bluuebunny/crossref_metadata_2025 huggingface dataset:
Puis in spoken French: from time adjunct to additive conjunct?
Authors: Hansen Maj-Britt Mosegaard
Published: October 2008

In this paper I present an analysis of the discourse connective puis, as it is used in (relatively) informal spoken French. I argue that this item has been (and possibly still is) subject to a process of grammaticalization, whereby its basic function has changed from that of a time adjunct to that of an additive conjunct taking discourse acts in its scope, with the further possibility that it may be moving towards becoming a true conjunction. I moreover hypothesize that the meaning of conversational puis may be represented as a set of instructions, directing the hearer to search for two and only two elements to be connected, and to understand these two elements to be of separate relevance to a common integrator.
From le finale to au final
Authors: Grieve James
Published: October 2008

The new inter-assertional connector au final has evolved in recent years. The accepted spelling of the musical term le finale, from which it derives, has come to be le final. The noun has also acquired meanings in contexts removed from its original technical fields of opera and music in sonata form: film, fiction, fashion parades, car rallies, etc. In some extended usages, it appears to have been restricted from the idea of‘climactic conclusive ensemble’ to ‘end’. This may be the origin of au final. The earliest dating for this neologism is at present 1986. It functions as a connector in the range of concluders and resumers such as enfin, finalentent, en somme, au total.
Valeur énonciative des variations de hauteur mélodique en français
Authors: Morel Mary-Annick
Published: October 2008

Poursuivant un ensemble de travaux développés à Paris III sur les relations entre énonciation et intonation dans le français oral spontané, je presénte ici quelques hypoth`ses nouvelles sur la valeur énonciative de ces variations. Je propose de considérer que le point le plus haut de la plage intonative du locuteur montre que les deux participants du dialogue sont impliqués dans le point de vue qui est développée (ce qui se produit entre autres à la finale du «theme» ou de l'interrogation totale), alors que les niveaux inférieurs de la plage intonative signifient que le locuteur développe un point de vue qui lui est personnel et qui ne met pas en jeu une pensée autre (ceci se produit entre autres à la finale d'une assertion ou d'une injonction). Je propose aussi de considérer qu'il y a un niveau neutre de Fo, où se situent les hésitations et les incises (lorsque le locuteur juge nécessaire d'ajouter des gloses sur ce qu'il est en train d'énoncer).
A l'écoute du langage Dire et se contredire: il ne manquerait plus que ça!
Authors: Wilmet Marc
Published: October 2008

Toutes les langues abondent en formules clichées, plus ou moins transparentes, plus ou moins opaques. L'usager moyen ne s'inquiète guère de leur constitution, sauf à partager la frénésie analytique d'un Cottard (chez Proust), quand le naïf docteur, puis sentencieux professeur, disséque les expressions du sang bleu, la beauté du diable, une vie de bdton de chaise, le quart d'heure de Rabelais, dormer carte blanche, être réduit à quia, brûler les planches … (cf. A la Recherche du temps perdu, coll. de la Pléiade, I, 200–201 et passim).
‘Les gosses ça se lève tôt le matin’: l'interprétation générique du syntagme nominal disloqué au moyen de ce ou ça
Authors: Carlier Anne
Published: October 2008

L'insertion des pronoms ce et çα, reléguant le SN qui occupe originellement la position sujet en position disloquée, peut engendrer une interprétation générique de ce SN sans néanmoins exercer systématiquement cet effet. Le présent article offre une explication de ce problème en faisant le départ entre les propriétés inhérentes aux pronoms ce et çα et les propriétés qui résultent de leur insertion dans un contexte propositionnel déterminé. L'examen de la gamme des articles pouvant introduire le SN générique dans une construction de dislocation au moyen de ce ou çα met en lumière une contrainte surprenante: l'article le, tout en s'accommodant d'un nom massif, s'allie difficilement à un nom comptable. Cette différence distributionnelle entre les SN génériques ‘le + N comptable’ et ‘le + N massif’ trouve son origine dans une différence entre leurs valeurs respectives: alors que celui-là opère une réduction de l'extension à une entité individuelle, celui-ci appréhende l'extension comme un ensemble.
‘De la belle ouvrage’: cross–gendering in unconventional French
Authors: George Ken
Published: October 2008

In spite of the linguistic ‘dirigisme’ during the past three and a half centuries, there remains in contemporary French a number of nouns of double or doubtful gender. Non-standard usage is potentially even more prone to fluctuation and hesitation, given the relative lack of awareness in spontaneous, informal speech of official norms. The changes of gender that have occurred and the anomalies – real or perceived – that have arisen in unconventional French are attributable to a variety of processes, both morpho-syntactic and semantic in nature. Most cases can be explained in terms of one or other of these processes (e.g. apocope, ellipsis, syllepsis). However some remain mysterious, contradicting established patterns. Intra-register gender attraction may well occur, though it is likely to be unconscious. The question of zero gender and neutralization is also raised.
Playing ‘follow my leader’ in Anglo-Norman studies
Authors: Rothwell William
Published: October 2008

Throughout the present century the nature of Anglo-Norman and its role in the history of both French and English has been misunderstood and misrepresented by the endless repetition at second hand of views that have their origin in the nineteenth–century ‘reconstructionist’ movement in French philology. Evidence readily available from original sources of many kinds shows that the French used in England between the Conquest and the end of the fourteenth century is at once a more complex and far more important phenomenon than current writing on the subject would suggest, especially as regards the history of the English language.
The new stability of unstable –e in French
Authors: Walker Douglas C.
Published: October 2008

Much recent work (e.g. Hansen 1994) is demonstrating that French schwa is becoming stable in many contexts where it formerly deleted freely. In this paper, I expand on Hansen's study of the new stability of schwa, extending consideration to the lexicalized conditioning of the stability as indicated in four contemporary pronouncing dictionaries of Standard French. This increasing stability also provides evidence for a reanalysis of schwa as underlying /œ/; the implications of this analysis for the distinction between lexical and post-lexical rules are briefly explored.
Pour une approche syntaxique des dislocations
Authors: Blasco Mylene
Published: October 2008

:L'enjeu de cet article est, à partir de I'observation du fonctionnement et de la distribution de données orales attestées et d'exemples écrits, de donner un statut autonome à la dislocation et de mettre à jour plusieurs cas de dislocations qui different tant par le statut syntaxique du syntagme disloqué que par l'éventail des relations référentielles qui l'unissent au pronom clitique.

Nous montrons que la prise en compte de la place de l'élément disloqué (avant le verbe / après le verbe), les marques formelles que sont les prépositions, les comportements des différentes catégories grammaticales et les bomes syntaxiques révélées par les subordonnées imposent alors une répartition de la dislocation en trois grands types:

le double marquage d'une fonction syntaxique conjointement effectué par le syntagme disloqué et le pronom clitique qui sont alors coréférents;

les cas de dislocations ou le segment disloqué est adjoint au pronom clitique uniquement de par les différentes relations référentielles qu'il entretient avec le clitique;

les cas de dislocations où l'élément disloqué est adjoint à l'ensemble de la construction verbale car il n'est ni en relation syntaxique avec le verbe, ni en relation référentielle avec le pronom clitique.
Approche de l'identité d'un préverbe à travers l'analyse des variations sémantiques des unités préverbées
Authors: Franckel Jean-Jacques
Published: October 2008

Cet article propose une caractérisation unitaire du préverbeRE- fondée non pas sur un sens premier ou central, mais sur la façon, par hypothése spécifique, dont ce préverbe intervient dans la régulation des interactions avec l'unité préverbée d'une part, l'unité et son co-texte d'autre part. La variation sera done au coeur de cette caractérisation, qui se présentera comme un pôle de structuration de cete régulation, et que nous présenterons comme uneforme schématique.
French complement clitic sequences: a template approach
Authors: Watson Keith
Published: October 2008

In this article I shall propose an explanation of the ordering and co-occurrence constraints operating within complement clitic sequences in French, which I shall present as template-formed syntactic constituents. I shall argue that these result from the interaction of two features – [+Accusative] and [+Individua-tion] (in the sense of Blanche-Benveniste (1978) and Blanche-Benveniste et al (1987)) – in conjunction with certain phonological constraints. Furthermore, I shall argue that, once explained, the complement clitic sequence can be seen to constitute an efficient referential system, well adapted to the role of 'kernel sentence’ which, together with the subject clitics and the verb, it performs in Modern French.
Propriétés extrinsèques en sémantique lexicale
Authors: Cadiot Pierre , Nemo François
Published: October 2008

La signification lexicale est souvent conçue, au moins partiellement, en termes de description ou, dans notre terminologie, de propriétés intrinsèques (PI). Nous explorons ici l'hypothèse inverse que le mot (notamment le nom) renvoie directement aux types de relations, 1° que le locuteur entretient avec les référents variés que tel mot lui permet de construire, 2° que ces référents entretiennent avec leur environnement. C'est sans doute le sens même des noms qui doit être identifié avec ces rapports ou propriétés extrinsèques (PE). Du coup, les emplois polysémiques, métonymiques ou métaphoriques sortent complètement de leur marginalité pour tendre à se confondre avec la signification lexicale elle-même, les usages dénominatifs masquant plutôt cette signification.
Les énoncés pseudo-clivés en: le plus/le moins
Authors: Roubaud Marie-Noëlle
Published: October 2008

La construction avec superlatif à l'intérieur de la construction verbale (ce qui me plaît le plus c'est …) est la plus connue. Cependant les données du français parlé font émerger l'existence d'énoncés dans lesquels le superlatif est en tête de la construction verbale (le plus qui me plaît c'est …). On pourrait faire l'hypothèse que ces énoncés ne sont qu'une variante des constructions jugées standard. Cependant on peut démontrer, au vu des exemples attestés, que l'hypothèse dérivationnelle est inadéquate. Les énoncés avec superlatif en tête n'ont pas tous leur correspondant dans l'autre structure et laissent une grande part de liberté dans l'interprétation des relations syntaxiques.
L'Écoute Du Langage The recipe for success: syntactic features of la chronique gastronomique
Authors: Engel Dulcie M.
Published: October 2008

This paper examines some syntactic features in the discourse of food, and in particular recipes and cookery pieces published in the French press.

It is argued that specific genres often display linguistic features related to the communicative function of the genre. Concentrating on the basic elements of the cooking process, that is, [irreversible process] [application of heat] [object-food] (Newman, 1975: 56), we examine the syntactic structure of NPs and VPs in French cookery writing in the press, which are characterised by complexity. Drawing parallels with the findings of Blanche-Benveniste (1995 a, b), we demonstrate how syntax can reflect function and meaning in a restricted text-type.
The sociolinguistic gender pattern in French: a comparison of two linguistic levels
Authors: Armstrong Nigel
Published: October 2008

In this article I examine different rates of development, at the linguistic levels of variable pronunciation and discourse, of a sample of French girls aged 11–12. These girls, in contrast to their older counterparts, show variable linguistic behaviour on the phonological level that aligns with the well attested pattern of the avoidance by female speakers of vernacular forms: the ‘sociolinguistic gender pattern’. At the same time, in discourse one female speaker shows a manipulation of conversational tone, as evidenced by her behaviour across speech styles, that is comparable to adult competence. I argue that the disjunction between the girls's communicative competence on these two levels is due to the different social functions that variation fulfils on each level: while variable phonology may serve to express a speaker's location in a social-regional nexus that younger speakers have yet to engage with fully, the discourse level expresses more central aspects of a speaker's identity that can plausibly be assumed to develop earlier.
The acquisition of connectors in French L2 narrative discourse
Authors: Kerr-Barnes Betsy
Published: October 2008

The article examines the use of connectors in oral narratives of 27 adult American learners of French, who are classified in four groups according to length of instruction and type of learning environment, i.e. classroom or immersion or mixed. The patterns of acquisition are found to be in general quite similar to those of child LI French learners, including a routinised use of one or more markers which serve as pause fillers. Surprisingly, even very proficient learners show overgeneralisation of some connectors, in particular of transitional connectors (alors, donc) and discourse-structuring particles (eh bien, bon), whose functions are relatively opaque.
L'absence de déterminant dans l'impératif nominal
Authors: Peterson Kerstin
Published: October 2008

L'impératif nominal, qui sert à donner un ordre sous forme nominale au lieu de verbale (p. ex. ‘Silence!’), présente un cas intéressant et peu étudié de l'alternance entre présence et absence de déterminant dans un syntagme nominal. L'étude d'un corpus du point de vue de la situation énonciative et de l'effet sémantique des exemples permet de faire des hypothèses sur le signifié des différents types de détermination dans l'impératif nominal, et en particulier de deceler les conditions de l'absence de determinant.
Quand est-ce qu'un chien devient l'animal?
Authors: Theissen Anne
Published: October 2008

Si elle est immédiate, la réprise définie anaphorique d'un syntagme indéfiniun N(un chien … l'animal) semble être un site approprié pour une anaphore infidèle (un chien … l'animal), mais non tellement pour une anaphore fidèle (un chien … le chien). Ce constat, inattendu, conduira, dans un premier temps, à identifier des exigences spécifiques à la reprise définie immédiate. Dans un second temps, il permettra d'expliquer comment le changement dénominatif et donc l'emploi d'un terme hyperonyme dans le syntagme de reprise définie peut satisfaire à ces exigences.
Un structuralisme de bonne compagnie: Lucien Tesnière et son héritage
Authors: Kupferman Lucien
Published: October 2008

La fin des années cinquante a marqué sans conteste un tournant dans l'histoire de la linguistique Moderne. De la parution de compilations d'Emile Benvéniste ou d'André Martinet qui signalaient l'avénement définitif du structuralisme sur les scènes universitaires françaises à la parution du premier ouvrage de Chomsky outre-Atlantique qui sonnait déjà le glas de ce même structuralisme, en passant par les Eléments de Lucien Tesnière dont la sensibilité était évidemment structuraliste, mais dont certains thèmes ressemblaient commedes cousins à ceux de Syntactic Structures, la linguistique devenait une discipline triomphatrice dont d'autres s'efforçaient de s'inspirer.
Vers une modélisation de l'accentuation du français: première partie
Authors: Di Cristo Albert
Published: October 2008

Nous proposons d'effectuer dans cette étude un large tour d'horizon des problèmes liés à l'interprétation de l'accent en général et de l'accentuation du français contemporain en particulier. Cet « état des lieux » (première partie) débouche sur l'esquisse d'une modélisation du cadre accentuel du français (seconde partie) fondée sur une classification fonctionnelle des catégories d'accentuation et la mise en œuvre généralisée du principe de bipolarisation accentuelle qui permet, selon nous, de rendre compte du caractère probabilitaire de l'accentuation du français et de la variabilité de ses des motifs rythmiques attestés dans les formes prosodiques de surface.
Vers un schéma de la différence: le cas de mais
Authors: Nyan Thanh
Published: October 2008

Pour un morphè;me donné, tel quemais, un schéma général sera normalement constitué de traits communs aux divers emplois. Prenant le contre-pied de cette démarche, nous partirons d'une base commune pour aller vers un schéma dit 'de la difference'. La question qui nous préoccupe en premier lieuétant celle de savoir comment rendre compte du fait que d'un cas à l'autre, certains traits et fonctions ne sont pas présents au même degré, ou même disparaissent.
‘Salut! Ça va? Vous avez passé un bon weekend?’
Authors: Peeters Bert
Published: October 2008

Using Wierzbicka's natural semantic metalanguage, this paper sets out to show the pragmatic differences between ‘health enquiries’ and ‘weekend routines’ in French and (Australian) English. In French, except in rare cases, ‘health enquiries’ and ‘weekend routines’ must be introduced by means of a greeting of some sort. In (Australian) English, they may take the place of conventional greeting behaviour. Phaticity in the case of the English phrases is considerably higher than in the case of the French phrases, which, in the context of an intercultural encounter, may result in pragmalinguistic and/or sociopragmatic failure.
Déplacement et mode d'action en français
Authors: Rossi Nathalie
Published: October 2008

On s'intéresse, dans le domaine notionnel du déplacement, aux énoncés du type Nom de repéré + Verbe de déplacement + Preposition + Nom de repère. II s'agit dans un premier temps de mettre en rapport les catégories aspectuelles de Vendler (1967) avec la notion de polarité de Boons (1985 et 1987), afin de décrire plus finement, d'abord les verbes de déplacement, puis les prepositions, présents dans les énoncés mentionnés (en précisant notamment la notion de borne). Les contributions respectives des verbes et des prépositions à la valeur des énoncés – sur le plan du mode d'action – sont ensuite mesurées, ce que I; on est à même de faire de façon pertinente grâce à l'homogénéité des traits ([+/− changement de lieu de référence], [+/− durée]) constitutifs des valeurs respectives des trois segments (verbe, préposition et énoncé). Enfin, sont ainsi dégagé;es des rè;gies permettant de prédire la valeur des énoncés.
A Weighted Generalization of Gao's n + D − 1 Theorem
Authors: HAMIDOUNE YAHYA O.
Published: October 2008

Let G denote a finite abelian group of order n and Davenport constant D, and put m = n + D − 1. Let x = (x1,. . .,xm) ∈ Gm. Gao's theorem states that there is a reordering (xj1, . . ., xjm) of x such that

Let w = (x1, . . ., wm) ∈ ℤm. As a corollary of the main result, we show that there are reorderings (xj1, . . ., xjm) of x and (wk1, . . ., wkm) of w, such that

where xj1 is the most repeated value in x. For w = (1, . . ., 1), this result reduces to Gao's theorem.
Implantation
Authors: Chapman Michael G.
Published: October 2008

Human implantation has become the focus of considerable scientific interest with the advent ofin vitrofertilization and other assisted conception techniques. The frustratingly high failure rates associated with these procedures has led to detailed appraisal of possible causes. Without basic knowledge of the physiological processes involved, little progress has been achieved. Investigations have broadly concentrated on the endometrium/uterine environment and blastocyst quality. However, information on both these aspects in the human being is limited. Even in animal reproduction, the mechanisms of implantation are far from understood, although some of the possible factors involved have been studied. By necessity, much of this review extrapolates from animal data.
Comprehensive examination of the human fetus
Authors: Harman CR
Published: October 2008

We cannot talk to the fetus. Our ability to place the fetal condition accurately in context, therefore, lies with indirect evidence and inferred responses. We can examine the fetus. We can do so in a most comprehensive fashion, addressing the salient points of fetal anatomy, both structural and functional. We are able to perform routine evaluation of every system and the methodology is available to assess critical areas such as the heart and the central nervous system in specific detail.
Renal disease in pregnancy
Authors: Kincaid-Smith Priscilla , Fairley Kenneth
Published: October 2008

There is an intimate relationship between the kidney and pregnancy. Renal plasma flow increases by 50–70% during a normal pregnancy and the glomerular filtration rate by about 50%.1These changes commence in the first trimester and fall in the last trimester reaching normal levels within about four weeks postpartum. These physiological changes are accompanied by striking anatomical changes which consist of dilatation of the ureter, pelvis and calyces, together with an increase in renal parenchymal size. The dilatation i s more marked on the right and may appear in the first trimester. At term, 90% of pregnant women show this change.2
Sodium balance in pregnancy
Authors: Brown Mark A
Published: October 2008

Sodium is the major cation in the extracellular fluid volume (ECFV) and as such, is the most important determinant of osmolality and of the volume of this fluid compartment. Hence any alteration in the control of body sodium will be reflected by changes in the ECFV, including the maternal plasma volume. There is no doubt that expansion of the plasma volume is a necessary and desirable event during pregnancy, influencing positively both maternal and fetal outcome. Therefore, studies of sodium balance in pregnancy provide important information relevant to both mother and fetus.
Infection and premature rupture of the membranes
Authors: Seo Kyung , McGregor James A , French Janice I
Published: October 2008

Premature rupture of the membranes (PROM) and preterm birth

Preterm birth remains a paramount problem in health care worldwide. In the USA, approximately 6–10% of births occur preterm.1–3Gestational age at birth is the most important determinant of an infant's morbidity and mortality. Preterm infants account for approximately 75% of neonatal deaths,3–5as well as incalculable direct and indirect financial costs and morbidity.6–9
Immune thrombocytopenia in pregnancy
Authors: Browning James , James David
Published: October 2008

Autoimmune thrombocytopenia (ITP)

1) The risks to mother and fetus have previously been overstated.

2) There is no maternal test which will accurately determine fetal thrombocytopenia.

3) The only reliable test for fetal thrombocytopenia is cordocentesis – this carries a higher morbidity than that of fetal intracerebral haemorrhage from ITP.

4) Contrary to received wisdom, there is no evidence that, even for the most severely thrombocytopenic infant, abdominal delivery protects against intracranial haemorrhage.

5) Management therefore involves keeping the maternal platelet count above 50 × 1091 and choosing the route of delivery on normal obstetric grounds.

Alloimmune thrombocytopenia

1) Alloimmune thrombocytopenia is commoner than hitherto believed (0.15% all neonates).

2) The fetal risks are considerable: intracranial haemorrhage occurs in 4% of cases antenatally and in 10% in labour. The risks are virtually confined to those with a platelet count of less than 30 × 109l−1.

3) Cordocentesis is justified for the ‘at risk’ fetus; fetal immunoglobulin or platelet therapy can be given.

4) When the fetal platelet count is below 50 × 109l−1, abdominal delivery should be planned.

5) A maternal screening test for neonatal alloimmune thrombocytopenia exists (lack of P1A1 antigen).
Endocrinology of labour
Authors: Challis John RG , Riley Simon C , Yang Kaiping
Published: October 2008

Preterm labour, defined as delivery before 37 weeks of completed pregnancy, continues to present a major problem in clinical obstetrics and remains the major contributory factor to the perinatal mortality and morbidity statistics. While it is now possible, with recent advances in neonatal care, to take infants delivered very prematurely and provide them with the lifelines that will ensure their ultimate discharge from the neonatal intensive care nursery, the cost of this form of management – in terms both of health care funds and of emotion – is extraordinarily high. Hence there remains a strong rationale for attempting to understand the underlying biochemistry and physiology of labour in order to develop methods of recognizing the patient in true preterm labour, and of developing better strategies to prevent or to manage this condition. In the best of our neonatal intensive care settings, survival of the infant born at 28–30 weeks’ gestation, or greater than 1500 grams, may be greater than 90%. Thus, the clinical management strategy may be directed more towards sustaining intrauterine life for 4–6 weeks in those patients presenting in preterm labour before this time in order to gain time for intrauterine maturation of these fetuses before they are delivered to the tertiary care NICU setting.
Active management of labour
Authors: Turner MJ , Rasmussen MJ , Stronge JM
Published: October 2008

It is now 21 years since active management of labour was first reported in theBritish Medical Journal. Whether one agrees with Professor O'Driscoll or not, there is little argument that his views on the care of women in labour have had a major impact on obstetrics worldwide. As active management comes of age, it is appropriate to review the literature on this subject.
Amniotic fluid volume dynamics
Authors: Glibert William M , Moore Thomas R , Brace Robert A
Published: October 2008

From the moment of implantation until delivery some 37 weeks later, the human embryo or fetus is surrounded by fluid. Initially this fluid is a transudate from maternal and embryonic tissues which provides nutrients for the growing embryo. Starting in early pregnancy, the fetal kidneys begin to contribute substantial quantities of urine to the amniotic fluid volume. At mid pregnancy, when the skin becomes keratinized, the kidneys become the main source of amniotic fluid. Fetal swallowing is the main route of amniotic fluid removal. Although fetal urine production and swallowing have been studied in both human pregnancy and animal models, the knowledge from these investigations is not sufficiently extensive to explain overall amniotic fluid volume regulation. None the less, it is clear that the amniotic fluid is in a dynamic, ever-changing state. The production rate of the fetal urine in the human fetus at term (800–1200ml/day) is sufficient to replace completely the entire amniotic volume every 12–24 hours1. While the fetus is producing large volumes of urine, the volume of amniotic fluid is normally maintained within a very narrow range. Deviations from the normal range are often associated with significant perinatal morbidity and mortality.
Pathophysiology of amniotic fluid volume homoeostasis
Authors: Ross Michael G , Ervin M Gore
Published: October 2008

Human and ovine fetuses produce and absorb prodigious amounts of water and electrolytes daily. As will be described, fetal fluid exchange approximates to 300–400ml/kg per day near term. On a per kilogram basis, this is equivalent to an adult ingesting and secreting 15–20 litres per day. Upon delivery, the newborn rapidly adjusts to a much reduced rate of fluid exchange. In this respect, the fetus resembles an amphibian during development: an aquatic phase of in utero gestation and a comparatively arid state following delivery. Although the amphibian-like pattern of development may be partly an example of ‘ontogeny recapitulates phylogeny’, the remarkable volume of fetal fluid exchange suggests an important physiological role for amniotic fluid.
Smoking in pregnancy
Authors: Newnham John P
Published: October 2008

During nine months of pregnancy, a woman who smokes 20 cigarettes each day will inhale nicotine, tar and carbon monoxide more than 50 000 times. This smoke contains chemicals known to be mutagenic and carcinogenic and will interfere with the normal growth and development of her child. Recent studies have revealed disturbing long-term consequences for the offspring. This article reviews the constituents of cigarette smoke, the effects of tobacco usage on the pregnancy, child and placenta, and strategies by which smoking during pregnancies may be prevented.
Eicosanoids and preterm labour
Authors: Mitchell Murray D
Published: October 2008

Products of arachidonic acid metabolism (eicosanoids, e.g. some prostaglandins and leukotrienes) have important roles in the maintenance of pregnancy, and certain diseases of pregnancy such as pregnancy-induced hypertension and the machanism(s) of parturition both at term and before term. The volume of literature describing these last relationships dictates that the present review has to be focused rather than global in nature. Only studies of preterm labour in women and the use of human tissues will be discussed in detail despite the limitations in experimental designs that are imposed on such studies. Emphasis will be placed on studies of cyclo-oxygenase and to a lesser extant lipoxygenase pathways of arachidonic acid metabolism mentioning only briefly the pathways for catabolism of these eicosanoids. It should be noted also that eicosanoids from the epoxygenase pathways and those not derived from arachidonic acid will not be discussed here. The review of literature will not be comprehensive but rather selective in order to focus on specific issues of importance or controversy. In developing concepts of regulation I have emphasized studies with amnion since this tissue has received most attention experimentally. The significance of the eicosanoids in the mechanisms of labour at term and before will be described primarily in a section in which I have attempted to deleneate those regulatory mechanisms that are considered most significant in, or specific to, pregnancy and parturition. Studies of labour at term will be freely interspersed with studies specific to preterm labour since the latter are limited, and we need a ‘strandard’ for comparison; moreover, results from one series of studies helps the development of concepts for the other. Finally, the reader is directed to several excellent reviews that concentrate on areas not emphasized in this review.1–7
Pregnancy immunology
Authors: Johnson Peter M , Ramsden Gordon H
Published: October 2008

Immunology is a fast developing and intriguing biomedical science, which can give rise to specific considerations about the physiological process of both successful and unsuccessful vivparous pregnancy. It is normal in clinical organ transplantation for unmatched foreign tissues (allografts) to provoke immunological rejection by the host, unless there has been prior tissue matching (histocompatibility antigen tissue typing) or immunosuppressive therapy. Thus, it is still not fully clear how, after ‘random’ mating, haplo-nonidentical fetal tissue is able to survive in the potentially hostile immunocompetent maternal environment. The majority of pregnancies survive uninterrupted and there has now been much speculation and research regarding the immunological success of pregnancy (i.e. nature’s transplant). Medawar orginally offered four nonexclusive hypotheses to explain the enigmatic immunological survival of normal pregnancy:

1) the conceptus is not immunogenic and therefore does not evoke an immunological response;

2) pregnancy alters the maternal immune response;

3) the uterus is an immunologically privileged site;

4) the placenta is an immunological barrier between the mother and the as yet immunologically incompetent fetus.

Before discussing these, as well as some of the clinical immunological problems that may arise during pregnancy, it is necessary to outline some of the basic components of the normal immune system. This will lead to a description of current understanding of immunological events at the fetomaternal interface as well as the maternal immune response in human pregnancy.
Vaso-active factors in pregnancy
Authors: Myatt L
Published: October 2008

Pregnancy results in profound physiological changes in the cardiovascular system, yet these changes are completely reversible. It is apparent that vaso-active factors, some as yet probably unidentified, which act as humoral or local autocrine or paracrine regulators of vasular resistance, play a major role in these cardio-vascular changes. This role may be heightened in pregnancy when there has to be a large increase in blood flow to the uterus and placenta while maintaining adequate flow to other vascular beds. Our knowledge of the mechanisms of action of these vaso-active factors and their interactions with each other still remains incomplete. Alterations in synthesis and action of these vaso-active factors may occur in pregnancies associated with pregnancy-induced hypertension, pre-eclampsia or intra-uterine growth retardation. Investigation of such alterations may help to elucidate the roles of vaso-active factors in both normal and pathological situations. The gestational hormones oestrogen and progesterone, are obviously prime candidates as overall regulators of the cardiovascular changes of pregnancy and as agents which alter the synthesis or action of other vaso-active factors. Currently, much attention is being focused on the role of local autocrine or paracrine vaso-active factors which may be produced by the endothelium or by the underlying vascular smooth muscle cells and alterations in their production or action in the hyptertensive disorders of pregnancy. The endothelium forms the largest endocrine organ within the body and so its importance in the mediation of vascular events should not be under-estimated. The principal objective of this review is to examine the roles of these many autocrine and paracrine vaso-active factors during pregnancy and their relation with the overall regulation of the vascular system. Changes which may occur and be involved in the aetiology of pre-eclampsia and growth retardation will also be examined.
Aspirin in pregnancy
Authors: Bremer Henk A , Wallenburg Henk CS
Published: October 2008

Aspirin, acetylsalicylic acid, is the most frequently consumed drug in pregnancy, taken mostly without a prescription because of headache or a minor ailment. Numerous preparations containing acetylsalicylic acid are freely available over the counter under a variety of proprietary names, and in many cases pregnant women and their doctors may be unaware that aspirin is being taken.
The renin angiotensin aldosterone system and pregnancy
Authors: Pipkin F Broughton
Published: October 2008

Given the phylogenic antiquity of the renin angiotensin system (RAS) and the high degree of renin gene sequence conservation between species, it is perhaps not surprising that the RAS should be central to cardiovascular homeostasis. Nor, given the common embryological origin of the kidneys and reproductive tracts, is it especially surprising that the system should be influenced by, and may itself influence, the state of pregnancy. In this review I shall attempt to give an outline of the workings of the system in normal and in hypertensive pregnancy. The RAS is now known to be involved in spheres far beyond the ‘simple’ control of sodium and water homeostasis, and hence of blood pressure. Its roles in reproduction and in fetal life in animals have been very recently reviewed; this review will therefore confine itself to human studies unless otherwise stated.
The classification of placenta praevia – time for a change?
Authors: Oppenheimer Lawrence W , Farine Dan , Ritchie JW Knox
Published: October 2008

The techniques employed in the diagnosis of placenta praevia have altered radically since Guillemeau first described the condition in 1685, stating that ‘The surgeon must consider if it is the child or if it is the after-birth who presents first’. However, his description went unnoted, for Giffart in narrating a case of haemorrhage wrote in 1730: ‘I cannot receive as absolutely true the opinion of those authors, who say that the placenta is always attached to the fundus uteri, for in this case, as in many others, I have every reason to believe that it adhered on the internal orifice, or very near to it; and that, in dilating, the latter occasioned the separation of the after-birth, and as a consequence the haemorrhage.’
Audit of antenatal care
Authors: Hall Marion H
Published: October 2008

Although antenatal care was widely introduced in the Western world only in the 20th century, it is now universally accepted and advocated as beneficial and advisable for all pregnant women and hence consumes a considerable amount of accommodation, equipment, professional time and costs to the women themselves. Resource use is rarely measured routinely but must vary enormously because of differences in the amount and intensity of care proposed, and in its uptake, in different geographical settings. However, even when resource use is at the lower end of the spectrum, antenatal care should be audited so that the needs of women and their babies can be best addressed.
Management problems in the pregnant diabetic
Authors: Van Assche FA
Published: October 2008

Major progress has been made in the knowledge and management of diabetes and pregnancy. However diabetes in pregnancy remains an important medical complication, with implications for mother and child in both the short and the long term. There are still controversies concerning the diagnostic criteria of gestational diabetes and concerning the best strategry for the treatment of this disorder. There is even less agreement about whether gestational diabetes is a pathological condition. The perinatal mortality in gestational diabetes has recently become as low as that in the general population. This has led to the conclusion that gestational diabetes is no more than a variant of metabolic adaptation during pregnancy. However, fetal hyperinsulinism is present in gestational diabetes, resulting in macrosomia, neonatal complications and most probably long term consequences. Improvements in the care of the preexisting insulin-dependent pregnant diabetic have been achieved but further progress in understanding the underlying mechanisms and in preventing and treating the disease are important goals for the near future.
Prostaglandins and cervical dilatation
Authors: van Dessel T , Frijns JH , Wallenburg HC
Published: October 2008

The efficacy of labour is determined by uterine, fetopelvic and cervical factors. Whereas the first two of these are well recognized, acknowledgement of the modulating function of the cervix during labour is relatively new. In particular, clarification of the synthesis and metabolism of prostaglandins has contributed considerably to our understanding of the biological control of the cervix.
Pregnancy and the thyroid
Authors: Kendall-Taylor P
Published: October 2008

The normal thyroid secretes thyroxine (T4) and, to a lesser extent, triiodothyronine (T3). The T4 is transported in the circulation to peripheral tissues largely bound to thyroxine binding globulin (TBG); T3, which is produced in peripheral tissues by deiodination of T4, also binds to TBG. It is, however, the free thyroid hormone concentration which determines the metabolic state, by its action on T3 nuclear receptors in the cells of kidney, heart, liver, anterior pituitary and other tissues.
Pregnancy alcohol consumption
Authors: Taylor David J
Published: October 2008

Alcohol was discovered soon after the development of waterproof pots to store and transport water and fruit. Liquids produced by spontaneous fermentation of grains, sugars and fruits were found to enhance pleasure. During the middle ages alchemists discovered that distillation increased this power and thought they had found the elixir of life. Since then almost every culture has used alcohol. Each society has introduced its own restrictions on the availability, exports, imports and consumption of alcoholic beverages within its religious and political structure. Generally, drinking levels which interfere with self-control or result in individual, familial or societal harm are disapproved by all cultures.
Detection of fetal abnormalities by ultrasonography
Authors: Bronshtein M , Yoffe N , Zimmer E , Blumenfeld Z
Published: October 2008

Diagnostic ultrasonography has achieved an almost universal role in the practice of obstetrics, due to technological improvements in equipment and the experience acquired by well-trained ultrasonographers. Within the general population, over 3% of children reportedly have major congenital malformations that are life-threatening, require major surgery or have serious cosmetic effects. Many of these malformations can be detected antenatally by obstetric ultrasound. The introduction of high frequency transvaginal ultrasonography is a major development in the area of obstetric ultrasonography. Using this method, fetal anomalies have been successfully identified as early as the first trimester of pregnancy, leading some investigators to advocate routine ultrasound examination during pregnancy in order to screen for fetal anomalies at a gestational age that permits consistently accurate diagnosis and maximizes parental choice.
Prevention of preterm birth
Authors: Kurki T , Ylikorkala O
Published: October 2008

For an infant without lethal congenital malformations there is no risk greater than to be born too early. In addition, preterm birth with its many consequences may compromise the life of the whole family. Thus, prevention of preterm birth is one of the greatest challenges in obstetrics. However, this has proven to be difficult. This difficulty is in part due to the fact that, although we know a large number of clinical factors which are know a large number of clinical factors which are associated with preterm birth, the final mechanisms triggering the onset of preterm contractions or premature rupture of the fetal membranes (PROM) have remained largely unclear. We review the prevention of preterm birth in the light of the newest data; an interested reader is also referred to other recent overviews on the same topic.
External cephalic version at term
Authors: Hofmeyr GJ
Published: October 2008

It is remarkable that, for all the sophistication of current obstetric practice, uncertainty should persist concerning the management of as fundamental a problem as breech presentation, particularly with respect to the place of external cephalic version (ECV). This review will focus on information available for guiding clinical decisions, and practical aspects of the procedure.
Practical management of pregnancy in systemic lupus erythematosus
Authors: MM Buchanan Neil , Khamashta Munther , Kerslake Sian , J Hunt Beverley , RV Hughes Graham
Published: October 2008

Systemic lupus erythematosus (SLE) is a multi-system disorder belonging to the connective tissue group of diseases characterized by circulating non-organ-specific autoantibodies. Its incidence may be increasing and, as milder cases are recognized, it is becoming a condition likely to be encountered in many medical settings. The peak onset is during the child-bearing years when the sex ratio approaches 13:1 in favour of females. Fertility rates are normal and hence pregnancy becomes a common management problem in this group of patients.
Diagnosis of fragile X syndrome
Authors: Mulley JC , Sutherland GR
Published: October 2008

Fragile X syndrome accounts for between one third and one half of all X-linked mental retardation. It is the most common cause of familial intellectual handicap and is second in prevalence only to Down’s syndrome among the mental retardations. The syndrome is known to affect about 1 in 2500 males and a similar number of females. It has been detected in all ethnic groups with access to modern medicine. The economic and social costs of this disorder made the determination of its molecular basis a high priority.
Fetal cardiovascular reflex responses to hypoxaemia
Authors: Giussani Dino A , Spencer John AD , Hanson Mark A
Published: October 2008

The fetus mounts a coordinated cardiovascular response to an insult of acute hypoxaemia which involves neural and endocrine components. During acute hypoxaemia in late pregnancy there is a transient bradycardia, a gradual increase in arterial blood pressure and an increase in heart rate variability. In addition, there is a redistribution of the combined ventricular output favouring the cerebral, myocardial and adrenal circulations by shunting blood away from the peripheral circulations. A component of the increase in peripheral vascular resistance and the increase in arterial blood pressure during acute hypoxaemia is mediated via increases in plasma concentrations of vasoconstrictor hormones such as vasopressin, angiotensin II and neuropeptide Y. Whilst an increase in plasma ACTH and cortisol is also seen during acute hypoxaemia, their contribution to cardiovascular control in fetal sheep is less clear.

Evidence has been presented to suggest that a number of these cardiovascular and endocrine responses to acute hypoxaemia are chemorefiex in nature, mediated principally by carotid chemoreceptor afferents. In addition, this reflex may be modifiable in terms of changes in magnitude and gain: first, by an influence of the intrauterine environment during chronic hypoxaemia and second, through genetic influences, in animals adapted to life at high altitude.
The management of intrapartum fetal distress
Authors: Arulkumaran S
Published: October 2008

It is logical to deliver a distressed fetus as quickly as possible in the most appropriate way either abdominally or vaginally. Unfortunately, the diagnosis of fetal distress is not always precise compared with the diagnosis of placenta praevia or anaemia in pregnancy. By common usage and for want of a better term, the situation where the clinician feels that the baby might be hypoxic and acidotic is termed fetal distress. The fetus may also become distressed because of infection or injury associated with labour. Many babies are delivered operatively for fetal distress and are in excellent condition. One could argue that, in such cases, action had been taken long before the fetus actually became distressed and hence the baby was born in good condition.
Daycare assessment and hypertensive disorders of pregnancy
Authors: Walker JJ
Published: October 2008

Hypertension is a common problem occuring in around 12–15% of all pregnancies. It remains one of the major causes of maternal death. Because of its perceived risk and the difficulty in deciding who has a problem and who does not, obstetricians often admit a patient found to be hypertensive to hospital for closer observation. This “play safe” approach can cause much inconvenience to the patient and her existing family. The result of this policy is that pregnancy hypertension is responsible for around 25% of all antenatal admissions. It is a major burden on health service resources in terms of manpower and hospital accommodation. Inpatient management may vary between different hospitals but the cornerstone is to keep the patient in hospital in order to allow serial monitoring of blood presure. Strict bedrest has been suggested to have therapeutic value but this has never been substantiated. As some of these patients will progress to more severe forms of the disease, it is important that there is early recognition of any signs of progression.