Sir John Dewhurst

Fetal response to maternal anxiety: a factor in antepartum heart rate monitoring

SummaryWomen in late pregnancy were subjected to mild psychological stress by listening, through headphones, to a prerecorded sequence of sounds which included that of a baby crying. Maternal reaction was detected using maternal heart rate and maternal skin resistance. Coincidental changes were observed in fetal heart rate patterns. Fetal heart rate pattern changes similar to those induced by the tape-recorded sounds have been observed during ‘non-stressed’ antepartum monitoring when patients were disturbed by sounds significant to them.

Placental lactogen as a reliable index of fetal outcome in threatened abortion during early pregnancy

SummaryHuman placental lactogen (HPL) levels in the serum of patients with vaginal bleeding between 7 and 22 weeks of pregnancy were compared with normal levels. When HPL was measured during the bleeding episode, all 25 patients who had low HPL levels went on to abort and all 27 patients who had normal levels had pregnancies with a normal outcome. When HPL was measured before the bleeding episode, all 10 patients with low levels went on to abort but so did 20 out of 29 with normal levels. It is concluded that abnormal HPL levels during a bleeding episode are an accurate means of predicting outcome of the pregnancy but HPL levels before the onset of the bleeding are less useful. Drug-induced pregnancies showed no significant differences in HPL levels from those not induced by drugs.

Human chorionic gonadotrophin β-subunit in normal and abnormal early pregnancy

SummaryA prospective study was carried out of 125 patients in early pregnancy. Ultrasound examination was performed on every patient to estimate gestational age and blood was taken for serum β-subunit human chorionic gonadotrophin (HCG) assay. The patients were divided into groups according to the outcome of the pregnancy. HCG levels in 39 successful pregnancies in which there had been bleeding did not differ from those in 40 normal pregnancies. There was no alteration in HCG levels during episodes of bleeding.Thirty-two patients aborted spontaneously in the first trimester. These were divided into missed abortions (5) where fetal tissue was seen and an- embryonic pregnancies (27) where no fetal tissue was identified histologically. The average levels of HCG in these pregnancies were reduced, but the results of serial tests overlapped those for normal pregnancy. These findings may be explained by the histological presence of hydropic chorionic villi producing HCG in some cases of anembryonic pregnancy. Th...

Sexual activity after treatment of carcinoma of the cervix

SummaryA group of women was studied 1–3 years after radical surgery and radiotherapy for carcinoma of the cervix to assess the effects of treatment on their sexual lives. New measures of sexual activity were derived. Sexual activity before and well after the radical therapy was assessed and activity after treatment by surgery or radiotherapy was compared with a matched control group of women who had pelvic surgery for benign conditions with ovarian salvage. Linear analogue scales were used where appropriate but they were found in a pilot survey to be wanting in assessing certain areas of sexual performance.Sexual interest and lubrication were decreased after radical surgical and radiotherapeutic treatment compared both with before treatment and with benign control groups. Despite this, those who had been treated for malignant disease enjoyed and strived for intercourse and the implications of this are discussed.

Gynaecological case reports: Labial adhesions in menopausal women

SummaryLabial adhesions are usually seen in the very young (Bowles and Childs, 1943) and sometimes in the very old (Dewhurst, 1976). It is rare for ‘middle aged’ women to present with symptoms related to this condition. Two such cases presented at Chelsea Hospital for Women with symptoms that were directly attributable.

Reduced dose of oestrogen in combination with cyproterone acetate in the treatment of hirsutism

SummaryCyproferone ac in combination with cthinyloestradiol is widely used in Europe and Great Britain as the most successful drug therapy for hirsutism (Hammerstein et al., 1975: Underhill and Dewhurst, 1979). The oestrogen provides cycle control, contraception and elevation of sex hormone binding globulin. Various side effects of this regimen have been reported, many of which are similar to those reported with the use of oral contraceptives. In an attempt to reduce these side effects the dose of ethinyloestradiol was reduced from 50 μg (as suggested in the Hammerstein regimen) to 30 μg.

Chromosomal aspects of reproductive failure

SummaryChromosomal abnormalities are among the more important causes of reproductive failure, which is defined here as the inability to give birth to a live, healthy child. The subject is complex, and although our knowledge of it is increasing, so are its complexities. It is becoming more and more difficult for the practising clinician to keep abreast of the problem and advise patients accordingly. This review aims to present an up-to-date picture

Anosmia and hypogonadism

SummaryTHE association of anosmia with hypogonadism, which is now referred to as Kallmanns syndrome, was first reported in males (Kallmann et al., 1944). It is now apparent that it occurs also, although less commonly, in females (Mroueh and Kase, 1968; Sparkes et al., 1968; Santen and Paulsen, 1973; Simpson, 1976). It is sometimes familial, the mode of inheritance being autosomal dominant (Santen and Paulsen, 1973; Simpson, 1976). Reports of families in which more than one female is affected are limited (Le Marquand, 1954; Santen and Paulsen, 1973). The following is a report of a family in which two sisters are affected.