S. T. Liang

Homozygous α‐thalassaemia: clinical presentation, diagnosis and management. A review of 46 cases

Summary. Forty‐six hydropic infants with homozygous α‐thalassaemia born during a period of 10 years have been reviewed. The incidence was 1: 1550 total births, and accounted for 81% of all non‐immune hydrops. The male to female ratio was 1: 1.4. There was increased incidence of anaemia, pregnancy induced hypertension, antepartum haemorrhage, malpresentation, prematurity, fetal distress, difficult vaginal delivery, caesarean section, retained placenta. postpartum haemorrhage and congenital abnormalities. Antenatal diagnosis by DNA hybridization with subsequent abortion of the affected fetuses is the best method to decrease maternal morbidity and to reduce the incidence of hydrops fetalis in couples at risk. For those with no previous history, but with early onset hypertension and/or polyhydramnios, sonography is useful in making an earlier diagnosis, and in reducing avoidable morbidity, because DNA analysis can be done before caesarean section and aggressive neonatal management is instituted.

Zinc deficiency is not a cause for abortion, congenital abnormality and small‐for‐gestational age infant in Chinese women

Summary. Zinc concentration in serum and hair was measured in a cross‐sectional study of 437 Chinese women of whom 310 were normal controls studied at various stages of pregnancy and up to 12 months after delivery. The rest had spontaneous abortions, fetuses with a birthweight below the 10th centile for gestation or congenital abnormalities. Zinc concentration fell throughout normal pregnancy, the fall being greater in serum than in hair. There was no correlation between serum and hair levels. The infant birthweight had a positive correlation with serum level but a negative correlation with hair level. Abortion, low birthweight and congenital abnormality were not associated with low concentrations of zinc in plasma or hair.

Aetiological Factors in the Genesis of Pregnancy Hydronephrosis

Summary: In order to identify possible aetiological factors in the genesis of physiological hydronephrosis in pregnancy, the degree of pelvic‐calyceal dilatation in 90 asymptomatic pregnant women was correlated with levels of plasma oestradiol, progesterone, 24‐hour urinary oestriol, the site of the placenta, birth‐weight of the fetus, and pelvic inlet measurements. A grading system based on maximum calyceal diameter was used; 90% of the patients were found to have at least mild dilatation on the right side. No correlation was demonstrated between the degree of hydronephrosis and the levels of oestradiol, progesterone and 24‐hour urinary oestriol excretion. The birth‐weight of the fetus and its relationship with the pelvic inlet measurements also did not correlate with the occurrence of hydronephrotic changes in the kidneys. The only significant positive finding was a higher incidence of moderate and severe hydronephrosis occurring in patients with a right‐sided placenta than compared with the left (x2= 4.77; p < 0.05), although the sensitivity and specificity in predicting hydronephrosis from a right‐sided placenta is low (53% and 66% respectively). Our results support the hypothesis of a mechanical aetiology in the genesis of pregnancy hydronephrosis, where vascular compression on the ureters may be an important contributory factor. Our study has also shown that urinary tract infection and reduction of creatinine clearance were not more common in patients with moderate or severe pelviccalyceal dilatation.

Perinatal Colonization of Group B Streptococcus: An Epidemiological Study in a Chinese Population

Summary: An epidemiological study of perinatal colonization of group B streptococcus (GBS) was carried out prospectively in a Chinese population. One hundred and sixty‐eight mother‐infant pairs were studied. Maternal carriage rate from multiple sites was 19.0%, with an overall neonatal colonization rate of 19.6%. There was no neonatal sepsis due to GBS. No obstetrical risk factors that could influence material carriage could be identified. Neonatal colonization was associated with premature/prolonged rupture of membranes, increased duration of rupture of membranes and intrapartum pyrexia. The number of infected sites and the density of organism in each site in the infant were directly proportional to the number and density of organisms in the culture‐positive sites in the mother. Ser‐otypical study showed a complete absence of type II GBS in this population. Since the vertical transmission rate was only 37.5%, it is postulated that nosocomial spread of the organism contributed significantly towards colonization of the infants in our study population.

Chorioangioma of the placenta: an ultrasonic study. Case report

Chorioangioma and trophoblastic tumours are the most common primary tumours of the placenta. The incidence of chorioangioma is about 1% (Wallenburg 1971; Sprit & Kagan 1980). Apparently, only tumours that exceed 5 cm in diameter. or that are multiple, are clinically significant and these cases are relatively rare (Wallenburg 1971). In the majority of patients diagnosis is made after the delivery of the placenta. The role of ultrasound in the diagnosis of placental abnormalities has now been recognized (Mulhern ef al. 1980), but only a few reports have described the ultrasound appearance of chorioangioma in situ (Asokan et al. 1978; Dao et al. 198 1 ; OMalley et ai. 198 1).

ADVANCED PREGNANCY IN THE RUDIMENTARY HORN OF A BICORNUATE UTERUS

Abstract. Ultrasound was useful for the diagnosis of advanced pregnancy in the non‐communicating rudimentary horn of a bicornuate uterus. The role of ultrasonography in early diagnosis of this condition in order to improve fetal salvage was discussed.

Ultrasonic Detection of Maternal Ascites in Patients with Severe Pre‐Eclampsia

Summary: Ultrasonography is a reliable method in the detection of free fluid in the abdomen. In 2 patients with severe pre‐eclampsia, maternal ascites was diagnosed by ultrasound. Both babies were delivered prematurely by Caesarean section, indicated by deteriorating maternal condition. One of the babies died in the early neonatal period. The sonologist should be aware of the possible presence of peritoneal free fluid in patients with severe pre‐eclampsia, and be able to demonstrate this accordingly in the ultrasonogram.