Fetal tachyarrhythmias.

Fetal tachyarrhythmias are uncommon but are associated with significant perinatal mortality and morbidity. Fetal echocardiography permits the accurate determination of the nature of the arrhythmia. Transplacental or direct fetal therapy with anti-arrhythmic drugs can successfully cardiovert the fetus in utero with a subsequent reduction in perinatal problems.

The changing pattern of eclampsia over a 60-year period.

Objective: To determine changes in the incidence and pattern of eclampsia within the same geographical area over a 60-year period.

Design: A retrospective, descriptive study of 1259 consecutive women classified, at the time, as having had an eclamptic convulsion between the years 1931 and 1990.

Setting: A large city centre teaching hospital and the surrounding catchment area.

Combined spinal-extradural anaesthesia for preterm and term caesarean section: is there a difference in local anaesthetic requirements?

In a non-blinded observational study, we have tested the null hypothesis that there is no difference in local anaesthetic requirements for subarachnoid anaesthesia between women presenting for Caesarean section at term or preterm (38-42 and 28-35 weeks' gestation, respectively). Using a combined spinal-extradural technique, 2.25 ml of 0.

Patient-controlled analgesia following caesarean section: a comparison of morphine and meptazinol.

Forty-eight women were investigated in a prospective double-blind study and randomised to receive intravenous patient-controlled analgesia (PCA) with meptazinol or morphine following elective caesarean section. Women received PCA boluses of 1 mg morphine or 10 mg meptazinol with no background infusion. Total drug consumption measured over a 24 h period, pain (visual analogue scores), sedation scores, incidence of nausea and vomiting, and requests for rescue analgesia were compared.

Spinal anaesthesia for Caesarean section: effect of Sprotte needle orientation.

We induced spinal anaesthesia in 100 women presenting for elective Caesarean section with the mother in the right lateral position. Patients were allocated randomly to have the side eye of the 24-gauge Sprotte spinal needle pointing in one of four directions: group A, cephalad; group B, right lateral; group C, left lateral; group D, caudad. Isobaric bupivacaine 0.

Randomised, controlled trial of efficacy of midwife-managed care.

Background: Midwife-managed programmes of care are being widely implemented although there has been little investigation of their efficacy. We have compared midwife-managed care with shared care (ie, care divided among midwives, hospital doctors, and general practitioners) in terms of clinical efficacy and women's satisfaction.

Methods: We carried out a randomised controlled trial of 1299 pregnant women who had no adverse characteristics at booking (consent rate 81.

Combined simple and complex cord knots.

Both double true knots and complex knots of the umbilical cord are rare events. This report presents a case in which the two occurrences were combined. Apart from some early decelerations in the first stage of labour, there was no evidence of fetal compromise.

Tailored written invitations for second round breast cancer screening: a randomised controlled trial.

Objectives: Firstly, to determine if attendance for second round mammography screening in those sent a tailored letter (that is, making reference to their screening history) is increased compared with those sent a standard letter; secondly, to investigate the acceptability of tailored letters.

Setting: North West Glasgow Breast Screening Centre.

Methods: A randomised controlled trial.

Emergency caesarean section during labour: response times and type of anaesthesia.

Eighteen percent of 212 consecutive emergency caesarean sections at term were classified as truly 'urgent' (requiring delivery within 20 min). The interpretation of the intrapartum cardiotocographs was generally accurate, although after an independent review of the tracings six cases classified originally as 'urgent' had Krebs scores > 4. Among the 'urgent' cases the median total time interval from decision to operate to delivery of the baby was 25 min (IQR between 20 and 33).

Plasma prostaglandin metabolite concentrations in normal and dysfunctional labour.

Objective: To determine the concentrations of the metabolites of prostaglandin E2 (PGEM) and of prostaglandin F2 alpha (PGFM) prior to the onset of labour and during spontaneous labour, and to correlate the changes in concentrations of these metabolites with labour outcome.

Design: Longitudinal study throughout labour.

Setting: Labour ward of a large maternity unit.

Providing for women following miscarriage.

It is apparent that an increased awareness amongst health care workers of the need for parents to grieve the loss of their baby, regardless of the gestation, is essential. It should also be noted that this time of coming to terms with the loss can be quite lengthy. This healing may be aided by support groups such as the Miscarriage Association, and also through pre-pregnancy counselling clinics.

A comparative study of intramuscular ketorolac and pethidine in labour pain.

A single dose block randomised double-blind study comparing intramuscular ketorolac, 50 mg of pethidine and 100 mg pethidine was carried out in multiparous women. Pain intensity and sedation effect were recorded at inclusion to the study, half hourly for the first 2 h, then hourly until 6 h after delivery. Maternal and neonatal side effects were noted including the Apgar scores and the baby's requirements for resuscitation.

Umbilical artery and uteroplacental velocimetry in pregnancies complicated by idiopathic low birthweight centile.

Umbilical artery and uteroplacental Doppler flow velocity waveforms were studied in 35 pregnancies complicated by idiopathic low birthweight centile. Thirty fetuses (86%) were below the 5th centile birthweight for gestation. Fifteen (43%) had an abnormal umbilical artery systolic to diastolic ratio.

An economic evaluation of daycare in the management of hypertension in pregnancy.

Objective: To evaluate the efficiency of daycare in the management of hypertension in pregnancy compared with inpatient management with prior domiciliary visits.

Design: Comparative study.

Setting: Two maternity teaching hospitals, Glasgow Royal Maternity Hospital which has an established daycare unit and Aberdeen Maternity Hospital with no daycare unit.

Randomised trial of continuous nasogastric, bolus nasogastric, and transpyloric feeding in infants of birth weight under 1400 g.

Forty three infants under 1400 g were fed by a bolus nasogastric, continuous nasogastric, or transpyloric route. There were more complications with transpyloric feeding and no identifiable benefits in the growth rate, oral energy input, or chosen biochemical indices of nutrition. Bolus or continuous nasogastric feeds rather than transpyloric are better routine methods in infants of low birth weight.

The effect of acute and chronic antihypertensive therapy on maternal and fetoplacental Doppler velocimetry.

Maternal and feto-placental Doppler flow velocity waveforms were studied during acute and chronic antihypertensive therapy in patients with pregnancy-induced hypertension. Eight primigravidae were acutely treated with oral nicardipine. Diastolic blood pressure fell at 30, 45 and 60 min after nicardipine.

Teenage pregnancy in Scotland: trends and risks.

Teenage pregnancy, considered to be associated with social and medical risks, is seen as a growing problem. Population based information from the Registrar General (Scotland) and Notification of Abortion permitted an analysis of the trends in the numbers, rates and outcomes of pregnancies among women aged less than 20 years. In addition, clinical information is available on all deliveries in Scottish hospitals from the standard hospital discharge document permitting analysis of the association of defined complications with age.

Doppler flow velocimetry in hypertension in pregnancy.

Early studies suggested that Doppler ultrasound held great promise as a noninvasive, repeatable, and simple method of predicting hypertension in pregnancy and identifying those hypertensive pregnancies at high risk of maternal and fetal complications. Further studies have tempered this early enthusiasm by revealing the multiplicity of factors that may influence the Doppler waveform pattern. This makes interpretation of changes in the FVW pattern difficult.

Does the brachial artery Doppler flow velocity waveform reflect changes in downstream impedance?

Brachial artery Doppler flow velocity waveforms were recorded from 10 nonpregnant women and 19 women with uncomplicated pregnancies. The pregnant group showed higher peak systolic frequencies (3.24 compared with 2.

The role of postnatal x-ray pelvimetry after caesarean section in the management of subsequent delivery.

The purpose of this study was to investigate the influence of postnatal x-ray pelvimetry after caesarean section on the management of the subsequent pregnancy. The case records of 331 women delivered by casearean section in their first pregnancy were reviewed. By standard radiological criteria, the pelvis was considered to be inadequate in 248 (75%) of them and adequate in 83 (25%).

Determinants of perinatal outcome in pregnancy-induced hypertension with absence of umbilical artery end-diastolic frequencies.

Forty-three pregnancies that were complicated by pregnancy-induced hypertension and either absence of umbilical artery end-diastolic frequencies (n = 32) or reversal of umbilical artery end-diastolic frequencies (n = 11) were reviewed. The incidence of perinatal mortality and morbidity was similar for the two Doppler patterns. Perinatal survival was highly dependent on the gestational age when hypertension first appeared.

Umbilical artery flow velocity waveforms during spinal anesthesia.

The umbilical artery Doppler flow velocity waveform was recorded during spinal anaesthesia prior to elective caesarean section in 15 uncomplicated pregnancies. Although spinal anaesthesia was associated with a significant fall in maternal systolic and diastolic blood pressure, there was no change in the umbilical artery Pulsatility Index either after preloading the maternal circulation with 750-1000 ml of Hartman's solution or for the first 15 min after subarachnoid injection of 0.5% bupivacaine.