Use of magnesium sulphate in Scottish obstetric units.

The greater efficacy of magnesium sulphate compared with diazepam or phenytoin in the treatment of eclampsia is now generally accepted. We used a postal questionnaire to establish the frequency and nature of use of magnesium sulphate in obstetric units in Scotland. Ninety percent of units responded and of these 90% were either using the drug or intended to do so. There was considerable heterogeneity in the indications for its use and some important omissions in the monitoring of patients receiving the drug. The introduction of magnesium sulphate for a rare indication to units with no previous experience of its use may be associated with significant risks to obstetric patients.

Scottish gynaecologists: their views on hormone replacement therapy.

In a postal questionnaire Scottish gynaecologists were asked their views on the use of Hormone Replacement Therapy (HRT). They were almost unanimous in support of HRT, but varied in the circumstances in which they would recommend it and in the length of time they would prescribe it. The need for designated Menopause Clinics was seen to be limited, with most smaller Units preferring the present practice of menopausal patients being seen at general Gynaecology Clinics. Most of those replying thought that General Practitioners (GPs) should continue to be the main providers of the therapy but 89 (77%) felt that Well Women/Family Planning Clinic (WW/FPC) doctors could be an alternative source. Several problems associated with the use of the therapy were indicated. These included uncertainties about the risks of long term use and the management of unscheduled vaginal bleeding, but there was also concern over the administrative and prescribing costs if the therapy is to be widely used as prophylactic medication.

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. Contrary to current perceptions, pregnancies and births among teenagers are not more frequent in 1988 when compared to 1975. There has been, however, a large increase in births to single women, a group with particular problems. The obstetric risks when compared to older women, are small and probably socially, not age related. These include a slightly higher rate of pre-term delivery and low birthweight and a later presentation for specialist antenatal care. The proportion of pregnancies affected by neural tube defects which are terminated is lower among women under 20. These medical risks are small, however, compared to the well-documented social and economic problems which will have long term and indirect effects on health.

PIP: An analysis of trends in numbers, rates, and outcomes of pregnancies in women of 19 years and less was performed using population-based data from the Registrar General of Scotland, of all deliveries in Scottish hospitals from 1975 to 1988. The data were taken from the standard maternity discharge document including live and stillbirths, and from the 1975-87 Notifications of Abortion records. Pregnancies/1000 women ranged from 40 in 1983 to 50 in 1975. Proportionally more pregnancies were terminated in 1987. The number of live births to single women rose from 11.4 to 22.2/1000 over the period. In 1987 there were fewer marriages during pregnancy, and a lower proportion of pregnancies in married women. The total number of live births to women 20 decreased from 8267 in 1975 to 6158 in 1988, while those in single women rose from 2297 to 4558, from 28% to 74%. There were no evident trends in teen pregnancies, but an increase in the termination rate in teens was apparent. Most teen births occurred in mature out-of-school women. While 32% of primiparous women aged 18 booked for prenatal care at 21 weeks or more, there was no increase in anencephaly or spina bifida, which would have been detected by prenatal screening. Hypertension occurred in 14% of women 20 and in 21% of those 20. Operative deliveries were more common in women aged 20-24, and more often resulted in low birth weight. Low birth weight occurred in 8% of women, compared with 7% in those 20 (p0.01). When social factors were controlled, there were no differences in birth weight and gestation length. Indicators of social deprivation are discussed. The longterm implications of loss of education, training, employment, and stable marriages were considered more detrimental to the young mothers than the adverse health effects of early pregnancy.

Co-incidental Von Willebrands disease and immune thrombocytopenia in pregnancy: treatment with high dose intravenous immunoglobulin.

We report a rare association of Von Willebrands disease and idiopathic immune thrombocytopenia in pregnancy. The major threat to the successful outcome of the pregnancy was posed by the acquired disorder. The use of high dose immunoglobulin allowed a normal delivery, without any adverse effects on mother or child.

The effect of the synthetic steroid Org OD14 on fibrinolysis and blood lipids in postmenopausal women.

Two groups of postmenopausal women were compared. One group of 13 was given the synthetic steroid Org OD14 to suppress climacteric symptoms and one group of 14 was given placebo. After a 2 week baseline period the subjects received daily for 12 weeks, either 2.5 mg Org OD14 or placebo. There were no significant differences between the groups pre-treatment. Compared with the placebo group, during treatment, the Org OD14 group showed the following significant differences: higher haemoglobin, haematocrit, platelet count, plasminogen, fibrinolytic activity on fibrin plates and antithrombin III and lower fibrinogen. No significant differences between the groups were found in alpha 2 antiplasmin levels, total cholesterol, total triglycerides, bilirubin or transaminase levels but the Org OD14 group had significantly lower levels of HDL cholesterol. With the exception of the haemoglobin and haematocrit levels all of the differences had disappeared by 2 weeks post treatment.

Abnormally elevated pregnancy specific beta 1 glycoprotein (SP1 beta) with very low placental lactogen (hPL) concentrations in a pregnancy with satisfactory outcome.

Pregnancies with very low maternal serum concentrations of placental function monitors, yet resulting in a normal outcome, have been reported occasionally before (4, 6). We report here a case in which maternal serum placental lactogen (hPL) concentrations were very low, urinary estrogen output assessed by estrogen/creatinine ratio was satisfactory, but maternal serum pregnancy specific beta 1 glycoprotein (SP1 beta) concentrations were grossly elevated. Ultrasound findings suggested impairment of growth. The outcome of the pregnancy was satisfactory, although the baby, apparently of 38-40 weeks' gestation, developed mild respiratory distress.

Renal tubular function in normal pregnancy.

Maternal plasma and urine concentrations of beta2- microglobulin and gamma-glutamyl transpeptidase (EC:2.3.2.2) were measured serially in normal pregnancy. These parameters remained constant throughout and can therefore be used to evaluate tubular function in pregnancies complicated by renal disorders.

EPH gestosis in Glasgow, 1970.

Perinatal deaths due to EPH gestosis which occurred in Glasgow during 1970 were studied. There was a high frequency of perinatal deaths among babies born to primigravidae below the age of 20 years and to mothers with proteinuria. The majority of the deaths occurred in babies weighing less than or equal to 2,500 g. It is suggested that some of the deaths were avoidable and that a further reduction in perinatal mortality can still be achieved.