bluuebunny/crossref_metadata_2025 huggingface dataset:
ENGAGEMENT OF THE FETAL HEAD IN PRIMIGRAVIDAE AND ITS RELATIONSHIP TO DURATION OF GESTATION AND TIME OF ONSET OF LABOUR
Authors: Weeks A. R. L. , Flynn M. J.
Published: August 2005

In a retrospective survey on the time of engagement of the fetal head in 462 unselected consecutive primigravidae it was seen that by the end of the 37th week of gestation (259 days), engagement had occurred in only 23 per cent of them. The highest rate of engagement was from 39 to 40 weeks of gestation (273 to 280 days) and in 50 per cent of patients, engagement occurred between 38 and 42 weeks (266 to 294 days). The mean interval between engagement and delivery was 1–39 weeks (9.7 days), the median was 7 days, and the mode was less than 7 days. In 80 per cent of patients the engagement‐delivery interval was less than 14 days. These findings strongly suggest that in the majority of primigravid patients the fetal head does not engage between 36 and 38 weeks of gestation (252 to 266 days) as is commonly believed.
RELATIONSHIP BETWEEN CONTINUOUS FETAL HEART RATE PATTERNS AND APGAR SCORE IN THE NEWBORN
Authors: Bissonnette J. M.
Published: August 2005

The relationship between the continuous fetal heart rate pattern in the first stage of labour and the one‐minute Apgar score of the newborn was examined in 714 patients. The highest incidence of fetal depression (one‐minute Apgar score less than 7) was observed with the late deceleration pattern and with variable deceleration associated with an abnormal baseline. Variable deceleration with a normal baseline and loss of beat‐to‐beat variation, both complicated and uncomplicated, were associated with infants with a low Apgar score to a greater degree than were the other patterns.
TREATMENT OF STRESS INCONTINENCE BY A FIBRIN BIOPLAST
Authors: Horn Bela , Kover Jozsef , Marton Istvan
Published: August 2005

A new simple method of treating urinary stress incontinence is to fix a fibrin implant vaginally to the bladder neck and upper urethra. The support provided by the implant is maintained after its resorption by the fibrous tissue which replaces it. The two‐year cure rate in 85 patients was 93 per cent.
SUCCESSFUL PREGNANCY AFTER CONSERVATIVE SURGERY AND RADIOTHERAPY FOR DISGERMINOMA OF THE OVARY
Authors: McCarthy T. G. , Milton P. J. D.
Published: August 2005

A 19‐year‐old patient was treated for disgerminoma of the right ovary by right salpingo‐oophorectomy and pelvic radiotherapy in 1967. The left ovary was shielded after the first two treatments and the patient has since conceived three times and has shown no evidence of recurrence of the tumour.
GYNANDROBLASTOMA OF THE OVARY
Authors: Anderson M. C. , Rees D. A.
Published: August 2005

A gynandroblastoma of the ovary in a 17‐year‐old girl is reported. Primary amenorrhoea, hirsuties and slight clitoral enlargement were associated with the tumour and high levels of circulating testosterone were found. This is the first gynandroblastoma in which Reinke crystalloids have been identified in the Leydig cell component. The criteria for the diagnosis of this tumour and its histogenesis are discussed.
CYTOLOGICAL DIAGNOSIS OF A PRIMARY MALIGNANT MELANOMA OF THE VAGINA
Authors: Victro Lewis B. , Chapman Patricia A.
Published: August 2005

The cytological appearances of a primary malignant melanoma of the vagina are described. A diagnosis of melanocarcinoma, made from smears showing malignant cells with melanin pigment in their cytoplasm, was confirmed histologically.
AN EPIDEMIOLOGICAL STUDY OF RECENT TRENDS IN ECTOPIC PREGNANCY
Authors: Beral Valerie
Published: August 2005

Data from two independent sources in England and Wales, the first based upon persons discharged from hospital and the second upon general practitioner consultations, indicate that the incidence of ectopic pregnancy has been increasing since the late 1950s, with a particularly sharp increase since 1970. Time trends in the age and regional distribution of ectopic pregnancy suggest that the increasing use of intrauterine contraceptive devices may be a major factor contributing to this recent increase in extrauterine gestations. In contrast, recent age and regional trends in tubal infection appear to be unrelated to the trends in ectopic pregnancy. The possible contribution of progestogen‐only contraceptives, induced abortion and tubal surgery to the recent increase in extrauterine pregnancy cannot be assessed from the available data.
AMINO ACID COMPOSITION OF AMNIOTIC FLUID IN INTRAHEPATIC CHOLESTASIS OF PREGNA4NCY, PRE‐ECLAMPSIA AND RHESUS INCOMPATIBILITY
Authors: Ylöstalo P. , Tuderman L. , Kuutti E.‐R. , Järvinen P. A.
Published: August 2005

The levels of free amino acids in amniotic fluid were determined in twenty patients with normal pregnancy, five with intrahepatic cholestasis of pregnancy, twelve with pre‐eclampsia, and four with rhesus incompatibility. In pre‐eclampsia there was no significant change in the amino acid composition of the amniotic fluid. In recurrent intrahepatic cholestasis the concentration of 15 out of the 22 amino acids studied was significantly higher than normal and the mean concentration of 4 others was more than 20 per cent above normal without this being statistically significant. In rhesus incompatibility there was a significant decrease in the concentration of 13 amino acids, and a decrease of more than 20 per cent in the mean concentration of 5 others.
THE DISTRIBUTION OF PLACENTAL LACTOGEN IN THE HUMAN TERM PLACENTA
Authors: Gau Gillian , Chard T.
Published: August 2005

Serial frozen sections of human term placentae were examined by quantitative morphology and, after extraction, by a radioimmunoassay for human placental lactogen (HPL). The total quantity of HPL in the placenta was estimated as 720 mg. The amount of HPL was related to the amount of trophoblast in any area, but otherwise did not vary in different parts of the placenta. A semi‐logarithmic relationship was observed between the amount of HPL and the percentage trophoblast in a section. It is suggested that the amount of HPL in a given area of the placenta is related to the blood‐flow in that area.
PLASMA OESTRADIOL AND PROGESTERONE ESTIMATION FOR THE MONITORING OF INDUCTION OF OVULATION WITH CLOMIPHENE AND CHORIONIC GONADOTROPHIN
Authors: Swyer G. I. M. , Radwanska Ewa , Mcgarrigle H. H. G.
Published: August 2005

Two hundred and thirty‐five courses of treatment with clomiphene and human chorionic gonadotrophin (HCG) were administered for the induction of ovulation in 75 infertile women (three with primary amenorrhoea, 45 with secondary amenorrhoea and 27 with oligomenorrhoea) of whom 61 had previously been unsuccessfully treated with clomiphene alone. The treatment was monitored by plasma oestradiol estimations on day 15 and day 22 in 103 cycles and by plasma progesterone estimations on day 22 in all 235 cycles. Injections of HCG were given on days 15 and 22. Twenty patients failed to respond to treatment (43 courses). The remaining 55 patients showed no response in 32 courses, deficient responses in 55 cycles and adequate responses in 105 cycles (plasma progesterone level exceeding 10 ng per ml on day 22). The mean values (±D) of plasma oestradiol on day 15, reflecting follicular development, were: 73±30 pg per ml for cycles with no response; 255±182 for deficient cycles and 366±226 pg per ml for adequate cycles. There was a positive correlation (r =0±57) between day 15 plasma oestradiol and day 22 plasma progesterone values. Increased clomiphene dosage resulted in higher plasma oestradiol and progesterone levels. Thirty‐nine pregnancies occurred in 34 out of 55 patients capable of response (62 per cent). The plasma progesterone levels during conception cycles were higher than those in non‐conception cycles in the same patients. Monitoring of induction of ovulation by plasma hormone estimations allows detection and correction of inadequate response.
PITUITARY RESPONSIVENESS TO SYNTHETIC LUTEINIZING HORMONE RELEASING HORMONE (LH‐RH) DURING THE MENSTRUAL CYCLE AND IN FEMALE HYPOGONADISM
Authors: Nakano R. , Kotsuji F. , Tojo S.
Published: August 2005

The pituitary responsiveness to synthetic luteinizing hormone releasing hormone (LH‐RH) in female patients with primary and secondary hypogonadism was tested and compared with that in normal women with regular menstrual cycles. A 200 μg dose of synthetic LH‐RH was injected intravenously into 15 normal menstruating women, 8 patients with primary hypogonadism and 5 patients with secondary hypogonadism and the serum luteinizing hormone (LH) and follicle stimulating hormone (FSH) response to LH‐RH was investigated using double‐antibody radioimmunoassay. In normal women, the LH response to LH‐RH in the pre‐ovulatory phase was greater than that seen in the follicular (p<0.05) and luteal phases (p<0.05) of the menstrual cycle. In contrast, no significant difference in the FSH response was demonstrated among the three different phases of the cycle. The serum LH response to LH‐RH in primary hypogonadism was greater than that in the follicular (p<0.01) and luteal phases (p<0.0l) of the cycle. The serum FSH response in primary hypogonadism was markedly greater than that in the follicular (p<0.01), preovulatory (p<0.0l) and luteal phases (p<0.0l) of the menstrual cycle. Conversely, the LH levels after LH‐RH administration in secondary hypogonadism were significantly lower than in the follicular (p<0.01), preovulatory (p<0.0l) and luteal phases (p<0.01) of the cycle. The FSH response in secondary hypogonadism was slightly below that in the follicular phase (p<0.05). Thus, the FSH response to LH‐RH in primary hypogonadism and the LH response in secondary hypogonadism seemed to be sufficiently characteristic to have diagnostic value.
GANGRENE OF A FETAL LIMB DUE TO AMNIOCENTESIS
Authors: Lamb M. P.
Published: August 2005

An unusual case of fetal damage after amniocentesis in the second trimester is described.
THE DIAGNOSIS OF EARLY PREGNANCY FAILURE BY SONAR
Authors: Robinson Hugh P.
Published: August 2005

In a series of 425 consecutive patients examined by sonar in the first half of pregnancy 176 ultimately aborted. On analysis of the sonar and post‐abortion findings it was found that the aborted pregnancies fell into five clearly defined groups; blighted ova or anembryonic pregnancies, missed abortions, hydatidiform moles and early and late live abortions. The blighted ova and the missed abortions comprised by far the largest and the early live abortions the smallest groups. Strict diagnostic sonar criteria of abnormality, independent of menstrual or clinical histories, were established for the first three of the groups, and an absolute diagnosis could be made at the time of the first examination in all cases of missed abortion and hydatidiform mole and in just over half of the cases of blighted ovum, the remainder requiring a second and occasionally a third examination. In the first half of the study the majority of the patients were allowed to abort spontaneously but with increasing confidence in the techniques patients were offered termination whenever the diagnosis of an abortive pregnancy was made. Anticipation of fetal death in utero or impending abortion of a live fetus proved to be a much more difficult problem, and in only those patients who aborted a live fetus before the tenth week of pregnancy did the sonar examination reveal any significant abnormality. Possible aetiological backgrounds to these groups of abortions are discussed in the light of the sonar findings.

I am grateful to Professor Ian Donald for his advice and comments during this investigation and I thank the obstetric consultants of the Queen Mother's Hospital whose patients were included in this study, and Mr J. Devlin and his department for preparing the illustrations. This work was performed under the provisions of a Medical Research Council Programme Grant in the University of Glasgow, with Professor Ian Donald as the Programme Leader.
PROGNOSIS IN THREATENED ABORTION: A COMPARISON: BETWEEN PREDICTIONS MADE BY SONAR, URINARY HORMONE ASSAYS AND CLINICAL JUDGEMENT
Authors: Duff G. B.
Published: August 2005

One hundred patients admitted to hospital with a diagnosis of threatened abortion were assessed by means of sonar, urinary oestrogen, pregnanediol and human chorionic gonadotrophin (HCG) assays and clinical examination. Assay of oestrogen excretion was the most accurate (86.5 per cent) in predicting the ultimate outcome of pregnancy, but did not give as much information as sonar examination which gave an accurate prognosis in 84 per cent of cases and was much quicker to perform. The reasons for the sonar failures are discussed. Assay of urinary pregnanediol excretion gave an accurate indication of outcome in 74 per cent of cases and 24‐hour urinary HCG in 70 per cent although random urinary HCG estimations provided an accurate prediction in only 54.5 per cent of cases. Clinical examination presented the usual difficulties in assessing uterine size and predicting abortion from the amount of bleeding and pain.
CIGARETTE SMOKING IN PREGNANCY: DIFFERENCES IN PERIPHERAL CIRCULATION BETWEEN SMOKERS AND NON‐SMOKERS
Authors: Ashton Heather
Published: August 2005

Ten smokers and ten non‐smokers were followed serially from 12 to 16 weeks of pregnancy to six weeks postnatally. Measurements of calf and foot blood flow and toe and finger skin temperature were made at 4 to 6 week intervals in both groups, and the acute effects on the peripheral circulation of smoking one standard cigarette were also measured in the smokers at each stage of pregnancy. Comparison between the smokers and non‐smokers showed that in the last trimester of pregnancy smokers had significantly higher foot blood flow and toe and finger temperature than non‐smokers. These circulatory variables rose during the period of pregnancy studied in smokers but altered little in non‐smokers. There was no significant difference in calf blood flow between the groups. Smoking a cigarette during pregnancy caused a fall in foot blood flow and in finger and toe skin temperature. Smoking increased calf blood flow between 12 and 25 weeks of pregnancy but decreased it in late pregnancy. Previous investigations of blood flow in pregnancy have not differentiated between smokers and non‐smokers. It is suggested that the rise in foot blood flow and skin temperature believed to occur generally during pregnancy applies mainly to smokers. Some possible reason for differences in skin blood flow between smokers and non‐smokers in pregnancy are discussed.
METABOLISM OF PROSTAGLANDINS WITHIN THE PREGNANT UTERUS
Authors: Keirse M. J. N. C. , Turnbull A. C.
Published: August 2005

The metabolism of E and F prostaglandins has been studied in both fetal and maternal tissues obtained from the pregnant human uterus. Both 15‐hydroxy‐prostaglandin dehydrogenase and 13,14‐prostaglandin reductase are shown to be widely distributed in these tissues. Comparison of the levels of enzyme activity in different tissues demonstrates that the greatest metabolism of prostaglandins takes place in the membranes and placenta and that there is much less in the myometrium and the decidua. The lowest enzyme activity was found in the umbilical cord, and no metabolism could be demonstrated in amniotic fluid or in umbilical venous blood. The significance of these findings is discussed.
AN APPRAISAL OF LUMBAR EPIDURAL BLOCKADE IN LABOUR IN PATIENTS WITH MULTIPLE PREGNANCY
Authors: Crawford J. Selwyn
Published: August 2005

A series of 102 patients with a multiple pregnancy (including three sets of triplets) delivered vaginally is presented. An epidural block was provided for 55 of these patients, and comparisons were made between these patients and those who did not have an epidural block. There was a higher incidence of low Apgar‐minus‐colour (A‐C) scores at one minute among the second twins of at least 36 weeks gestation in the epidural series, but no other remarkable contrasts in the (A‐C) scores of the respective group of infants. In the non‐epidural series two second twins of at least 36 weeks gestational age apparently suffered severe cerebral trauma. Of the 91 liveborn infants in the non‐epidural series, five died (two with intracranial haemorrhage, three with hyaline membrane disease); of the 112 live‐born infants in the epidural series, two died (both with hyaline membrane disease). The incidence of instrumental delivery of infants presenting by the vertex, and of breech extraction, was markedly higher in the epidural series. The mean interval between full dilatation of the cervix and delivery of the first twin was greater in the epidural series, but the mean interval between delivery of the first and second infant was smaller in the epidural series. It is concluded that the provision of an epidural block for labour and delivery to patients with a multiple pregnancy is beneficial to the infants.
THE INFLUENCE OF ABNORMAL GLUCOSE TOLERANCE (HYPERGLYCAEMIA AND HYPOGLYCAEMIA) ON PREGNANCY OUTCOME WHEN OESTRIOL EXCRETION IS SUBNORMAL
Authors: Abell David A. , Beischer Norman A.
Published: August 2005

Subnormal urinary oestriol excretion was present in 611 (13.9 per cent) of 4403 consecutive patients in whom a glucose tolerance test had been performed and urinary oestriol excretion measured during the third trimester of pregnancy. Hypoglycaemia (5th centile) had a significant association with subnormal oestriol excretion. The perinatal mortality rate was significantly higher in the presence of abnormal glucose tolerance when oestriol excretion was low. Normo‐glycaemia was associated with a perinatal mortality rate of 1.7 per cent when oestriol excretion was persistently low, whereas in the presence of hyperglycaemia (95th centile) the perinatal mortality rate was 12.5 per cent (P<0.01) and when there was hypoglycaemia the rate was 14.8 per cent (P<0.001). Small‐for‐dates babies occurred in 46.3 per cent of pregnancies complicated by hypoglycaemia and persistently subnormal urinary oestriol excretion. The advantage of routine urinary oestriol assay and glucose tolerance testing in pregnancy is emphasized.
PROGRESSION IN RESPONSE PATTERNS OF FETAL HEART RATE THROUGHOUT LABOUR
Authors: Liu D. T. Y. , Thomas G. , Blackwell R. J.
Published: August 2005

A study of 70 fetal heart rate (FHR) traces throughout labour has allowed analysis of FHR responses associated with approximately 7000 individual uterine contractions. The significance of the less emphasized FHR patterns has been assessed and an attempt has been made to identify any trend or progression in the occurrence of these patterns. Transient acceleration was the most frequently occurring response in early labour and was the first observed response in the majority of cases. Decelerations became prevalent as labour progressed. A hypothesis is proposed to explain the observed overall progression in FHR responses and the possible physiological mechanisms underlying the cyclic changes in response patterns which occur throughout the course of labour.
SMOKING, HUMAN PLACENTAL LACTOGEN AND BIRTH WEIGHT
Authors: Boyce A. , Schwartz D. , Hubert C. , Cedard L. , Dreyfus J.
Published: August 2005

Human placental lactogen (HPL) was measured in 525 serum samples from 144 pregnant women and related to smoking habits and the birth weight of their infants. Women smoking during pregnancy were found to have a level of HPL significantly lower than the non‐smokers (p<0.05). A significant correlation between HPL and birth weight was found (r = 0.38; p < 0.00l) which remained significant when smoking was held constant (r = 0.35; p < 0.001). There was no relationship between birth weight and smoking when HPL was held constant.
THE EFFECTS OF STILBOESTROL AND QUINESTROL UPON COAGULATION AND FIBRINOLYSIS DURING THE PUERPERIUM
Authors: Howie P. W. , Evans K. , Forbes C. D. , Prentice C. R. M.
Published: August 2005

Two oestrogens, stilboestrol and quinestrol, were used to inhibit lactation and their effects upon coagulation and fibrinolysis were compared with control patients before delivery, during the puerperium and six weeks after delivery. During the first week of the puerperium, stilboestrol therapy was associated with rises of factors IX and X and quinestrol therapy with rises of factors IX and 11. Six weeks after delivery, the clotting factors were similar to the control values in those who had received stilboestrol but factor II was still raised in the quinestrol treated patients. Additionally, a significant rise of factor X in the quinestrol group was noted at this time. Plasma antithrombin levels rose during the first week of the puerperium in all three groups but, six weeks after delivery, they were lower in those who had received oestrogens. Stilboestrol and quinestrol were also associated with a rise of plasminogen and antiplasmin concentration during the first week of the puerperium. Six weeks after delivery, quinestrol treated patients still had raised levels of plasminogen and antiplasmin while the stilboestrol treated patients only had raised levels of antiplasmin. These changes in coagulation and fibrinolysis are similar to those reported during oral contraceptive therapy. The persisting changes six weeks after delivery in women who had taken quinestrol might indicate an increased thrombogenic risk when long acting oestrogen preparations are used to inhibit lactation.
A FOREIGN BODY IN THE RECTUM PRESENTING AS A VULVAL ABSCESS A CASE REPORT
Authors: Aletor G. A.
Published: August 2005

A case of trans‐rectal impaction of a foreign body in the perineum is reported. The importance of rectal palpation during pelvic examination is re‐emphasized.
RELEASE OF LYSOSOMAL ACID PHOSPHATASE INTO THE CYTOPLASM OF DECIDUAL CELLS BEFORE THE ONSET OF LABOUR IN HUMANS
Authors: Gustavii Björn
Published: August 2005

In order to elucidate the mechanism triggering the onset of spontaneous labour, decidual cells obtained at elective Caesarean section at term were studied histologically and cytochemically. Although some of the cells were well preserved, many of them showed degenerative changes and signs of release of the lysosomal marker enzyme acid phosphatase into the cytoplasm indicating lysosomal labilization. Since human decidua contains Iysosomal phospholipase A, an enzyme which specifically removes prostaglandin precursor acids from tissue phospholipids and thereby provides substrate for prostaglandin synthesis, the lysosomal labilization might be of significance in the initiation of labour. It is suggested that this labilization is induced by altered levels of sex steroids.
PALMITIC ACID AND LECITHIN MEASUREMENTS IN AMNIOTIC FLUID
Authors: Moore R. A. , O'Neil K. T. J. , Cooke R. J. , MacLennan A. H.
Published: August 2005

A method is described for the rapid and quantitative estimation of total amniotic fluid palmitic acid. Palmitic acid and lecithin were measured in 140 samples of amniotic fluid in normal and abnormal pregnancy, and the correIation coefficient between the two parameters was 0–93. It is concluded that amniotic fluid palmitic acid measurements are of value in the prenatal determination of fetal pulmonary maturity.
FETAL HEART RATE MONITORING DURING BREECH LABOUR
Authors: Wheeler Timothy , Greene Keith
Published: August 2005

Forty‐two breech deliveries were monitored throughout labour. Serious asphyxia at birth occurred in 15 babies, in every case preceded by abnormalities in the fetal heart rate. Interpretation of the records implicated umbilical cord compression as the likely cause of asphyxia.
BIOCHEMICAL AND HAEMATOLOGICAL CHANGES DURING THE INDUCTION OF LABOUR AT TERM WITH OXYTOCIN, PROSTAGLANDIN E2 AND PROSTAGLANDIN F2α
Authors: Gowenlock A. H. , Taylor D. S. , Sanderson J. H.
Published: August 2005

A total of 75 patients had labour induced near term using intravenous oxytocin, prostaglandin E, or prostaglandin Fza. Biochemical and haematological investigations were performed to assess hepatic, renal and adrenocortical function and changes in platelet adhesiveness. In doses which were similarly effective in inducing labour, both prostaglandins were without the water‐retaining effect of oxytocin. Adrenocortical stimulation was greatest with oxytocin. No difference between these agents was observed for the other measurements made.
AN EVALUATION OF HUMAN PLACENTAL LACTOGEN LEVELS IN HYPERTENSION OF PREGNANCY
Authors: Kelly Anne M. , England P. , Lorimer J. D. , Ferguson J. C. , Govan A. D. T.
Published: August 2005

Maternal plasma levels of human placental lactogen (HPL) are decreased in hypertensive pregnancies and the concentration is related to the severity of the condition. Of infants who had HPL concentrations in the fetal danger zone (more than 2 SD's below normal mean) 75 per cent developed fetal distress, neonatal asphyxia or were light for dates. Patients who are identified in this way have lighter infants and placentae than their unidentified counterparts with normal HPL levels.
SERUM CYSTINE AMINOPEPTIDASE AND THE NORMAL WEIGHT BABY IN NORMOTENSIVE AND HYPERTENSIVE PREGNANCY
Authors: Chapman L. , Burrows‐Peakin R. , Rege V. P. , Silk E.
Published: August 2005

The levels of serum cystine aminopeptidase have been studied serially in normotensive and hypertensive mothers who delivered healthy, normal weight‐for‐dates babies. A normal range, both for enzyme level and maximum and minimum rates of increase of the enzyme during gestation, was established for each group, those of the hypertensive patients exhibiting different characteristics from the curves in normotensive patients. It is suggested that such differences be considered when assessing pregnancies complicated by hypertension.
PREGNANCY IN PATIENTS WITH COELIAC DISEASE
Authors: Ogborn A. D. R.
Published: August 2005

Successful pregnancy can occur both before and after the diagnosis and treatment of gluten‐sensitive enteropathy. Abortion and intrauterine growth retardation are the main associated obstetric problems but their incidence may be reduced in the more severe cases by adherence to a strict gluten‐free diet and dietary supplements. The present report concerns 60 pregnancies in 25 patients with coeliac disease.
SERUM LIPIDS IN PREGNANCY AND SOCIO‐ECONOMIC STATUS
Authors: Oladunni Taylor G. , Akande E. O.
Published: August 2005

Serum total and free cholesterol, phospholipids and erythrocyte free cholesterol levels were determined at four‐weekly intervals from the first trimester until term in pregnant Nigerian women from three different socio‐economic levels. The results showed a similar pattern of serum lipids in all three groups with a similar percentage increase at the peak levels. Serum phospholipids and total cholesterol levels were not significantly increased after the second trimester in contrast to reports of a progressive hyperlipaemia in pregnant women of Western countries. Erythrocyte free cholesterol levels showed a mirror image of those of serum free cholesterol.
ELECTROENCEPHALOGRAPHIC CHANGES AFTER INTRAAMNIOTIC PROSTAGLANDIN F2α AND HYPERTONIC SALINE
Authors: Shearman R. P. , Lyneham R. C. , Walsh J. C. , Itzkowic D. , Shutt D. A.
Published: August 2005

Six major convulsions have been seen among 555 patients who had therapeutic second trimester abortion by intra‐amniotic prostaglandin F2α (PGF2α). Five of 21 patients receiving intra‐amniotic hypertonic saline and 5 of 16 patients receiving PGF2α showed abnormalities in electroencephalograms after treatment. These changes were relatively minor in all saline patients and in three receiving PGF2α, but two patients receiving PGF2α showed epileptiform spike activity after infusion. There was no correlation between the electroencephalographic (EEG) changes and peripheral venous levels of PGF2α or its metabolite, 13, 14 dihydro‐15 keto PGF2α (15 keto‐h2‐F2α).
PATHOLOGICAL MECHANISMS TO EXPLAIN SOME CASES OF AMENORRHOEA WITHOUT ORGANIC DISEASE
Authors: Shaw R. W. , Butt W. R. , London D. R.
Published: August 2005

A test is described to define the site of the lesion causing amenorrhoea in women of child‐bearing age who have normal ovaries and a normal response to luteinizing hormone‐releasing hormone (LH‐RH). Patients able to produce a release of LH following the administration of 1 mg. of oestradiol benzoate (EB) have normal hypothalamic function and thus the site of the defect must lie more centrally in the brain. Patients unable to show these LH surges have either a primary or econdary abnormality affecting their hypothalamic oestrogen “receptor” mechanism or their ability to produce LH‐RH.
THE RESISTANT OVARY SYNDROME
Authors: Dewhurst C. J. , DE Koos Edmond B. , Ferreira H. P.
Published: August 2005

A patient is described with primary amenorrhoea, raised FSH and LH levels and ovaries containing many primary follicles. These features were characteristic of the “resistant ovary syndrome”. After ovarian wedge resection the patient began to menstruate.
FETAL DEATH IN ECLAMPSIA: II THE EFFECT OF NON‐THERAPEUTIC FACTORS
Authors: Neutra Raymond , Neff Raymond
Published: August 2005

The ability of 15 variables to predict fetal death is examined among 173 eclamptic women admitted to the only public maternity hospital in Cali, Colombia, between 1st January 1964 and 31st December 1970. In addition to low gestational age and retarded fetal growth, high systolic pressure and the unmarried status carried excess risk. Primiparae appeared to be of lower risk because their eclampsia tended to occur late in gestation and was characterized by less retarded fetal growth. Older women and women with a history of abortion appeared to be of higher risk because they tended to have higher systolic pressures. A discriminant function risk formula is presented which generated groups with a nine‐fold difference in fetal death rates. This formula could be used to standardize for relevant non‐therapeutic factors which might vary between patient groups who had received different therapeutic regimens.
HORMONAL RESPONSES TO A FIRST COURSE OF CLOMIPHENE CITRATE IN WOMEN WITH AMENORRHOEA
Authors: Kjeld J. M. , Harsoulis P. , Nader S. , Kuku S. F. , Fraser T. R.
Published: August 2005

The hormonal criteria of a “normal” or “ovulatory” response, and three grades of subnormal anovulatory responses, were defined during a first course of treatment with clomiphene citrate in twenty patients with amenorrhoea for which no organic cause could be found. The hormonal responses were estimated by frequent serum measurements and by the menstrual response. Seven patients had a normal or ovulatory response with a late rise of serum progesterone and subsequent menses. Their serum luteinizing hormone (LH) and oestradiol (E2) responses were greater than in spontaneous menstrual cycles. Five patients gave only partial responses, with menstruation and no prior rise of progesterone. Their serum LH and E2 responses were generally lower than in the normal group but had the same pattern except for an absence of the luteal phase rise in E2. Five patients who did not menstruate showed smaller and more variable responses. The remaining five showed no hormonal rerponses. The second and third groups had ovulatory responses on subsequent clomiphene courses, whereas no improvement was shown by the last group. The serum E2 responses offered the most sensitive index of the responsiveness to clomiphene. Response values in our normal group suggested that higher progesterone levels need to be reached after clomiphene administration than in spontaneous cycles for ovulation to be inferred. The serum prolactin showed no consistent response during the clomiphene test; three patients with moderately raised basal prolactin levels had “normal” responses.
REPLACEMENT HORMONE THERAPY IN GONADAL DY SGENESIS
Authors: Dewhurst C. J. , de Koos Edmond B. , Haines R. Magnus
Published: August 2005

Curettage carried out during the third week of treatment with ethinyl oestradiol in 14 patients with gonadal dysgenesis showed cystic glandular hyperplasia in seven patients with some hyperplastic changes in one other. One of these seven patients developed a large endometrial polyp and in one atypical changes were found in the hyperplastic endometrium. In seven patients treated by an oestrogen‐progestogen combination normal secretory endometrium was seen in five, proliferative change only in one (thought to be due to incorrect timing of the curettage) and a small proliferative polyp in association with secretory endometrium elsewhere in the uterus in the seventh. In view of these changes and report of adenocarcinoma of the endometrium in patients with gonadal dysgenesis treated with oestrogens alone it is suggested that a regime of low dose oestrogen therapy for 21 days accompanied by a progestogen on days 15 to 21 is preferable to oestrogens alone.
UTERINE ACTIVITY IN lNDUCED LABOUR
Authors: Steer P. J. , Little D. J. , Lewis N. L. , Kelly Mary C. M. E. , Beard R. W.
Published: August 2005

A study was made of the characteristics of oxytocin‐induced labour. Twelve patients with, and eight without membrane rupture were closely matched for factors likely to influence the character and duration of labour. In both groups uterine activity increased until a stable state was achieved following which there was little alteration until delivery. The duration of labour was shorter in the group with ruptured membranes as compared with intact membranes although, paradoxically, the uterine activity tended to be greater when the membranes were intact.
OEDEMA OF THE UMBILICAL CORD AND RESPIRATORY DISTRESS IN THE NEWBORN
Authors: Coulter J. B. S. , Scott J. M. , Jordan M. M.
Published: August 2005

Oedema of the umbilical cord, defined as visible oedema in a cord wish a minimal cross sectional area of 1.3 cm2, is found in 10 per cent of deliverieo. It is seen more frequently in certain complications of pregnancy such as abrupti placentage, maternal diabetes, macerated intrauterine death and in conditions affectint the infant including prematurity, rhesus isoimmunization, respiratory distress syndrome (RDS) and transient respiratory distress (TRD). There is a higher incidence in infants delivered by Caesarean section. There is no significant association between cord oedema and either fetal distress or neonatal asphyxia nor is there any correlation with maternal hypertension or oedema. The mechanism of production of the oedema is discussed; low oncotic pressure, raised hydrostatic pressure in the placenta and umbilical cord, and an increase in total water in the feto‐placental unit are considered. The presence of oedema of the cord may reflect similar changes in the lungs which antenatally predispose an infant whose pathway for production of surfactant is immature to develop RDS and the mature infant to develop TRD. The value of cord oedema as a warning sign is stressed.
CHANGES IN PLASMA NON ESTERIFIED FATTY ACIDS AND SERUM GLYCEROL IN PREGNANCY
Authors: McDonald‐Gibson R. G. , Young Maureen , Hytten F. E.
Published: August 2005

Changes in plasma nonesterified fatty acids (NEFA) and serum glycerol in pregnancy were examined in a semi‐serial study of 85 women. A preliminary study showed that it was almost impossible to achieve standardized conditions for sampling, and the compromise of taking a single venous sample without stasis, after 30 minutes rest and about 12 hours fasting, was adopted. Although there were large individual variations the patterns of change were, in general, the same for NEFA and glycerol although the two were not closely correlated. There was no convincing change before 30 weeks of pregnancy but both increased in the last ten weeks, fell sharply in the first week post partum, and then rose again to late pregnancy levels by 6 weeks post partum before falling to non‐pregnant levels by between 3 and 6 months post partum. Those patterns of change are in broad accord with changes of fat storage and lipolysis associated with the reproductive cycle. Changes in the patterns of NEFA were trivial; the only significant alteration was a small rise in the proportion of C16:O (palmitic) in late pregnancy.
MASSIVE SUBCHORIAL THROMBOHAEMATOMA (BREUS' MOLE)
Authors: Shanklin D. R. , Scott J. S.
Published: August 2005

Ten placentae with massive subchorionic thrombohaematomas are reported. This lesion, which is composed of maternal clotted blood, separates the chorionic plate of the placenta from the villous chorion and is traversed by the main cotyledonary branches of the fetal circulation. In some instances it dissects into the layers of the chorionic plate. In anatomical terms it is identical to the lesion which has been described in early pregnancy under the title of Breus’ mole. Previous reports suggested that the lesion was confined to early pregnancies and was a consequence of fetal death. In our series all ten placentae were from pregnancies of at least 25 weeks' maturity and six were more than 30 weeks. Seven infants were liveborn and three survived the neonatal period. Differential diagnosis is discussed along with aetiology, which is still obscure although earlier theories implicating fetal death may be discounted.
RATE OF FALL IN PLASMA PROGESTERONE AND TIME TO ABORTION FOLLOWING INTRA‐AMNIOTIC INJECTION OF PROSTAGLANDIN F2α WITH OR WITHOUT UREA, IN THE SECOND TRIMESTER OF HUMAN PREGNANCY
Authors: Walker Sheila M. , Flint A. P. F. , Turnbull A. C.
Published: August 2005

Progesterone concentrations have been determined in a total of 175 peripheral plasma samples obtained serially from 20 women undergoing mid‐trimester abortion. In ten patients abortion was induced by intra‐amniotic administration of 50 mg. of prostaglandin F2α (PGF2α) alone; in ten others it was induced with 50 mg. of intra‐amniotic PGF2α with 80 g. of urea. Mean instillation‐abortion intervals were 29.0 hours in the group receiving PGF2α alone and 12.1 hours in the groups receiving PGF2α and urea. In eight of the patients treated with PGF2α and urea, and in four of those treated with PGF2α alone, there were significant decreases in progesterone level (determined by calculation of correlation coefficients) during the instillation‐abortion interval. When plotted against instillation‐abortion times, calculated rates of decrease in peripheral plasma progesterone levels showed a statistically significant regression (p<0.05). This indicates that progesterone levels drop most rapidly in patients with shorter instillation‐abortion times. There was no relationship between initial progesterone levels and instillation‐abortion times.
AN OPERATION FOR RESTORATION OF URINARY CONTINENCE FOLLOWING TOTAL LOSS OF THE URETHRA
Authors: Hudson C. N. , deV Hendrickse J. P. , Ward Anne
Published: August 2005

Twenty‐three patients with urethral loss have been treated by the simple creation of a “spout” from the bladder wall. The procedure is suggested for the surgical treatment of lymphopathia venereum and for consideration in certain other conditions when urinary diversion is unacceptable.
MYOCARDIAL INFARCTION AND RHEUMATIC HEART DISEASE IN PREGNANCY CASE REPORT
Authors: Hughes T. B. J.
Published: August 2005

Myocardial infarction is a rare complication of pregnancy, only 45 proven cases having been reported. In only one patient was rheumatic heart disease an associa‐ted factor (Goldberger and Pokress, 1950).
VAGINOPLASTY AT THE CHELSEA HOSPITAL FOR WOMEN: A COMPARISON OF TWO TECHNIQUES
Authors: Feroze R. M. , Dewhurst C. J. , Welply G.
Published: August 2005

The results have been compared of 37 McIndoe‐Read operations and 39 Williams' operations carried out at the Chelsea Hospital for Women. The Mclndoe‐Read procedures comprised 28 primary operations for congenital absence of the vagina, five repeat procedures and four operations for other conditions; the Williams' procedures comprised 27 primary operations, four operations following the previous vaginoplasty and eight operations following other procedures. The results favoured the Williams' vulvovaginoplasty. Special mention must be made of the dangers of repeating the McIndoe‐Read procedure and of the fact that the vagina constructed by the Williams' technique showed no tendency to contract if intercourse did not occur.
RELATION BETWEEN PLACENTAL SITE AND LENGTH OF GESTATION
Authors: Harris V. G.
Published: August 2005

Two theories related to uterine action have been brought together to see whether the site of placental implantation influences the onset of labour: (1) that uterine contractions begin asymmetrically from a “pacemaker” in one uterine horn, and (2) that progesterone from the placenta blocks myometrial contractility primarily at the site of implantation. Case records were examined of 182 patients who had placental locations performed and who had a spontaneous onset of labour. Where the placenta was implanted in the right upper quadrant of the uterus labour occurred on average four days sooner than when it was implanted in the left upper quadrant: the difference was statistically significant.
PLASMA SEX STEROID AND GONADOTROPHIN PATTERNS IN HUMAN MENSTRUAL CYCLES
Authors: Dodson Kay S. , Coutts J. R. T. , Macnaughton M. C.
Published: August 2005

Sensitive and specific displacement analysis methods for the assay of steroid hormones in small volumes of plasma are described. Plasma sex steroid and gonadotrophin hormone patterns were determined throughout a number of normal menstrual cycles. The mean cycles showed patterns which were similar to those described by other workers. However, examination of individual cycles provided information which may contribute to our understanding of menstrual cycle regulation with particular reference to the pattern of 17a‐hydroxyprogesterone and steroid‐gonadotrophin interactions.
INFERTILITY IN WOMEN WITH APPARENTLY OVULATORY CYCLES
Authors: Dodson Kay S. , Macnaughton M. C. , Coutts J. R. T.
Published: August 2005

Six infertile patients had been studied previously (Dodson et al., 1975b) and were shown to produce inefficient corpora lutea which appeared to be predetermined by ovulation of “poorly grown” follicles. In a second cycle these infertile patients were treated with 50 mg of clomiphene per day for five days. The resulting plasma sex steroid and gonadotrophin profiles were compared with those found before treatment and with the profiles in normal patients (Dodson et al., 1975a). Treatment with clomiphene appeared to produce increased follicular growth and more active corpora lutea.

Thanks are due to Dr. Philip England, Research Department, Glasgow Royal Maternity Hospital, who supervised the LH assays; Mr. Alan Craig, Searle Scientific Services, who supervised the FSH assays; Dr. P. D. G. Dean for a gift of oestradiol antiserum; Mr. W. McNally, Department of Obstetrics and Gynaecology, for art work and the Medical Research Council for financial support (MRC 971/222/C).
CHANGES IN THE RENIN‐ANGIOTENSIN SYSTEM IN PRIMIGRAVIDAE WITH HYPERTENSIVE DISEASE OF PREGNANCY
Authors: Symonds E. M. , Pipkin F. Rroughton , Craven D. J.
Published: August 2005

Plasma renin concentration, renin activity and angiotensin II (AII) have been studied in 35 primigravidae at or near term immediately prior to surgical induction of labour. A highly significant positive correlation was established between diastolic blood pressure at the time of sample collection and plasma AII. This relationship was observed over the range of diastolic pressure studied irrespective of the diagnosis made at the time of admission to hospital. In patients with hypertension, a significant negative relationship was established between plasma renin concentration and renin activity and AII. Furthermore, plasma AII levels were higher for a given plasma renin activity or plasma renin concentration in the hypertensive women than in the normotensive group. These findings suggest that the renin‐angiotensin system is actively involved in hypertensive disease of pregnancy and that suppressed levels of renin concentration and activity may result from elevated angiotensin levels. It is suggested that the utero‐placental complex may be the source of the elevated AII levels.
ASSESSMENT OF PLACENTAL FUNCTION IN NORMAL AND PATHOLOGICAL PREGNANCIES BY ESTIMATION OF PLASMA OESTRADIOL LEVELS AFTER INJECTION OF DEHYDROEPIANDROSTERONE SULPHATE
Authors: Korda A. R. , Challis Janice J. , Anderson Anne B. M. , Turnbull A. C.
Published: August 2005

A test of placental function was assessed by measurement of plasma oestradiol levels in 32 patients after intravenous injection of 50 mg dehydroepiandrosterone sulphate (DHAS). Every pregnant patient showed a rise in plasma oestradiol after DHAS; two puerperal patients showed no rise. It was not possible to distinguish the variable response in normal pregnancy from that in patients with severe hypertension and proteinuria or with retarded intrauterine fetal growth. The test was of no value in one hypertensive patient as a predictor of fetal death eight da ys later or, in another, to confirm fetal death of two days duration. Our results do not suggest that this test is a useful addition to currently available tests of placental endocrine function.
RECURRENT BLEEDING FROM THE LOWER SEGMENT SCAR—A LATE COMPLICATION OF CAESAREAN SECTION
Authors: Stewart K. S. , Evans T. Wade
Published: August 2005

Hysterectomy became necessary six months after Caesarean section because of recurrent severe haemorrhage from the uterine scar.
ESTIMATION OF FETAL WEIGHT FROM ULTRASONIC MEASUREMENT OF TRUNK CIRCUMFERENCE
Authors: Higginbottom J. , Slater J. , Porter G. , Whitfield C. R.
Published: August 2005

A new method of estimating fetal weight from the circumference of the fetal trunk, measured by ultrasound, is described. Comparison of weights estimated in this way with the actual birth weights of 50 fetuses, delivered not more than 48 hours later, shows a mean error in prediction of only 75 g, and in 94 per cent the error was less than 145 g. With such accuracy, the method is of clinical value, particularly in anticipating difficult delivery and in monitoring growth of the fetus at risk.
FAILURE OF HEPARIN THERAPY TO AFFECT THE CLINICAL COURSE OF SEVERE PRE‐ECLAMPSIA
Authors: Howie P. W. , Prentice C. R. M. , Forbes C. D.
Published: August 2005

In view of the association between pre‐eclampsia and disseminated intravascular coagulation, three patients presenting with severe pre‐eclampsia before the 28th week of pregnancy were treated with heparin. In all three patients, there was deterioration of hypertension and proteinuria that necessitated the withdrawal of treatment after five to six days. During treatment, serum and urinary fibrinolytic degradation products (FDPs) continued to rise or remained unaltered, plasminogen levels showed a steady fall, and the platelet count remained at a reduced level. These data suggest that heparin was an ineffective form of treatment and did not prevent the intravascular fibrin deposition associated with severe pre‐eclampsia.
THE DISTRIBUTION WITHIN THE PLACENTA, MYOMETRIUM, AND DECIDUA OF 24Na‐LABELLED HYPERTONIC SALINE SOLUTION FOLLOWING INTRA‐AMNIOTIC OR EXTRA‐AMNIOTIC INJECTION
Authors: Gustavii B.
Published: August 2005

24Na‐labelled hypertonic saline solution was injected into the uterus by the intra‐amniotic or the extra‐amniotic route, and six hours later determinations were made of the 24Na content of the placenta, myometrium, and decidua. The tissue specimens were obtained by subtotal hysterectomy. The activity of 24Na proved to be high in the decidua and in the fetal part of the placenta, but low in the myometrium. During labour, large amounts of prostaglandins have been found in the decidua, but little or none in the placenta. The present findings therefore lend further support to the assumption that hypertonic saline solution provokes abortion by inducing release of lysosomal phospholipase A, into the cytoplasm of damaged decidual cells, resulting in prostaglandin synthesis and liberation.