Students' assessment of a course in obstetrics and gynaecology.

A complete annual entry of 181 students were administered a questionnaire in which they were invited to make value judgements about all aspects of their 3-month course in obstetrics and gynaecology. The resulting performance indicators were used to compare individual staff and clinical firms.

Patients' attitudes to student doctors.

The attitudes of 92 patients to student doctors in a maternity unit were assessed by questionnaire. A total of 76% of attitude statements by patients were favourable to the presence of student doctors. There was a significant trend for patients from lower social class groups to have more positive attitudes to student doctors (0.01 less than P less than 0.05). There was a slight tendency for male students to elicit more favourable attitudes than female students (0.05 less than P less than 0.05).

Reliability of cardiotocography in predicting baby's condition at birth.

A prospective study of 6825 labours was undertaken to determine the relation between the Apgar scores of the babies at one minute and the cardiotocograph tracing in labour. The sensitivity of an abnormal tracing was 35.2% for babies who needed intermittent positive pressure ventilation and 20.0% for babies who did not but who had Apgar scores of less than 7. The sensitivity of an abnormal tracing for all babies with an Apgar score of less than 7 was 23.2%. The positive predictive value of an abnormal tracing was 8.7% for babies who needed intermittent positive pressure ventilation and 18.7% for babies who did not but who had an Apgar score of less than 7. The positive predictive value of an abnormal tracing was 27.4% for all babies with an Apgar score of less than 7. The specificity of the tracing was 93.4% for babies with an Apgar score of 7 or over. The relatively high incidence of false positive predictions might be explained on the grounds that abnormalities in the cardiotocograph tracing are a more sensitive indicator of hypoxia than the Apgar score. False negative predictions might have been due to adverse factors other than hypoxia--for example, fetal trauma, compression of the head, infection, and analgesia in labour. These findings suggest that the current overdependence on fetal monitoring by cardiotocography alone should be examined and that other reliable indicators for non-hypoxic fetal distress should be sought.

Polyamine interaction with pregnancy serum in suppression of lymphocyte transformation.

Biogenic polyamines interacting with pregnancy serum elicit potent suppression of lymphocyte transformation in vitro. Within the assay limits, activity was first shown after about 15 weeks' gestation and reached its highest level at about 28 weeks. This level was maintained until term. It is thought that specific humoral amine oxidases were the cause. Fetal-cord serum and non-pregnancy serum were inactive. This system may have an immunoregulatory function in pregnancy.

Maternal-fetal mixed lymphocyte reactivity in pre-eclampsia.

Two-way mixed lymphocyte reactivity (2-way-MLR) between maternal and fetal lymphocytes in vitro, and one-way mixed lymphocyte reactivity (1-way-MLR) of maternal lymphocytes (responders) to stimulation by mitomycin-treated fetal lymphocytes (stimulators), were investigated in normal and pre-eclamptic pregnancies. No relationship was observed between pre-eclampsia and the 2-way-MLR. The 1-way-MLR was lowest in normal pregnancy, higher in mild pre-eclampsia, and highest in severe pre-eclampsia, although none of these differences were statistically significant.

Spontaneous lymphocyte transformation in pregnancies complicated by pre-eclampsia.

There was no significant difference between the mean spontaneous transformation rates of maternal lymphocytes from normal pregnant women and patients with pre-eclampsia.