Plasma cortisol (11-hydroxycorticosteroid) was studied during and after pregnancy in Nigerian women. A rise was found throughout pregnancy which was accompanied by increased binding but the absolute levels were lower than those reported by others. During labour there was a further rise in plasma cortisol which was no longer detectable on the first day after delivery. Six weeks post partum, cortisol levels rose again and this rise was attributed to the stress of lactation. In contrast to previous reports the ratio between maternal and cord blood cortisol levels was found to be narrow.
Levels of unconjugated cortisol, cortisone and 11-deoxycortisol were measured in umbilical arterial and venous plasma, and in maternal antecubital and uterine venous plasma by a method specific for each steroid, utilizing competitive proteinbinding radioassay following steroid fractionation by column chromatography. Samples were obtained (1) at elective Caesarean section, (2) at vaginal delivery or emergency Caesarean section after induced labour, and (3) at vaginal delivery or emergency Caesarean section after labour of spontaneous onset. In the umbilical circulation there was no significant arteriovenous difference for any of the steroids measured. There were significantly higher (p
The excretions of total oestrogens and 11-deoxy-17-oxogenic steroids (as a measure of pregnanetriol) were measured during 61 courses of treatment with gonadotrophins in 26 patients. During the follicular phase of the induced cycles the increase in oestrogens was more rapid than that of pregnanetriol; the latter was not significantly raised until the day before giving the ovulating dose of human chorionic gonadotrophin (HCG). The use of these estimations to monitor treatment is discussed; at present the most reliable index is the total oestrogen excretion and a method of treatment is described whereby some multiple pregnancies and hyperstimulation may be avoided. Steroid excretion is very variable in the early luteal phase. There is a tendency for elevated values to occur in hyperstimulated patients whether they conceive or not.
A technique of radio-active isotope placental localization using 113mIndium and a portable scintillation detector is described. It gave reliable results in 80 per cent of patients. The results were equivocal in 20 per cent. There were two false positive, but no false negative results. Doppler ultrasound was compared but gave unsatisfactory results in that a false negative rate of 28·5 per cent was obtained for placenta praevia.
A safe, atraumatic method of measuring clearance of 133Xe in the region of the placenta is described. The gas was inhaled for two minutes, and external monitoring of the placental area and of the expired air was continued for a further 25 minutes. The placental clearance curve was analyzed into two exponential components, with and without correction for recirculation of the tracer. There was a significant difference of 15 per cent between the results of the two methods of analysis. No difference was found between the mean clearance rates of 19 normotensive and 19 hypertensive patients. The birthweights of the babies were used to assess total placental function, and its relationships to the clearance rates is discussed.
Uniformly labelled 14C glucose was administered intravenously to eight patients in the mid-trimester of pregnancy who were about to undergo hysterotomy and tubal ligation. After delivery of the fetus the fetal liver was removed and the extent of incorporation of 14C glucose into hepatic lipids estimated. Significant levels of 14C were found in all fetal lipid fractions. When these levels were compared with the corresponding levels of 14C incorporation into the maternal serum lipids there was no correlation. It is concluded that much if not all the newly synthesized lipid in the fetal liver is of fetal origin, and has not been synthesized by the mother and subsequently transferred to the fetus via the placenta.
Information is presented on the experinece gained in the management of a series of 91 pregnant female adolescents aged 13-16 years who were delivered at the St. Giles Hospital in London during the January 1964 to December 31 1967 period. 88 of the adolescents were dauthters of men belonging to social classes 4 and 5; 10 of the 91 adolescents were non-Europeans. The course of pregnancy labor and puerperium was compared to a control group of 1568 consecutive primigravidae aged 16-36 years. A higher incidence of toxemia excessive weight gain anemia and congenital abnormality was encountered in the study group. There is a great need for early and intensive antenatal care of the pregnant adolescent. Labor in the pregnant adolescents was found to be easier and quicker than in the older primigravidae. The head was late in engaging in the study group but no cephalo-pelvic disproportion was found. 98.9% of the patients had a normal vaginal delivery. The psychological effect of pregnancy on the adolescent female is related to the support and reaction of her family. The mother was almost always likely to accept the pregnancy more readily than the father.
16 postmenopausal women were studied for fibrinolytic activity before and after treatment of 10 mg daily of 17-beta-estradiol by blood samples, and vein biopsies. Fibrinolytic activity in vein biopisies did not change during treatment; plasminogen, urikinase inhibitors and alpha-2-macroglobulin also remained unchanged. Antithrombin 3 decreased from 105% to 90% (p.01), prothrombin and Factor 7 plus Factor 10 increased 9% (p.01), Factor 5 decreased 12%, Factor 7 decreased and Factor 8 increased 29% (p.05). It is concluded that 17-beta-estradiol a naturally-occurring estrogen, may be safer than synthestic estrogens for postmenopausal substitution therapy.
Serum levels of oestradiol-l7β dehydrogenase have been determined in 113 normal pregnant women. The mean level increases ten-fold from the 8th to the 40th week. Serum levels of this enzyme have been determined in women with threatened abortion in the first trimester and in women with intrauterine death of the fetus. Low or declining levels of the enzyme activity were associated with abortion, but the serum levels in cases of intrauterine fetal death corresponded to those of normal pregnancy.
Oestradiol-17β, given intramuscularly in a dose of 1 mg., was found to increase the serum level of luteinizing hormone (LH) but not of follicle stimulating hormone (FSH) in eight women 48 to 72 hours after the administration. This increase of LH was preceded by a decrease in the serum levels of both FSH and LH. When 5 or 10 mg. of progesterone was administered five days after the injection of oestradiol-17β, a second increase of LH was observed in two of four women. These results suggest that changes in the ovarian secretion of both oestradiol-17β and progesterone may be of importance for the appearance of the midcycle surge of LH in women.
Plasma levels of progesterone and estradiol-17beta were measured using radioimmunoassay methods in 52 blood samples obtained from 10 women aborting after intraamniotic instillation of prostaglandin F2alpha. Mean falls in plasma progesterone of 55.7% and in estradiol-17beta of 46.6% were noted. There was a highly significant correlation between falling concentrations of both steroids and the instillation-abortion interval (p 0.001).
SummaryA series of 189 cases of abruption of the placenta admitted in the five years from 1965 to 1969 to Bellshill Maternity Hospital, Lanarkshire, is reported. There was one maternal death and a perinatal loss of 55 per cent. The role of Caesarean section in improving infant survival in selected cases after the 34th week of gestation is discussed.
Since 1932 a total of 194 women who had 253 pregnancies after rupture of the pregnant uterus have been listed, including the 28 patients with 36 such pregnancies who are the subject of this report. Twenty-five of the women (12·8 per cent) had a repeat rupture. Two patients died. The risk of repeated rupture is least if the scar is confined to the lower uterine segment; greater if the scar extends into the upper segment; and greatest in patients who have had previous rupture of a classical Caesarean section scar. The management of these patients is discussed in the light of these findings.
The incident age distribution for Stage I, Stage II and Stage III carcinoma of the cervix in 12 regions in England and Wales between 1945 and 1969 was studied. For the various geographical areas considered during the same five-year period, the mean age points for a given stage of carcinoma of the cervix were usually tightly clustered. The highest mean ages for a given stage were usually found in the least industrialized areas and this was most noticeable for the period 1965 to 1969. The mean age for Stage I carcinoma of the cervix fell slightly between 1950 and 1969. No similar decrease occurred for Stages II and III.
The survival and recurrence-free rates of 355 cases of carcinoma of the endometrium treated at St. Thomas' Hospital have been analysed with reference to the stage of the tumour, its histological type, the age of the patient, and the treatment.
The five-year survival rate was 70.0 per cent and the ten-year survival rate 63.4 per cent.
Simple total hysterectomy and bilateral salpingo-oöphorectomy in Stage I cases resulted in a ten-year survival rate of 75-8 per cent. In this series Wertheim's hysterectomy did not improve the survival or recurrence-free rate. The pelvic lymph node involvement rate in those cases treated by Wertheim's hysterectomy was low.
On reviewing the cases of massive pulmonary haemorrhage in newborn infants in Oxford over the years 1948 to 1968, inclusive, 49 cases not associated with major congenital malformations were traced. These cases were not uniformly distributed over these years; there was a progressive decline in incidence which parallelled the decline in stillbirth and neonatal mortality rates. Massive pulmonary haemorrhage was found to be associated with a wide range of aetiological factors, and analysis of these factors by the Aberdeen Clinico-pathological Classification showed that the decrease in incidence was due to improvements in obstetrical care and organization. Some differences from the findings of the Perinatal Mortality Survey are presented, and the seasonal distribution of cases born outside the hospital is shown. Lt is concluded that many cases of massive pulmonary haemorrhage may be prevented.
The seasonal distribution of the sex ratio of livebirths has already been correlated with the seasonal distribution of rainfall approximately 320 days earlier. The daily rainfall readings and the daily analysis of drinking water in Brisbane, Queensland, have now been compared with daily births in the maternity hospitals of that city. The interval between the two sets of events ceases to be a mere approximation and becomes a fairly precise 320 days.
There was also an interval of exactly 320 days between the smog which covered Greater London from 5th to 9th December 1952, and the births of 109 males and 144 females at 16 London hospitals from 22nd to 26th October 1953. That anomaly occurred in the middle of an extended period during which very masculine sex ratios had otherwise consistently prevailed.
From a sample of 271,519 births occurring in England and Wales from 1967 to 1971 tables have been prepared describing the relationship of birth weight to gestational age, subdivided by the sex of the infant and parity of the mother. The sample was composed of single babies born live in National Health Service (NHS) hospitals at gestational ages of 28 to 44 weeks and they comprised approximately 8.5 per cent of all such births occurring in NHS hospitals during the study period. No secular trend in birth weight was observed. The distribution of birth weights at a given gestational age was normal above 36 weeks but skewed or bi-modal in preterm infants. The non-normal distribution of preterm infants could be described accurately in terms of a mixture of two normal distributions with different mean values but the same standard deviation. The population with the higher mean birth weight comprised approximately one-third of the observations each week between 28 and 34 weeks but was only 0.79 per cent of all births. The mean birth weight varied between 3.10 and 3.37 kg. equivalent to that of term infants of 38 to 39 weeks' gestation. The sex ratio was similar to that of term infants. The sex ratio (the number of single male infants born alive for every 100 female infants) of the population with the lower mean birth weight rose with increasing prematurity and was 127.9 between 28 and 34 weeks. It is concluded that the population of infants with the higher mean birth weight is composed mainly of pregnancies in which the length of gestation was mistaken. The error in gestational age is not a multiple of months but is continuously distributed. These pregnancies form a small fraction of all births but an important fraction of preterm births.
Colposcopy is a useful tool in the diagnosis of carcinoma of the cervix since it allows the magnified observation of the transformation zone where most if not all squamous carcinomas originate. Experience with colposcopy in the diagnosis of cervical cancer in 200 patients from July 1958-June 1964 revealed that atypical lesions were seen in 89% of the cases and abnormal cytology were found in 92.5% (including 6.5% classified simply as atypical). Of the 28 patients in whom cytology detected atypical or negative findings colposcopy revealed atypical cells in 24. In only 4 patients did the carcinoma remain undistinguishable by both methods. Colposcopy yielded only 22 nonsuspicious or normal results (16 among patients more than 40 years old). Colposcopy therefore is a useful adjunct to cytology and to the selection of the best type of cervical biopsy in each case. This procedure also provides useful information for choosing between conservative treatment and hysterectomy is a valuable aid in the prevention of carcinoma of the cervix and provides data for research.