Telephone support for pregnant women: outcome in late pregnancy.

AIM: The aim of the study was to test the psychosocial benefits of a telephone support program for pregnant women. METHOD: Randomised controlled trial. The study sample were women recruited from an antenatal clinic and general practice surgeries who were less than 20 weeks gestation and either single or in a relationship where the partner was unemployed. Women in the intervention group received weekly telephone calls throughout their pregnancy. All women were interviewed initially and at 34 weeks gestation. There were 66 women in the control group and 65 women in the intervention group. RESULTS: The intervention and control groups did not differ significantly on the psychosocial measures at baseline. Comparisons at 34 weeks were made by analysis of covariance using the baseline scores. The intervention group at 34 weeks had lower stress scores than the control group (means 16.5 vs 18.4, p = 0.02), lower trait anxiety (means 35.2 vs 39.4, p = 0.04) and less depressed mood (means 6.6 vs 8.1, p = 0.02). Self esteem was higher for the intervention group (means 34.9 vs 32.5, p = 0.008). The intervention failed to alter smoking but the intervention women did report more use of community resources (p = 0.02) and were less likely to skip meals (p = 0.03). CONCLUSION: A low cost health promotion program of telephone support during pregnancy can significantly improve a woman's psychosocial status during pregnancy.

A randomized controlled trial in a hospital population of ultrasound measurement screening for the small for dates baby.

Poor fetal growth is an important cause of perinatal mortality and morbidity. Based on the hypothesis that early diagnosis of fetal growth problems leads to more appropriate management and therefore, improved outcome, a randomized controlled trial of ultrasound measurement was performed on 1,528 women booked through a hospital antenatal clinic. This compared a number of perinatal outcomes between the group who had a routine 2-stage examination (early dating and 34-week scan) and a group who had only a dating scan and then additional scans as generated by their clinical situations. No significant differences could be found between the groups when these perinatal outcomes were considered. These results mirror previously published randomized controlled trials. Selection of women for third trimester ultrasound examination for suspected fetal growth problems should be based on careful clinical assessment and should not be routine.

Gestational trophoblastic disease in New Zealand, 1980-1986.

During the period 1980 to 1986, inclusive, 350 cases of gestational trophoblastic disease were recorded within New Zealand; of these cases nearly 70% were reported to a Register established to obtain epidemiological information. Clinical information obtained with the notifications revealed no difference in incidence of gestational trophoblastic disease among the 3 main ethnic groups which make up the New Zealand population; the uterine fundus was recorded as being large for dates in only 26%; the most common clinical presentation was as a threatened abortion; 7% of the cases were diagnosed at either routine ultrasound examination or at termination of pregnancy, there having been no suspicions prior to that procedure. A review of histological material obtained following notification suggested that the histological diagnosis of trophoblastic disease could not be substantiated in 14.7% of cases. During the period under review, therefore, there were 299 cases of trophoblastic disease (all but 2 of which were hydatidiform mole) and 447,667 pregnancies giving an incidence of 1 case of trophoblastic disease per 1,497 pregnancies.

Ovarian relapse in a young woman with acute lymphoblastic leukaemia.

Bilateral ovarian relapse in a young woman with acute lymphoblastic leukaemia (ALL) was treated by oophorectomy and intensive chemotherapy. She remains well off therapy 97 months following diagnosis and 45 months from ovarian relapse.

Ultrasound and ovulation.

Diagnostic ultrasound may be used to both investigate unexplained infertility and monitor all types of infertility treatment in women. Presented in this paper are the numbers of cycles scanned and the numbers of scans performed over the period from November 1981 to March 1986. In patients with unexplained infertility there was only a 39% rate of normality observed with ultrasound. Ultrasound observation of ovulation in patients on clomiphene or gonadotrophin therapy showed a disappointingly low rate.

Estrogen-induced transcortin increase and progesterone and cortisol interactions: implications from pregnancy studies.

The concentrations of progesterone, cortisol, estradiol, and transcortin binding capacity (TBC) were measured in plasma samples of women during normal pregnancy. Between 10 weeks and 20 weeks gestation, the mean of TBC increased linearly, and the mean increase in TBC for a given estradiol increment was constant until the estradiol concentrations reached approximately 30 nmol per liter. The results were consistent with the increase in TBC having been induced by estradiol; however, there was an inherent upper limit of response. Progesterone and cortisol were each linearly related to TBC, but the ratios of progesterone:TBC and cortisol:TBC showed no systematic trend throughout the period studied, and there was no systematic relationship between TBC and the progesterone:cortisol ratio. There was, however, a linear relationship between TBC and the progesterone + cortisol sum, such that a unit increase in TBC was accompanied by an approximate unit increase in the total concentration of the two main transcortin binding steroids. Some cases of spontaneous abortion or habitual abortion might be due to aberrant metabolic influence on progesterone of binding protein; in the instances studied, no evidence was found for this.

The realities of screening for the small for dates fetus using ultrasound measurement.

Screening for the small for dates fetus using ultrasound measurement of the fetal abdominal circumference resulted in a significantly increased rate of diagnosis compared with clinical examination. However, when the perinatal mortality and morbidity amongst infants with a birthweight less than the 10th percentile for gestation in the screened group was compared with that of similar infants in a nonscreened groups who attended the same antenatal clinic but who either booked or were referred late, there was no significant difference.

Second trimester maternal serum alpha-fetoprotein as an indicator of fetal risk.

Serum alpha-fetoprotein levels were raised to 2.0 or more times the median for gestation in 30 of 507 singleton pregnancies after excluding pregnancies complicated by fetal neural tube defects. The serum alpha-fetoprotein levels were significantly more often elevated in pregnancies complicated by prematurity, fetal heart rate abnormalities, delivery of a small for dates infant, a perinatal death and admission of the baby to the neonatal unit. While the predictive value of an elevated serum alpha-fetoprotein was 76% for abnormal outcomes in general it ranged between only 16% and 46% for specific abnormalities. The usefulness of this assay relates only to its ability to predict an abnormal outcome when performed during the second trimester.

Caesarean section in Christchurch.

Base hospital caesarean section rates in Christchurch have risen from 4.1% in 1967 to 14.1% in 1982. However, the Christchurch district caesarean section rate for 1982 was only 9.6%. Analysis of the indications for caesarean section according to the year showed that most indications have increased in frequency and that between 1977 and 1982 this increase was highly significant for failure to progress and fetal distress. Analysis of the indications for caesarean section according to the type of antenatal booking revealed that in 1982 private patients underwent caesarean section more frequently than clinic patients and that they were more likely to have the caesarean section for failure to progress or fetal distress. Emergency transfer patients had an even higher primary caesarean section rate for most indications.

Maternal serum alpha 1-antitrypsin concentrations in normotensive and hypertensive pregnancies.

Maternal serum alpha 1-antitrypsin concentrations were measured serially in pregnant women who were normotensive and those with mild, moderate, and severe hypertension of pregnancy from 27 weeks' gestation to term. alpha 1-antitrypsin concentrations increased with advancing gestation in all four groups. In addition, the hypertensive pregnancies showed higher than normal concentrations at each stage of pregnancy, with values in the severe hypertension group being higher than values in the other two hypertensive groups. At 35-36 weeks' gestation to term the increase in alpha 1-antitrypsin in the severe hypertension group was significant (p less than 0.05) when compared with the normotensive group. Although plasma oestriol and progesterone concentrations increased with advancing gestation in all groups, there was no direct relation between their concentrations and the increase in alpha 1-antitrypsin concentration in the hypertensive groups.

Antenatal biochemical screening to predict low birthweight infants.

Urine and plasma oestriol, plasma progesterone, human placental lactogen, beta 1-glycoprotein and serum cystyl aminopeptidase were measured at intervals during 608 pregnancies. The predictive accuracy of low values for identification of pregnancies with low birthweight outcomes was assessed for each test at various gestations. Data were analysed to obtain 10th-90th centile values for each test from 28 weeks to delivery. Groups with values under different centile levels were compared: those under the lower centiles had higher proportions but smaller absolute numbers of low birthweight infants than those under higher centiles. No test was superior to the others at all centiles and gestations. Biochemical screening of pregnant populations to identify high-risk groups for intensive fetal monitoring has limited potential. If screening is used, the definition of high-risk groups is best achieved by practical rather than statistical criteria. If monitoring facilities are available and well accepted by patients then higher centile 'cut-offs' to define fetal risk may be used than when they are not. Combining any pair of tests with values below the 10th centile did not reduce false positive and negative predictions any more than could be achieved by movement of centiles up or down for a single test.

Measurement of the fetal biparietal diameter by ultrasound is not an accurate method of detecting fetal growth retardation.

Seventy-one patients had serial ultrasound examinations performed during the third trimester of pregnancy. Diameter, circumference and area measurements were made of the fetal head, thorax and abdomen. In three of five infants with birthweights below the 10th percentile no biparietal diameter measurements were below the 10th percentile whereas all five infants had at least the last two abdominal circumference measurements below the 10th percentile. The correlation coefficient between the various fetal parameters, measured within two weeks of delivery and birthweight averaged 0.83 for the thorax measurements and 0.85 for the abdomen measurements but was only 0.60 for the biparietal diameter. It is recommended that fetal abdominal measurements should be used for diagnosing growth retardation and not biparietal diameter measurements.