R. H. T. Ward

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.

HUMAN PLACENTAL LACTOGEN LEVELS IN AMNIOTIC FLUID IN RHESUS ISOIMMUNIZATION

Human placental lactogen (HPL) levels were measured in the amniotic fluid of 56 patients with rhesus isoimmunization. The more severe the disease the higher were the levels attained and the earlier in pregnancy did the rise occur. Levels above 1μg./ml. at any stage of pregnancy suggested an unfavourable outcome for the fetus, while levels less than 0.7μg./ml. after the 28th week of pregnancy indicated a favourable outcome. There was no relationship between the concentration of HPL in amniotic fluid, and the volume of amniotic fluid and there was thus no need to correct HPL levels for amniotic fluid volume. It is concluded that HPL estimations in amniotic fluid are a useful adjunct to other tests in the management of rhesus isoimmunization.

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.

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.

THE TREATMENT OF MILD ADRENAL HYPERPLASIA AND ASSOCIATED INFERTILITY WITH PREDNISONE

Thirty patients with mild post-pubertal adrenal hyperplasia, characterized by raised urinary 17-oxosteroid levels and variable combinations of irregular menses, hirsuties, infertility, and spontaneous abortion, were treated with 2.5 to 10 mg of prednisone per day and all conceived (55 pregnancies). With this treatment, regular, ovulatory cycles occurred immediately in 25 patients, and after two to six months, in the rest. Treatment reduced raised 17-oxosteroid levels to normal and brought about some improvement in hirsuties and acne. Forty-seven pregnancies ended in the birth of liveborn infants; one of these died of prematurity and another had congenital emphysema. One pregnancy was terminated, two were of unknown outcome and five (9.4%) ended in abortion. Before treatment, 20 out of 22 pregnancies (91%) had ended in abortion.