OBJECTIVE: To evaluate a possible association between neighbourhood socio-economic status and spontaneous premature birth in Alberta births. METHODS: The study design was a retrospective cohort of all births in Alberta for the years 2001 and 2006. The primary outcome was spontaneous preterm birth at <37 weeks gestation. Neighbourhood socio-economic status was measured by the Pampalon Material Deprivation Index for each Statistics Canada census dissemination area. Births were linked to dissemination area using maternal postal codes. RESULTS: The analysis comprised 73,585 births, in which the rate of spontaneous preterm delivery at <37 weeks was 5.3%. The rates of spontaneous preterm delivery for each neighbourhood socio-economic category ranged from 4.9% (95% CI 4.5%–5.2%) in the highest category to 6.3% (95% CI 6.0%–6.7%) in the lowest (p<0.001). After controlling for smoking, parity, maternal age and year, we found that women living in the highest socio-economic status neighbourhoods had an adjusted spontaneous preterm birth rate of 5.1% (95% CI 4.7%–5.5%) compared to 6.0% (95% CI 5.6%–6.4%) for women living in the lowest (p=0.003). CONCLUSION: This study documented a modest increase in the risk of spontaneous preterm birth with low socio-economic status. The possibility of confounding bias cannot be ruled out.

Potato (Solanum tuberosum L. subsp. tuberosum) is one of the most important food crops in Canada. Potato cyst nematodes, Globodera rostochiensis (Wollenweber, 1923) Skarbilovich, 1959 and Globodera pallida (Stone, 1973) Behrens, 1975, are considered the most economically important nematode pests of potatoes worldwide and are the subject of strict quarantine regulations in many countries including Canada. In Canada, G. rostochiensis was found in the Saanich Peninsula of Vancouver Island, British Columbia and both G. rostochiensis and G. pallida are present on the island of Newfoundland (3). During August of 2006, soil and roots of potato plants collected from a 19.2-ha field in the Saint-Amable region, Quebec, were submitted to the Nematology Laboratory, Canadian Food Inspection Agency, Ottawa. Golden, spherical-shaped cysts were found associated with the roots and were also extracted from the soil. The nematodes recovered were identified by morphological and morphometric analysis and DNA analysis. Measurements and morphological observation of 60 second-stage juveniles were as follows: body length = 427.4 ± 22.0 (395 to 495) μm; stylet length = 21.3 ± 1.2 (18 to 23) μm; distance from stylet base to dorsal esophageal gland opening = 5.5 ± 0.9 (3.5 to 7.0) μm; tail length = 46.7 ± 3.7 (36 to 58) μm; hyaline tail terminus = 21.1 ± 3.1 (13 to 27) μm; and the shape of stylet basal knobs varied from rounded to lateral flattened. Observations for 35 mature cysts were: number of cuticular ridges between anus and vulval fenestra = 21 ± 6 (12 to 31); fenestral length = 18.4 ± 3.6 (11 to 30) μm; distance from anus to the edge of fenestra = 81.1 ± 30.4 (29 to 165) μm; Granek's ratio = 4.4 ± 1.6 (1.8 to 6.0), with parallel wavy cuticular ridges between anus and vulval fenestra. These observations conformed to the published description of G. rostochiensis (2). Additionally, the identification was supported by the PCR-restriction fragment length polymorphism pattern of the ITS-1 region amplified using primers 18S (5′-TTGATTACGTCCCTGCCCTTT-3′) and rDNA1.58S (5′-ACGAGCCGAGTGATCCACCG-3′) and digested with BstU I and a PCR product specific for G. rostochiensis (1). Sequence of a 1,190-bp PCR fragment of ribosomal DNA amplified using primers rDNA1 (5′-TTGATTACGTCCCTGCCCTTT-3′) and rDNA2 (5′- TTTCACTCGCCGTTACTAAGG-3′) showed 99.0 to 100% identity with published DNA sequences of the same genomic region for G. rostochiensis (4). The sequence is available from the authors upon request. The origin of the introduction of G. rostochiensis into Saint-Amable is unknown. An intensive soil survey is underway to define the infested area, and strict quarantine measures have been taken to prevent further spread of G. rostochiensis. To our knowledge, this is the first evidence of the occurrence of G. rostochiensis in Quebec, Canada. References: (1) A. Fullaondo et al. Nematology 1:157, 1999. (2) A. M. Golden et al. Proc. Helminthol. Soc. Wash. 39:64, 1972. (3) A. R. Stone et al. Plant Dis. Rep. 61:590, 1977. (4) S. A. Subbotin et al. Nematology 2:591, 2000.

In Brief OBJECTIVE To estimate the efficacy of vaginal misoprostol for medical management of missed abortion. METHODS Fifty women with missed abortion were randomized to treatment with up to two 800-mg doses of misoprostol vaginally or a placebo. Participants were reviewed daily for 2 days, then again at 1 week. A blood sample for hemoglobin and serum β-human chorionic gonadotropin (βhCG) was obtained on day 1 and the hemoglobin level checked again on day 7. Complete abortion was defined as expulsion of the products of conception without dilation and curettage (D&C) and a negative follow-up urine βhCG test after 4 weeks, or as no products of conception obtained at D&C in cases of suspected incomplete abortion. RESULTS The rate of complete abortion was 80% (20 of 25) in the misoprostol group and 16% (four of 25) in the placebo group, relative risk 0.20 (0.08, 0.50), P < .001. The rate of D&C was 28% (seven of 25) in the misoprostol group and 84% (21 of 25) in the placebo group, relative risk 0.33 (0.17, 0.64), P < .001. One participant in the misoprostol group had an emergency D&C for heavy bleeding. No participants required blood transfusion. The mean reduction in hemoglobin from day 1 to day 7 was 3.2 g/L in the misoprostol group versus 4.3 g/L in the placebo group, P = .72. Patient satisfaction with misoprostol treatment was high with 19 of 21 participants reporting they would try medical management again if they experienced another missed abortion. CONCLUSION Medical management of missed abortion is effective, reduces the need for D&C, and is associated with high levels of patient satisfaction. Treatment of missed abortion with misoprostol resulted in completed abortions in a high proportion of cases and reduced the need for dilation and curettage.

The use of ultrasound has facilitated early diagnosis of missed abortion in an increasing percentage of patients, but the optimal management of these women is not yet clear. This study investigated the efficacy of vaginally administered misoprostol in the treatment of women with an ultrasound diagnosis of nonviable pregnancy who were not experiencing any cramping or bleeding. Fifty women were randomly assigned to receive either misoprostol or placebo by vaginal insertion. Follow-up visits were at 24 hours, 48 hours, and 1 week after insertion of the medication. Treatment was repeated if there was no satisfactory response at 24 hours. If at 48 hours there was no response or if an incomplete abortion was suspected, patients were offered a dilation and curettage (D\u0026C). β-Human chorionic gonadotropin (β-hCG) levels were measured at the time of initial treatment, again at the 48 hour visit, and 4 weeks after presumed successful conclusion of treatment. Hemoglobin was measured at the initial visit and again at 1 week. The patients in both groups were similar in clinical and demographic characteristics. Their median gestational age was 12 weeks. Cramping began within 24 hours for all of the women receiving misoprostol and for only five of those treated with placebo. After the first dose of misoprostol, 10 of the 25 women in this group appeared not to have a successful response to treatment. However, the results of the 48-hour follow-up visit indicated that 21 of 25 patients had aborted completely, 3 had evidence of an incomplete abortion, and I woman remained unchanged. Most patients reported heavy bleeding that waned after passage of a tissue mass from the vagina. Severe bleeding necessitated an emergency D\u0026C in one patient whose hemoglobin dropped from a postoperative level of 141 g/liter to 129 g/liter on day 7. Two women with persistent bleeding underwent D\u0026C, but no products of conception were found in the histologic specimen. One patients noticed the expulsion of necrotic tissue 2 weeks after treatment. At the 4-week visit, despite an apparent complete response, one patient continued to have a positive pregnancy test. When a D\u0026C was performed, a small bit of trophoblastic tissue was found in the surgical specimen. Within 1 week of initial treatment, four women in the placebo group aborted completely, and two had incomplete abortions. No change was seen in the other 20 patients. Analysis of the laboratory data showed no significant differences between the two groups in hemoglobin changes or concentrations, mean serum β-hCG levels or changes, or gestational sac size. Among patients receiving misoprostol, one woman experienced severe gastrointestinal side effects, and two had severe pain that was not relieved with codeine. Nearly 80% of the patients who responded to a questionnaire indicated that they were very satisfied with the vaginal misoprostol approach and would undergo this method of treatment again should the need arise. A similar percentage would recommend this treatment to a friend.

OBJECTIVE: To estimate the efficacy of vaginal misoprostol for medical management of missed abortion.METHODS: Fifty women with missed abortion were randomized to treatment with up to two 800-mg doses of misoprostol vaginally or a placebo. Participants were reviewed daily for 2 days, then again at 1 week. A blood sample for hemoglobin and serum beta-human chorionic gonadotropin (betahCG) was obtained on day 1 and the hemoglobin level checked again on day 7. Complete abortion was defined as expulsion of the products of conception without dilation and curettage (D&C) and a negative follow-up urine betahCG test after 4 weeks, or as no products of conception obtained at D&C in cases of suspected incomplete abortion.RESULTS: The rate of complete abortion was 80% (20 of 25) in the misoprostol group and 16% (four of 25) in the placebo group, relative risk 0.20 (0.08, 0.50), P < .001. The rate of D&C was 28010 (seven of 25) in the misoprostol group and 84% (21 of 25) in the placebo group, relative risk 0.33 (0.17, 0.64), P < .001. One participant in the misoprostol group had an emergency D&C for heavy bleeding. No participants required blood transfusion. The mean reduction in hemoglobin from day 1 to day 7 was 3.2 g/L in the misoprostol group versus 4.3 g/L in the placebo group, P = .72. Patient satisfaction with misoprostol treatment was high with 19 of 21 participants reporting they would try medical management again if they experienced another missed abortion.CONCLUSION: Medical management of missed abortion is effective, reduces the need for D&C, and is associated with high levels of patient satisfaction. (C) 2002 by the American College of Obstetricians and Gynecologists.

During the course of investigating a 10-year-old boy because of progressive deterioration of intellectual functioning, ataxia, and hemiplegia, an absence of serum hexosaminidase activity was noted. A skin biopsy examined by electron microscopy showed axonal accumulations of dense osmiophilic deposits. Because of the patient's age at onset and the slowly progressive nature of his ilness, we are reporting an atypical juvenile case of Sandhoff disease.

LONDON. Royal Society, April 26.—“On the Coagulation of the Blood.” Preliminary Communication. By W. D. Halliburton, M.D., B. Sc., Assistant Professor of Physiology, University College, London. Communicated by Prof. E. A. Schäfer, F.R.S. (From the Physiological Laboratory, University College, London.)