bluuebunny/crossref_metadata_2025 huggingface dataset:
DIAGNOSTIC VALUE OF THE UNSTRESSED ANTEPARTUM CARDIOTOCOGRAM
Authors: Visser G. H. A. , Huisjes H. J.
Published: August 2005

The unstressed antepartum cardiotocogram (CTG) is principally judged by two aspects: baseline irregularity, and reaction to Braxton Hicks contractions and fetal movements. A classification into normal, sub‐optimal, decelerative, and terminal CTG was devised. The ominous significance of the terminal CTG was confirmed in 26 patients; nine of the fetuses died in utero and the other 17 were delivered by elective Caesarean section; only one newborn was neither small‐for‐dates nor acidaemic. The significance of the other three categories was evaluated in 428 patients in whom labour was induced. All patients with repeated decelerative antepartum CTG showed signs of fetal distress during labour and most of them required Caesarean section; patients with a normal or sub‐optimal CTG rarely showed signs of fetal distress during labour. The incidence of growth retardation was 41 per cent in the combined decelerative and sub‐optimal groups against 9 per cent in the normal group. In comparing these results with studies of the oxytocin challenge test, it was concluded that, except in the case of a sub‐optimal CTG, the oxytocin challenge test has no place in obstetrics.
THE EFFECT OF INTRAVENOUS SALBUTAMOL UPON PLASMA AND URINARY POTASSIUM DURING PREMATURE LABOUR
Authors: Smith S. K. , Thompson D.
Published: August 2005

Plasma potassium and urinary potassium excretion were measured in eight patients in premature labour treated with salbutamol, and in ten patients at full term in spontaneous labour. There was a significant fall in plasma potassium concentration following salbutamol infusion, but no change during labour in the control groups. Urinary potassium excretion was similar in both groups.
EFFECT OF BROMOCRIPTINE ON THE PREMENSTRUAL SYNDROME. A DOUBLE‐BLIND CLINICAL TRIAL
Authors: Andersen A. N. , Larsen J. F. , Steenstrup O. R. , Svendstrup Birgit , Nielsen J.
Published: August 2005

Twenty‐one patients suffering from the premenstrual syndrome were each studied during three menstrual cycles. After a control cycle, bromocriptine and placebo were given during the luteal phase of the cycle in a random double‐blind cross‐over manner, each patient serving as her own control. The dosage of bromocriptine was 2·5 mg twice daily. Serum prolactin levels were found to be equal during the follicular and luteal phases, except when reduced by bromocriptine. Serum progesterone and oestradiol‐17‐β were within normal ranges, and did not change during treatment. Medication considerably improved all the premenstrual symptoms, but mastodynia was the only one where bromocriptine was significantly better than the placebo.
POLYCYSTIC OVARIAN DISEASE: DIAGNOSIS, FREQUENCY AND SYMPTOMS IN A GENERAL GYNAECOLOGICAL PRACTICE
Authors: Declercq J. A. , van de Calseyde J. F.
Published: August 2005

A study was undertaken to assess the relative frequency of polycystic ovarian disease (POD) among patients with menstrual irregularities and/or hirsutism, and was based on 24‐hour urinary steroid profiles under basal conditions, after dexamethasone suppression and after human chorionic gonadotrophin (HCG) stimulation. The final diagnosis was confirmed by laparoscopy or laparotomy and ovarian histology. Fifty‐six patients were studied, 38 (68 per cent) of whom had POD. Laboratory results were subjected to multivariate discriminant analysis and a discriminant function was calculated to classify patients into POD and non‐POD subgroups. Steroid profiling under basal conditions was sufficient to classify most of the patients into one of three groups: normal, POD, and other endocrinopathies. Of the patients with POD, 70 per cent had an abnormal reaction to dexamethasone or HCG. Significant differences were found in the steroid profiles of ovulating and non ovulating patients with POD.
INTRAUTERINE GROWTH RETARDATION ASSOCIATED WITH HYPOXIA DUE TO BRONCHIECTASIS
Authors: Templeton A.
Published: August 2005

Two pregnancies in a young patient who had undergone lobectomy for bronchiectasis are described. Both were complicated by intrauterine growth retardation. The only abnormality detected was maternal hypoxaemia, and this was assumed to be causal.
RUPTURED RENAL ARTERY ANEURYSM IN PREGNANCY CASE REPORT
Authors: Saleh Y. Z. , McLeod F. N.
Published: August 2005

A patient who survived rupture of a renal artery aneurysm in pregnancy is described. The aneurysm was caused by fibromuscular dysplasia of the renal artery.
NORTH‐EAST ESSEX PERINATAL MORTALITY SURVEY—1971 TO 1975
Authors: Owen J. D.
Published: August 2005

A method of carrying out a Perinatal Mortality Survey in a non‐academic district obstetric service is described. The results show a trend of improving perinatal mortality and the various factors that may be influencing this trend are discussed.
PREGNANCY HEARTBURN IN NIGERIANS AND CAUCASIANS WITH THEORIES ABOUT AETIOLOGY BASED ON MANOMETRIC RECORDINGS FROM THE OESOPHAGUS AND STOMACH
Authors: Bassey O. O.
Published: August 2005

A study by questionnaire of the incidence of pregnancy heartburn in two groups of Nigerians and one group of Caucasians showed an incidence of 9·8 per cent in all Nigerians as against 78·8 per cent in Caucasians. The difference was highly significant (x2= 102·75; P<0·0001). An oesophageal manometric study of the lower oesophageal sphincter in 12 non‐pregnant women and in 12 pregnant Nigerians (10 without heartburn and 2 with heartburn) showed that the mean lower oesophageal sphincter pressure (±SD) in the pregnant patients without heartburn was 20·1 ±7·0 mm Hg as against 17·9 ±7·0 in the non‐pregnant women. While one pregnant subject without heartburn had a lower oesophageal sphincter which was partially displaced into the thorax, none of the non‐pregnant women had such sphincter displacement. The two pregnant women with heartburn had low resting sphincter pressures and in both of them the sphincters were partially in the thorax. It is argued that pregnancy heartburn is due to the displacement of the lower oesophageal sphincter into the negative pressure environment of the thorax where the sphincter is less capable of resisting reflux. It is also argued that pregnancy heartburn is commoner in Caucasians than in Nigerians because the sphincter in non‐pregnant Caucasians is often partly intrathoracic and is thus more easily displaced completely into the thorax by the pregnant uterus.
LARGE AIRWAYS FUNCTION DURING NORMAL PREGNANCY
Authors: Milne J. A. , Mills R. J. , Howie A. D. , Pack A. I.
Published: August 2005

Specific airways conductance and forced expiratory volume in one second were measured monthly from the first trimester until term in 30 subjects in the course of a normal pregnancy. Measurements were also made in the postpartum period. There was no significant change in these measurements either throughout pregnancy or compared with postpartum values. Our results suggested that the function of the larger pulmonary airways was not altered in pregnancy.
A STUDY OF THE EFFECTS OF BROMOCRIPTINE ON SERUM PROLACTIN, FOLLICLE STIMULATING HORMONE AND LUTEINIZING HORMONE AND ON OVARIAN RESPONSIVENESS TO EXOGENOUS GONADOTROPHINS IN ANOVULATORY WOMEN
Authors: Pepperell R. J. , Evans J. H. , Brown J. B. , Bright Margaret I. , Smith Margery A. , Burger H. G. , Healy D.
Published: August 2005

Twelve anovulatory patients with normal serum prolactin values and six with elevated values were treated with bromocriptine and the effects on serum prolactin, FSH and LH levels were recorded. Ovulation resulted in one patient who had normal prolactin values and in all six who had raised values. No patient with normal basal prolactin values showed an increase in serum FSH during therapy with bromocriptine, whereas 5 of the 6 patients with elevated values showed significant increases. Similar results were obtained for LH. Although these differences were highly significant (P<0·005) the majority of the serum FSH and LH values remained within the normal ranges. Five patients with normal basal prolactin values and one with elevated values were also treated with human pituitary gonadotrophin (HPG). An increase in ovarian responsiveness to HPG during therapy with bromocriptine was recorded in the one patient with initially elevated prolactin values. It was concluded that bromocriptine acts by allowing FSH to rise above threshold requirements for follicular stimulation.
OUTPATIENT LAPAROSCOPIC STERILIZATION
Authors: Keeping J. D. , Smith I.
Published: August 2005

summary

A prospective survey is described of 200 consecutive patients who had outpatient laparoscopic sterilizations by coagulation and division of the Fallopian tubes. The procedures were acceptable to patients, free of morbidity or complications and made minimal demands on the existing hospital services.
FETAL HEART RATE PATTERNS AND UTERINE ACTIVITY AFTER SEGMENTAL EPIDURAL ANALGESIA
Authors: Jouppila P. , Jouppila R. , Käär K. , Merilä M.
Published: August 2005

The effects of low‐dose segmental epidural analgesia on fetal heart rate (FHR) patterns, uterine activity, and some clinical features were examined in a series of 105 normal parturients. The aim of the analgesic technique was to relieve pain during the first stage of labour by blocking the sensory nerve fibres at the spinal level of T 10 to T 12, with either 0·5 per cent bupivacaine or bupivacaine with adrenaline 1 : 200 000, the dose varying from 10 to 25 mg. Obvious pathological changes (late decelerations, prolonged fetal bradycardia, variable deceleration, or loss of beat to beat variation) in FHR patterns within the first 30 minutes after the beginning of analgesia were noted in 9 per cent of the patients. Addition of adrenaline to the analgesic agent seemed to reduce uterine activity for 60 minutes after the analgesia and this was reflected in a longer interval between the block and delivery. A 25 per cent fall in systolic blood pressure was recorded in 11 per cent of the patients. Nine patients required vacuum extractions. Our results show that the epidural technique employed has distinct advantages over the previous methods, which require larger doses of the analgesic agent, and is therefore safer for the fetus; the addition of adrenaline to the analgesic agent is contraindicated.
TUBERCULOSIS OF THE FEMALE GENITAL TRACT—A CHANGING PICTURE
Authors: Hutchins C. J.
Published: August 2005

Twenty‐one patients with tuberculosis of the female genital tract are presented, and the clinical features, method of diagnosis and treatment are discussed. The condition affected an older group of patients than described earlier, and often took the form of chronic infection with abscess formation.
METHODS OF RECORDING FETAL MOVEMENT
Authors: Wood C. , Walters W. A. W. , Trigg P.
Published: August 2005

Patient, observer and instrumental methods for recording fetal movements are described. Significant correlations between both patient and observer, and patient and instrumental fetal movement counts, were found. Significant diurnal, daily and weekly variation in fetal movement counts occurred which need to be considered in the interpretation of the frequency of fetal movements as an indication of fetal welfare.
SCREENING FOR FETAL NEURAL TUBE DEFECTS BY MATERNAL PLASMA ALPHA‐FETOPROTEIN DETERMINATION
Authors: Clarke P. C. , Gordon Y. B. , Kitau M. J. , Chard T. , Letchworth A. T.
Published: August 2005

A total of 5539 consecutive pregnant patients at three maternity units in the City and Hackney District of London were screened for fetal neural tube defect by measurement of maternal plasma alpha‐fetoprotein (AFP) levels. Only 25·7 per cent of women booked at 16 to 22 weeks, the optimum time for this screening test; 54·1 per cent booked before 16 weeks and 20·2 per cent after 22 weeks. Of the women tested before 23 weeks, 300 had elevated levels of AFP in plasma and 14 of them had fetuses with abnormalities known to cause a rise in AFP levels (12 fetuses had a neural tube defect and 2 had alimentary tract abnormalities). Of women examined before 23 weeks, half of those with twin pregnancies had elevated levels of plasma AFP as did 16·7 per cent of those who ultimately had a spontaneous abortion.
EVALUATION OF MEASUREMENT OF MATERNAL PLASMA ALPHA‐FETOPROTEIN LEVELS AS A SCREENING TEST FOR FETAL NEURAL TUBE DEFECTS
Authors: Bond E. B. , Thompson W. , Elwood J. H. , Cran G. W.
Published: August 2005

Maternal plasma alpha‐fetoprotein (AFP) levels were estimated on 1844 consecutive patients at the time of their first hospital antenatal visits. There were 28 pregnancies with an ‘abnormal’ outcome: 19 patients had twins, 3 had an anencephalic fetus, and 6 a fetus with a spina bifida (4 of these had an open neural tube defect). Evaluation of maternal plasma AFP levels as a screening test for neural tube defects at 15 to 19 weeks gestation indicated a sensitivity of 50 per cent taking the‘cut‐off’point as the 95th centile of the plasma AFP levels in pregnancy with a normal outcome.
A REVIEW OF 50 PREGNANT PATIENTS WITH KYPHOSCOLIOSIS
Authors: Kopenhager T.
Published: August 2005

An analysis of the obstetric and medical complications in 50 pregnant kyphoscoliotic patients is presented.
CHANGES IN THE CONCENTRATION OF CORTISOL IN AMNIOTIC FLUID AFTER INTRA‐AMNIOTIC PROSTAGLANDIN FOR MIDTRIMESTER ABORTION
Authors: MacKenzie I. Z. , Pooley Georgina , Challis J. R. G.
Published: August 2005

The effects of intra‐amniotic prostaglandin E2 (PGE2) and PGF2a on the concentration of cortisol in amniotic fluid and in maternal peripheral plasma of patients undergoing abortion between 16 and 23 weeks gestation have been examined. There was a significant (P≤0·01) increase in the concentration of cortisol in amniotic fluid four hours after PGE2, but not after PGF2a. The concentration of cortisol in the maternal peripheral plasma increased in both groups with the progression of abortion, but the levels were not significantly correlated with those in amniotic fluid. These results suggest that by mid‐pregnancy fetal cortisol production can be stimulated by PGE2 but the mechanism of this action remains to be elucidated.
ANTIBODY ACTIVITY TO TYPE 1 AND TYPE 2 HERPES SIMPLEX VIRUS IN HUMAN CERVICAL MUCUS
Authors: Coughlan B. M. , Skinner G. R. B.
Published: August 2005

Neutralizing antibody activity in cervical mucus to type 1 herpes virus was detected in 24 of 28 patients, and to type 2 herpes simplex virus in 18 of 24 patients. The neutralizing antibody activity resisted heat inactivation for 30 minutes at 56·C, was independent of complement and followed first order kinetics. There was evidence of antibody against both virus types in immunoglobulin fractions IgG and IgA, the latter containing approximately threefold greater neutralizing antibody activity per unit of immunoglobulin concentration. Type 1 and type 2 neutralizing antibody activity showed a positive but weak correlation and a type‐common immunoprecipitin was identified in all concentrated pooled mucus samples. However, type‐specific neutralizing antibody against both virus types was identified in pooled mucus samples by heterologous absorption techniques. There was a relatively higher average type 2 neutralizing antibody activity in the mucus than in the serum and there was no correlation between serum and mucus antibody levels for either virus type. These observations support the concept of an independent local antibody system for herpes simplex virus in the uterine cervix.
EFFECT OF MATERNAL GLUCOSE INGESTION ON FETAL BREATHING AND BODY MOVEMENTS IN LATE PREGNANCY
Authors: Lewis P. J. , Trudinger B. J. , Mangez J.
Published: August 2005

Fetal breathing movements and fetal whole body movements were observed over 2 hours in 22 normal singleton pregnancies between 34 and 38 weeks gestation using a real time ultrasonic B scan method. The proportion of time fetuses spent making breathing movements increased from 9.9 per cent to 48.3 per cent within one hour of their fasting mothers taking a 50 g glucose drink. Fetal whole body movements were not increased after maternal glucose ingestion. Arousal of the fetal central nervous system seems dependent on the level of fetal blood glucose.
THE EFFECT OF PREGNANCY AND TWO DIFFERENT CONTRACEPTIVE PILLS ON SERUM LIPIDS AND LIPOPROTEINS IN A WOMAN WITH A TYPE III HYPERLIPOPROTEINAEMIA PATTERN
Authors: Muller D. P. R. , Pavlou C. , Whitelaw A. G. L. , McLintock D.
Published: August 2005

We report a woman who had a moderate elevation of serum triglycerides with a type III pattern of hyperlipoproteinaemia when taking a normal diet. She developed eruptive xanthomata with a grossly raised serum triglyceride concentration and chylomicronaemia when pregnant and also when taking a combined oral contraceptive pill containing 50 μg of oestrogen. The xanthomata cleared and the triglyceride level fell when the combined oral contraceptive pill was changed to one with a lower oestrogen content, clofibrate was prescribed and the diet was restricted in carbohydrate and fat. Persistent chylomicronaemia is a serious complication of pregnancy because of the risk of pancreatitis and the potential risk of fetal malnutrition. Treatment with diet and clofibrate is indicated. High oestrogen‐containing contraceptive pills appear to be contraindicated in patients with type III or other hypertriglyceridaemic states.
INHIBITION OF LACTATION AND INHIBITION OF PROLACTIN RELEASE AFTER MECHANICAL BREAST STIMULATION IN PUERPERAL WOMEN GIVEN TAMOXIFEN OR PLACEBO
Authors: Masala A. , Delitala G. , Lo Dico G. , Stoppelli I. , Alagna S. , Devilla L.
Published: August 2005

Tamoxifen was given orally to 60 puerperal women to inhibit lactation. Twenty control puerperal women were given placebo. Fifteen women receiving tamoxifen and 15 women receiving placebo were studied before, during and after the use of a breast pump under basal conditions and after five days of treatment. Tamoxifen was effective in inhibiting lactation; no rebound phenomena were observed. Its administration was free from side effects. This drug was capable of preventing the prolactin release induced by mechanical breast stimulation. Placebo failed to inhibit lactation and had no effect on prolactin release induced by the use of a breast pump.
SERUM PROLACTIN, GONADOTROPHIN AND OESTROGEN LEVELS IN WOMEN RECEIVING HORMONE REPLACEMENT THERAPY
Authors: Lind T. , Cameron E. H. D. , Hunter W. M.
Published: August 2005

Prolactin, oestrone, oestradiol, FSH and LH concentrations have been determined in postmenopausal women receiving different forms of hormone replacement therapy. While the serum oestrogen levels achieved were sufficient to cause a significant decrease in circulating FSH and LH levels, no significant change in prolactin concentrations was found. Two other findings are of interest: despite the absolute concentrations achieved, the ratio of FSH to LH and the ratio of oestradiol to oestrone did not change significantly on any of the hormone formulations used; and while FSH and LH were both suppressed to a significant degree on therapy neither was suppressed to premenopausal values suggesting the possibility of a ‘female inhibin’ in the normal regulation of gonadotrophin secretion.
SPONTANEOUS VOIDING AFTER SURGERY FOR URINARY INCONTINENCE
Authors: Stanton S. L. , Cardozo Linda , Chaudhury Nasreen
Published: August 2005

Eighty patients with urinary incontinence were treated by colposuspension and bladder neck plication. Fourteen patients had difficulty in establishing normal micturition postoperatively. Of these, 10 patients took longer than 21 days to void and had reduced peak urine flow rates after surgery; the other four patients voided within ten days of surgery but had reduced peak urine flow rates before and after surgery and all had residual urines in excess of 100 ml following surgery. The value of the preoperative diagnosis of pre‐existent bladder dysfunction by symptomatology and the peak urine flow rate is discussed.
HAEMORRHAGE INTO THE ANTERIOR PITUITARY DURING PREGNANCY AFTER INDUCTION OF OVULATION WITH CLOMIPHENE
Authors: Nagulesparan M. , Roper J.
Published: August 2005

A 34‐year‐old woman with secondary amenorrhoea and primary infertility became pregnant after treatment with clomiphene. She developed pre‐eclampsia. Visual symptoms were experienced due to rapid enlargement of the anterior pituitary gland. The patient was delivered by Caesarean section. At subsequent craniotomy the patient was found to have haemorrhage into the pituitary gland, but histological examination of the pituitary tissue which was removed revealed no tumour tissue. One year after delivery the patient was still amenorrhoeic and had galactorrhoea with hyperprolactinaemia indicating that she probably had a small pituitary adenoma which was incompletely removed during neurosurgery.
NEONATAL ELECTROCARDIOGRAPHIC CHANGES IN RELATION TO CARDIOTOCOGRAPHIC CHANGES
Authors: Hökegård K.‐H. , Karlsson K. , Lilja H. , Rosén K. G.
Published: August 2005

Electrocardiograms (ECG) were made immediately after delivery in 28 infants with normal cardiotocographic patterns in labour and in 29 with abnormal patterns. Changes in the S‐T segment and T‐wave were quantified in a scoring system. High and peaked T‐waves (high T/QRS‐ratios) were significantly more common in the group with abnormal cardiotocographic patterns. The infants with ECG‐changes also had significantly lower Apgar scores and more neonatal complications. The immediate postpartum ECG seems to be a useful indication of the accumulated hypoxic stress to which the child has been subjected in labour.
METABOLIC EFFECTS OF BETA‐SYMPATHOMIMETIC DRUGS AND DEXAMETHASONE IN NORMAL AND DIABETIC PREGNANCY
Authors: Borberg C. , Gillmer M. D. G. , Beard R. W. , Oakley N. W.
Published: August 2005

Marked hyperglycaemia and hyperinsulinaemia were observed in two normal women in premature labour treated with an intravenous infusion of a β‐sympathomimetic drug and intramuscular dexamethasone injections. Similar therapy in a chemical diabetic patient caused diabetic ketoacidosis, while treatment of an insulin dependent diabetic with dexamethasone alone resulted in a major increase in her insulin requirements. It is suggested that the diabetogenic effects of β‐sympathomimetic drugs and dexamethasone may be additive and that regular plasma glucose estimations should be made when they are used, especially in patients with impaired glucose tolerance.
THE SIGNIFICANCE OF A LOW AMNIOTIC FLUID CREATININE AND A MATURE LECITHIN/SPHINGOMYELIN RATIO
Authors: Jenkins D. T. , Wishart M. M.
Published: August 2005

Creatinine levels were measured in 546 specimens of amniotic fluid with a lecithin/ sphingomyelin ratio of 2.5 or more. With amniotic fluid creatinine levels below the normal range, 3 of 6 infants had major congenital abnormalities and two had severe rhesus isoimmunization; 3 of the infants died. Of 514 cases with amniotic fluid creatinine levels within the normal range (mean±2 SD), 13 babies (2.5 per cent) had major congenital abnormalities but only one of the babies died, giving a perinatal mortality rate of 0.2 per cent. The significance of these findings is discussed.
CYCLIC CHANGES IN THE CONCENTRATION OF PROSTAGLANDIN F2α IN HUMAN UTERINE FLUSHINGS
Authors: Maathuis J. B.
Published: August 2005

Prostaglandin F2α (PGF2α) was measured by radioimmunoassay in uterine flushings obtained from 41 women at various stages of the menstrual cycle. The concentration of PGF2α changed significantly during the cycle, with highest values in the mid secretory phase of the cycle (mean 9.1 ng/ml of uterine flushing, range 3.9 to 16.0 ng/ml, n = 9). The still unresolved role of intrauterine PGF2α is discussed in relation to luteolysis, myometrial contractility and implantation.
TESTOSTERONE IN THE MOLAR VESICLE FLUID AND THECA‐LUTEIN CYST FLUID
Authors: Chew P. C. T. , Ratnam S. S. , Goh H. H.
Published: August 2005

Testosterone was estimated by radioimmunoassay in molar vesicle fluid in 41 patients and theca‐lutein cyst fluid in three patients with hydatidiform moles. The testosterone concentration in the molar vesicle fluid ranged from 0.4 ng/ml to 28.1 ng/ml with a mean±SEM of 6.0±1.0 ng/ml while in the theca‐lutein cyst fluid, it ranged from 4.7 ng/ml to 23.5 ng/ml. Oestradiol‐17β and human chorionic gonadotrophin (HCG) were also estimated in the molar vesicle fluid. The oestradiol‐17β concentration ranged from 0.1 ng/ml to 26.2 ng/ml with a mean±SEM of 10.7±1.1 ng/ml. HCG concentration ranged from 18 000 to 150000 mIU/ml with a mean±SEM of 49 800 ± 5 000 mIU/ml. A positive correlation was found between testosterone and oestradiol‐17β (r =+0.37; P<0.01) but not between testosterone and HCG (r = 0.32; 0.1>P>0.05). Our findings suggest that molar trophoblast is the major source of testosterone.
CELL‐MEDIATED IMMUNITY IN PREGNANT PATIENTS WITH AND WITHOUT A PREVIOUS HISTORY OF SPONTANEOUS ABORTIONS
Authors: Garewal G. , Sehgal S. , Aikat B. K. , Gupta A. N.
Published: August 2005

The percentage of T‐cells was studied in pregnant patients with a previous history of spontaneous abortions, in patients without such a history and in nonpregnant controls. The percentage of T‐cells remained unaltered during the three trimesters of normal pregnancy. In patients with a previous history of spontaneous abortions, the T‐cell percentages were lower in the second and third trimesters than in non‐pregnant controls, but the values did not differ statistically from corresponding values in those patients with no previous history of spontaneous abortion (normal pregnancy). The phytohaemagglutinin (PHA)‐induced transformation of lymphocytes was depressed in the second and third trimesters of both patients with a normal pregnancy and those with a previous history of spontaneous abortions. Thus, while the percentage of T‐cells remained unaltered during pregnancy, their response to PHA falls in the second and third trimesters.
WATER RELATIONS OF EARLY EMBRYOGENESIS
Authors: GOOD W .
Published: August 2005

Attention is drawn to the changes in maternal serum osmolality that accompany ovulation, fertilization and early embryogenesis, and the possible significance of those changes is discussed in relation to the sequence of development. From these considerations it is tentatively concluded that maternal hydration influences all stages of early development, and that transient derangement of maternal body fluid regulation could, therefore, be a significant factor in the aetiology of fetal malformations.
DYSPNOEA DURING NORMAL PREGNANCY
Authors: Milne J. A. , Howie A. D. , Pack A. I.
Published: August 2005

The incidence, severity and time‐course of dyspnoea were assessed in 62 women on eight occasions throughout a normal pregnancy. Fifteen per cent of subjects noticed an increase in dyspnoea in the first trimester compared with the non‐pregnant state and in almost half of them dyspnoea was experienced before 19 weeks gestation; 76 per cent complained of this symptom by 31 weeks gestation. After this time, few subjects noticed any increase in their symptoms.
THE RELEVANCE OF ANTENATAL AND INTRAPARTUM FETAL HEART RATE PATTERNS TO FETAL OUTCOME
Authors: Liu D. T. Y. , Blackwell R. J. , Tukel S.
Published: August 2005

Antenatal fetal heart rate (FHR) as an indicator of fetal status was evaluated in two separate studies. The first attempted to determine, in 30 minutes of continuous recording from each of 50 antenatal patients, relationships between spontaneous FHR changes and fetal condition before and after birth. No significant association was found between observed FHR patterns and antenatal or neonatal fetal status. The second study used induction of labour as a stress test, because similar conditions to that required for oxytocin stress testing were present and there was the advantage of direct FHR recording. In 150 induced and monitored labours, FHR changes associated with the first six suitable contractions seldom related to Apgar scores at birth or development of fetal distress in active labour. Fetuses showing no response to contractions tended to have better Apgar scores than those which showed FHR decelerations. Results from these studies do not substantiate reports that FHR changes arising spontaneously, or in response to induced contractions, reflect satisfactorily the existing or subsequent fetal status.
MATERNAL PLASMA AND AMNIOTIC FLUID PROLACTIN LEVELS IN NORMAL AND HYPERTENSIVE PREGNANCY
Authors: Yuen B. Ho , Cannon Wendy , Woolley Suzanne , Charles Ellen
Published: August 2005

Prolactin levels in the plasma and amniotic fluid of 121 normal pregnant women, 78 women with pre‐eclampsia and 30 women with essential hypertension complicating pregnancy were determined by radioimmunoassay. Mean prolactin levels in plasma, but not in amniotic fluid, were significantly lower than controls in the group with pre‐eclampsia (P<0.01) and in the group with essential hypertension (P<0.05). These findings suggest altered production and/or clearance of prolactin from the maternal compartment in these patients and may explain their increased response to pressor agents.
NITROUS OXIDE TRANSFER ACROSS THE PLACENTA AND CONDITION OF THE NEWBORN AT DELIVERY
Authors: Hay Douglas M.
Published: August 2005

Nitrous oxide transfer to the fetus was measured in 14 consecutive patients having a Caesarean section near term. Better babies, as assessed by birth weight and Apgar score at five minutes, were associated with better transfer of nitrous oxide. The correlation was probably attributable to differences in placental blood flow, although it is not possible to prove this.
CORD BLOOD HYPERTRIGLYCERIDAEMIA AS AN INDEX OF FETAL STRESS: USE OF A SIMPLE SCREENING TEST AND RESULTS OF FURTHER BIOCHEMICAL ANALYSIS
Authors: Elphick M. C. , Harrison A. T. , Lawlor J. P. , Hull D.
Published: August 2005

In this preliminary study, 120 cord blood samples were subjected to a simple on‐the‐ward triglyceride screening procedure and 15 were designated as being high and another 15 randomly selected as controls. All the samples were then subjected to detailed biochemical analysis for fatty acid profiles and/or concentrations of free fatty acids, triglycerides (TG), phospholipids, cholesterol esters and glycerol. Eleven of the samples designated ‘high’ were associated with one or more of the following clinical conditions: family history of ischaemic heart disease, maternal starvation, fetal distress, light‐for‐dates babies and excessive weight gain during pregnancy. There was an association between high TG levels and high glycerol levels. The fatty acid pattern of the TG was altered when at abnormally high concentration, in particular oleic acid was increased relative to the others, and this was associated with an increase in cholesterol ester oleic acid. The possible mechanisms resulting in cord hypertriglyceridaemia are discussed.
A SIX‐POINT SCORING SYSTEM FOR ANTENATAL CARDIOTOCOGRAPHS
Authors: Pearson J. F. , Weaver Judith B.
Published: August 2005

A six‐point scoring system for antenatal cardiotocography based upon baseline fetal heart rate (FHR) and FHR response to fetal movements and Braxton‐Hicks contractions has been described and tested in 89 patients. The ‘six‐point score’ obtained within 24 hours of delivery or death of the fetus (D—1) was shown to be strongly associated both with the one‐minute Apgar score and the nutritional status of the infant as reflected by centile birth weight. In 21 patients whose D—1 ‘six‐point score’ was 4 or less, analysis of the cardiotocographs performed on the previous day (D—2) showed that 14 infants already showed evidence of hypoxia. In the remaining seven patients, however, the previous day's six‐point score had been normal (5 or 6); in six of these patients a persistently low daily fetal movement count or placental abruption led to repeat cardiotocography. Hypoxia affected the three components of the score in a progressive manner. Firstly there were alterations in the response of the FHR to Braxton‐Hicks contractions followed by changes in the FHR response to fetal movements. Finally, fetal movements ceased and baseline FHR changes occurred mainly in the form of a tachycardia. The method of scoring was simple to use and could standardize reporting.
A CONTROLLED TRIAL OF PUNCTURE SITES FOR AMNIOCENTESIS
Authors: Leach G. , Chang A. , Morrison J.
Published: August 2005

A controlled trial to determine a better site for amniocentesis was carried out over a 6‐month period, involving 98 obstetric patients. The suprapubic and nuchal puncture sites for amniocentesis were compared. The failure rate was found to be lower when the suprapubic site was used, and no significant difference in morbidity was found in the two groups.
THE SITE OF UMBILICAL CORD INSERTION AND BIRTH WEIGHT
Authors: Woods D. L. , Malan A. F.
Published: August 2005

The site of the insertion of the umbilical cord into the placenta was determined in 940 consecutive term infants. No relation was found between birth weight and whether the cord was inserted centrally, eccentrically or marginally.
EFFECT OF MATERNAL DEXAMETHASONE THERAPY ON THE LEVELS OF OESTROGENS, PROGESTERONE AND CHORIONIC GONADOTROPHIN IN AMNIOTIC FLUID AND MATERNAL SERUM
Authors: Ylikorkala O. , Dawood M. Y. , Kauppila A. , Tuimala R.
Published: August 2005

Ten women were given dexamethasone intramuscularly in order to accelerate fetal lung maturation. Amniotic fluid and maternal serum were assayed for oestrone, oestradiol‐l7β, oestriol, progesterone and chorionic gonadotrophin by specific radioimmunoassays before and after the treatment. No hormonal changes were observed in amniotic fluid. The serum levels of oestrogens 2 to 5 days after treatment were not significantly different from those before treatment, indicating that the previously reported suppression of oestrogen production by glucocorticoids disappears rapidly after treatment stops.
PLASMA NON‐ESTERIFIED FATTY ACIDS, CORTISOL AND GLUCOSE IN MATERNAL BLOOD DURING ABORTION INDUCED WITH INTRA‐AMNIOTIC PROSTAGLANDIN F2α
Authors: Ward H. , Whyley G. A. , Fairweather D. V. I.
Published: August 2005

Serial estimations were made of plasma non‐esterified fatty acids (NEFA) and glucose in 43 patients, and of plasma cortisol in 27 patients, during mid‐trimester abortions induced with intra‐amniotic prostaglandin F2α (PGF2α). The mean plasma concentrations of NEFA, cortisol and glucose showed rises after PGF2α. There was no relation between these rises and the induction‐delivery interval, signs of fetal distress or of intrauterine fetal death. The changes in plasma NEFA were related to the fasting level and there was an inverse relation between the changes and the patients'weight. A positive correlation existed between the change in plasma concentrations of cortisol and glucose.
CIRCULATING LEVELS OF ALPHA‐FETOPROTEIN AND PREGNANCY SPECIFIC β1 GLYCOPROTEIN IN PREGNANCIES WITHOUT AN EMBRYO
Authors: Bennett M. J. , Grudzinskas J. G. , Gordon Y. B. , Turnbull A. C.
Published: August 2005

Ten patients with depressed serum alpha‐fetoprotein (AFP) levels at 14 to 15 weeks gestation were found to have no embryo on ultrasonography: two patients had hydatidiform moles and the remainder had anembryonic pregnancies (blighted ova). The pregnancy specific β1 glycoprotein (SP1) levels in serum were measured in all these ten patients. Seven of the eight patients with anembryonic pregnancies and one of the two patients with molar pregnancies had low serum SP1, levels. These observations suggest that the measurement of AFP and SP1 may provide biochemical evidence of pregnancy without an embryo.
THE EFFECTS OF LONG‐TERM THERAPY WITH OESTRIOL UCCINATE ON THE HAEMOSTATIC MECHANISM IN OSTMENOPAUSAL WOMEN
Authors: Toy J. L. , Davies J. A. , Mcnicol G. P.
Published: August 2005

In a previous report we showed that oestriol succinate administered to post‐menopausal women caused fewer changes in haemostatic function over a four‐month period than ethinyloestradiol. Potential longer‐term effects were studied in postmenopausal women treated for osteoporosis with oestriol succinate for up to 12 months. Over this period there was no significant change in concentration of plasma coagulation factors, an increase in plasminogen concentration and euglobulin lysis activity, and an inconsistent increase in platelet sensitivity to aggregation induced by ADP and collagen. The relative lack of effect of oestriol succinate on coagulation function is encouraging with regard to the future incidence of thromboembolic complications of therapy.

We thank the Special Trustees of the General Infirmary, Leeds, for their financial support. Organon Laboratories Limited gave generous financial assistance and provided oestriol succinate tablets. We are grateful to Professor B. E. C. Nordin for allowing us to study patients under his care. Mrs G. Fieldhouse, Mrs B. Griffin, Mrs A. Spencer and Mr J. Leek gave valuable technical assistance.
THE PERCENTAGE OF GRANULOCYTE‐LIKE CELLS IN HUMAN OVIDUCT EPITHELIUM
Authors: van Bogaert L.‐J. , Maldague P. , Staquet J. P.
Published: August 2005

The ratio of granulocyte‐like cells to epithelial cells was examined in the fimbriae, ampullary and isthmic regions of oviducts obtained from normal women of reproductive age, from postpartum women, from menopausal women, from women on combined oral contraceptives and from women with adnexal pathology. Only patients on oral contraceptives had a significantly high percentage of granulocyte‐like cells as did one patient with acute salpingitis.
SUCCESSFUL PREGNANCY IN A 44‐YEAR‐OLD HAEMODIALYSIS PATIENT
Authors: Sheriff M. H. R. , Hardman M. , Lamont C. A. R. , Shepherd R. , Warren D. J.
Published: August 2005

A 44‐year‐old patient had been treated by intermittent haemodialysis for almost three years when she presented with a 28‐week pregnancy. Successful delivery of a healthy but small infant was achieved by Caesarean section at 36 weeks. The successful outcome of this pregnancy was attributed to close control of the haemoglobin concentration and blood chemistry, and to increased frequency of dialysis. The relative value of various chemical tests of fetal maturity in the presence of maternal renal failure are discussed.

We are grateful to Dr J. Durant for help with hormone assays and their interpretation and to our nursing staff for their careful support.
PLASMA STEROID CHANGES IN PRE‐TERM LABOUR IN ASSOCIATION WITH SALBUTAMOL INFUSION
Authors: Bibby J. G. , Higgs S. A. , Kent A. P. , Flint A. P. F. , Mitchell M. D. , Anderson A. B. M. , Turnbull A. C.
Published: August 2005

Serial measurements of peripheral plasma concentrations of progesterone and oestradiol‐17β were made in 23 women with singleton pregnancies who were given intravenous salbutamol in an attempt to inhibit pre‐term labour. Mean levels of both hormones fell significantly during salbutamol infusion but returned to pre‐treatment levels after therapy was stopped. Plasma human placental lactogen concentrations did not change during salbutamol infusion, suggesting that the fall in steroid hormone levels was unlikely to be an effect of altered uterine or placental blood flow.
VAGINAL PROSTAGLANDIN E2 IN THE MANAGEMENT OF FETAL INTRAUTERINE DEATH
Authors: Southern E. M. , Gutknecht G. D. , Mohberg N. R. , Edelman D. A.
Published: August 2005

The results of a multicentre clinical trial of prostaglandin E2 (PGE2) administered by the vaginal route in the management of intrauterine fetal death and missed abortion showed an overall efficacy of 97 per cent. The mean induction‐abortion interval was 10·7 hours with a mean total dose of 60·4 mg of PGE,. Side effects were tolerated well and there was no evidence of significant alterations in hepatic or renal function.
TOTAL AND FREE CORTISOL IN AMNIOTIC FLUID DURING LATE PREGNANCY
Authors: Björkhem I. , Lantto O. , Lunell N.‐O. , Pschera H.
Published: August 2005

Total cortisol levels were measured in 81 samples of amniotic fluid obtained from 72 patients in the third trimester of pregnancy; 19 of them had pre‐eclampsia and the remainder had no pre‐eclampsia, hypertension or renal disease. In accordance with previous studies, there was a rise in the concentration of amniotic fluid cortisol with advancing gestation; the rise was steepest after 40 weeks, the amniotic fluid cortisol levels invariably being above 700 nmoI/I between 41 and 43 weeks of pregnancy. Amniotic fluid cortisol may thus be of value in diagnosing postmaturity. A relatively low correlation was found between total cortisol levels and lecithin/sphingomyelin ratios in amniotic fluid unless results were ranked for gestational age. Total cortisol concentrations in amniotic fluid obtained from patients with pre‐eclampsia were significantly higher than in controls. The concentration of free cortisol in amniotic fluid changed much less than total cortisol. Thus total cortisol should be measured in studies of the fetal capacity to synthesize corticosteroids.
COMPARISON OF PLASMA STEROID AND GONADOTROPHIN PROFILES IN SPONTANEOUS CYCLES IN WHICH CONCEPTION DID AND DID NOT OCCUR
Authors: Sobowale O. , Lenton Elizabeth A. , Francis B. , Cooke I. D.
Published: August 2005

Luteinizing hormone (LH), follicle stimulating hormone (FSH), oestradiol and progesterone were measured in plasma from blood samples obtained daily throughout 23 menstrual cycles in a total of 18 normal women. Eight of these women were trying to conceive at the time of investigation and five succeeded. The subjects were divided into those who were not exposed to pregnancy (Group I), those who became pregnant (Group II) and those who were trying to become pregnant but failed to do so (Group III). The mean profiles of each of the four hormones were similar for the three groups studied. Statistical comparisons (using ‘t’ tests) between Groups II and III showed that FSH concentrations were significantly lower (P<0·01) in the late follicular phase (Days —7 to —3 before the LH peak) in Group III. Similarly, progesterone concentrations were significantly lower (P<0·05) during the early luteal phase (Days +3 to +7 after the LH peak) in Group III.

The willing co‐operation of all the women who took part in this study is gratefully acknowledged. We are also grateful to Miss L. Brook, Mrs L. Sexton, Mrs D. Cocker, Mrs J. 0. Southall and Mr R. Tovey for skilled technical assistance and to Miss B. McNeill for typing the manuscript. This study was supported in part by the Medical Research Council.
FETAL HAZARDS OF THE INTRAUTERINE PRESSURE CATHETER: FIVE CASE REPORTS
Authors: Trudinger B. J. , Pryse‐Davies J.
Published: August 2005

Five patients with fetal complications associated with the use of an intrauterine pressure catheter in labour are described. In four, a fetal vessel was punctured either by the catheter or its introducing sheath. In the remaining patient, cord compression resulted from entanglement with the catheter. These problems may by minimized by a careful catheter introduction technique.
MATERNAL PLASMA ALPHA‐FETOPROTEIN SCREENING FOR FETAL NEURAL TUBE DEFECTS
Authors: Brock D. J. H. , Scrimgeour J. B. , Steven J. , Barron Lillas , Watt Muriel
Published: August 2005

Maternal plasma alpha‐fetoprotein (AFP) screening for fetal neural tube defects (NTD) was used as a part of routine antenatal care in three hospitals over a 26 month period. Blood samples were obtained for plasma AFP measurement at 15 to 20 weeks gestation from 6377 women, representing 79 per cent of antenatal bookings. The outcome of pregnancy was ascertained in 96 per cent of patients: 13 cases of anencephaly and 7 of open spina bifida were detected by plasma screening and a further 3 cases of open NTD through the mother's previous medical history and amniotic fluid determination. Four fetuses with open NTDs and four with closed NTDs were not detected by plasma AFP measurement and the detection efficiency for open NTDs was thus 83 per cent. Integration of screening into the existing pattern of antenatal care required only minor alterations in clinic schedules. Some extra time was needed for explanation of the objectives of the study, for ultrasound examination and for amniocentesis. Eight patients declined the offer of a plasma test, while only one refused an amniocentesis.
MATERNAL SERUM ALPHA‐FETOPROTEIN AND BIRTH WEIGHT IN TWIN PREGNANCIES
Authors: Wald N. J. , Cuckle H. , Stirrat G. M. , Turnbull A. C.
Published: August 2005

In 102 twin pregnancies the mean birth weight of each pair showed a statistically significant negative association with maternal serum alpha‐fetoprotein (AFP) levels early in pregnancy. Women with AFP levels of four or more times the median value for singleton pregnancies gave birth to infants with a median birth weight 660 g less than that of infants born to women with AFP levels between 1·0 and 1·5 times the median for singleton pregnancies. Maternal serum AFP has been shown to be an early predictor of low birth weight delivery in singleton pregnancies. Our results indicate that this is also true in twin pregnancies.
SIMPLIFIED MANAGEMENT OF PREGNANCY COMPLICATED BY DIABETES
Authors: Cassar J. , Gordon H. , Dixon H. G. , Cummins M. , Joplin G. F.
Published: August 2005

Simple methods for the management of pregnancy complicated by diabetes are described. Emphasis was placed on keeping patients out of hospital, good control of diabetes and vaginal delivery at 38 weeks: using these methods, there were nine perinatal deaths in a consecutive series of 101 pregnancies complicated by diabetes. Four of the perinatal deaths were due to the respiratory distress syndrome. The patients whose diabetes was diagnosed during pregnancy had significantly heavier babies (18 pregnancies, mean birth weight 3337 g) than the established diabetics (83 pregnancies, mean weight 301 1 g) despite significantly lower fasting blood glucose levels in the former and similar mean gestational ages at delivery. Mean fasting blood glucose levels for the whole series during the first, second and third trimesters were 9·0, 6·7 and 5·6 mmol/l respectively. The mean duration of antenatal stay in hospital for complications related to diabetes was 29 days. Diabetic retinopathy did not seem to be adversely affected by pregnancy.
HYPOVOLAEMIA, PRE‐ECLAMPSIA AND DIURETICS
Authors: Maclean A. B. , Doig J. R. , Aickin D. R.
Published: August 2005

Six patients with severe pre‐eclampsia were found to have low central venous pressures. This was considered to be an indication that hypovolaemia was present, despite concurrent generalized oedema. Treatment with sufficient intravenous saline and albumin, to restore the central venous pressure to normal, resulted in improved renal function and avoidance of permanent renal impairment in all cases. These observations support the view that diuretics should not be administered to patients with pre‐eclampsia.
THE PASSAGE OF FAT EMULSION ACROSS THE HUMAN PLACENTA
Authors: Elphick M. C. , Filshie G. M. , Hull D.
Published: August 2005

Six patients near term were given an intravenous infusion of a fat emulsion (Intralipid) a few hours before normal delivery or Caesarean section. Six other non‐infused patients were studied as controls. Maternal venous and umbilical venous and arterial blood samples were taken at delivery and analyzed for individual fatty acid concentrations in triglyceride, free fatty acid (FFA) and phospholipid fractions. The emulsion, being rich in oleic and linoleic acids, affected the composition of the maternal triglycerides. The fetal lipids were also altered and the infusions resulted in large positive umbilical venous‐arterial (v‐a) differences in FFA and triglyceride fatty acid concentrations, but this was not the case for phospholipid concentrations. The fatty acids with the largest v‐a differences were those prominent in the emulsion.
THE EFFECT OF SEX STEROIDS ON THE IN VITRO SYNTHESIS OF DNA BY MALIGNANT OVARIAN TUMOURS*
Authors: Darwish D. H.
Published: August 2005

The deoxyribonucleic acid (DNA) synthesis of 12 ovarian tumours was studied by means of short term organ tissue culture, exposure to tritiated thymidine and subsequent autoradiography and visual grain counting. The DNA synthesis in each tumour was studied before and after exposure to 12 separate hormone combinations. It was found that any combination of 17β‐oestradiol with either of the two progestogens used had greater inhibitory potential than when any of three hormones tested was used alone.