J. C. McClure Browne

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.

THE DIAMETER OF THE UTERINE ISTHMUS DURING THE MENSTRUAL CYCLE, PREGNANCY AND THE PUERPERIUM

The diameter of the uterine isthmus was measured in 188 patients under different physiological conditions. It was found that measurements were reproducible with a low mean coefficient of variation (3 per cent). In the non‐pregnant patient the highest measurements were recorded during the menstrual period and the lowest in the preceding week. The isthmic diameter increased during the first trimester of pregnancy when it was slightly greater in parous than in nulliparous patients. Even 9 to 12 weeks after delivery, the diameter of the isthmus had not fallen to the size recorded in parous patients more than four months postpartum.

EXPERIENCES WITH INTRAPERITONEAL TRANSFUSION

SINCE Liley described the first successful intraperitoneal transfusion in 1963 there has been much interest in this technique and its value in the possible salvage of infants severely affected by rhesus iso-immunization. Sporadic single case reports have appeared in the literature and Liley (1964), Holman and Karnicki (1964), Queenan and Douglas (1965) and Bowman (1965) have reported series of cases in which intraperitoneal transfusion was used. This paper records our initial experience with the technique and suggests some methods by which further improvement in the results may be obtained. Our experience dates from May 1964 and to date involves 22 infants, including 2 sets of twins. In all 49 transfusions have been carried out and the overall results are recorded in Table 1.

ESTIMATION OF CLEARANCE RATE OF INHALED XENON‐133 IN THE PLACENTAL REGION OF THE PREGNANT UTERUS

A safe, atraumatic method of measuring clearance of 133Xe in the region of the placenta is described. The gas was inhaled for two minutes, and external monitoring of the placental area and of the expired air was continued for a further 25 minutes. The placental clearance curve was analyzed into two exponential components, with and without correction for recirculation of the tracer. There was a significant difference of 15 per cent between the results of the two methods of analysis. No difference was found between the mean clearance rates of 19 normotensive and 19 hypertensive patients. The birthweights of the babies were used to assess total placental function, and its relationships to the clearance rates is discussed.

PLACENTAL LOCALISATION USING RADIOACTIVE CARBON MONOXIDE AND THE GAMMA CAMERA

Abstract A method of placental localisation is described using in-vivo labelling of erythrocytes with carbon-11-monoxide, and the gamma camera. This method was found to be safe, accurate, and rapid, and also comfortable for the patient. It compares favourably with other radioisotopic methods of localising the placenta. Its future use in the management of antepartum haemorrhage is a practical possibility.

CLINICAL TRIAL OF AUDIO-ANALGESIA IN CHILDBIRTH.

AUDIO-ANALGESIA is a technique in which intense acoustic stimulation, employing “white sound”, is used to reduce or eliminate pain. Interest in this technique was stimulated by the publication of Gardner and Licklider (1 959) who described the use of sound to allay pain produced in dental operations. There have been several reports dealing with audio-analgesia in dental practice which are impressive for their consistency in describing successful clinical application. The reports are comprised mainly of personal opinions; data from controlled clinical study on the effectiveness of the technique are lacking. It has been suggested that the pain of the uterine muscle during exaggerated uterine contraction is due to ischaemia (Moir, 1934). We therefore performed an experiment to investigate the effect of white sound on visceral pain produced by contraction of ischaemic muscle (Moore, McClure Browne and Hill, 1964). The results did not indicate that sound stimulation altered the pain threshold but the fact that we failed to find an effect in an experimental situation does not necessarily mean that no effect exists. We decided that a clinical trial of audioanalgesia in childbirth was desirable, because no dependable relationship has yet been established between the action of analgesic agents and experimentally produced pain in man (Beecher, 1957).