John Dewhurst

Predictive value of ultrasound measurement in early pregnancy: a randomized controlled trial

Summary. Early fetal biparietal diameter (BPD) measurements were obtained with ultrasound in 1062 women attending for antenatal care; a random half had the results withheld from the obstetricians. Of the 1026 women who were sure of the dates of their last normal menstrual period, 829 (81%) were found to have appropriate biparietal diameter measurements, in 3% the pregnancy was more than 2 weeks further advanced and in 14% more than 2 weeks less than calculated. In 30% of the women whose results were intended to be withheld, the code had to be broken because of clinical concern. There were no differences in fetal outcome (birthweight centile, Apgar score at 1 min and perinatal mortality) in the women whose BPD results were known compared with those whose results were withheld from the obstetrician. But a significantly larger number of labours were induced for suspected growth retardation when the gestational age was known.

The treatment of premenstrual tension with mefenamic acid: analysis of prostaglandin concentrations

Summary. Eighty patients with premenstrual tension were treated prospectively with mefenamic acid for a mean period of 13 months. Most of them (86%) reported significant relief of premenstrual tension. Symptoms of dysfunctional menorrhagia or primary dysmenorrhoea were also alleviated. In 19 patients, the plasma concentrations of prostaglandin (PG) E2, PGF2α and 13,14‐dihydro‐15‐keto‐prostaglandin F2α (PGFM) were measured at intervals throughout three menstrual cycles. During the first cycle the patients received no treatment; in the subsequent two cycles they received either mefenamic acid or placebo in a randomized double‐blind crossover manner. Similar measurements were made in 22 matched control subjects. The plasma concentrations of PGE2, PGF2α and PGFM were significantly lower in the 19 patients in all three menstrual cycles compared with the values in the control subjects. Excess synthesis of prostaglandins of the 1 series may occur in premenstrual tension and, by precursor depletion, result in decreased synthesis of the 2‐series prostaglandins.

The use of the fasciocutaneous flap in vaginal reconstruction

Summary. Vaginoplasty in two girls with severe vaginal stricturing due to congenital adrenal hyperplasia is described. The strictures were so tight and long that conventional flap techniques were inappropriate, and long fasciocutaneous flaps from redundant labioscrotal tissue were used. This technique has gained wide usage in plastic surgery, but has not been described previously in this site.

IVALON SPONGE HYSTEROSACROPEXY FOR GENITAL PROLAPSE IN PATIENTS WITH BLADDER EXTROPHY

Two patients with bladder extrophy are presented. Both had had corrective surgery in childhood and subsequently presented with recurrent procidentia after a previously unsatisfactory repair operation. Both were treated hysteroscaropexy (a new procedure) which is described in detail and when reviewed 12 months later were symptom‐free with good genital tract support.

FURTHER CLINICAL EXPERIENCEIN THE TREATMENT OF HIRSUTISM WITH CYPROTERONE ACETATE

Further experience in the treatment of female hirsutism with the anti‐androgen cyproterone acetate is reported. Two‐thirds of treated patients have shown improvement but relapse occurred within two or three months of stopping treatment. Acne also healed in two patients.

VAGINAL BLEEDING IN CHILDHOOD: A REVIEW OF 51 PATIENTS

A search of the medical records at the Hospital for Sick Children, Great Ormond Street and Chelsea Hospital for Women, London, revealed 51 cases of vaginal bleeding in children under the age of 10 occurring in the years 1962 through 1977. The bleeding was caused by some form of precocious puberty in 37 patients (73 per cent). Eight of these patients had cyclical vaginal bleeding in the absence of secondary sexual development or advanced bone age. Fourteen patients (27 per cent) bled because of a local lesion and six of these had a malignant neoplasm of the genital tract.

AN ENDODERMAL SINUS TUMOUR OF THE VAGINA IN AN INFANT WITH SEVEN YEAR SURVIVAL CASE REPORT

Malignant tumours of the vagina in infants and children are fortunately rare events. The Botyroid sarcoma (mesodermal mixed tumour or rhabdomyosarcoma) has until recently been the least uncommon but the clear cell adenocarcinoma associated with diethyl‐stilboestrol (DES) therapy taken by the mother during pregnancy is now more often seen. One of the rarest vaginal tumours in this age group is the endodermal sinus tumour and it is also one of the most malignant. A case is described in an infant who is still alive and well seven years after treatment.

SECRETION PATTERNS OF PLASMA‐PROGESTERONE, 17‐HYDROXYPROGESTERONE AND 20 α HYDROXYPREGN‐4‐EN‐3‐ONE IN EARLY NORMAL PREGNANCY

Plasma levels of progesterone, 17‐hydroxyprogesterone and 20 α hydroxypregn‐4‐en‐3‐one were established from 4 to 16 weeks gestation by sampling 15 normal patients twice weekly. Apart from a peak at week 5, the mean levels of progesterone remained constant at about 24 ng/ml until week 10 and then rose progressively to 40 ng/ml at week 16.20 α hydroxypregn‐4‐en‐3‐one remained within the 7 to 9 ng/ml range apart from a peak at week 5. A significant decrease in mean levels of 17‐hydroxy‐progresterone was noted from week 5 to a nadir of 3 ng/ml at week 11. It would appear that the main hormone production of progesterones in pregnancy has been taken over by the placental unit by the 10th week.

GONADAL DYSGENESIS AND X CHROMOSOME DELETION

Three cases of gonadal dysgenesis associated with deletion of the long arm of the X chromosome and one associated with an isochromosome for the long arm are here described. Their features support the proposition that genes concerned with ovarian differentiation are located in the region of the centromere. The long arm of the X chromosome may, nonetheless, contain some statural determinants whilst loss of all the short arm material may occasionally be associated with normal stature.

PLASMA PROSTAGLANDIN CONCENTRATIONS AFTER CERCLAGE IN EARLY PREGNANCY

A prospective, randomized controlled study was made to measure the circulating levels of 13, 14‐dihydro‐15‐keto‐prostaglandin F (PGFM) in two groups of women having cervical cerclage early in the second trimester of pregnancy. One group of patients was given omnopon by intramuscular injection for 24 hours after operation and the other salbutamol by intravenous infusion. A significant rise in circulating PGFM was found in both groups after cervical cerclage and the magnitude of the rise was similar in the two groups; levels of PGFM in both groups had returned to the preoperative levels within 24 hours of operation. The levels of PGFM before and after operation showed no relation to the eventual outcome of the pregnancy, which was successful in 80 per cent of patients.