Antenatal diagnosis of molybdenum cofactor deficiency.

Analysis of uncultured chorionic villus material from a woman at risk of fetus with sulfite oxidase deficiency revealed a deficiency of sulfite oxidase. This was confirmed on termination of the pregnancy.

Antenatal urinary screening for drugs of addiction: usefulness of sideroom testing?

Based on a pilot study of 400 samples at our Antenatal Clinic (which yielded 3.5% positives when assessed for amphetamines, cannabinoids and opiates) 600 consecutive patients attending Antenatal Booking Clinic had urine samples tested in the sideroom for amphetamines, barbiturates, cocaine metabolites, methadone and opiates using the Syva EMIT ETS apparatus. Positive samples were checked in the West Midlands Regional Laboratory for Toxicology, initially by EMIT-dau on a second ETS instrument and then by thin layer and gas chromatography. Two per cent produced a total of 14 positive EMIT results. Cocaine metabolites and methandone were not detected. Four specimens could not be confirmed as positive. In one sample, amphetamine-like compounds were isolated but not identified. Positive identification was made in the remaining seven specimens (two cannabinoid, two pseudoephedrine, one pseudoephedrine plus dihydrocodeine and two dihydrocodeine). There was a serious problem of false positive results observed in the initial sideroom testing. The value of sideroom testing for drugs of abuse was assessed in relation to the technical problems and to the small rate of drug positive samples.

Ethnic differences in incidence of very low birthweight and neonatal deaths among normally formed infants.

The incidence of very low birthweight babies (less than 1500 g) and neonatal mortalities in this group were analysed for the 15,608 births to mothers of various racial origins at this hospital during the years 1979-82 inclusive. Very low birth weight occurred less commonly in the European (9.1/1000) and Pakistani (10.1/1000) groups and most commonly in the West Indian group (23.2/1000). Neonatal survival in West Indians, however, was better than in any other group. Analysis of the stillbirths weighing less than 1500 g showed a lower rate in the West Indians compared with that of the European, Pakistani, and Indian groups. There was no evidence of a higher incidence of 'light for dates' in very low birthweight West Indian neonates.

Ethnic differences in incidence of very low birthweight and neonatal deaths among normally formed infants

The incidence of very low birthweight babies (less than 1500 g) and neonatal mortalities in this group were analysed for the 15,608 births to mothers of various racial origins at this hospital during the years 1979-82 inclusive. Very low birth weight occurred less commonly in the European (9.1/1000) and Pakistani (10.1/1000) groups and most commonly in the West Indian group (23.2/1000). Neonatal survival in West Indians, however, was better than in any other group. Analysis of the stillbirths weighing less than 1500 g showed a lower rate in the West Indians compared with that of the European, Pakistani, and Indian groups. There was no evidence of a higher incidence of `light for dates' in very low birthweight West Indian neonates.(AU)

Ethnic differences in congenital malformations.

Perinatal deaths and major lethal and non-lethal congenital malformations occurring in this hospital from 1979-82 inclusive were related to the ethnic group of the 15 438 mothers. The highest crude perinatal mortality rates occurred in Indian and Pakistani populations (18.3 per 1000 and 24.1 per 1000 respectively). The highest incidence of congenital abnormality also occurred in these groups (13.3 per 1000 and 12.8 per 1000 respectively), but there was considerable variation in the distribution of different malformations.

Ethnic differences in birthweight-related parameters with particular reference to possible maternal nutritional risk factors.

Three birthweight-related parameters were examined in the deliveries occurring from January to July 1982 at Dudley Road Hospital, Birmingham, in 3 major ethnic groups and in relation to possible maternal nutritional risk factors in the European and Indian groups. Ponderal index did not correlate with either mean or 'corrected' birthweight especially in the West Indians. The 3 maternal nutritional risk factors appeared to be of greater fetal prognostic value in the Indian group than in the European group.

Ethnic differences in the distribution of congenital malformations.

Major lethal and non-lethal congenital malformations occurring in babies born in Dudley Road Hospital in 1979, 1980 and 1981 were related to the ethnic group of the mother. There was an increased incidence of gastrointestinal malformations in the Indian group and an increased incidence of abnormalities that could be associated with consanguinity and increased maternal age in the Pakistani group. A sample population (2000 mothers) was obtained in the first 7 months of 1982 to determine the maternal age distribution and consanguinity rates in the various ethnic groups.

Ethnic differences in the distribution of normally formed singleton stillbirths.

The normally formed singleton stillbirth deliveries occurring in Dudley Road Hospital in 1979, 1980 and 1981 were classified according to the primary aetiology. There was a higher than normal stillbirth rate in the Indian group which was almost entirely accounted for by the increased number of stillbirths falling into the 'intrauterine death before labour' group.

Analysis of ethnic differences in perinatal statistics.

The 3996 mothers delivered at Dudley Road Hospital, Birmingham, in 1979 were analysed for their ethnic origins. Social classes IV and V predominated in all groups. A high proportion of Indian mothers fell into the low-risk group based on age and parity but had the highest stillbirth and perinatal mortality rates (15.1 and 27.5/1000 respectively) and infants of low mean birth weight (2986 g). Elderly and multiparous mothers were characteristic of the Pakistani and Bangladeshi groups. Young, primiparous mothers were more common among the West Indians and Europeans, in whom the stillbirth and perinatal mortality rates were low; infants in the European group had a mean birth weight higher than in any other group (3231 g). From these findings ethnic origin of the mother is apparently an important factor in perinatal mortality.

Analysis of ethnic differences in perinatal statistics

The 3996 mothers delivered at Dudley Road Hospital, Birmingham, in 1979 were analysed for their ethnic origins. Social classes IV and V predominated in all groups. A high proportion of Indian mothers fell into the low-risk group based on age and parity but had the highest stillbirth and perinatal mortality rates (15.1 and 27.5/1000 respectively) and infants of low mean birth weight (2986 g). Elderly and multiparous mothers were characteristic of the Pakistani and Bangladeshi groups. Young, primiparous mothers were more common among the West Indians and Europeans, in whom the stillbirth and perinatal mortality rates were low; infants in the European group had a mean birth weight higher than in any other group (3231 g). From these findings ethnic origin of the mother is apparently an important factor in perinatal mortality.(AU)

The influence of smoking on the haemostatic mechanism in pregnancy.

A prospective study through pregnancy is described comparing smokers with non-smokers in an attempt to assess possible changes in the haemostatic mechanism. Various components of the coagulation and fibrinolytic enzyme systems were assayed serially up to 38 weeks of gestation. Plasma fibrinogen was lower in the smokers than in the non-smokers. Also plasminogen was slightly decreased and plasminogen activator activity and serum F.D.P. increased in the former group. Although the results failed to demonstrate motor disseminated intravascular coagulation in smokers, the pattern of a possible low grade syndrome emerged.

PIP: During pregnancy, 12 women who smoked more than 10 cigarettes/day and 12 nonsmokers had blood taken and analyzed at 12, 20, 25, 30, 34, and 38 weeks of gestation. Fibrinogen, plasminogen, plasminogen activator, serum fibrin degradation products, antithrombin 3, alpha 1 antitrypsin, and alpha 2 macroglobulin were measured. The only significant (p .05) difference was that plasma fibrinogen was lower among smokers at 20 weeks. However, there were other patterns of difference -- mean fibrinogen and plasminogen levels were slightly lower throughout pregnancy and reached a lower peak in the smoking group. Fibrinolytic activity fell in the smokers to the same low level as in nonsmokers by 38 weeks, but at a slower rate. Serum fibrin degradation products and alpha 2 macroglobulin were consistently higher in the smoking group. Although the findings showed no major disseminated intravascular coagulation in smokers, there was a pattern of a possible low-grade syndrome.

Sequential studies on components of the haemostatic mechanism in pregnancy with particular reference to the development of pre-eclampsia.

Components of the haemostatic mechanism were studied at intervals in 60 primigravidae over the course of pregnancy and the puerperium; 12 of these developed pre-eclampsia. During pregnancy there was a fall in fibrinolytic activity and fibrinolytic capacity and a rise in fibrinogen, FR-antigen, alpha 1-antitrypsin and alpha 2-macroglobulin. The women who subsequently developed pre-eclampsia could not be identified on the basis of these measurements. Following delivery there was a more rapid return of fibrinolytic activity and capacity towards normal in the women who had not had pre-eclampsia. The urinary FR-antigen level was higher in the women with pre-eclampsia.

Components of the haemostatic mechanism at birth in pre-eclampsia with particular reference to fetal growth retardation.

A comparative study of proteinuric pre-eclampsia and normal pregnancy has been carried out to assess changes in the haemostatic mechanism in maternal and umbilical vein blood at birth. The results demonstrated changes in pre-eclampsia compatible with hypercoagulability with, in particular, depressed fibrinolysis. No strong pattern of differences from normal pregnancy or pre-eclampsia emerged when growth retarded infants were studied as a separate group.

A serial study of coagulation factors XII, XI and X in plasma in normal pregnancy and in pregnancy complicated by pre-eclampsia.

A serial study of coagulation factors XII, XI and X in plasma has been carried out on 60 primigravidae, prospectively comparing those who remained normal with those who developed pre-eclampsia. In the normal group of 48 patients, the levels of all factors rose as pregnancy advanced, a secondary increase in factors XI and X occurring in the puerperium. Cord levels of all three factors were depressed. In the pre-eclampsia group of 12 patients, factor XII was significantly higher than in the normal group throughout the study, while factors XI and X were slightly lower. Observed changes failed to support the idea of a strong primary role for the coagulation mechanism in the pathogenesis of pre-eclampsia.