Treatment of menstrual migraine by oestradiol implants.

The suppression of cyclical ovarian activity and the creation of constant oestradiol levels in blood by subcutaneous oestradiol implants has been used to treat 24 patients with menstrual migraine for up to five years. Twenty-three patients improved with treatment, 20 (83%) became completely or almost completely headache-free. Regular monthly periods were induced with cyclical oral progestogens.

Obstetric characteristics in different racial groups.

A detailed analysis of 2632 consecutive pregnancies in white, black and Asian women, who were delivered during the period 1978 to 1980, found significant differences between the three ethnic groups. Asian primiparae had the longest first and second stages of labour, with the highest incidence of prolonged latent phase (14%) and primary dysfunctional labour (30%). Black primiparae and multiparae had the highest incidence of secondary arrest in the first stage of labour (10% and 4% respectively) and of primary dysfunctional labour, with the greatest recourse to emergency caesarean section (13% and 4% respectively).

Should we abandon Kielland's forceps?

To assess the risks associated with the use of Kielland's forceps 2708 consecutive deliveries were studied prospectively and the neonatal outcome related to the mode of delivery. Of the 1191 primigravidas, 279 (23.4%) underwent instrumental delivery, of whom 65 (5.

Pregnancy in sickle cell disease in the UK.

The complications and outcome of 125 pregnancies in women with sickle cell disease between 1975 and 1981 are reviewed. There were no maternal deaths, but a perinatal mortality rate of 48 per 1000. The main maternal complications were sickling crises (38%), anaemia (65%), infections (61%) and severe pregnancy-induced hypertensive disease (5%).

Pregnancy in women with sickle cell trait.

The complications and outcome of 334 pregnancies in women with sickle cell trait between 1975 and 1981 are reviewed. The perinatal mortality rate was 6 per 1000. The main maternal complications were recurrent urinary tract infections (6%) and haematuria (16.

Outcome of spontaneous labour in multigravidae.

From a study of 2000 consecutive labours, the outcome of 847 multigravid patients admitted in spontaneous labour was examined. Labour was classified according to the cervimetric pattern, and response to oxytocin given according to a strict protocol with the use of a nomogram and partogram. The mean 'observed first stage' was 3.

Social and obstetric features associated with smoking in pregnancy.

The smoking habits of 2000 consecutive pregnant women have been analysed in relation to their race, social features and obstetric results. Only 60% of white patients were non-smokers compared with 80% of blacks and 90% of Asians, and whereas 20% of white patients smoked heavily only 3% of blacks or Asians did. Smokers booked later and were more frequently unsure of their dates, unemployed, unmarried and defaulters from the antenatal clinic.

Prolonged pregnancy: is induction of labour indicated? A prospective study.

A prospective controlled study of 2000 patients to determine the incidence of postmaturity and the effect of a policy of non-induction of labour in prolonged pregnancy is reported. 'Certain postmaturity' was identified in 4% of the patients and was associated with an increased incidence of babies with Apgar scores of less than 5 at 1 min; induction of labour at 42 weeks gestation did not affect the neonatal outcome compared with that in patients allowed to go into spontaneous labour. Induction of labour in patients designated as 'certain postmature' and 'uncertain postmature' reduced the number of vaginal deliveries and increased the caesarean section rate from 9.

Features predictive of brachial plexus injury during labour.

The labours of 8 patients which resulted in the birth of babies with brachial plexus injury were studied. Four of the mothers were Black, 1 was Asian and 3 were White. Seven had instrumental deliveries.

Predictive value of cervimetric labour patterns in primigravidae.

From a study of 2000 consecutive labours the outcome of the 684 primigravid patients admitted in spontaneous labour has been examined according to their cervimetric progress during the first stage of labour. A partogram and labour stencil were used to identify dysfunctional labour which was treated with a standard protocol of augmentation by oxytocin. This policy achieved labours with a mean 'observed first stage' of 6.

Scanning electron microscopy of the endometrial cell surface in postmenopausal women receiving oestrogen therapy.

The surface ultrastructure of normal and abnormal endometrial cells from patients receiving oestrogen therapy for the climacteric syndrome was studied by scanning electron microscopy. Patients with endometrial pathology were treated with oral progestogens. Excessive oestrogen stimulation caused proliferation of cilia and microvilli.

Hormonal profiles in postmenopausal women after therapy with subcutaneous implants.

Plasma hormones were estimated in 24 postmenopausal patients who had been castrated. Each was given a sub-cutaneous implant of either 100 mg or 50 mg of oestradiol, or 50 mg of oestradiol with 100 mg of testosterone, or 200 mg of testosterone. Plasma hormone estimations were repeated at two weeks, one month and then monthly for up to 12 months.

The effect of lumbar epidural analgesia on the rate of cervical dilatation and the outcome of labour of spontaneous onset.

A study of 1055 spontaneous labours is presented relating progress and outcome to the presence of a lumbar epidural block in 282 of these patients and to the need for oxytocin augmentation in 427. Graphs for cervical dilatation starting at admission to hospital were constructed for normal and dysfunctional labours of spontaneous onset. Patients requiring augmentation of labour had a lesser cervical dilatation on admission to hospital, a longer first stage, more instrumental deliveries, more Caesarean sections and a greater number of babies with a low Apgar score.

Endometrial disease after treatment with oestrogens and progestogens in the climacteric.

A prospective study of 745 women receiving different regimens of hormone treatment for the climacteric for a total of 21 736 months was performed. There was a lower incidence of endometrial hyperplasia in biopsy specimens in the women receiving cyclical low-dose oestrogen by mouth than in those receiving cyclical high-dose oestrogen by mouth. The incidence of abnormalities in the women receiving sequential oestrogen and progestogen was lower than in either of these two groups.

A study of the benefits and acceptability of ambulation in spontaneous labour.

A prospective study of 300 consecutive deliveries has been made to assess the benefits and acceptability of ambulation during spontaneous labour. Ambulation during the first stage occurred in 48 patients with 55 non-ambulant patients acting as controls. No difference in the length of first or second stage, incidence of fetal distress or mode of delivery was observed.

Outcome of normal and dysfunctional labor in different racial groups.

Spontaneous labor in patients of different racial groups has been studied relating progress and outcome to whether labor was dysfunctional as defined by the partogram and action line. Forty-three percent of primigravidas and 17.6 to 25.