D. F. Hawkins

Outcome of pregnancies complicated by severe hypertension and delivered before 34 weeks; stepwise logistic regression analysis of prognostic factors

The outcome is described for 106 patients with severe hypertension in pregnancy requiring delivery between 26 and 34 weeks. Management was with methyldopa, hydralazine when required and delivery by caesarean section when indicated. Most patients were delivered for cardiotocographic fetal distress or unstable maternal blood pressure. Eighty‐five babies (80%) survived and were well at follow‐up at 1 year; the perinatal mortality was 123/1000 total births. One patient had postpartum eclampsia, one had pulmonary oedema and one had transient renal failure, but all mothers left hospital well. Stepwise logistic regression analysis showed that the primary positive factor for survival of a healthy baby was gestational age, which was strongly correlated with birthweight. The need for caesarean section as an emergency, hypotension after parenteral hydralazine, intrauterine growth retardation, and severe proteinuria were adverse factors. Intraventricular haemorrhage had a major adverse effect on neonatal survival; it was predisposed to by prolonged maternal hypertension and by low gestational age.

Antibacterial activity in human amniotic fluid: relationship to zinc and phosphate

Antibacterial activity, tested with B. subtilis, was present in all 44 human amniotic fluids at between 36 and 42 weeks of pregnancy and was unrelated to gestational age within these limits, or to maternal age or parity. High‐molecular‐weight (β‐lysin) activity, present in all samples, was directly related to concentration of bound zinc, but not to that of free zinc. Low‐molecular‐weight antibacterial activity (<1000 Daltons) was only present in nine specimens, but sub‐threshold concentrations were demonstrable by concentrating the ultrafiltrates in more than half of the remaining specimens. Low‐molecular‐weight activity in the ultrafiltrates was directly related to the concentration of bound zinc in the original amniotic fluid. Neither high‐ nor low‐molecular‐weight antibacterial activities were associated with amniotic fluid phosphate levels.

A COMPARATIVE STUDY OF THREE LOW DOSE PROGESTOGENS, CHLORMADINONE ACETATE, MEGESTROL ACETATE AND NORETHISTERONE, AS ORAL CONTRACEPTIVES

Three low dose progestogens, chlormadinone acetate (0·5 mg), megestrol acetate (0&5 mg) in oil, and norethisterone (0·35 mg), taken daily, were employed as oral contraceptives in postnatal women who desired to postpone their next pregnancy for up to a year. In a lower and middle social class population net pregnancy rates (life table) were five to six per 100 woman‐years, of which about half were due to failure to take the tablets. Side effects other than menstrual disturbance were few. Norethisterone was the least likely of the three preparations to lead to discontinuation because of disturbance of menstruation. There were three ectopic gestations amongst 35 pregnancies in 4500 woman‐months of use. Ninety‐five patients with varicose veins, 15 with a history of thrombophlebitis and 23 with a history of liver disease took progestogens without relevant untoward effects.

Maternal weight and girth changes in late pregnancy and the diagnosis of placental insufficiency.

In the absence of dietary advice, the average weight gain in pregnancy of European women living in West London is less if their baby is “small‐for‐dates” than if the baby is of normal weight. The greatest reduction in maternal weight gain associated with intrauterine growth retardation is noted between 34 weeks and delivery.

Antibacterial activity in human amniotic fluid: dependence on divalent cations

Summary. Antibacterial activity, tested against Bacillus subtilis, was present in all 34 samples of human amniotic fluid collected between 37 and 41 weeks gestation. High‐molecular–weight (β‐lysin) antibacterial activity was reduced after treatment with ethylene diamine tetra–acetic acid (EDTA), but not after treatment with 1, 10‐phenanthroline or diphenylthiocarbazone. The activity was restored following incubation with magnesium, calcium, or zinc. Low‐molecular‐weight antibacterial activity (<1000 daltons) in acid–alcohol extracts was reduced after treatment with dithizone, but not after treatment with EDTA or 1, 10 phenanthroline. Activity was restored after treatment with manganese, cobalt or zinc. High‐molecular‐weight (β‐lysin) activity was therefore biochemically similar to serum p‐lysin but biochemically different from the low‐molecular‐weight antibacterial component of amniotic fluid.

EFFECT OF COPPER ON GROWTH OF HUMAN CERVICAL EPITHELIAL CELLS IN TISSUE CULTURE

Copper sulphate in concentrations of 4×10−4M or more completely prevents outgrowth of explants of human cervical squamous epithelium in monolayer tissue culture. Concentrations of 3×10−5M copper or more reduce the rate at which cells in the cultures enter the mitotic phase. These findings are discussed in relation to the use of copper‐releasing intrauterine contraceptive devices.

Persistent fetal sinus bradycardia associated with maternal anti-Ro antibodies. Case report.

A 29-year-old woman had had two uneventful pregnancies both of which had resulted in the normal birth of healthy babies with normal heart rates. Nine years after the second delivery the patient developed polyarthralgia and an erythematous malar rash. Serology at that time was positive for antinuclear factor (titre 1 in 256) and anti-Ro antibodies but negative for antiphospholipid antibodies. Systemic lupus erythematosus was suspected and the symptoms were controlled with a non-steroidal anti-inflammatory agent (ibuprofen 400 mg twice daily). One year later she attended the antenatal clinic after 12 weeks amenorrhoea in her third pregnancy. The disease had been quiescent for 6 months and she had stopped all treatment just bcfore conception. Her 5crOlogy wa5 unchanged and VDRL testing was negative. Ultrasonography at 18 weeks revealed an appropriately sized, apparently normal fetus. ‘lhe pregnancy continued uneventfully until 32 weeks when a mild cxaccrbation of the lupus erythematosus developed. At this time a fetal bradycardia of 90 bea tsh in was discovered on routine auscultation. Complete heart block was suspected hut cardiotocography. which confirmed the bradycardia. showed a normally reactive hcart ratc pattcrn (Fig. 1). Ultrasonography revealed a well-grown active fetus with normal amniotic fluid volunie and no malformation. Detailed fetal echocardiography demonstrated

Fetal‐pericardial effusion in association with congenital heart block and maternal systemic lupus erythematosus. Case report

Case report A28-year-old woinanwho had had signs of intermittently severe systemic lupus erythematosus (SLE) for 2 years attended the antenatal clinic at eight weeks gestation in her second pregnancy. In the three years preceding this pregnancy she had had thrombocytopcnic purpura, erythema nodosum and lymphocytic swelling of the salivary glands. Her first pregnancy at the age of 25 years was complicated by severe haemolytic anaemia and, later, by severe hypertension and resulted in a stillborn baby weighing 1380 g a t 31 weeks. This outcome was attributed to placental infarction. Subsequently she had a StevensJohnson type illness with oculocutaneous manifestations. She had persistently high titres of antinuclear Cactor and anti-Ro (anti-SS-A) antibody, but insignificant levels of anticardiolipin antibody. Treatment had been with steroids and, at times, azathioprine. In the current prcgnancy prednisolone was increased from 5 to 1 0 mg/day and she was given low-dose aspirin (7Smg daily). At 18 weeks, ultrasonography showed a normal fetus with a normal heart rate. At 25 weeks a serious deterioration i n the maternal condition occurred and she was admitted because of chest and loin pain: vomiting and pyrexia. She developed a small pleural effusion and had radiological and electrocardiographic evidence of myocarditis. The maternal anti-Ko antibody titre had risen

Extraction of a low molecular weight antibacterial peptide from human placenta

‘The antibacterial activity of human amniotic fluid is widely documented (e.g. Hawkins & Scane 1983). The principal antibacterial components are P-lysin (Gusdon 1962; Ford et al. 1981) and a low molecular weight peptide (Schlievert er al. 1976; Scane & Hawkins 1984, 1986). This study sought to determine the distribution of the low molecular weight antibacterial component within the pregnant uterine cavity.

Sensitivity of Trichomonas vaginalis to chemotherapeutic agents.

The trichomonacidal activities in vitro of six drugs were compared using strains of Trichomonas vaginalis freshly isolated from patients. Metronidazole, nitrimidazine and nifuratel were all active in concentrations of the order of 1 μg./ml. Amphotericin B, a mixture of polyethylene glycols, and natamycin was much less active. Three out of ten strains of Trichomonas vaginalis were resistant to 1 mg./ml. of natamycin. Since nitrimidazine and nifuratel are less therapeutically effective than metronidazole, it is possible that some substance in vaginal tissues or secretion tends to protect the organisms against these drugs.