Screening for Down's syndrome: experience in an inner city health district.

OBJECTIVE: To review the experience of Down's syndrome screening in an inner city health district. DESIGN: In this retrospective study the names of the women were obtained from the Regional Cytogenetic Laboratory and District Down's Syndrome Register. Antenatal notes of the mothers were studied. Maternal age during the affected pregnancy, screening test performed if any, gestational age at booking and at screening, screening test results, and pregnancy outcome were reviewed. SETTING: An inner city health district. POPULATION: Down's syndrome cases diagnosed prenatally and postnatally. INTERVENTIONS: None. RESULTS: Antenatal diagnosis of Down's syndrome was made in 15/45 women (33.3%); Edwards' syndrome was diagnosed antenatally in 2/5 women. Screening was not performed in eight women (17.8%) whose infants were affected by Down's Syndrome; it was also not performed in one woman whose baby was affected by Edwards' syndrome due to late presentation to the antenatal clinic or loss of the blood sample. Nineteen women (42.2%) with a Down's syndrome pregnancy and two women with a Edwards' syndrome pregnancy had had a negative screening test. Three women had had a positive screening test but declined amniocentesis. Among those who had a screening test, the overall detection rate of screening was 48.6% (18/37) for Down's syndrome and 50% (2/4) for Edwards' syndrome. The detection rates in different ethnic groups did not show significant difference. Four women chose not to have termination following diagnosis of Down's syndrome, giving a total reduction rate of 21%. CONCLUSION: Screening programmes for Down's syndrome have not yet resulted in a substantial reduction in the number of affected babies. In addition to trials at developing screening programmes with better detection rates, efforts should be made to improve the provision of the screening service and the quality of antenatal care in general with emphasis on early presentation and optimal understanding of the implications of the tests.

Blood pressure in the arm and leg in late pregnancy.

Arm and leg blood pressures were measured by an indirect sphygmomanometric method in 12 women in late pregnancy and the results were compared with those in 12 matched non-pregnant women. In most of the pregnant women the diastolic blood pressure measured in the leg fell significantly with a change in posture from the supine to lateral position. In contrast, no significant change was observed in arm blood pressure with postural change after correcting for hydrostatic pressure difference. The interpretation of these findings is discussed with particular reference to methodology of blood pressure measurement.

A prospective randomized control trial comparing medical and surgical treatment for early pregnancy failure.

A prospective randomized control trial was designed to assess the effectiveness of single dose, 800 microg misoprostol administered p.v. compared with surgical evacuation for the treatment of early pregnancy failure. A total of 80 women with a diagnosis of early pregnancy failure were randomized to study (vaginal misoprostol) and control (surgical curettage) groups. Success of treatment, side-effects as assessed during, immediately after and 10 days after treatment, and patient satisfaction were compared. Intravaginal misoprostol was successful in 82.5% (33 out of 40) of the patients. None of the control group patients required a repeat evacuation. The number of patients who experienced significant abdominal pain following treatment did not differ between the groups. The duration of pain was shorter in the control group; however, they required more analgesics during this short period. The number of patients with significant vaginal bleeding, the duration or severity of bleeding did not show any significant difference between the groups. All 33 patients in the study group who had successful treatment expressed satisfaction, whereas only 58% of the control group did so. In conclusion this randomized control study demonstrated the efficacy and safety of the administration of 800 microg of misoprostol p.v. for the management of early pregnancy failure.

Enthusiasm and teamwork--the basis for increase in laparoscopic surgery for ectopic pregnancy: an Inner London district hospital experience.

Laparoscopic surgery is the gold standard in the surgical management of ectopic pregnancy. It results in lower morbidity, less impact on reproductive health and faster return to normal activity. However, laparoscopic management is not available to all women. Between April 2001 and March 2002 a prospective audit of surgical management of ectopic pregnancy was carried out; 88.7% were performed laparoscopically, most due to concerted consultant input to the care of women with ectopic pregnancy.

Fallopian tube ciliary beat frequency in relation to the stage of menstrual cycle and anatomical site.

BACKGROUND: The cyclical changes in ciliary structure and motion within the human Fallopian tube are well documented. Previous investigators have studied ciliary beat frequency (CBF) in relation to menstrual cycle and anatomical site, but with conflicting results. METHODS: Using a technique that records variations in light intensity, we have studied the changes in CBF in relation to the menstrual cycle and anatomical site. Fallopian tubes were collected from 26 women who underwent hysterectomy for benign conditions. Menstrual history, hormone profile and endometrial biopsy results were used to determine the stage of the cycle. Fourteen women were in the proliferative phase, and 12 women in the secretory phase. RESULTS: Mean CBF for all subjects was 5.3 plus minus 0.2 Hz. There was no significant difference in CBF in relation to anatomical site. In the fimbrial region the ciliary beat was faster in the secretory (5.8 plus minus 0.3 Hz) as compared with the proliferative phase (4.9 plus minus 0.2 Hz), P < 0.02. CONCLUSIONS: It is possible that this increase in fimbrial CBF may contribute to ovum retrieval and transport after ovulation. However, the reproductive significance of the changes in CBF in relation to the menstrual cycle needs further investigation.