Chemistry and quality of Hibiscus (Hibiscus sabdariffa) for developing the natural-product industry in Senegal.

The objectives of this study were to assess and improve the quality of the hibiscus calyces from Senegal over 2 production seasons (2004 to 2005), to develop and adapt new procedures for the determination of hibiscus anthocyanins and analysis of the 2 major ones, delphinidin-3-sambubioside and cyanidin-3-sambubioside. The foreign matter, total ashes, and acid insoluble ashes showed that the calyces harvested in 2005 were produced following hygienic practices, while the color assessment of the calyces and analysis of hibiscus active principles also showed higher amounts of anthocyanins in 2005. A protocol to measure anthocyanins by pH-differential UV-Vis spectrophotometry was adapted to measure the hibiscus anthocyanins from a water extract. The spectrophotometric method for quantitation of total anthocyanins showed a close correlation (r(2)= 0.82) when compared with the HPLC method, suggesting the use of the colorimetric method in quality control programs as an affordable alternative method to assess anthocyanin content in hibiscus. New and raised standards for the cleanliness and active principle content in hibiscus are also proposed. This study demonstrated that the implementation of a quality control program and the application of agricultural good practices in the production and processing of hibiscus calyces can lead to higher quality natural plant products.

Diffuse placental chorioangiomatosis and fetal hydrops.

A highly unusual case of a pregnancy complicated by diffuse placental chorioangiomatosis that resulted in a live-birth and short-term fetal survival is reported. The potential for antenatal diagnosis and intrauterine treatment to optimise fetal outcome is discussed.

Idiopathic intracranial haemorrhage in the fetus.

Intracranial haemorrhage in the fetus has been reported with associated mortality and morbidity. This case report describes idiopathic subdural haematomas diagnosed at 32 weeks of gestation, with delivery by caesarean section of a live male infant in good condition at 34 weeks.

Fetal thyrotrophin: the best indicator of long term thyroid function after in utero exposure to iodine-131?

A woman treated with radioiodine for thyrotoxicosis was subsequently found to be 19 weeks pregnant at the time of treatment. Fetal thyroid hormone levels in utero were normal or mildly elevated but fetal thyrotrophin (TSH) levels were very high. The baby remained euthyroid after birth, but required treatment with thyroid hormone replacement to normalise the TSH level. Neurodevelopment was normal at age 36 months.

A case of unexplained mild Rh (D) haemolytic disease in utero.

This report describes the case of a patient with a history of HDN complicated by fetal losses, in which the alloantibody in this particular pregnancy did not appear to cause HDN in utero. No protective HLA-DR antibodies could be demonstrated, and transport of IgG across the placenta appeared to be normal. The infant's red cells possessed a normal D antigen and his mononuclear phagocyte system appeared unimpaired. However, the number of molecules of IgG bound in vivo per fetal red cell was below the level usually associated with significant haemolysis and HDN.

Needle modifications for invasive fetal procedures.

OBJECTIVE: To investigate the effect of needle size and siliconization on fetal blood sampling, transfusion, and electrocardiography. METHODS: Standard needles were modified by increasing the internal (but not the external) diameter and either siliconization of the bore or external Teflon coating. The siliconized needles were subjected to a series of flow experiments with either blood or saline at various driving pressures, and assessed in clinical use during fetal transfusion and fetal blood sampling. The Teflon-coated needles were used for fetal transfusion to try and facilitate the fetal electrocardiogram (ECG). RESULTS: Under conditions simulating fetal transfusion, the siliconized needle allowed a 93% increase in flow rate compared to the standard needle (P < .05). Samples obtained after fetal transfusion with the siliconized needles were free of clots, whereas 50% of the post-transfusion samples with the standard needle had clots present. Similarly, samples taken for fetal platelet count were free of platelet clumping and clots with siliconized needles, but not with standard needles. Fetal ECG recordings were recorded successfully when Teflon-coated needles were used to access the fetal circulation via the intrahepatic vein. CONCLUSIONS: Modifications to standard needles improved blood flow and reduced the activation of coagulation during both fetal intravascular transfusion and platelet count measurement. Direct fetal ECG recording was facilitated by Teflon coating the external surface of the needle, insulating the fetal signal from maternal electrical signals.

In utero pacing for fetal congenital heart block.

We report what we believe is the first percutaneous transvenous intracardiac cardiac pacing of a fetus. The case is important because it demonstrates that transvenous fetal cardiac pacing is technically possible and provides a basis for development of the technology.

Longitudinal assessment of amniotic fluid index.

OBJECTIVE: To derive a longitudinal gestational reference range for amniotic fluid index and to compare it with the established cross-sectional reference range. DESIGN: Longitudinal prospective study. SETTING: Liverpool Maternity Hospital and Mill Road Maternity Hospital, both teaching hospitals in central Liverpool. SUBJECTS: One hundred and fifteen pregnant women, in whom the expected date by the last menstrual period and ultrasound scan at 18 to 19 weeks were in agreement by seven days, were recruited. They were divided into two groups and scanned at four weekly intervals as follows: Group A: scanned at 20, 24, 28, 32, 36, 40; and Group B: scanned at 22, 26, 30, 34, 38, 42. RESULTS: Amniotic fluid index varies with gestation, rising from early gestation to peak at 30 weeks and then falling from 36 to 42 weeks. Comparison of our reference range with that of Moore and Cayle (1990) shows obvious differences at the lower limit. CONCLUSION: We have established a normal longitudinal reference range for the amniotic fluid index. Our ranges, derived from longitudinal data, would seem a more appropriate reference than the established reference ranges derived from cross-sectional data. In particular, the differences at the lower limits may have considerable clinical implication in the use of amniotic fluid index in the prediction of fetal compromise.

Management of pregnancies complicated by rhesus (D) antibodies.

The management of anti-D alloimmunization is still changing. The mainstay of monitoring for severe disease is now ultrasonography. Non-Rh(D) antibodies are now a relatively common cause of alloimmune anaemia and should be looked for in all pregnancies.

Relief of presumed compression in oligohydramnios: amnioinfusion does not affect umbilical artery Doppler waveforms.

The suggestion that amnioinfusion improves umbilical artery Doppler indices of downstream resistance in oligohydramnios by relieving cord compression was investigated by obtaining waveforms before and immediately after amnioinfusion in 16 pregnancies with severe oligohydramnios. There was no significant difference in the change in umbilical artery pulsatility index (PI) between 11 pregnancies in which amniotic fluid volume was restored (mean delta PI = -0.07, 95% confidence interval -0.17 to +0.07), and 5 pregnancies in which immediate vaginal leakage of infused fluid prevented restitution of amniotic fluid volume. Fetal heart rate did not change significantly in either group. End-diastolic frequencies did not return with restitution of amniotic fluid volume in the 2 pregnancies in which they were absent before infusion (absent in 1, reverse in 1). This study suggests that restitution of amniotic fluid volume in human pregnancies complicated by severe oligohydramnios does not acutely alter the umbilical artery PI.

The influence of suture material on vaginal vault granulations following abdominal hysterectomy.

A questionnaire was circulated to 1147 members (consultant status) and fellows of the Royal College of Obstetricians and Gynaecologists to survey the current management of the vaginal vault following abdominal hysterectomy. Of the 56% who responded, the majority (87%) routinely close the vault. An interrupted mattress suture is used by 60%, a continuous suture by 43% and the Lembert suture by 2%. Chromic catgut is favoured by 60%, a synthetic polymer by 33% and plain catgut by 6%. We then organized a prospective, randomized trial involving 114 women who underwent total abdominal hysterectomy for benign indications. No. 1 polygalactide (Vicryl) was used in 58 women, and No. 1 chromic catgut in 56. Overall, 37 (32%) had vault granulations 6 weeks post-operatively. Chromic catgut had been used in 25 (68%) and polygalactide in the remaining 12 (32%) (P = 0.01). Only 2 (5%) of these women denied any symptoms, while the rest complained of vaginal discharge, bleeding or both. Neither the patients' age, weight or parity, nor the status of the surgeon influenced the occurrence of granulations. We conclude that the widespread use of chromic catgut revealed by our survey is unacceptable: polygalactide, a synthetic polymer, is associated with fewer vaginal vault granulations than chromic catgut.