SummaryThere were 66 974 births at the three largest Dublin maternity hospitals in the years 1980–1982. Data on numbers of spontaneous and elective births, birthweight and perinatal mortality were analysed by day of the week. Perinatal mortality rates were highest on Wednesdays and Saturdays. The rate on Sunday was close to average. The largest number of perinatal deaths per day occurred on Wednesdays and the smallest on Sundays. Significant variations in mortality rates and percentage low birthweight were found among the 19% of infants who were born electively, but not among those born after a spontaneous onset of labour. High‐risk pregnancies, including many with intrauterine fetal death, were induced in large numbers from Tuesdays through Saturdays with a peak on Wednesdays. Low risk cases were induced mainly from Monday through Fridays with a peak on Fridays. The pattern of perinatal mortality through the week followed closely that of the risk status of pregnancies delivered electively. The results indicate that the pattern of perinatal mortality by day of the week of birth was determined by a highly organized weekly routine of selective elective delivery.

Sex hormone binding globulin (SHBG) capacity was reduced in 9 of 31 patients with polycystic ovarian (PCO) disease and the mean level in PCO patients was significantly less (p less than 0.001) than normal. Serum testosterone levels were elevated in 21 of 32 PCO patients and the mean level was significantly elevated (p less than 0.001). Serum androstenedione values were raised in 17 of 31 patients and the mean value was also significantly raised (p less than 0.001). Serum dehydroepiandrosterone sulphate (DHAS) concentrations were elevated in only 2 of 14 patients. Urinary 17-oxo and 17-oxogenic steroids were normal in all patients studied. Basal follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were normal but LH release following injection of luteinizing hormone-releasing hormone (LH-RH) was enhanced. A highly significant negative correlation (r=--0.449; p less than 0.01) was found between the logarithm of testosterone and the logarithm of LH levels. Serum prolactin concentrations were elevated in 4 of 21 PCO patients. Thyroid-stimulating hormone (TSH) values were normal. Eighteen of 20 patients ovulated following treatment with clomiphene and nine became pregnant. Five of 12 of patients treated with oestrogen/progesterone preparations noticed an improvement in their hirsutism. It is suggested that the normal cyclical release of LH is inhibited in PCO disease by a negative feedback by androgens to the hypothalamus or the pituitary, and that wedge resection should be reserved for patients in whom other forms of treatment have failed.

SummaryPremature ovarian failure was studied in ten women under the age of 30; eight had an ovarian biopsy and five of these showed primordial follicles. Plasma levels of oestradiol and progesterone were similar to the follicular phase of a normal menetrual cycle, but in eight patients cervical smears showed a cornification index of less than one per cent. Levels of both androgens and of sex hormone binding globulin capacity were generally normal. Administration of LH‐RH caused a release of FSH which was similar to post menopausal women and higher than normally menstruating women, and a release of LH which was higher than both. Two patients were treated with exogenous gonadotrophins without effect.

SUMMARYExogenously administered oestradiol or progesterone was found to induce augmentation of LH and FSH release in response to LHRH administration in patients with the polycystic ovary (PCO) syndrome. The effect of oestradiol upon LH release in the patients was significantly less than the augmented release induced in normal women (P < 0.02). In contrast, progesterone induced a significantly greater LH release in PCO patients than normal women studied during the early follicular phase (P < 0.001) but less than that in normal women studied during the mid‐follicular phase of the cycle (P < 0.01). The effects on FSH release in the PCO patients were less marked but similar to those in normal women with comparable basal steroid levels.The results suggest that both oestradiol and progesterone can modify the hypothalamic‐pituitary axis in the PCO syndrome in a manner similar to that observed in normal women and a failure of these ‘positive feedback’ mechanisms does not appear to be the cause of the ovulatory deficiency in this syndrome.

Summary The characteristics of normal labour in 1306 white, Asian and black parturients have been established following a prospective study of 3217 consecutive labours. Asian patients were found to be of significantly shorter stature than white or black women (p<0.001) and their infants significantly lighter than those of white (p<0.001) and of black (p<0.05) women, and a low positive correlation was found between maternal height and infant birth weight. The mean duration of the first stage of labour, taken from the time of admission to the labour ward, was 5‐6 hours in primiparae and 3.7 hours in multiparae. The mean durations of the second stage of labour were 41.5 and 17.4 minutes respectively. The correlations between the duration of the first and second stages of labour were too low to be of value in patient management. Similar low correlations were found between the duration of the second stage of labour and both infant birth weight and the Apgar score at one minute. Cervical dilatation‐time curves, constructed with reference to the cervical dilatation found on admission to the labour ward, revealed no significant differences in the progress of normal labour in the different racial groups.

A radioimmunoassay is described for the measurement of dehydroepiandrosterone sulphate in serum. The method requires 0.1 ml of serum that needs no purification other than a single ether extraction. It is both rapid and economical, procedural losses are small and precision and accuracy are acceptable for both normal and pathological sera. Normal values have been established for children and adults which show a relationship to chronological age, values rising steadily as puberty intervenes, peak values occurring between 20 and 27 years, with a decline thereafter. An empirical curve was fitted to the data and approximate normal limits were obtained. The mean value for pregnant women in the age range 20–40 years, was statistically significantly lower than in non-pregnant, premenopausal women. The levels of dehydroepiandrosterone sulphate in cord and newborn blood, were higher than at any other time during childhood until signs of puberty were demonstrable. Elevated levels are reported in six patients with untreated congenital adrenal hyperplasia and in one patient with a tumour of the adrenal cortex. It is suggested that this assay provides a useful and precise index of adrenal androgen secretion.

SummaryInjection of oestradiol benzoate was found to elicit a surge of luteinizing hormone (LH) in 15 of 19 patients with polycystic ovary (PCO) syndrome; follicle stimulating hormone (FSH) was also released, in conjunction with the LH surge, in eight patients. It is concluded that the oestrogen feedback mechanisms controlling mid‐cycle gonadotrophin release are functioning normally in the majority of patients with PCO syndrome. Ovulation was subsequently induced by clomiphene alone in those patients who had an LH surge, and by a combination of clomiphene and human chorionic gonadotrophin (HCG) in those who had not shown any LH release.

SUMMARYThe response to synthetic luteinizing hormone‐releasing hormone was studied in eighteen patients with the polycystic ovary syndrome. The release of follicle‐stimulating hormone was similar to that found in normal women. The mean response of luteinizing hormone was similar to that found in the luteal phase, but significantly greater (P<0.02) than that found in the early follicular phase of the normal menstrual cycle. Basal serum levels of FSH and LH, estimated in twenty‐five patients, were similar to those found in normal subjects. The sex hormone binding globulin capacity was reduced in twenty‐four of them. Basal serum testosterone levels were elevated in twelve of twenty‐two patients and the mean level was significantly greater (P<0.01) than the mean level of normal women. Basal serum androstenedione levels were elevated in nine of twenty‐two patients and the mean level was also significantly greater (P<0.02) than normal. There was a highly significant negative correlation (r=−0.86; P<0.001) between basal testosterone and LH levels. These data suggest that the pituitary gland of patients with the polycystic ovary syndrome contains adequate amounts of LH but that the ovulatory surge of LH which occurs in normal women is inhibited by testosterone acting on either the pituitary or, more probably, on the hypothalamus.

A simple rapid method for the measurement of sex hormone binding globulin (SHBG) capacity, using 0.2ml of serum, is described. [4-14C] Testosterone is used as the saturating ligand at one dose level for all samples except pregnancy sera. Albumin bound [4-14C] testosterone is separated from the globulins with ammonium sulphate and the labelled globulin fraction counted. Pre-treatment of sera with a charcoal suspension under defined optimum conditions removes endogenous steroids associated with the binding proteins without affecting the binding [4-14C] testosterone to SHBG. The method shows good reproducibility with a coefficient of variation of 4% for male and 4.7% for female serum. Association constants measured for normal male, female and pregnancy sera were 3.6 × 108 M−1 , 3.2 × 108 M−1, and 1.7 × 108 M−1 at 20°, respectively.

Summary Theplacental transmission oflincomycin wasstudied in 60patients inlatepregnancy. A peakmaternalblood level of125Fg/mlwasrecorded 45minutesafter injection,anddetectable levels werestill presentup to42 hoursafter asingle injection. A peakcordbloodlevel of 27Rug/ml wasrecorded 55minutesafter injection; cord bloodlevels wereaboutaquarter ofthematernal blood levels, andinmostcasesno levels weredetectable 24 hoursafter asingle injection. Thepassage oflincomycin intoandoutoftheliquor wasslowerandmorevariable, butsomehoursafterinjection theliquor levels were alwayshigherthanthematernalorcordbloodlevels, anddetectable levels werestill present intheliquor 52 hoursafter asingle injection. Repeated injections didnot leadtoanysignificant accumulation oflincomycin. The onlysideeffect was a possible caseofneuromuscular blockina motherdelivered bycaesareansection. No infant wasadversely affected.

SummaryOne thousand consecutive cases of diagnostic laparoscopy are reported. The commonest indications were infertility, amenorrhoea and pelvic pain. Abnormalities were detected in 37.5 per cent of patients with primary infertility, and in 51 per cent of patients with secondary infertility. Laparoscopy provided a more accurate assessment of tubal patency and function than did hysterosalpingography. An ovarian biopsy was taken from 39 patients and provided more definitive information towards the diagnosis and management of patients with amenorrhoea than did urinary steroid investigations. In patients with pelvic pain the clinical findings were confirmed in 61.5 per cent of patients; in 27.4 per cent unsuspected abnormalities were found, and in 11.1 per cent the clinical diagnosis was shown to have been wrong. A diagnosis of early unruptured tubal pregnancy was confirmed in 33 per cent of patients with indefinite clinical findings. The majority of patients with dysmenorrhoea had no abnormality. The only serious complication was a uretero‐vaginal fistula after attempted biopsy of a streak ovary and later hysterectomy.