Partial placenta membranacea.

Seven pregnancies complicated by partial placenta membranacea occurring over a 2-year period are described. The condition is encountered more frequently than the total or near-total form, but is similarly associated with recurrent antepartum haemorrhage, miscarriage or preterm delivery. Diagnosis by ultrasound scan may prove difficult. Five pregnancies had histological evidence of chorioamnionitis, which may have helped to precipitate labour; three fetuses showed pulmonary inflammatory changes of at least 2 days' duration. No maternal predisposing factors could be elicited.

A prospective study of haemostatic tests at 28 weeks gestation as predictors of pre-eclampsia and growth retardation.

A panel of haemostatic tests was performed on 400 primiparous women at 28 weeks to test whether one or more could predict the development of pregnancy complications. Fifteen women subsequently developed pre-eclampsia with significant proteinuria and 13 delivered growth retarded infants. There were no significant differences between mothers in the pre-eclampsia group and 22 randomly selected controls. A stepwise logistic discriminant analysis of the data did not produce a significant model. In the growth retarded group only beta thromboglobulin levels were significantly lower than in the controls (p less than 0.05), although in the logistic discriminant analysis the inclusion of both beta thromboglobulin and fibrin degradation products led to a borderline significant improvement in fit of the model. We conclude that the haemostatic variables studied are not significantly changed at 28 weeks nor clinically useful predictors of either pre-eclampsia or fetal growth retardation.

Intravenous nutrition during a twin pregnancy.

A case is reported of a woman in the third trimester of a twin pregnancy who required intravenous nutrition because of inadequate absorption of nutrients due to a jejunoileal bypass. Weight gain was poor, and there was evidence of intrauterine growth retardation before commencement of intravenous feeding. She received overnight intravenous nutrition for 6 weeks and gained weight with ultrasound evidence of fetal growth. During the 33rd week of gestation, she was delivered of healthy twin males who were at appropriate birth weights and development for their age of gestation. The considerations in intravenous nutrition for a twin pregnancy after jejunoileal bypass are discussed.

Haemoglobin A1c levels in normal and diabetic pregnancies.

Serial measurements of the HbA1c levels were performed during pregnancy in 4 groups of patients attending Antenatal Clinics: 36 normal pregnancies; 16 pregnancies in established insulin-dependent diabetic patients; 9 patients with gestational diabetes diagnosed during that pregnancy; and 21 patients who had been diagnosed as having gestational diabetes in at least one previous pregnancy. In the normal pregnancy HbA1c levels showed a small but significant increase from the end of the first trimester to delivery despite blood glucose levels remaining constant throughout. In the insulin-dependent and gestational diabetic patients, blood glucose levels remained significantly higher than in the normal throughout pregnancy but only in insulin-dependent diabetic patients and the newly diagnosed untreated gestational diabetic patients were the HbA1c levels significantly higher than in the normal. In those patients who had previous pregnancies complicated by gestational diabetes, blood glucose levels were significantly higher than in the normal but HbA1c levels were not. This dissociation between blood glucose and HbA1c levels in gestational diabetic pregnancies in particular limits the value of HbA1c levels in monitoring antidiabetic treatment in such pregnancies.

The utilization of an estrogen assay system in obstetric practice.

Subsequent to reviewing 626 perinatal deaths in relation to estrogen assay, 1500 consecutive pregnancies were analyzed in detail in regard to utilization of urinary estrogen assays. 2710 assays were performed on 456 cases. The perinatal mortality rate in this high-risk group was 8.8 per 1000 compared with the overall hospital rate of 15.1. Estrogen assays give efficient aid to pregnancy management economically; ways in which their contribution could be improved are suggested.

Maternal estrogen excretion before perinatal death.

As the value of urinary estrogen measurement in prevention of perinatal death has been questioned, a series of 626 consecutive perinatal deaths was studied to identify possible failures of the technique. 101 deaths related to singleton pregnancies during which urinary estrogen excretion had been measured; 32 deaths were preceded by normal estrogen excretion but no antepartum death from chronic placental failure occurred in this group, whereas 28 of the 69 deaths preceded by abnormal excretion were attributed to this cause. Most of these deaths were for various reasons regarded as unavoidable. There was one death possibly due to induction of labor done because of abnormal estrogen excretion. 4 deaths following abnormal results might have been avoided by appropriate action. 13 deaths might have been prevented if the assays had been performed in cases in which indications were present. It is concluded that urinary estrogen excretion is abnormal before fetal death from chronic placental failure. Other techniques to detect risk of fetal death have not undergone such extensive validation.

Primary carcinoma of the fallopian tube associated with tuberculous salpingitis. A case report.

A patient with co-existent carcinoma and tuberculosis of the Fallopian tube is described. Tuberculosis was diagnosed by the finding of numerous typical granulomata throughout the uterus, tubes and ovaries, and by exclusion of other possible causes of these; and carcinoma by the finding of solid tumour, with a marked anisocytic appearance, invading submucosa. Despite the well recognised epithelial hyperplasia seen in tuberculous salpingitis, there remains no evidence that the occurrence of carcinoma in such cases is other than fortuitous.