Summary Synthetic luteinizing hormone‐releasing hormone (LH‐RH) was given intravenously in a dose of 100μg. to 24 normal regularly menstruating women at various stages of the same menstrual cycle. The luteinizing hormone (LH) response was always greater during the luteal phase (days 22 to 24) than during the early follicular (days 4 to 6) or mid‐follicular phases (days 8 to 10). No statistical difference was shown between the two groups studied in the early and mid‐follicular phases for LH release, but in four subjects, studied on four occasions in the same cycle, the greatest release of LH occurred on day 14. The follicle stimulating hormone (FSH) responses were more variable although every patient showed a significant rise in circulating FSH after the injected LH‐RH. The luteal phase response was greater in all but four of the subjects tested. However, a significantly larger response (0.1 0.05) was seen in the early follicular phase when compared with the mid‐follicular phase responses. No correlation between LH or FSH responses and circulating progesterone levels could be demonstrated in any of the subjects. A negative correlation (r=−0.55; 0.1>p>0.05) was found between sum of FSH increments and circulating oestradiol during the early follicular phase, but no such correlation was seen in the mid‐follicular phase responses. Similarly, a negative correlation between sum of FSH increments and oestradiol (r=−0.70; 0.05>p>0.02) was demonstrated in the luteal phase responses, but no correlation with LH response was apparent.
Summary The total soluble protein and the concentration of the contractile protein actomyosin were estimated in the human placenta at varying stages of gestation. As maturity and differentiation of the placenta occurred the proteins increased in concentration. The actomyosin was thought to be present in the smooth muscle fibres in the chorionic plate, and related to the placental vessel walls. The contractile property of the smooth muscle and the demonstration of contractile protein suggested that they play an active role in the dynamics of placental circulation.
SummaryContinuous records of fetal heart rate were made weekly during the last trimester of 15 normal pregnancies. Using an ultrasonic technique, a total of 124 records, each lasting 50 minutes, was obtained. With increasing length of gestation there was a small but significant reduction in mean heart rate and an increase in beat‐to‐beat variation. On some occasions, two distinct patterns of beat‐to‐beat variation could be distinguished in the same record. These appeared to be related to fetal movement.
Summary A pregnancy termination service has been set up for patients living in the catchment area of a National Health Service hospital, without expansion of staff or facilities except by one extra, lay counsellor. The use of beds has been minimized by employing outpatient techniques in the majority of suction abortions. The organization is described in detail and the role of the counsellors is stressed. In the first year of the service, 488 of 529 patients who attended the weekly clinics had their pregnancy terminated; 433 had a suction abortion, 75 per cent of which were done under local anaesthesia, the proportion increasing to 93 per cent with greater experience. The use of local anaesthesia for suction abortion, compared with general anaesthesia, was not associated with any increase in the incidence of incomplete evacuation of the uterus (5.9 per cent) or possible sepsis (5.1 per cent) amongst women followed up, but there was a much smaller operative blood loss up to 10 weeks' gestation. Intrauterine contraceptive devices (IUCD) were fitted at the end of 44 per cent of suction abortions and this procedure was not associated with any increased incidence of postoperative pain or sepsis. The results in patients whose pregnancy was terminated by other methods are also reported. Following abortion, 84 per cent of patients attended a special follow‐up and contraception clinic. Of all patients who underwent abortion, at least 82 per cent were using a reliable contraceptive method (oral, IUCD, or sterilization), and, in addition, a quarter of those not followed up had been fitted with an IUCD after suction abortion.
SummaryA spring‐loaded clip designed to be inserted through a 10 mm. diameter laparoscope was applied under local analgesia to the Fallopian tubes of 297 patients between September 1972 and November 1973. In three other patients the procedure was carried out under general anaesthesia. Apart from vasovagal reactions which occurred in 25 patients there were no major complications. Up to November 1973 four pregnancies were reported; they were all due to faulty application of the clips.
SummaryA prospective survey of 25 patients with endometrial carcinoma was undertaken and the findings were compared with those of 50 patients in each of two control groups. This paper presents only the clinical aspects of the survey. Contrary to the general belief, women with endometrial carcinoma are no more obese or hypertensive than comparable controls; nor is there any evidence of a genetic predisposition. But they are notably less fertile and appear to menstruate to a later age.
SummaryThree patients with dissecting aneurysm of the aorta in pregnancy are presented and the literature is briefly reviewed. Two of the three patients died. Accurate diagnosis is important because recent advances in management have improved the outlook for the patient.
SummaryThree cases of placenta praevia accreta after lysis of uterine synechiae are presented. The possibility of the above complication in a pregnancy following the treatment of Asherman's syndrome is emphasized. These cases must be under special antenatal care and if diagnosed in time they should be treated by Caesarean section and in most cases Caesarean hysterectomy is probably the safest procedure.
SummaryA total of 412 patients had second trimester abortions and in five of them a rupture of the cervix was detected. An attempt is made to relate the occurrence of this complication to age, parity and to the method of stimulating uterine activity.
SummaryThere has been no reported systematic exploration of the hypothesis that the low birthweight of infants whose mothers smoke in pregnancy is mediated by depressed caloric intake. Using gestational weight gain as an index of energy balance, we have studied this question among 162 mothers and their liveborn singleton infants, in a poor, black, urban American community. Smoking mothers had lower mean weekly weight gain (0.73 versus 0.90 pounds per week; t=2.63; p<0.01), and a strong and highly significant gradient of decreasing weight gain with increased amount smoked (0.017 fewer pounds per week gained per additional cigarette per day; F=12.45; p<0.005). Women who stopped smoking before delivery had higher weight gain than those who continued; the difference was not significant, but numbers were small. Regression analyses were performed in order to quantitate the unique and joint contributions of smoking and change in maternal weight to birthweight. At least half, and usually closer to three‐quarters, of the effect of smoking on birthweight was jointly shared with maternal weight change. Smoking is in all likelihood depressing fetal growth, in large part, by depression of caloric intake, reflected by lower maternal weight gain. No other examined differences between smokers and non‐smokers accounted for these differences.
Summary A method of definitive antenatal diagnosis for spina bifida is described. Preliminary amniocentesis is performed at 12 to 14 weeks' gestation for alpha1‐fetoprotein. If this result is normal, an amniogram carried out at 18 to 20 weeks' gestation gives a good outline of the fetal back and a view of the fetal spine so that a confident diagnosis of a baby without a neural canal defect is possible, thus avoiding termination of pregnancy.
SummaryThe uterine inflammatory response to the presence of an intrauterine contraceptive device (IUCD) may have some role in the mechanism of action of the device. In comparing a group of women using a polythene IUCD (Lippes loop) with a control group, it was shown that there was a significant elevation in serum IgG and IgM (Holub et al., 1971). In the present study a stainless steel IUCD was used (Inhiband, Ayerst) to repeat the experiment measuring changes in serum immunoglobulins G, A and M in the same persons in order to exclude other non‐specific causes for any increases. IgA is usually the antibody related to inflammatory responses of mucosal surfaces, but such serum measurements were not mentioned in the group of women using polythene IUCDs. In this paper significant elevation of IgG and IgM was confirmed, but this tends to remit after about a year. A progressive rise in serum IgA levels was found to occur during the same period of study.
SummaryPneumoperitoneum for laparoscopy was induced in a series of 105 patients by inserting the Verres needle through the uterine fundus. The results indicate that this technique is simple and safe.
SummaryIn order to define metabolic factors which control human placental lactogen (HPL) secretion two types of experiment have been conducted: (a) hypoglycaemia was induced by intravenously‐injected insulin in 21 normal women in late pregnancy; and (b) a sustained hyperglycaemia was obtained by glucose infusion in six normal women in late pregnancy. Serum HPL was determined using an immunosorbent antibody radioimmunoassay procedure. Blood glucose was estimated in both experiments and plasma immunoreactive insulin in the second. The results show an inverse relationship between blood glucose and serum HPL concentrations. Hyperglycaemia caused the HPL level to fall and conversely insulin‐induced hypoglycaemia caused it to rise. Moreover, declining blood glucose levels after the cessation of a glucose infusion were accompanied by an increase in HPL comparable to that seen during frank hypoglycaemia.
SummaryThe Copper 7 or Dalkon shield standard size intrauterine contraceptive devices (IUCDs) were inserted immediately following vaginal suction termination of pregnancy. A total of 121 patients was randomly selected for each device. The insertion of an IUCD at the time of termination did not increase the incidence of immediate complications. During the subsequent 12 months patients fitted with an IUCD at the time of termination had the same incidence of menstrual upsets, pregnancies, expulsions or removals of the IUCD as patients fitted with an IUCD in the non‐pregnant state. There was no difference in the complication rates of the two devices used at the time of termination.
Summary A modification of Semm's bivalve speculum is described which makes it possible to use a vulsellum to steady the cervix without restricting the view obtained.
SummaryVaginal trichomoniasis was found in 7.6 per cent of women admitted to medical and surgical wards of a general hospital. Three‐quarters of the infected patients had small trichomonads (average diameter less than 16μ), and half of these reported vaginal discharge and sometimes irritation; most of them had marked inflammatory changes in desquamated vaginal squamous cells. Patients infected with large trichomonads (16μ or more) were asymptomatic. During culture in vitro of small trichomonad strains for up to 30 days, the organisms present tended to become progressively larger and giant forms appeared. With large trichomonad strains there was some decrease in size during the first three days, but thereafter changes in the cultures resembled those seen in cultures derived from small strains. After prolonged culture, size and morphology of organisms derived from small and large strains became identical. Patients with carcinoma in situ of the cervix and vaginal trichomoniasis tended to harbour small trichomonads.
SummaryThe technique of isoelectric focusing in polyacrylamide gel was used to investigate the protein patterns of amniotic fluid obtained from women with rhesus isoimmunization. There were no specific changes in protein pattern which could be related to the severity of haemolytic disease. Qualitative changes in the electrophoretic mobility of transferrin were demonstrated. Serial investigations showed that these changes were related to gestational age and were probably a feature of normal pregnancy. The phenomenon appears to be due to alteration in the sialic acid content of the transferrin, presumably the result of alteration in neuraminidase activity.
SummaryThe correlation between HL‐A antibodies in pregnancy and fetal sex was studied in 960 women. Significantly more male infants than expected were born to women who developed HL‐A antibodies during their first full pregnancy. It is concluded that the male fetus evokes a stronger response than the female. With increasing parity the preponderance of male births decreased in women with HL‐A antibodies. By contrast, in women who did not develop antibodies the proportion of male births increased progressively. It is suggested that these findings may be attributed to the presence of a sex chromosome‐linked histocompatibility system in man, which interacts with the HL‐A system.
Summary The effectiveness in clinical practice of conventional analgesia, with pethidine and 50 per cent nitrous oxide in oxygen (Entonox) has been studied in 663 consecutive patients. More than 75 per cent of mothers stated that they had obtained little or no pain relief from pethidine in the manner in which it was administered. In comparison, nearly half the patients who received Entonox had satisfactory analgesia and the incidence of acceptable pain relief with both agents was unrelated to parity. The number of patients receiving satisfactory analgesia was disturbingly low.
