Fetal loss from umbilical cord abnormalities--a difficult case for prevention.

The summaries of 12 pregnancies in which fetal distress and death were thought to be the result of umbilical cord abnormalities are presented. These included six cases of stricture and torsion of the cord, one case of umbilical vein aneurysm, one case of perivascular haemorrhage near the fetal end of the cord, one case of umbilical vein thrombosis, two cases of true knot of the cord and one case of very short cord. The perinatal mortality was 75% in the whole group (9 out of 12 fetuses), there being eight stillbirths and one neonatal death. Of the 12 fetuses, only three were small for dates at delivery. Nine patients volunteered the history of a decrease in fetal movements, and non-stress cardiotocography (NST) was abnormal in eight patients. It was noted, however, that fetal death tended to occur rapidly after an abnormal test. Observations in our series indicated that antepartum fetal deaths due to umbilical cord abnormalities are still difficult to prevent, as it is often impossible to detect fetal distress in time for appropriate intervention. Prompt action to deliver the baby after an abnormal NST appears to be a necessary step to prevent antepartum deaths due to such causes.

Comparison of four different dosages of injectable bromocriptine retard for puerperal ablactation.

The clinical efficacy, tolerance and effect on plasma prolactin levels of four different dosages of intramuscular bromocriptine retard were compared. 108 Chinese puerperas with a mean body weight of 58 kg, who chose not to breast-feed following vaginal delivery, were randomized into four equal groups. The patients in each group were given intramuscular bromocriptine retard: 20, 30, 40 or 50 mg. The injection was well tolerated by all, except for two patients who developed small haematomas at the site of the injection and 2 patients who complained of dizziness. Ablactation occurred in 100% of the patients in the 40 mg group, but was successful in only 92 and 91% of the patients in the 20 and 30 mg groups, respectively. There were two cases of suboptimal response in the 50 mg group, despite marked reduction in plasma prolactin levels. Both these patients had developed moderate breast engorgement before they received the injection. The difference in response among the four groups was not statistically significant. We recommend that the injection be given prior to the development of breast engorgement.

Evaluation of the WHO criteria for 75 g oral glucose tolerance test in pregnancy.

A group of pregnant women at high risk of developing diabetes in pregnancy had paired oral glucose tolerance tests (OGTT) using a 100 g load followed by 75 g load. When the World Health Organization (WHO) criteria and the National Diabetes Data Group (NDDG) criteria were compared, the 2-h plasma glucose value after the 100 g load was the most discriminative in differentiating those with normal glucose tolerance, impaired glucose tolerance and gestational diabetes mellitus. When only the 2-h plasma glucose values were assessed, the WHO test (75 g: 8 mmol/l) agreed with the NDDG test (100 g load: 9.2 mmol/l) in the diagnosis of glucose intolerance in 60% of subjects only. Using the same criteria at 2-h (8 mmol/l) the agreement between these tests was 47%. Reducing the glucose load from 100 g to 75 g produced a reduced glucose response in 49% of the subjects, with a significant decrease in the area under the glucose response curve.

Lesbianism in the Chinese of Hong Kong.

Some historical and literary background regarding lesbianism in China is given. The demographic data, family background, and behavioral characteristics of 15 Chinese lesbians are described and compared with a matched group of married women. More lesbians were adopted, reported unhappy childhoods and hostile family atmospheres, had parents who preferred them to be boys, and attended sexually segregated schools. The subjects differ from their Western counterparts in having a closer relationship with their mothers and in the absence of oral sexual practice.

Is treatment needed for mild impairment of glucose tolerance in pregnancy? A randomized controlled trial.

The study was designed to identify those pregnant women who are diagnosed as having gestational diabetes by National Diabetes Data Group (NDDG) criteria, but normal glucose tolerance (NGT) or impaired glucose tolerance (IGT) by the World Health Organization (WHO) criteria, and to test whether treatment changed the perinatal outcome in those with NGT and IGT. The 216 women with an abnormal 100 g oral glucose tolerance test (OGTT) using NDDG criteria were subjected to a 75 g OGTT. Using the WHO criteria, 111 women (51%) had NGT, 98 (45%) had IGT and 7 (3%) had frank diabetes mellitus. Those with NGT and IGT were randomized into control and treatment groups. The perinatal outcome in these two groups was comparable whether the NGT and IGT groups were analysed together or separately except, that in those who were treated for IGT, smaller babies were born one week earlier than in the control group (3407 g vs 3110 g, P less than 0.01). This suggests that the WHO criteria can safely replace the 100 g OGTT with substantial savings in manpower, money and patients' time.