Syam S Roopnarinesingh

AMNIOTIC FLUID CREATININE IN NORMAL AND ABNORMAL PREGNANCIES

Amniotic fluid creatinine values were studied in normal, toxaemic and diabetic pregnancies. In normal patients, there was a consistent linear rise as pregnancy progressed, although there were variations in the levels at each stage of pregnancy in different patients. There was also a linear rise in toxaemia, but levels were much higher than in normal pregnancy at the same period of gestation, although the rate of increase was similar. In both groups, there was a significant correlation between birthweight and creatinine values.

OBESITY IN THE JAMAICAN PARTURIENT

The reproductive performance of one hundred obese negro women was compared with that of an equivalent number of negro women of average weight. The main hazards of obesity were hypertension and diabetes mellitus. The incidence of prolonged labour was not increased, and there was a low incidence of prematurity. The infants were significantly larger in the obese group but despite this, dispropor‐tion seldom occurred. The obese patients gained less weight antenatally, and lost more in the puerperium, than the controls. There was an age‐related difference in mean antenatal weight‐gain and puerperal weight‐loss in the obese, but not in the controls.

Instability of the tracheal tube in neonates. A postmortem study.

A postmortem study of the degree of displacement of the tracheal tube was performed on 13 neonates of varying birthweights. There was significant movement of the tube on flexion and extension of the neck, and on opening the infants mouth. Our findings lend support to certain techniques of tracheal tube placement; the ultimate aim is to position it accurately.

AMNIOTIC FLUID UREA AND CREATININE IN NORMAL PREGNANCY AND IN PRE-ECLAMPSIA

Urea and creatinine concentrations in the amniotic fluid and maternal blood were studied in normal and toxaemic mothers. There was a good correlation between liquor creatinine and duration of pregnancy, but a significant relationship between liquor urea and gestational age was not established. In pre‐eclampsia, levels of urea and creatinine in the amniotic fluid were significantly greater than normal values, at corresponding periods of gestation. These changes in the amniotic fluid were not accompanied by a similar increase in the maternal serum, and are consistent with the concept of a renal origin for this fluid. It is postulated that this trend in pre‐eclampsia reflects the inability of the placenta to fulfil its transfer function.

Diabetes in pregnancy.

Objective: To determine whether there is an association between the level of glycemic control and perinatal complications in pregnant diabetic patients. Methods: Two hundred sixty confirmed cases of pre‐existing diabetes, gestational diabetes and impaired glucose tolerance were analyzed to assess risk factors, modality of treatment, level of blood sugar control and effect on perinatal morbidity and mortality. Results: Risk factors for the development of diabetes included age (> 25 years), East Indian ethnic origin, glycosuria, and a history of diabetes in a first‐degree relative. Treatment consisted of diet alone or in combination with soluble insulin. There is a marked increase in perinatal mortality and maternal morbidity if normoglycemia is not maintained. Conclusions: A greater emphasis must be placed on the detection of diabetes in pregnancy and effective treatment should be instituted as early as possible to achieve normoglycemia if associated complications are to be reduced.

AMNIOTIC FLUID HEAT-STABLE ALKALINE PHOSPHATASE IN NORMAL PREGNANCY AND IN PRE-ECLAMPSIA

Estimations of levels of heat‐stable alkaline phosphatase in amniotic fluid and maternal serum were performed in 78 normal and 27 pre‐eclamptic pregnant mothers. The concentration of this enzyme was greater in maternal serum than in amniotic fluid in both normal pregnancy and pre‐eclampsia, and the correlation between maternal serum HSAP and liquor HSAP in both groups was statistically significant. Mean values of liquor HSAP were higher in pre‐eclampsia than in normal pregnancy at corresponding periods of gestation, and in both groups there was an abrupt rise in levels after the 36th week of pregnancy

THE YOUNG NEGRO PRIMIGRAVIDA IN JAMAICA

The course of pregnancy and labour in 122 Negro primigravidae under 16 years of age has been compared with those in 122 primigravidae aged 22. The average age of menarche was 1·5 years earlier in juvenile primigravidae. The increased hazards to the teenager are toxaemia of pregnancy, prematurity and postpartum haemorrhage.

Vaginal breech delivery and perinatal mortality in twins.

An objective analysis of our clinical experience with the intrapartum management of twin gestations was undertaken in order to determine whether or not routine caesarean section is justified when the first twin presents by the breech. The perinatal mortality rate for breech first twins delivered vaginally was not statistically different from vertex presentations. There was no perinatal loss among babies delivered vaginally by the breech. There was no difference in perinatal outcome for the breech first twin born abdominally or vaginally. Our findings have allayed the fear that non-vertex vaginal delivery of the first or second twin is dangerous. We conclude that in the absence of a uterine scar or a footling presentation, there is no valid reason to prohibit vaginal delivery when either twin presents by the breech.

Fetal outcome among obese parturients

A controlled study of the fetal outcome among 300 obese gravidae revealed a perinatal loss ten times greater than among non‐obese mothers. Diabetes mellitus, pre‐eclampsia and advanced maternal age overwhelmingly contributed to this difference. However infants of obese grand multiparae were not at additional risk. Considering live infants the 1 min Apgar score was significantly lower in the study group and was confined to those mothers not at the extremes of maternal age, parity and gestational age. There was no difference in Apgar scores among infants delivered by cesarean section. However significantly more infants of obese mothers delivered vaginally were depressed. These results emphasize the need for stricter obstetric care in the elderly obese mother and those with pre‐eclampsia and diabetes. The uncomplicated obese parturient appears to be at no additional risk in terms of fetal outcome.

IRON STORES IN PREGNANT PATIENTS WITH ANAEMIA AND HAEMOGLOBIN S

Marrow aspiration in 22 pregnant women with haemoglobin S revealed a high incidence of iron deficiency. Eighteen patients showed depleted iron stores while depots were adequate in four patients. The practice of denying iron to pregnant women with haemoglobinopathies is not recommended; nor is the use of prophylactic iron in all patients with sickle cell disease or trait advised. It is suggested that it is better to diagnose and treat the iron deficiency specifically.