I MacGillivray’s research while affiliated with University of Bristol and other places

One hundred and fourteen pregnant women with singleton pregnancies and a diastolic blood pressure greater than 90 mmHg in the absence of proteinuria were randomly allocated to receive either labetalol or no antihypertensive agent. Both groups were stratified into primigravidae and multigravidae. There were no differences between the study groups in terms of maternal age, gestation and blood pressure at recruitment. The only statistically significant difference found was a reduction in hospital inpatient antenatal stay for labetalol treated primigravidae (mean 9.5 v. 13.6 days; p 0.02). There were no differences in the incidence of preterm delivery, mode of onset of labour or mean birthweight between treatment and control groups. Although not statistically significant there were trends suggesting a possible prolongation of pregnancy for parous patients, a reduction in emergency caesarean sections and an increase in spontaneous vaginal deliveries for labetalol treated women.

Intra-uterine growth retardation (IUGR) is the main contributory factor in the increased perinatal morbidity and mortality associated with pregnancy induced hypertension. Seventy-six primigravidae and 38 parous women with non-proteinuric hypertension (diastolic blood pressure >90mmHg) and singleton pregnancies were allocated at random to receive either labetalol or no anti-hypertensive treatment. At recruitment maternal age, blood pressure and gestational age were similar in both treatment and control groups. For primigravidae 16 per cent (7/45) of the controls delivered a baby with weight less than the 10th centile for gestational age compared with 19 per cent (6/31) in the labetalol treated group. A birth weight less than the 10th centile for gestational age occurred in 2 out of 18 multigravid controls and 4 out of 20 of the multigravid labetalol treated group. There were more admissions to the neonatal unit for the babies of labetalol treated mothers. A limited meta-analysis of the results combined with those of two other controlled trials suggests that the drug contributes to intra-uterine growth retardation (P The possibility of labetalol having a direct adverse effect on fetal growth requires further evaluation in a larger random controlled study.

It is the development of proteinuria in pregnancy-induced hypertension which is associated with an increased perinatal mortality. There is some evidence to suggest that labetalol may diminish the amount of proteinuria in patients who have already developed proteinuric pre-eclampsia. A randomised controlled study design was used to investigate whether labetalol treatment, started when a persistent diastolic blood pressure greater than 90 mmHg was observed, influenced the subsequent development of proteinuria. One hundred and fourteen women with singleton pregnancies and hypertension in the absence of proteinuria were randomised to receive either labetalol or no antihypertensive therapy. At recruitment maternal age, blood pressure and gestation were similar in both the labetalol and control groups. There was no difference in the frequency, quantity or timing of subsequent proteinuria between treatment and control groups. Overall 34% of primigravidae and 10% of parous women developed proteinuria. Labetalol did, however, control the blood pressure in 45 of the 51 treated women (88%) within 24 h. This effect was often shortlived requiring dose escalation after 3 to 5 days in the majority of cases. Labetalol was well tolerated and no significant maternal toxicity was noted.

The records of Aberdeen men requesting vasectomy between 1978 and 1981 were studied and a sample of men were interviewed about 3 years after the operation; 85% completed the standard requirements for seminal analysis and were given the "all clear"; two-thirds were cleared after sending 2 samples and usually within 20 weeks after vasectomy; 10% of men sent at least 1 sample but were never cleared and the remaining 5% ignored the requirements. Information from 70 men (63 interviews, 7 questionnaires) gave some indication of reasons, often multiple, for incomplete or non-compliance; these included embarrassment, ambiguous feelings about having more children, inadequate understanding of reproductive physiology and blind faith in the surgeon.

The relationship between low social class and low birthweight or preterm deliveries is well established in singletons but not in twins. We present a study using all twin deliveries registered in Belgium in 1983 and in Aberdeen between 1951 and 1983. No significant relationship was found between social class and low birthweight, very low birthweight or preterm deliveries in the Belgian sample. In Aberdeen, we found significantly higher rates of low birthweight twins in low social classes. This increase of low birthweight twins in low social classes occurred in Aberdeen during the period 1951-1968, but not in the more recent data.

A questionnaire based survey was carried out in the Avon health districts to investigate the assessment and management of hypertensive disorders in the third trimester of pregnancy by health professionals. A total of 673 responses were analysed from 310 general practitioners, 48 hospital doctors, 214 hospital midwives, 81 community midwives and 120 student midwives. The study revealed a wide variation in the criteria used for the diagnosis of a hypertensive disorder in pregnancy and some outmoded recommendations for management. The importance of continuing education is stressed, in order to ensure that current research and the consensus of expert opinion is being relayed to the personnel involved in antenatal care.

The routine measurement of blood pressure is an essential part of antenatal care, and the accuracy of any one recording carries significance for the future management of that patient. A woman may have her blood pressure taken by many people during her pregnancy and it is important to know whether there are variations in the technique of measuring and recording these blood pressures. The most accurate way of measuring systemic arterial blood pressure is directly via an intra-arterial catheter; this is obviously not suited to everyday clinical practice, and best estimates have to be used. Nevertheless, it is generally agreed that, if indirect measurements are taken properly with a sphygmomanometer, hypertensive disease can be correctly detected. The British Hypertension Society and the American Heart Association have both recommended certain standards to increase the accuracy of measurement and recording of blood pressure and these are referred to throughout this paper.

Three paediatric pathologists, one perinatal paediatrician, one obstetrician, and one epidemiologist separately used information collected on 239 babies in an attempt to validate the Wigglesworth classification of perinatal deaths. This was first done using clinical data only, then using the combination of clinical and gross necropsy findings and finally using clinical, gross necropsy, histological and any other information (for example, chromosome analyses, microbiological investigations). Only 14 (6%) of deaths changed groups within the Wigglesworth classification when gross necropsy findings were considered as well as clinical findings, and altogether only 21 (9%) changed classification when complete investigations were available. There was an unacceptable amount (15%) of disagreement between the classifiers, largely the result of failure to comply with the rules laid down for classification. We set out amendments to Wigglesworth's original definitions to clarify certain ambiguities.