D. V. I. Fairweather

OBSTETRIC ASPECTS OF MIDTRIMESTER FETAL BLOOD SAMPLING BY NEEDLING OR FETOSCOPY

We describe our experience at University College Hospital, London, with the first 135 patients submitted to midtrimester fetal blood sampling for antenatal diagnosis of β‐thalassaemia major, other thalassaemias and homozygous sickle cell disease. Blind needling and fetoscopy with sampling are evaluated and their application dişcussed. With experienced operators 9 per cent of patients experienced a fetal loss.

CHANGES IN LEVELS OF SERUM NON‐ESTERIFIED FATTY ACID AND BLOOD GLUCOSE IN PREGNANCY

Serial studies of blood glucose and serum non‐esterified fatty acid (NEFA) levels from the sixth week of gestation to term in normal pregnancies are reported and correlated with (previously reported) levels of HPL from the same patients. The lowering of blood glucose concentration and the rise of NEFA concentration with advancing gestation are confirmed. High values of blood glucose were associated with low NEFA levels, and high values of NEFA with high values of placental lactogen (HPL). There was no correlation between glucose and HPL levels.

SIX YEARS'EXPERIENCE OF THE PREDICTION OF SEVERITY IN RHESUS HAEMOLYTIC DISEASE

Prediction charts used in the management of patients suffering from rhesus haemolytic disease are presented and the accuracy investigated for two methods of amniotic fluid analysis. In 468 samples from 141 patients there were 7·9 per cent errors of prediction when both methods were used together but in only four cases (2·8 per cent) was the error thought to have possibly contributed to wrong management.

ALPHA-FETOPROTEIN LEVELS IN MATERNAL PLASMA AND AMNIOTIC FLUID DURING PROSTAGLANDIN-INDUCED MID-TRIMESTER ABORTIONS: THE RELATION TO FETAL DISTRESS AND DEATH

Alpha‐fetoprotein (AFP) levels were measured in both plasma and amniotic fluid during 43 abortions induced with prostaglandin F2α (PGF2α) and their relationship to the induction‐abortion interval and signs of fetal distress or intrauterine death examined. The mean plasma AFP levels showed a progressive rise after PGF2α administration but abnormally high levels were found infrequently until the time of delivery. Feto‐maternal bleeding could explain the abnormally high plasma AFP levels which occurred early in a few cases. A shorter induction‐abortion interval was found in patients with normal plasma AFP levels. Neither fetal distress nor intrauterine death were associated with abnormally high plasma AFP levels. No change in AFP levels in amniotic fluid was found.

FACTORS INFLUENCING THE SPECTROPHOTOMETRIC EVALUATION OF LIQUOR AMNII

Factors influencing the spectrophotometric examination of liquor amnii have been investigated. Various methods of clarification and handling of liquor samples are compared, and their effects upon results obtained by seven currently used methods of assessment of bilirubin content are described. It is essential to follow the exact method originally described for each method of expression of liquor bilirubin content when using prediction graphs or tables to indicate severity of rhesus haemolytic disease.

A RANDOMISED DOUBLE BLIND CLINICAL TRIAL OF ABDOMINAL DECOMPRESSION FOR THE PREVENTION OF PRE‐ECLAMPSIA

A randomized double blind study of twice–weekly abdominal decompression from the 28th week of pregnancy, involving 411 primigravidae in three hospitals, is reported. No significant difference was noted in the admission rate for pre–eclampsia between 200 patients who were subjected to a suction pressure of 70 mm. Hg and 211 patients who were subjected to a suction pressure of only 20 mm. Hg. Although the length of hospital stay was significantly less in the former group, we conclude that routine antenatal decompression therapy plays no role in the prophylaxis of pre–eclampsia.

A COMPARATIVE STUDY OF PLASMA 17β-OESTRADIOL, PROGESTERONE, PLACENTAL LACTOGEN AND CHORIONIC GONADOTROPHIN IN ABORTION INDUCED WITH INTRA-AMNIOTIC PROSTAGLANDIN F2χ

Serial estimations were made in plasma of 17β‐oestradiol (E2), progesterone and human placental lactogen (HPL) in 43 patients and of human chorionic gonadotrophin (HCG) in 34 patients during mid‐trimester abortions induced with intra‐amniotic prostaglandin F2α (PGF2α). Mean plasma concentrations of all the hormones showed a progressive fall after PGF2α. There was no relationship between the fall in levels of progesterone, HPL and HCG and the induction‐abortion interval, signs of fetal distress or of intrauterine fetal death. Both the control level and the rate of fall of E2 were related to the induction‐abortion interval and a rapid decline preceded intrauterine fetal death. The relationships of the progesterone/E2 ratio and the amniotic fluid volume/progesterone ratio to the induction‐abortion interval were examined. The variation in the time at which significant falls in the concentration of individual hormones occurred was probably related to their respective half‐lives in plasma.

ENDOCRINE FUNCTION IN RHESUS ISO‐IMMUNIZATION

Serial assays of oestrone, oestriol, pregnanediol and chorionic gonadotrophin have been made in maternal urine from 32 weeks gestation until delivery in rhesus immunized patients whose infants suffered from haemolytic disease o varying severity. The results were compared with those from a series of normally pregnant women of comparable age and gestation period. In the rhesus patients no correlation could be demonstrated between severity of disease and endocrine profile. Assays of hormones and their metabolites were of little or no value in the management of patients with rhesus immunization.