Forty-nine obstetricians from three European countries were asked when they would advise delivery for a preterm fetus failing to thrive in utero, given various gestational ages, and a range of either umbilical artery Doppler flow velocity waveforms or CTG variability measures. Their responses indicated a wide area of disagreement about the correct timing of delivery, and a willingness to randomise patients to clinical trials of management. The area of uncertainty corresponded to the gestational age and Doppler bands at which participants have been entered to the pilot phase of a randomised trial of timed delivery, the Growth Restriction Intervention Trial (GRIT).

The relationship between maternal peripheral plasma concentrations of prostaglandin E2 and prostaglandin F2alpha metabolites (bicyclo-PGEM and PGFM respectively) and the level of uterine activity in spontaneous labour was studied in 10 nulliparous and 10 multiparous women. Plasma prostaglandin metabolites were measured by radioimmunoassay. Uterine activity was quantified by computer analysis of changes in intrauterine pressure and expressed as mean active pressure (MAP). As labour progressed, both parity groups showed a significant rise in MAP which was associated with a significant increase in the levels of PGFM. However, the percentage rise in PGFM did not significantly correlate with the percentage rise in MAP. At all stages in labour PGFM and MAP levels were higher in the nulliparous group compared with the multiparous group. Bicyclo-PGEM levels showed no significant change in the nulliparous group but rose in late first stage/second stage in the multiparous group. Our observations support a role for prostaglandin F2alpha in the generation of uterine activity in spontaneous labour. However, further study is required to elucidate the mechanisms controlling prostaglandin production by the fetal membranes and decidua in vivo, and how this relates to maternal peripheral plasma prostaglandin metabolite concentrations and the level of uterine activity.

The purpose of this study was to investigate the influence of postnatal x-ray pelvimetry after caesarean section on the management of the subsequent pregnancy. The case records of 331 women delivered by casearean section in their first pregnancy were reviewed. By standard radiological criteria, the pelvis was considered to be inadequate in 248 (75%) of them and adequate in 83 (25%). Of the women with a radiologically inadequate pelvis, 172 underwent an elective caesarean section. Seventy-six were allowed vaginal delivery: 51 of these women delivered vaginally and 25 required an emergency caesarean section. Of the women with a radiologically adequate pelvis, 61 achieved a vaginal delivery and 22 were delivered by caesarean section. All of the three cases of uterine rupture occurred in women with a radiologically adequate pelvis. This study suggests that x-ray pelvimetry is not a good predictor of the outcome of a trial of vaginal delivery. We conclude that the practice of routine postnatal pelvimetry should be abandoned.

BJOG: An International Journal of Obstetrics & GynaecologyVolume 98, Issue 4 p. 415-415 Randomized comparison of routine vs highly selective use of Doppler ultrasound and biophysical scoring to investigate high risk pregnancies Martin Whittle, Martin Whittle University Department of Midwifery The Queen Mother's Hospital Yorkhill Glasgow, ScotlandSearch for more papers by this authorFiona Fairlie, Fiona Fairlie University Department of Midwifery The Queen Mother's Hospital Yorkhill Glasgow, ScotlandSearch for more papers by this authorGreg Ryan, Greg Ryan University Department of Midwifery The Queen Mother's Hospital Yorkhill Glasgow, ScotlandSearch for more papers by this author Martin Whittle, Martin Whittle University Department of Midwifery The Queen Mother's Hospital Yorkhill Glasgow, ScotlandSearch for more papers by this authorFiona Fairlie, Fiona Fairlie University Department of Midwifery The Queen Mother's Hospital Yorkhill Glasgow, ScotlandSearch for more papers by this authorGreg Ryan, Greg Ryan University Department of Midwifery The Queen Mother's Hospital Yorkhill Glasgow, ScotlandSearch for more papers by this author First published: April 1991 https://doi.org/10.1111/j.1471-0528.1991.tb13439.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume98, Issue4April 1991Pages 415-415 RelatedInformation

One hundred nine patients with severe preeclampsia in the second trimester were studied. Pregnancy termination was recommended for those with gestational age less than or equal to 24 weeks (n = 25), whereas expectant management with aggressive maternal and fetal monitoring was recommended for those with gestational age greater than 24 but less than or equal to 27 weeks (n = 84). Ten of the 25 women in the early pregnancy group accepted termination and 15 elected to continue the pregnancy. The overall perinatal survival in the latter 15 patients was 6.7%, and maternal complications developed in six patients. Thirty of the 84 patients in the late second-trimester group had immediate delivery, and 54 had expectant management. The average length of pregnancy prolongation in the expectant group was 13.2 days (range, 4 to 28 days). Compared with the immediate delivery group, the expectant management group had significantly higher perinatal survival (76.4% versus 35%), significantly higher birth weights (880 versus 709 gm), and a lower incidence of neonatal complications. There were no differences between the two groups with regard to maternal complications. Expectant management with aggressive monitoring of maternal and fetal status at a perinatal center improves perinatal outcome in patients with severe preeclampsia with gestational age greater than 24 but less than or equal to 27 weeks.