Factors associated with preterm labour and changes in the cervix before labour in twin pregnancy.

A total of 132 twin pregnancies in black African women were studied prospectively after 30 weeks gestation. Delivery occurred before 37 weeks in 32%. There was a trend (0.1 greater than P greater than 0.05) towards a higher preterm delivery rate in nullipara (57%), in women under the age of 20 years (60%) and in those with a height/weight ratio of greater than 2.5 (50%). The cervix was assessed with a score based on the length of the canal minus the dilatation of the internal os. In both term and preterm labour there was a significant relation between a cervical score of 0 or a decrease in cervical score and the onset of labour within the subsequent 14 days (P less than 0.001). By these criteria to predict impending labour, 60% of all labours that ensured within 14 days of the assessment would have been predicted with a 20% false positive rate. When nulliparae were excluded the predictive value of cervical assessment for preterm labour was 80% with a false positive rate of less than 5%. Plasma oestriol levels were significantly higher in the preterm labour group but had no clinical prognostic value.

The prediction of fetal growth retardation in twin pregnancy.

A total of 132 twin pregnancies first seen at less than 36 weeks gestation were studied prospectively to determine the epidemiological and anthropomorphic factors associated with single or dual fetal growth retardation; the clinical, biochemical and ultrasound serial measurements that are predictive of single or dual fetal growth retardation, and to design scoring systems for the prediction of fetal growth retardation. A number of factors were associated with an increased risk of fetal growth retardation, but the highest risk was present when there was an abnormality in both plasma oestriol and placental lactogen, and the biparietal diameter growth rates were divergent. Scoring systems were derived using multi-variant discriminant analysis for three clinical situations: the patient seen for the first or second time; where only clinical facilities exist and the patient was seen on three or more occasions; and where facilities exist for the biochemical tests of placental function and ultrasonic measurement of the biparietal diameters. The scoring system for the last situation had the highest predictive rate and the lowest false positive rate.

Cervical cytology in pregnant black patients and potential selective screening programmes.

A study to evaluate the detection rate of abnormal cervices in pregnancy was undertaken at King Edward VIII Hospital, Durban. Cervical smears were taken from 2 000 randomly selected patients in the antenatal clinic. Twenty-two smears were abnormal (1,1%), of which 12 were carcinoma in situ (0,6%). We feel that cytological examination of cervical smears should be performed routinely on all antenatal patients, but if this is not possible, it should be performed on those of 25 years or older or of parity 2 or greater. This selective screening would then diagnose 92% of the patients with carcinoma in situ.

An evaluation of routine midtrimester ultrasonic scanning.

In a 2-year period 1,987 patients had a combined ultrasonic A and B scan between 16 and 30 weeks' gestation. The ultrasonic assessment of gestational age was shown to be more accurate than a definite menstrual history in 19,5% of patients using parameters of birth weight for gestation and the time of onset of spontaneous labour. All 31 sets of twins in the series were diagnosed at the first scan. There were 2 perinatal deaths among the twins, a perinatal mortality of 3,2%. Four unsuspected anencephalic fetuses were diagnosed and these pregnancies were terminated before 28 weeks. Two unsuspected molar pregnancies were diagnosed and evacuated. There were 58 false-positive diagnoses of placenta praevia, and 2 cases were missed. The situation of the placenta as revealed by ultrasound bore no relationship to abruptio placentae, but there was a significant relationship between a low-lying placenta and a history of threatened aboriton.

Gaucher's disease and pregnancy.

Two patients with Gaucher's disease during pregnancy are reported. In one there were severe puerperal hemorrhagic complications attributable to thrombocytopenia secondary to infiltration of the reticuloendothelial system by Gaucher cells. The conclusion as reported in previous literature, which is reviewed, regarding the absence of hemorrhagic complications is disputed since on of the cases reported here showed that these may be severe and occur late in the puerperium.

Rupture of an amoebic liver abscess in pregnancy. A case report.

The association between hepatic amoebiasis and pregnancy is rare. Between 1966 and 1976 only 5 cases have been described in the world literature. A sixth case is described, and the literature to date is reviewed. Guidelines for management are presented.

Divergent biparietal diameter growth rates in twin pregnancies.

Twenty-eight twin pregnancies were monitored by serial ultrasonic cephalometry from 30 or 31 weeks' gestation. The rates of growth of the individual twins as determined by biparietal diameters were similar in 11 cases (39%) and divergent in 17 (61%). When the rates of growth were divergent, the lesser rate was always below the mean for singleton pregnancies, and the incidence of small-for-gestational-age babies was 18 of 34 (53%). It was apparent that the greater the difference in biparietal diameters within the 2 weeks preceding delivery, the higher the risk of a small-for-gestation-age baby being delivered. No comment could be made on the growth rate prior to 28 weeks except that at diagnosis there was little or no difference in biparietal diameters.

Respiratory failure in pregnancy.

A case of respiratory failure in pregnancy associated with old poliomyelitis is presented and the available methods of treatment described.

Dolichocephaly--a source of error in serial cephalometry.

Two patients are presented in whom ultrasonic cephalometry suggested intrauterine fetal growth retardation. The respective newborn infants were normally grown and had dolichocephaly with a normal head circumference. Dolichocephaly should be considered when cephalometry alone suggests a diagnosis of placental insufficiency.