mass index (BMI) accessing assisted reproductive treatment (ART) is on the rise. Consequently, this study not only assessed the impact of BMI on fertilisation rates, embryo development and freezing during ART in women aged ≤38 years but also determined their subsequent pregnancy and delivery rates.MethodsData were retrospectively analysed from all cycles initiated in 2006/2007 for women aged ≤38 years. The BMI categorisations were as follows: normal – 18.5–24.9 kg/m2; overweight – 25–29.9 kg/m2; obese – 30–34.9 kg/m2; morbidly obese class I – 35–39.9 kg/m2; morbidly obese class П –≥40 kg/m2.ResultsObese and morbidly obese women required a significantly higher follicle stimulating hormone start dose than normal BMI women; however, they obtained significantly fewer oocytes (P < 0.05). Although BMI did not affect embryo development, morbidly obese class Π women had significantly reduced pregnancy rates compared to normal BMI women (30.5 vs 41.7%, respectively; P < 0.05). Furthermore, increasing BMI was positively correlated to increasing rates of preterm delivery (P < 0.05). Increasing BMI was also positively correlated to increasing delivery rates of singleton term macrosomic offspring (≥4000 g).ConclusionObesity in women aged≤38 years does not affect embryo development; however, it does reduce clinical pregnancy rates in women with a BMI≥40 and increases rates of preterm labour and delivery of macrosomic offspring.

Symptoms of bronchial hyperreactivity and asthma in relation to environmental factors. Arch Dis Child 1988;63:473-8. 18 Lunn JE, Knowelden J, Roe JW. Pattems of respiratory illness in Sheffield junior schoolchildren-a follow up study. BrJ Prev Soc Med 1970;24:223-8. 19 Ware JH, Ferris BG Jr, Dockerv DW, Spengler JD, Stram DO, Speizer FE.Effects of ambient sulfur oxides and suspended particles on respiratory health of pre-adolescent children. Am Rev Respir Dis 1986;133:834-42. 20 Braun-Fahrlander C, Ackermann-Liebrich U, Schwartz

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