Gastro-intestinal crises during pregnancy.

In general pregnancy is not associated with an increase in the incidence of gastro-intestinal (GI) conditions, but it is associated with an increase in the severity of these conditions. This is largely due to a delay in making the diagnosis. Delay is caused by a combination of factors.

Complex mosaicism associated with trisomy 9.

Fetal karyotypes can be routinely obtained by chorionic villus biopsy, amniocentesis, or fetal blood sampling. Interpretation of results and subsequent counselling can be complicated by pseudomosaicism or mosaicism confined to the placenta or other tissues. We illustrate this by reporting a case of an abnormal fetus with a total of three karyotypically different cell lines (46,XX; 47,XX, +9; and 47,XX, +del(9) (q11) in different tissues (placenta, lung, gonad, and skin).

Vaginal ultrasound and cervical cerclage: a prospective study.

Vaginal ultrasound is a new technique for the objective assessment of the pregnant cervix. Twenty patients (21 pregnancies) were scanned at regular intervals throughout pregnancy after cervical cerclage by the vaginal route. Patients were recruited in 2 consecutive years in each of two centers with a low incidence of cervical cerclage (less than 0.

Development of thermoregulation in infancy: possible implications for SIDS.

Over the first three months of life the infant's metabolic rate rises, which, together with the rise in ratio of mass to surface area, means that the net heat loss per unit surface area is 50% higher in a 3 month old infant than in a neonate. This, together with the thicker layer of subcutaneous fat and more effective peripheral vasomotor response to cold in a 3 month old infant, means that thermal balance is shifted in favour of heat conservation. The head is the site of 40% of heat production and of up to 85% of heat loss in an infant in bed: covers rising up over the head could therefore result in acute thermal imbalance with a rise in brain temperature not necessarily accompanied by a rise in body temperature.

Pre-eclampsia and trisomy 13.

Objective: To assess the reported association between field trisomy 13 and maternal pre-eclampsia.

Design: A retrospective case-control study.

Subjects: Twenty-five women who gave birth to trisomy 13 infants in southwest England between 1971 and 1989; 38 women who gave birth to trisomy 18 infants in the same region over the same time and 50 women with normal karyotype infants matched for age, parity, and date of delivery with the trisomy 13 group.

The effect of combined estrogen/progestogen treatment in women with hyperprolactinemic amenorrhea.

Eleven women with hyperprolactinemic amenorrhea were treated with a combined estrogen/progestogen preparation (Loestrin 30) for 3 months as hormone replacement therapy because of estrogen deficiency, with a view to protection against osteoporosis. Serum prolactin levels rose during the 1st month of treatment (p < 0.05) but did not rise significantly further during the 2nd and 3rd months.

The development of ultradian rhythms in the human fetus.

Objective: Our objective was to determine the normal sequence of neurobehavioral development in the human fetus between 14 weeks' gestation and delivery.

Study Design: The study was performed by longitudinal ultrasonographic observation of 45 low-risk singleton fetuses.

Results: During the first half of the midtrimester there was a high rate of spontaneous movement that appeared randomly distributed.

Comprehensive fetal assessment with three ultrasonographic characteristics.

Objectives: When three ultrasonographic characteristics--umbilical artery Doppler recording, growth (abdominal circumference), and biophysical profile score--are used in combination in assessment of fetuses at risk of chronic asphyxia: (1) What are the order and time scale for the development of abnormality with each characteristic? (2) What is the short-term outcome associated with abnormalities of the three characteristics? (3) Should we amend our fetal assessment protocol?

Study Design: An audit of 103 fetuses (100 mothers) referred to a tertiary center for fetal assessment because of suspected chronic fetal asphyxia was performed with three ultrasonographic characteristics, umbilical artery Doppler recording, measurement of abdominal circumference, and documenting the biophysical profile score.

Results: The order of deterioration (which had a very variable time scale) was umbilical artery Doppler recording, followed by abdominal circumference and finally biophysical profile score. Normal characteristics or an abnormal umbilical artery Doppler recording alone or an abnormal abdominal circumference alone was associated with an excellent prognosis.

A prospective controlled study of in-vitro fertilization, gamete intra-fallopian transfer and intrauterine insemination combined with superovulation.

The relative effectiveness of in-vitro fertilization (IVF), gamete intra-Fallopian transfer (GIFT) and intrauterine insemination (IUI) combined with superovulation in the treatment of infertility were compared in 151 couples undergoing a single cycle of treatment. Treatment was selected as appropriate (IVF for tubal disease, GIFT or IUI/superovulation for nontubal infertility) but possible bias due to non-randomization was overcome by all couples having had favourable fertilization in a previous cycle of IVF. Furthermore, in a preliminary study of initial IVF treatment in 265 couples from whom the study patients were drawn, implantation and pregnancy rates in the diagnostic groups were similar.

Subclavian vein thrombosis: a late complication of ovarian hyperstimulation syndrome.

Two cases of subclavian vein thrombosis following ovarian stimulation for in-vitro fertilization and subsequent ovarian hyperstimulation syndrome (OHSS) are described. Both occurred several weeks after complete resolution of the OHSS. The site of the lesions and their timing suggest that there is a generalized disturbance of coagulation associated with OHSS, which persists beyond the duration of the clinical syndrome.

Absence of fetal breathing and abnormal fetal behavior in prolonged preterm ruptured membranes: case report.

A case is described where prolonged serial observations were carried out on a fetus, between 26 and 3.5 weeks' gestation, the membranes having been ruptured from 23 weeks. No fetal breathing or cyclical activity was observed, and there was no evidence of development of linkage between the fetal behavioral state variables.

Development of visual evoked potentials following intrauterine growth retardation.

Visual evoked potentials to flash (FVEP) were recorded in 23 symmetrically growth retarded newborns of between 32 and 39 weeks gestational age and 41 normally grown controls. At 9 months post term FVEP recordings were repeated in 14 of the growth retarded and 26 of the control infants. The development of two long latency negative components of the wave form of the neonatal FVEP was delayed in the growth retarded infants.

Endometrial resection after radiotherapy for cervical carcinoma.

A patient with persistent chaotic menses during hormone replacement therapy after radiotherapy for cervical cancer was rendered amenorrheic by transcervical endometrial resection.

Intermittent fetal tachycardia and fetal hydrops.

A case is reported where fetal hydrops was noted 10 days after an initial observation of intermittent fetal tachycardia at 31 weeks. A diagnosis of supraventricular tachycardia was made and a successful conversion to sinus rhythm was achieved with maternally administered flecainide, with subsequent resolution of the hydrops. The fetus required no further treatment in pregnancy or at follow up.

Audit of a psychosexual clinic: patterns of attendance and outcome.

A retrospective study of consecutive case notes examined patterns of referral, work and outcome to identify ways in which the psychosexual service at a community psychosexual clinic could be improved. The study identified the characteristics of patients, including their source of referral, the presenting symptom, the number of visits and outcomes. It also suggested the need to develop better prognostic factors and outcome measures.

Epidural bupivacaine dilution for labour. A comparison of three concentrations infused with a fixed dose of fentanyl.

We have compared the effects of three epidural infusions in a randomised, double-blind study of 56 primigravid mothers in labour. An initial dose of bupivacaine 0.5% 8 ml was followed by infusion of either bupivacaine 0.

Non-immune hydrops. The importance of urgent investigation if the prognosis is to be improved.

We report three cases of non-immune hydrops which were successfully treated in-utero. Each case had a different aetiology requiring a specific treatment.

Bizarre fetal behaviour associated with lethal congenital anomalies: a case report.

Prolonged recording of behaviour was performed in a fetus at 36 weeks gestation, who was severely small for dates with no apparent aetiology. Detailed analysis of fetal behaviour was grossly abnormal. Behavioural states were absent and there were no intervals during which linkage of the state variables was demonstrated in a total of 120 min of observation.