bluuebunny/crossref_metadata_2025 huggingface dataset:
CEREBRAL VASCULAR DISEASE IN PREGNANCY 2—OCCLUSION
Authors: Amias A. G.
Published: August 2005

A report on 18 patients with occlusive lesions completes a study of 70 cases of cerebral vascular disease associated with pregnancy and the puerperium.

Cortical venous thrombosis has traditionally been accepted as the chief cause of strokes during pregnancy but full neurological investigation demonstrates a high proportion of arterial lesions. In the present series there were 9 cases of arterial occlusion; 6 presenting during pregnancy and 3 in the puerperium. The nine cases of cortical venous thrombosis all occurred in the puerperium.

The presentation, clinical course and outcome differed markedly between patients with arterial and venous lesions but it would be erroneous to rely on clinical features alone to distinguish them.

Cerebral vascular occlusions may be confused with haemorrhagic lesions, intracranial infection, idiopathic epilepsy and psychosis. The occurrence of a sudden fit in the puerperium may lead to the mistaken diagnosis of postpartum eclampsia although this did not arise here.

Active treatment by operation or with anticoagulants was carried out in half the cases; the other patients being treated symptomatically. The nature and extent of the pathological process appeared to be more significant in determining the outcome than the method of treatment employed. Venous lesions carried a higher initial mortality than arterial occlusions but recovery amongst the patients who survived was more rapid and complete than that following arterial strokes.

The method of management of a stroke occurring during pregnancy should be selected chiefly on neurosurgical grounds and the obstetric requirements considered secondarily.
PRODUCTION RATE AND SOURCES OF AMNIOTIC FLUID AT TERM
Authors: Biggs J. S. , Duncan R. O.
Published: August 2005

Flow measurements following drainage of the amniotic cavity in four normal patients at term indicated a production rate of amniotic fluid of 16–42 ml. per hour.

Serial measurements of oestriol and urea in the amniotic fluid and comparison with concentrations in the urine of the newborn infants indicated that the fetal urine contributed 2–5 per cent of the amniotic fluid in 3 patients, and 19–24 per cent in a fourth patient.

Serial measurements of chloride ion and comparison with animal experiments suggest that fetal respiratory tract fluid may contribute to amniotic fluid production in late human pregnancy.
ADENOCARCINOMA OF THE BODY OF THE UTERUS
Authors: Lewis B. V. , Stallworthy J. A. , Cowdell R.
Published: August 2005

A series of 129 cases of adenocarcinoma of the uterus treated by Wertheim's hysterectomy and lymphadenectomy is reported. Preoperative radium was given together with postoperative irradiation when pelvic lymph nodes were involved in metastatic cancer.

The five‐year survival was 71·5 per cent. This figure rose to 74 per cent when the growth did not involve the cervix.

The incidence of lymph node involvement was 13·2 per cent, or 11·2 per cent when the cervix was free from growth. The incidence of node involvement was related to the degree of differentiation of the tumour and the depth of myometrial invasion. Thirty‐six per cent of patients with positive nodes survived 5 years when lymphadenectomy was combined with external radiation. When death occurred the metastatic deposits were usually outside the pelvis.

It is concluded that lymphadenectomy need be performed only in patients with poorly differentiated and deeply invasive growth. Postoperative external irradiation is indicated if the nodes contain cancer.
EXCRETION OF OESTROGENS, PREGNANEDIOL AND CHORIONIC GONADOTROPHIN IN PATIENTS WITH HYDATIDIFORM MOLE
Authors: Campbell D. G. , Brown J. B. , Fortune D. W. , Pepperell R. , Beischer N. A.
Published: August 2005

Forty‐one patients with a diagnosis of possible hydatidiform mole were studied by HCG, oestrogen and pregnanediol determinations performed on 24‐hour collections of urine. The results were compared with those obtained in a control series involving 5000 HCG analyses, 679 oestrogen analyses and 1080 pregnanediol analyses performed over the relevant period of gestation in single pregnancies which produced surviving infants. Of the 17 patients who were shown to have a hydatidiform mole, 8 (47 per cent) had high HCG levels, 5 (29 per cent) had oestrogen levels below the first percentile for the control series and 5 of 13 patients had low pregnanediol levels (38 per cent). Five of the nine patients with molar pregnancies associated with normal HCG excretion had oestrogen excretion below the first percentile and one of the remaining four with normal oestrogen values had non‐pregnancy levels of pregnanediol. Thus the diagnosis of an abnormal pregnancy could be made in 14 of the 17 molar pregnancies studied (82 per cent). Two of the three exceptions had a fetus co‐existent with the mole. There were no viable pregnancies when the oestrogen and pregnanediol values were below the first percentile. Oestrogen and/or pregnanediol values in the range consistent with multiple pregnancy were found in four patients with molar pregnancies. In the molar pregnancies there was a correlation between the levels of HCG and the levels of oestrogens and pregnanediol excreted. After evacuation of the mole, the levels of oestrogens and pregnanediol remained elevated for up to three weeks in approximately half of the patients, whereas the HCG levels fell immediately. These findings support the view that in molar pregnancies, levels of oestrogens above 300 μg. per 24 hours and of pregnanediol above 10 mg. per 24 hours are derived mainly from the stimulation of theca lutein cysts in the ovaries.
A FURTHER STUDY ON FETAL LOSS AND CHILD MORTALITY IN THE NORTH OF NIGERIA
Authors: Lang J. R.
Published: August 2005

The maternity records of Vom Christian Hospital for the years 1963 to 1967 have been analyzed, and some of the results compared with those of a similar survey conducted at the same hospital 12 years ago.

The stillbirth rate of babies of the Birom tribe has fluctuated over the five‐year period, but has not fallen. It is 66·4 per thousand total single births.

The death rate of Birom babies in the first week of life is 47·8 per thousand live single births, and has not improved over the five years.

The perinatal mortality rate for Birom babies is 107 per thousand total single births.

The neonatal mortality rate for Birom babies, based on records of the previous three deliveries only, is 83 per thousand live single births.

The infant mortality rate for Birom children is 213 per thousand live births, while the overall “under five years childhood mortality rate” is 266·5 per thousand.

This compares favourably with the figure of 490·5 obtained twelve years ago for the same tribe.

The figure for overall fetal losses at all stages is 300 per thousand total births for both the Birom children and the children of the other 69 tribes represented in small numbers during the review period.

The commonest causes of death in children under five years old are measles (31 per cent), respiratory infections (21 per cent), dysentery (11 per cent), and febrile convulsions (10 per cent).

The average birthweight of single Birom babies born alive has increased slightly since the last survey, from 6 pounds ¼ ounce (2729 g.) to 6 pounds 4 ounces (2836 g.).

The sex ratio of all babies in whom the sex was recorded is 111 male to 100 female.

The incidence of twinning amongst the Birom mothers is 1 in 48, and is even higher amongst the other tribes attending the hospital (1 in 36).

In this series as many second twin babies survived as first.
OBSTETRIC SPRUE*
Authors: Whitfjeld C. R.
Published: August 2005

The investigation and follow‐up of 36 women, in whom folate deficiency during pregnancy was associated with intestinal malabsorption and jejunal mucosal changes, suggested that a pre‐existent chronic enteropathy had been unmasked or exacerbated, that this was usually due to gluten sensitivity, and that impaired absorption of folic acid may be the usual cause of megaloblastic pregnancy anaemia even in temperate countries.

As in tropical sprue, the folate requirements of pregnancy probably initiate a vicious circle of progressive folate depletion and increasing malabsorption. In addition to the immediate maternal and fetal risks, persistent malabsorption may lead to chronic ill health and acute relapses, especially during further pregnancies. Ileal involvement may lead to vitamin B12 depletion with neurological damage, and there is the eventual risk of intestinal malignancy. Continued supervision is therefore indicated, and gluten‐free diets may be advisable in most cases.
AUTOMATIC OXYTOCIN INFUSION EQUIPMENT FOR INDUCTION OF LABOUR
Authors: Francis J. G. , Turnbull A. C. , Thomas F. F.
Published: August 2005

Equipment has been developed for the automatic infusion of oxytocin using a positive pressure peristaltic pump. The automatic setting starts the infusion at 1 milliunit of oxytocin per minute and doubles the dose every 12‐5 minutes. When contractions are of adequate strength and frequency, the “manual” control is used to maintain the oxytocin dose rate, and for immediate and accurate adjustment to any required level. Using this equipment in a series of 130 cases, the average induction‐delivery interval was less than 8 hours. Continuous records of amniotic fluid pressure and fetal electrocardiography showed normal uterine contractions and fetal heart rate patterns.
PLACENTAL LOCALIZATION. A COMPARISON OF THE DOPPLER ULTRASOUND METHOD WITH THAT OF RADIOACTIVE CARBON MONOXIDE AND THE GAMMA CAMERA
Authors: Hakim C. A.
Published: August 2005

Placental localization was performed on 100 patients by two methods, the Doptone ultrasonic apparatus and radioactive carbon monoxide using the gamma camera. Confirmation of the exact site of the placenta was obtained by Caesarean section in 50 cases. Localization with the Doptone apparatus proved to be simple, inexpensive and accurate. It compared favourably with the radio‐isotopic method, which exposed the patient to a small dose of radiation and required complex laboratory‐based equipment.
THE RELATIONSHIP OF TOTAL AND DIFFERENTIAL LEUKOCYTE COUNTS WITH URINARY OESTROGEN AND PLASMA CORTISOL LEVELS
Authors: Cruickshank J. M. , Morris R. , Butt W. R. , Crooke A. C.
Published: August 2005

In a group of 20 women undergoing a course of human pituitary gonadotrophic hormone injections a significant positive correlation (P<0.001) between urinary total oestrogens and the total leukocyte, neutrophil and monocyte counts in blood was demonstrated. The relationship was independent of changes in progesterone secretion, plasma cortisol levels and the initial value of the total leukocyte count. In some individuals, differences up to 6000 cells per c.mm. exist between neutrophil counts associated with the lowest and the highest oestrogen levels.

A significant negative correlation (P<0.001) between plasma cortisol and the lymphocyte count was found. No relationship between plasma cortisol and urinary total oestrogens, total leukocyte, neutrophil and monocyte counts was seen,

In two women who became pregnant during the course of treatment, neutrophil count changes appeared to be a continuation of events that were happening before conception, indicating that neutrophilia of pregnancy is related to alterations in oestrogen production, separate from progesterone and plasma cortisol fluctuations. The possible role of oestrogens in association with the postmenopausal decrease and the normal ovulatory peak in neutrophil count was discussed. Their place in the scheme of general body defence against infection and their possible associations with obscure neutropenias in women were also considered.
THE RELATIONSHIP OF URINARY TOTAL OESTROGENS WITH HAEMOGLOBIN CONCENTRATION
Authors: Cruickshank J. M.
Published: August 2005

A study of 20 women undergoing a course of human pituitary gonadotrophic hormone injections at an endocrine clinic revealed a significant negative correlation (P<0.001) between urinary total oestrogens and haemoglobin concentration. This correlation was independent of changes in progesterone excretion, the initial haemoglobin level and menstrual loss. Mean differences of over 1 g. per 100 ml. exist in haemoglobin levels associated with the lowest and highest oestrogen groups (approaching 2 g. difference in certain individuals).

The tendency of oestrogens to suppress erythropoiesis and cause haemodilution is discussed in relation to the present findings.
LUMBAR EPIDURAL ANAESTHESIA IN LABOUR AND DELIVERY: ONE YEAR'S EXPERIENCE
Authors: Romine James C. , Clark Richard B. , Brown Willis E.
Published: August 2005

A series of 739 obstetrical patients who received lumbar epidural anaesthesia for labour and delivery has been reviewed. Satisfactory anaesthesia was produced in 78·8 per cent of all patients despite relative inexperience by many operators. The effect on the fetus is minimal. The technique, although somewhat complicated, is easily learned and provides safe, effective anaesthesia. Physicians wishing to use this technique must pay close attention to detail, monitor their patients carefully, and be proficient in forceps delivery.
THE NORMAL WEIGHT GAIN IN PREGNANCY: A SERIES FROM GENERAL PRACTICE
Authors: Craddock Denis
Published: August 2005

In a general practice the weight gain for the whole of pregnancy was carefully estimated in 158 consecutive antenatal patients with a complete weight record from before the 20th week of pregnancy until the 36th week or later. Fifty‐six nontoxaemic subjects not requiring dietary advice gained an average of 9·9 kg. for the whole of pregnancy and 77 non‐toxaemic subjects, who gained excessive weight during the early stages of pregnancy and were advised to diet, gained an average of 10·4 kg. The average weight gain in the whole series was 10·6 kg. There was no calorie control whatsoever and dieting consisted merely of reducing the intake of carbohydrates and in some cases of fats. It is contended that the building up of a large fat store during pregnancy is unnecessary and that the normal or optimum average weight gain in pregnancy should be regarded as 9·5 kg.±3·6 kg. rather than 12·5 kg. as quoted in recent British series.
URETHRAL LENGTHENING BY ADVANCEMENT OF THE EXTERNAL URETHRAL MEATUS IN THE TREATMENT OF URINARY STRESS INCONTINENCE IN THE FEMALE
Authors: Bennett Marjorie , Mitchell J. P. , Smith Patrick
Published: August 2005

A technique is described to cure stress incontinence in the female by urethral advancement. This technique is easily combined with a standard anterior repair. It is of particular value when a previous repair operation has failed and when scar tissue has distorted the urethral anatomy. It has also proved successful in cases of stress incontinence associated with a urethrocoele, when there is a “concertina” effect of the urethra.
TERMINATION HYSTERECTOMY
Authors: Lewis A. C. W. , Williams E. A.
Published: August 2005

Termination hysterectomy has been performed 56 times in the Division of Obstetrics and Gynaecology at Oxford from April, 1968, until the end of 1969. The operation is preferred over all others when the patient is highly parous, needs permanent contraception, and suffers from uterine disease. It is not essentially different from hysterectomy for other accepted indications. Termination hysterectomy may well be the procedure of choice when pregnancy is to be terminated and when sterilization is required.
A COMPARATIVE STUDY OF BLOOD FIBRINOLYTIC ACTIVITY IN NORMAL WOMEN, PREGNANT WOMEN AND WOMEN ON ORAL CONTRACEPTIVES
Authors: Menon I. Sudhakaran , Peberdy Mary , Rannie G. H. , Weightman Doris , Dewar H. A.
Published: August 2005

A decrease in blood fibrinolytic activity in women taking chlormadinone compared with normal women was found (p<0.01).

The mean fibrinolytic activity in pregnant women was significantly lower than that of normal women, those taking chlormadinone acetate and also those on a combined oestrogen‐progestagen preparation (p<0.001).

No significant difference in fibrinolytic inhibitor content was observed when normal women were compared with pregnant women (p>0.2) and those taking chlormadinone (p>0.3). On the other hand, the women on a combined oestrogen‐progestagen preparation had a lower fibrinolytic inhibitor content than both normal women (p<0.001) and those receiving chlormadinone (p<0.02).
FURTHER DEVELOPMENT AND EXPERIENCE IN AN ACTION LINE METHOD FOR THE MANAGEMENT OF RHESUS ISO‐IMMUNIZATION
Authors: Whitfield C. R. , Lappin T. R. J. , Carson Max
Published: August 2005

The further development of the previously described action line method of determining the time for intrauterine transfusion or delivery in rhesus iso‐immunization has been described. The method is easily interpreted and only occasionally requires more than two amniocenteses. It was used in 407 pregnancies with rhesus isoimmunization completed during a 30‐month period, a further 127 being managed correctly by other criteria.

Correct management along these lines reduced the rhesus mortality rate (including abortions) to 11·6 per cent, and to 9·5 per cent if high risk cases transferred from other rhesus centres are excluded. Reduction in rhesus mortality was particularly striking in first affected pregnancies (3·4 per cent) and when previous babies had required exchange transfusion but had survived (9·6 per cent).

Unnecessary prematurity was almost entirely eliminated in mildly affected and unaffected babies.
RADIOLOGICAL MATURITY OF THE SMALL‐FOR‐DATES FETUS
Authors: Croall J. , Grech P.
Published: August 2005

The accuracy of intrauterine radiological estimates of maturity in 93 fetuses of low birth weight for dates has been assessed.

Ossification delay sufficient to cause a high proportion of misleading underestimates of maturity occurred only in grossly underweight fetuses, viz. those who corrected birthweights were 200 g. or more below the fifth percentile of birthweights. In such cases, reliable X‐ray confirmation of maturity can only be obtained when a lower femoral epiphyseal centre is seen at 36 to 38 weeks. This happened in only one in three cases at 36 to 37 weeks, and in half the cases at 38 weeks.
PROSTAGLANDINS AND SPONTANEOUS ABORTION
Authors: Karim S. M. M. , Hillier K.
Published: August 2005

High concentrations of prostaglandins E2 and F2α have been found in human amniotic fluid following spontaneous abortion at 13–23 weeks gestation. Prosta‐glandin‐like activity is also present in maternal venous blood obtained during spontaneous abortion. Detectable amounts of prostaglandins E2 and F2α were not found in samples of amniotic fluid obtained from women during abdominal termination of pregnancy on therapeutic grounds. The possible role of prostaglandins in premature labour leading to spontaneous abortion is discussed.
UTERINE DISEASE AFTER THE MANCHESTER REPAIR OPERATION
Authors: Tipton R. H. , Atkin P. F.
Published: August 2005

Eighty‐two premenopausal patients treated by the Manchester repair operation were reviewed 6 to 12 years later. Two patients had developed uterine carcinoma, 29 had heavy or painful periods, and 8 had required abdominal hysterectomy. Unwanted pregnancies and the fear of pregnancy were major problems.
THE RELATIONSHIP OF THE SIZE AND COMPOSITION OF THE HUMAN PLACENTA TO ITS FUNCTIONAL CAPACITY
Authors: Garrow J. S. , Hawes Susan F.
Published: August 2005

An analysis was made of placentae from 500 consecutive deliveries of live singleton babies in the Royal Free Hospital, and of a further series of “high risk” patients, so as to bring the combined series to 700 cases.

The mother's age, height, parity, duration and complications of pregnancy, the type of delivery, the sex, birthweight and Apgar score of the child, and the weight and composition of the placenta were recorded and correlated.

Premature deliveries were significantly more common among short mothers, and with male children. Low Apgar scores were more common among babies born before 34 weeks gestation, but after that time there was no apparent relationship between duration of gestation and Apgar score.

The gross weight of the trimmed placenta continued to increase with advancing pregnancy duration, but this was entirely due to increased blood trapping in postmature placentae; the weight of the blood‐free placenta did not increase after term. The blood‐free weight of the placenta of dysmature babies bore approximately the same relationship to the weight of the baby as did that of well‐grown babies, but the dysmature placenta contained a greater proportion of insoluble, and presumably metabolically inert, protein.

It is concluded that to assess functional placental size it is necessary to correct for the amount of blood trapped in the placenta after drainage. However, the assessment of protein solubility is tedious and makes only a minor contribution to the estimation of the functional capacity of the placenta.
AMNIOTIC FLUID UREA AND CREATININE IN NORMAL PREGNANCY AND IN PRE‐ECLAMPSIA
Authors: Roopnarinesingh Syam , Morris David
Published: August 2005

Urea and creatinine concentrations in the amniotic fluid and maternal blood were studied in normal and toxaemic mothers. There was a good correlation between liquor creatinine and duration of pregnancy, but a significant relationship between liquor urea and gestational age was not established. In pre‐eclampsia, levels of urea and creatinine in the amniotic fluid were significantly greater than normal values, at corresponding periods of gestation. These changes in the amniotic fluid were not accompanied by a similar increase in the maternal serum, and are consistent with the concept of a renal origin for this fluid. It is postulated that this trend in pre‐eclampsia reflects the inability of the placenta to fulfil its transfer function.
AMNIOTIC AND URINARY OESTRIOL ASSAYS IN PREGNANCIES COMPLICATED BY RHESUS IMMUNIZATION
Authors: Michie Eileen A. , Robertson John G.
Published: August 2005

Oestriol was measured in 163 samples of amniotic fluid obtained by amniocentesis from 53 rhesus negative women. It was not possible to correlate the oestriol concentration in amniotic fluid shortly before delivery with the severity of haemolytic disease in the five severely affected infants in the series. In only two of eight patients whose infants died in the neonatal period was it possible to assess from the amniotic fluid oestriol results that the fetus was at risk. Five patients who aborted spontaneously before the 26th week of pregnancy generally had low oestriol concentrations in the amniotic fluid prior to abortion.

Eight patients were monitored by serial urinary oestriol assays before and after intrauterine transfusion. The results were helpful in prognosis. Fluctuating and falling levels indicated fetal deterioration while rising levels were associated with successful pregnancies.
OBSERVATIONS ON THE ROLE OF THE FETAL ADRENAL GLAND IN STEROIDOGENESIS DURING DIABETIC PREGNANCY
Authors: Charles D. , Ismail A. A. A. , Loraine J. A.
Published: August 2005

Clinical and endocrinological findings are reported in a patient with diabetes mellitus who was subjected to bilateral adrenalectomy for adrenal hyperplasia and to removal of 80 per cent of the pancreas on account of an islet cell tumour. The patient subsequently became pregnant as a result of treatment with Pergonal (Serono) and human chorionic gonadotrophin (HCG).

During the gestation period levels of HCG did not differ from normal while values for oestrogens and pregnanediol were at the lower end of or below the normal range.

Levels of urinary testosterone and epitestosterone during the pregnancy were considerably higher than in an adrenalectomized subject previously studied, suggesting that, in the presence of maternal diabetes, the main site of elaboration of precursors of these hormones was the fetal adrenal gland.
KIDNEY LENGTH AND URETERIC DILATATION IN THE PUERPERIUM
Authors: Bailey R. R. , Rolleston G. L.
Published: August 2005

Women within one week of delivery had larger kidneys than the normal for their body height. Shrinkage of renal length of 1 cm. occurred over a period of six months. Non‐obstructive dilatation of the lumbar segment of the right ureter was invariably demonstrated in the early puerperium, and dilatation of the left ureter was often present.
ENDOCRINOLOGICAL STUDIES IN WOMEN APPROACHING THE MENOPAUSE
Authors: Adamopoulos D. A. , Loraine J. A. , Dove G. A.
Published: August 2005

Serial assays of urinary FSH, LH, oestrogens and pregnanediol have been performed in 12 subjects approaching the menopause. Six of these women, designated premenopausal, were symptom free, while in the remainder, designated perimenopausal, symptoms of the menopause were present.

LH levels were some seven times higher in women approaching the menopause than in normal young women studied early in reproductive life. The corresponding elevation in FSH output was only three‐fold, and the mean FSH/LH ratios in the premenopausal and perimenopausal groups were 0.43 and 0.29 respectively.

Excretion values for oestrogens and pregnanediol tended to be lower in women approaching the menopause than in younger subjects, and in only 3 out of the 12 patients was there definite evidence on the basis of steroid assays that ovulation had occurred.

In both the pre‐ and perimenopausal subjects high urinary LH levels could co‐exist with oestrogen readings which were within or at the upper end of the normal range, suggesting that at this time of life the feed back mechanisms operating between the pituitary and the ovary are disturbed.

The data reported herein emphasize the differences which occur in endocrine function in late as opposed to early reproductive life.
CHEMOTHERAPY IN THE TREATMENT OF UNDELIVERED HYDATIDIFORM MOLE
Authors: Ma H. K. , Yip S. K. , Chun Daphne
Published: August 2005

Methotrexate and 6‐mercaptopurine given to five cases of undelivered hydatidiform mole brought about degeneration of molar vesicles in utero, which was indicated by a fall in urinary gonadotrophin and a reduction in the size of the uterus. Spontaneous evacuation of the molar tissue occurred in three cases and artificial termination in two. All evacuated and surgical specimens showed various degrees of degeneration of the molar vesicles. In the last follow‐up 28 months later all five patients were alive and well with no evidence of trophoblastic disease.
THE USE OF PROSTAGLANDIN E2 IN THE MANAGEMENT OF INTRAUTERINE DEATH, MISSED ABORTION AND HYDATIDIFORM MOLE
Authors: Filshie G. M.
Published: August 2005

Intravenous infusion of prostaglandin E2 was used successfully to evacuate the uterus in seven cases of intrauterine death, five cases of missed abortion and one case of hydatidiform mole. Haemorrhage associated with hypofibrinogenaemia occurred in one patient with an intrauterine death.
THE SIGNIFICANCE OF THE CHANGES IN THE CONTINUOUS FETAL HEART RATE IN THE FIRST STAGE OF LABOUR
Authors: Beard R. W. , Filshie G. M. , Knight C. A. , Roberts G. M.
Published: August 2005

A comparison between data derived from changes in fetal heart rate and p H of fetal blood in 279 high‐risk patients is described. The incidence of fetal acidosis was low when the continuous record of FHR showed good beat‐to‐beat variation in rhythm and no slowing during uterine contractions. The incidence of fetal acidosis accompanying fetal tachycardia or bradycardia was low if the rate remained unaltered during contractions. Decelerations of fetal heart rate accompanied by baseline tachycardia and/or loss of beat‐to‐beat variation were the changes most commonly associated with fetal acidosis and hence, by inference, with fetal asphyxia. Deep and/or delayed decelerations were also suggestive of fetal asphyxia. Late decelerations, although at first sight innocuous, were frequently found to be a sign of severe fetal asphyxia.
INTENSIVE CARE OF THE HIGH RISK FETUS IN LABOUR
Authors: Beard R. W. , Brudenell J. M. , Feroze R. M. , Clayton S. G.
Published: August 2005

The clinical details of 392 patients who were monitored over one year have been compared with those of unmonitored patients (1569) delivered during this time. Practical problems associated with monitoring are discussed. It has been found that fetal monitoring is a practical procedure on an average labour ward. Clinical management of the mother and fetus based on the results of monitoring has proved safe and has not led to an increase in operative interventions or intrapartum fetal mortality.
NUCHAL ENCIRCLEMENT BY THE UMBILICAL CORD
Authors: Tipton Richard H. , Chang Allan M.
Published: August 2005

Nuchal encirclement by the umbilical cord is a common cause of fetal distress, and may result in neonatal depression and acidaemia. Severe irregularity of the fetal heart gives prolonged warning of the condition. The temporal relationship of transient episodes of bradycardia to uterine contractions is not helpful in differentiating cord entanglement from other causes of fetal hypoxaemia.
CONTINUOUS LOW DOSES OF CLOMAGESTONE IN FERTILITY CONTROL
Authors: El Mahgoub S. , Karim M.
Published: August 2005

Clomagestone (supplied by Sohering, Berlin) 0.75 mg. was given daily for one year to 186 patients known to be fertile. Among 163 patients with complete follow‐up there were four pregnancies and three of them were due to patient failure. The length of cycles 77.5 per cent of the 1725 observed was between 25 and 35 days. Break‐through bleeding and spotting occurred in only 2.9 per cent of cycles. The occurrence of regular menstrual cycles and the results of endometrial and ovarian biopsies suggested that the function of the pituitary ovaries and uterus was not altered to any degree. The cervical mucus was rendered hostile to spermatozoa. Cervical smears revealed no changes suggestive of malignancy. Glucose tolerance and liver function tests were normal after one year of treatment.

Oral contraceptives containing oestrogen and progestogen affect hypothalamic, pituitary and ovarian function and may alter other physiological systems. There is doubt about the safety of these “combined pills” especially with regard to their role in the aetiology of thromboembolic disease. The administration of progestogens only as a method of contraception has therefore been recommended. Progestogens in sufficiently high doses suppress ovulation but in continuously administered low doses may be effective in fertility control without inhibiting ovulation (Rudel, 1964; Rudel et al., 1965; Martinez‐Manautou et al., 1966, 1967; a, b and c; 1969; and Avendano et al., 1970). Clomagestone is a progesterone derivative (6‐chloro‐17 acetoxy‐16 α methyl 1–4, 6 pregnanediene 3–20 dione). The present communication deals with the evaluation of this progestogen as a contraceptive when continuously administered in a daily dose of 0.75 mg.
CONFIGURATION OF THE FETAL ELECTROCARDIOGRAM IN RELATION TO FETAL ACID‐BASE BALANCE AND PLASMA ELECTROLYTES
Authors: Symonds E.M.
Published: August 2005

The configuration and time constants of the fetal electrocardiogram have been analyzed in relation to maternal and fetal acid‐base status and plasma electrolytes in 102 cases in which the fetus was considered to be “at risk”.

Computer analysis of the results showed that fetal acidosis is associated with prolongation of electrical systole (QT) and with T‐wave inversion, and that these changes became better defined at the time of delivery. Similar changes were seen in relation to fetal hyperkalaemia. A comparison of scalp blood pH and corrected QT times has shown that scalp blood pH provides the more reliable method for prediction of fetal condition at birth.

Maternal plasma sodium and potassium concentrations showed a highly significant positive linear correlation with fetal plasma sodium and potassium concentrations. Fetal plasma potassium levels showed a significant negative relationship with fetal blood pH and standard bicarbonate values. In the presence of fetal acidosis the ratio of fetal to maternal plasma potassium concentration increases, and hence a gradient for potassium loss from the fetus develops.
INTERPRETATIVE ASPECTS ON THE ACID‐BASE COMPOSITION AND ITS VARIATION IN FETAL SCALP BLOOD AND MATERNAL BLOOD DURING LABOUR
Authors: Jacobson Lennart , Rooth Gösta
Published: August 2005

Different acid‐base parameters determined in human fetal scalp blood during normal labour have been studied. In evaluating changes in fetal blood acid‐base components during labour changes in corresponding components in the maternal blood must be considered. A tentative model of the maternal‐fetal acid‐base interaction under normal conditions is presented.

It is stressed that several factors, such as time delay in transplacental transport of charged ions, and plasma water movements between different fluid compartments in the mother and the fetus as well as across the placenta, are still not very much understood and deserve further investigation before a proper evaluation of the potential clinical validity and value of fetal scalp blood sampling can be made.
ANTEPARTUM HAEMORRHAGE OF UNCERTAIN ORIGIN
Authors: Willocks James
Published: August 2005

A review of 307 cases of antepartum haemorrhage of uncertain origin occurring in a six‐year period (1964–69) confirms that the fetal risk in these cases is related to prematurity. Departure from a previous policy of routine induction of labour at 38 weeks did not cause fetal loss. Review of 189 cases of abruptio placentae occurring during the same period failed to show any case in which induction at 38 weeks on the grounds of previous antepartum haemorrhage would have prevented fetal loss, and it is concluded that such treatment is unnecessary in patients with a history of a previous minor episode of antepartum haemorrhage not due to placenta praevia.
NEONATAL ACIDAEMIA RELATED TO PROCRASTINATION AT CAESAREAN SECTION
Authors: Fothergill R. J. , Robertson A. , Bond R. A.
Published: August 2005

The clinical and biochemical state of infants delivered by elective Caesarean section has been investigated. The results have been related to the duration of anaesthesia to which the fetus was exposed.

In the group with a prolonged interval between induction of anaesthesia and delivery the Apgar scores were lower than in the other cases.

Evidence is presented which suggests that prompt delivery after induction of general anaesthesia is better for the infant than when long induction‐delivery times are accepted. The acid‐base state of the newborn infants was significantly less favourable in the “slow” than in the “fast” cases. The possible causes for the trend towards infant acidaemia in the “slow” cases are discussed.
MELANOTIC CYST OF THE OVARY
Authors: Anderson M. C. , McDicken I. W.
Published: August 2005

A case of an unusual, benign, melanotic cyst of the ovary is described. Its relationship with the so‐called “retinal anlage” tumour and its histogenesis are discussed.
46 XX KARYOTYPE IN FOUR TISSUES OF A TRUE HERMAPHRODITE
Authors: Dewhurst C. J. , Haines R. M. , Lucas Mary , Delhanty Joy
Published: August 2005

Chromosome examination of blood, skin, ovary and testis in a true hermaphrodite revealed only a 46 XX karyotype. Since the sex of upbringing and sexual orientation were entirely male the ovary and uterus were removed and the patient continued in the male role.
VAGINAL ADENOSIS: CLINICAL AND PATHOLOGICAL FEATURES WITH SPECIAL REFERENCE TO MALIGNANT CHANGE
Authors: Blaikley J. B. , Dewhurst C. J. , Ferreira H. P. , Lewis T. L. T.
Published: August 2005

Six cases of vaginal adenosis have been described. In two of them adenocarcinoma of the vagina was present; in one of these clear transition from benign adenosis to carcinoma was evident whilst in the other the association of benign mucous glands with the carcinoma strongly suggests that the latter arose from the former. The first of these patients survived for nine years free from disease and the second died of metastases after 7 years. In a third patient it was thought that early malignant change might be present. Despite the absence of treatment, however, no obvious change has occurred in the lesion over three years and smears have remained negative. The most prominent presenting symptom in the remaining cases was a mucoid vaginal discharge; other important symptoms include dyspareunia and postcoital bleeding. Treatment is discussed.
SERUM PROTEINS IN NORMAL PREGNANCY AND MILD PRE‐ECLAMPSIA
Authors: Minchin Clarke H. G. , Freeman T. , Pryse‐Phillips W.
Published: August 2005

Twelve serum proteins were measured by quantitative immuno‐electrophoresis in 40 patients; 20 normal, uncomplicated pregnancies, and 20 corresponding gravidae with evidence of mild pre‐eclampsia. Results from the two groups were compared and each contrasted with a group of 30 normal non‐pregnant women, aged 16–45 years.

α1‐lipoprotein, haptoglobin and haemopexin show no significant variation from normal.

α1 antitrypsin, α1 easily precipitable glycoprotein, GC globulin and caeruloplasmin are raised significantly above the normal level (P = 0.001) in both normal pregnancy and pre‐eclampsia.

Transferrin is also raised significantly in normal pregnancy (P = 0.01) and in pre‐eclampsia (P = 0.001).

α2macroglobulin, β1AC (C13) and β‐lipoprotein are significantly raised in pre‐eclampsia only–α2M (P = 0.01); β1AC (P = 0.001) and βLP (P = 0.01).

The only protein to show a significant difference between normal pregnancy and pre‐eclampsia is β1AC which is a little higher in pre‐eclamptic toxaemia (P = 0.5). These results are not affected by pairing the groups according to age, parity and weeks of gestation.
A COMPARATIVE STUDY OF ENERGY EXPENDITURE IN SOME COMMON DAILY ACTIVITIES OF NON‐PREGNANT AND PREGNANT CHINESE, MALAY AND INDIAN WOMEN
Authors: Banerjee B. , Khew K. S. , Saha N.
Published: August 2005

Twenty‐five pregnant Chinese women (11 during both second and third trimester and 14 in third trimester only) and 17 non‐pregnant Chinese women, 14 third‐trimester pregnant and 10 non‐pregnant Malay women, and 14 third‐trimester pregnant and 10 non‐pregnant Indian women were tested for energy cost during rest and under various common daily activities. It was found that the third trimester pregnant women of all three races expended significantly more energy per minute than the respective control groups during rest and in the majority of common daily activities such as sitting and reading, sitting and writing, ironing and washing small clothes. But it was also observed that the percentage increase of expenditure over resting metabolism in every activity was more in non‐pregnant controls than in pregnant women indicating that the pregnant women performed tasks in a more relaxed and economical way than the non‐pregnant controls. Eleven pregnant Chinese women expended in varying degrees more energy per minute in the third trimester pregnancy than in the second. (The body weights of the present pregnant groups were lower than the European standard.)
A CLINICAL AND RADIOLOGICAL ASSESSMENT OF FETAL AGE
Authors: Martin R. H. , Higginbottom James
Published: August 2005

Clinical measurement of the thigh in the newborn child of gestational age 30 to 43 weeks reveals that linear growth occurs at approximately 3 mm. per week. This information was used to measure the length of the femur of the fetus in utero, using standard X‐ray equipment. From this a prediction as to gestational age was made with a range of accuracy, at worst, of just less than two weeks and, at best, within the actual week of gestation.
THE EFFECTS OF PROSTAGLANDINS E2 AND F2α ADMINISTERED BY DIFFERENT ROUTES ON UTERINE ACTIVITY AND THE CARDIOVASCULAR SYSTEM IN PREGNANT AND NON‐PREGNANT WOMEN
Authors: Karim S.M.M. , Hillier K. , Trussell R. R.
Published: August 2005

Prostaglandin E2 and prostaglandin F2α both stimulate the intact non‐pregnant and pregnant human uterus. Doses required to provide long lasting stimulation when given by intravenous, subcutaneous and intramuscular routes had no effect on the cardiovascular system. Both the non‐pregnant and the pregnant uterus during early pregnancy showed a similar sensitivity to prostaglandin E2 and prostaglandin F2α. The non‐pregnant uterus was not inhibited by prostaglandin E2at any dose level.
THE EFFECT OF DEXAMETHASONE ON THE URINARY EXCRETION OF STEROIDS DURING PREGNANCY
Authors: Charles David , Pinkus Jack L. , Fanous Raouf , Chattoraj Sati C.
Published: August 2005

The urinary excretion of oestriol, total 17‐oxosteroids, pregnanediol and Pettenkofer chromogens were studied in eight pregnancies before, during and after the administration of dexamethasone. Both the oestriol and 17‐oxosteroid levels declined during the period of drug administration. The change in Pettenkofer chromogens was less consistent but generally paralleled the 17‐oxosteroid values. Pregnanediol excretion greatly increased in three subjects, decreased in one and was relatively unchanged in the other patients. The present studies support the concept that placental pregnenolone is utilized by the fetal tissues for the biosynthesis of oestrogen precursors and by the placenta for progesterone synthesis.
TALC AND CARCINOMA OF THE OVARY AND CERVIX
Authors: Henderson W. J. , Joslin C. A. F. , Griffiths K. , Turnbull A. C.
Published: August 2005

An extraction‐replication technique was used to examine tissue from patients with ovarian and cervical tumours. In both conditions talc particles were found deeply embedded within the tumour tissue. The close association of talc to the asbestos group of minerals is of interest.
PLASMA FACTOR IX LEVELS AND ORAL CONTRACEPTION
Authors: Elder M. G. , Hakim C. A. , Hawkins D. F.
Published: August 2005

Groups of patients were given conventional oestrogen‐progesterone oral contraceptives cyclically, or daily doses of chlormadinone acetate 0.5 mg. or norethisterone 0.35 mg., continuously, for six months. No changes in plasma coagulation factor IX were detected.
MARGINAL CIRCULAR HAEMATOMA DISRUPTING THE CHORIONIC PLATE OF THE PLACENTA
Authors: Howorka Edward , Kapczyński Witold
Published: August 2005

An unusual case of a large marginal circular haematoma of the placenta is described. Over a large area the haematoma disrupted the placenta, separating the chorionic plate with its great vessels and the insertion of the umbilical cord from the rest of the placental chorion. It is thought that the haematoma was produced by a prolonged strong contraction of the upper segment in which the major portion of the placenta was sited.
FAMILIAL MEDITERRANEAN FEVER, AMYLOIDOSIS AND ECLAMPSIA
Authors: Graff G. , Sharf M.
Published: August 2005

A case of eclampsia secondary to pre‐existing renal amyloidosis due to familial Mediterranean fever is presented.
THERAPEUTIC ABORTION AND INDUCTION OF LABOUR BY THE INTRAVAGINAL ADMINISTRATION OF PROSTAGLANDINS E2 AND F2α
Authors: Karim S. M. M. , Sharma S. D.
Published: August 2005

In 45 women pregnancy was terminated in the first and second trimesters and in 10 labour was induced at term by the intravaginal administration of prosta‐glandins E2 and F2α. With prostglandin E2 the average induction‐abortion interval in 30 women was 12½ hours, and in the 15 women in whom abortion was induced with prostaglandin F2α the average induction‐abortion interval was 14 hours 50 minutes.
MEDICAL INDUCTION OF LABOUR
Authors: Lilienthal C. M. , Ward J.P.
Published: August 2005

The effectiveness of inducing labour with intravenous oxytocics without surgical rupture of the membranes has been studied in 154 cases.

The mean successful induction‐delivery interval was 70 hours, and the mean induction‐delivery interval for all attempted inductions was 186 hours.

Most patients had multiple infusions. Only 47 per cent were delivered within 24 hours and 32 per cent were not delivered within 72 hours. Twelve per cent of cases were classified as “failed”.

The Caesarean section, premature delivery and perinatal mortality rates were comparable with those for other modes of induction. The postpartum haemorrhage rate of 18.2 per cent was exceedingly high.
A RAPID METHOD FOR THE MEASUREMENT OF OESTRIOL IN PREGNANCY PLASMA BY COMPETITIVE PROTEIN BINDING ANALYSIS
Authors: Corker C. S. , Naftolin F.
Published: August 2005

A simple and rapid (4 hour) method for the measurement of oestriol in pregnancy plasma is described. The method utilizes the technique of competitive protein binding analysis and requires 0.2 ml. of plasma or less for each estimation. One technician can process 40 or more specimens in one day. Serial samples can be analyzed as they become available. Information about precision, accuracy, specificity, and sensitivity are presented. The method has been used to assay oestriol in amniotic fluid and should be equally applicable to measurements of urinary oestriol excretion.
PLASMA OESTRIOL IN PREGNANCY
Authors: Macourt D. , Corker C.S. , Naftolin F.
Published: August 2005

Total plasma oestriol in pregnancy was estimated by a competitive protein binding method. The advantages of the measurement of plasma oestriol levels over the 24‐ or 48‐hour urinary oestriol assays are discussed. The pattern of plasma oestriol levels in the third trimester of pregnancy was investigated in over 400 healthy women and in general a uniform increase was found from the 28th week until term. Diurnal variation was found to be present, but this did not preclude the use of the method for assessing the feto‐placental unit. Exercise and meals had a minimal effect on the oestriol levels. Following delivery the level decreased sharply to reach, within four hours, one‐half that found just prior to delivery.
MATERNAL MORTALITY FROM CAESAREAN SECTION IN INFECTED CASES*
Authors: Gogoi M. P.
Published: August 2005

The treatment of 158 grossly infected patients in late labour has been reviewed. The morbidity and mortality following Caesarean section in such cases is high compared to vaginal delivery by destructive operation. Vaginal delivery by destructive operation in skilled hands is safer, although cases have to be carefully judged and selected. Caesarean section is not refused if the fetus is alive even in the presence of infection and it is the best method of treatment when the lower segment is on the verge of rupture, even if the fetus is dead.
POSTURE AND APPARENT PLASMA VOLUME IN LATE PREGNANCY
Authors: Chesley LeonC. , Duffus GillianM.
Published: August 2005

Two consecutive measurements were made of the T‐1824 space (apparent plasma volume) in each of 37 women in late pregnancy, one after lying supine for an hour and the other after lying on one side for an hour. Most of the patients were alternated with regard to the initial position. The supine position had three effects. (1) It usually decreased the apparent plasma volume. (2) Mixing of the dye often was not complete within the first ten minutes. (3) After the women turned on to their sides the optical densities of their sera usually increased, sometimes markedly.

When the women lay on their sides their apparent plasma volumes usually were greater than while they lay supine and mixing of the dye was complete within ten minutes.

The first two effects of the supine position vitiate estimates of the plasma volume during late pregnancy if they are made while the patient is lying on her back and they may explain, in part, the alleged decrease in plasma volume during the last weeks of gestation.
BARORECEPTOR REFLEX FUNCTION IN PRE‐ECLAMPSIA
Authors: Seligman S. A.
Published: August 2005

In normotensive pregnancy control of the arterial pressure by the baroreceptor reflex is set at a high level of sensitivity.

The baroreceptor reflex sensitivity is diminished in chronic hypertension both in the nonpregnant and pregnant.

In pre‐eclampsia there is interference with baroreceptor function. This is implicated in the instability of the blood‐pressure in this condition and in the lower degree of fall of blood pressure during sleep. The loss of baroreceptor function is not due to the raised level of the blood pressure.