J. Malcolm Pearce

Doppler ultrasound of the uteroplacental circulation as a screening test for severe pre-eclampsia with intra-uterine growth retardation

Two hundred primiparae underwent continuous-wave Doppler investigation of the uteroplacental circulation at 18-20 weeks gestation as a possible screening test for hypertension in pregnancy. Seventy-five women with abnormal waveforms suggestive of high uteroplacental resistance were tested again at 24 weeks when 21 demonstrated a persistent abnormality. Only nine (43%) of these went on to have an uncomplicated pregnancy, as compared with 150 (84%) of the remainder. Seventeen (8.5%) of the women in the study developed a hypertensive disorder of pregnancy, five of whom had abnormal waveforms at 18-20 weeks and at 24 weeks. These five women had a more severe degree of hypertension with proteinuria or intra-uterine growth retardation, and two required clinical intervention before term. The remaining 12 women were delivered at term of average, or heavier than average babies. Doppler investigation of the uteroplacental circulation at 24 weeks may prove to be a sensitive screening test for later severe pre-eclampsia with intra-uterine growth retardation.

The clinical implications of absent or reversed end-diastolic frequencies in umbilical artery flow velocity waveforms

We describe the clinical details of 37 pregnancies with loss or reversal of end-diastolic frequencies in the umbilical artery, as detected by Doppler ultrasound. This finding is an ominous sign of serious fetal compromise in the majority of cases, with a high incidence of growth retardation, oligohydramnios, preterm delivery and maternal hypertension. However, current knowledge does not indicate when these pregnancies should be delivered. The possible pathophysiology and available literature are discussed.

Sensory urgency: how full is your bladder?

Objective— To investigate whether women with sensory urgency have an abnormal perception of bladder fullness.

Ultrasonically guided percutaneous umbilical blood sampling in the management of intrauterine growth retardation

Ten patients, hospitalized because of severe asymmetrical fetal growth retardation before 32 weeks gestation, underwent ultra‐sonically guided percutaneous umbilical blood sampling because of concern over the fetal heart rate trace. In eight patients the fetus was judged to be acidotic and they were delivered immediately by caesarean section. In two patients the fetus was not considered to be acidotic and the pregnancy was allowed to go on. In those babies that were delivered the pH blood collected from the umbilical vein at the time of delivery was compared to the antenatal sample. There were no significant differences. The technique of antenatal umbilical vein blood sampling is readily learned and by assessment of fetal acid base status a more precise diagnosis can be made leading to appropriately planned management.

Randomised controlled trial of the use of human chorionic gonadotrophin in recurrent miscarriage associated with polycystic ovaries

Objective To determine whether the use of human chorionic gonadotrophin (hCG) would reduce the recurrent miscarriage rate in women with polycystic ovarian disease.Objective To determine whether the use of human chorionic gonadotrophin (hCG) would reduce the recurrent miscarriage rate in women with polycystic ovarian disease. Design Double-blind, prospective, randomised controlled trial. Setting A pregnancy loss clinic in a London teaching hospital. Subjects One hundred and ninety-one women with a history of three consecutive spontaneous first trimester miscarriages and polycystic ovary syndrome. Intervention 10000 i.u. of hCG or a placebo were given when the leading follicle was ≥ 21 ram, then 5000 i.u. of hCG or a placebo were given twice weekly until miscarriage or the tenth week of pregnancy. Main outcome measure Miscarriage rate. Results Women with polycystic ovaries who received hCG treatment had a lower miscarriage rate (14%) compared with women who received placebo (43%). In women with follicular phase luteinising hormone ≥ 10 iu/1, those who received hCG therapy had a miscarriage rate of 10% compared with a rate of 44% in women who received the placebo. When clomiphene was used for ovulation induction, women treated with hCG had a miscarriage rate of 14% compared with a rate 47 % in women who received the placebo. There was no significant benefit from hCG therapy in natural cycles. Conclusion The use of hCG in women with recurrent miscarriage and polycystic ovary syndrome improves the pregnancy outcome.

A comparative study of the fetal electrocardiogram recorded by the STAN and Nottingham systems

Objective To compare the T:QRS ratio recorded by the STAN and Nottingham fetal electrocardiogram (FECG) monitors.

Changes in platelet function in pregnancies complicated by fetal growth retardation

Platelet function was investigated in three patients with severely decreased fetal growth rates detected by ultrasound scanning. Only one patient had hypertension, which was mild and developed after decreased fetal growth and altered platelet responses had been detected. Much higher concentrations of platelet-activating factor (PAF) (20-500 nM) were required to stimulate maximal platelet aggregation in all three patients compared with the concentrations of PAF (5-10 nM) required in control pregnancies of similar gestational age. In a fourth patient, platelet desensitisation was observed 5 weeks before the detection of decreased fetal growth. These results are similar to those observed in women with hypertensive disorders of pregnancy, and indicate that there may be a similar change in platelet function in gestational hypertension and in fetal growth retardation, although the clinical manifestations are different.

Making waves: current controversies in obstetric ultrasound

Abstract Ultrasound is a diagnostic technique frequently used routinely in pregnancy in some parts of the world. This article reviews the current state of knowledge of its value, when it should be used and its potential hazards.

The design, effectiveness and acceptability of the arm sleeve for the prevention of body fluid contamination during obstetric procedures

Objective 1. To design a device that would reduce contamination of staff during obstetric procedures. 2. To undertake clinical trials to assess the effectiveness and acceptability of such a device.