BJOG : An International Journal of Obstetrics & Gynaecology

Fedrick, Jean; Adelstein, Philippa

doi: 10.1111/j.1471-0528.1978.tb15816.xpmid: 623719

The singleton births in the 1958 British Perinatal Mortality Survey (Butler and Bonham, 1963; Butler and Alberman, 1969) were used to study the aetiology of low birth weight of infants delivered at term. After exclusion of macerated stillbirths and infants with lethal congenital defects, 468 infants of 259 days or more gestation and a birth weight which was less than 2500 g were identified. The mothers and their pregnancies were compared with those of the population of 16 994 singleton births. Delivery at term of a low birth weight infant was significantly associated with maternal prepregnant weight, maternal height, maternal smoking, primiparity, maternal employment, low social class, a previous infant of low birth weight, threatened abortion and severe toxaemia. No significant associations were found with illegitimacy, area of residence, previous spontaneous abortion, essential hypertension, mild toxaemia, chronic or acute infections or other conditions. There were significant negative associations with a history of previous large infants and with maternal blood group AB.

Adelstein, Philippa; Fedrick, Jean

doi: 10.1111/j.1471-0528.1978.tb15817.xpmid: 623730

A method is described by which the risk of being delivered of a low birth weight infant at term can be predicted during the third trimester. A composite score is obtained by multiplying together relevant relative risks. The effectiveness of the method is discussed.

Wheeler, T.; Murrilis, A.; Shelley, T.

doi: 10.1111/j.1471-0528.1978.tb15818.xpmid: 623720

An external technique for recording the fetal heart rate (FHR) during pregnancy is described. The system is based upon the detection of the fetal electrocardiogram (ECG) from the maternal abdomen and elimination of the maternal QRS complexes by a new system of subtraction. Fetal QRS complexes with an amplitude of 10 microvolts or more were processed to produce heart rate recordings of much higher quality than previously obtained with the phonocardiographic and ultrasonic systems. The proportion of successful recordings was reduced between 27 and 34 weeks of gestation due to the decrease in size of the fetal QRS complex which occurred at this time; this was a major drawback of the ECG system.

Wheeler, T.; Murrills, A.

doi: 10.1111/j.1471-0528.1978.tb15819.xpmid: 623721

Ninety‐seven recordings of the fetal heart rate, lasting for one hour, were made from 59 normal patients between 21 and 41 weeks of gestation. The heart rate was measured from beat to beat using the R‐wave of the fetal electrocardiogram (ECG) as the indicator of each heart cycle. The recordings showed a significant decrease in the baseline heart rate as gestation advanced. Significant departures from the baseline took the form of short episodes of bradycardia in the earlier recordings and short episodes of tachycardia in the later recordings. The undulatory pattern of variability was most common (46 per cent of the recording time); the proportion of narrowed undulatory variability decreased significantly and the proportion of saltatory variability increased significantly as gestation advanced. From 34 weeks of gestation, long‐term changes in the pattern of the fetal heart rate, related to periods of fetal rest and activity, were observed in the recordings. The periods of rest lasted for an average of 15 minutes and were characterized by a reduction in heart rate variability to the narrowed undulatory and silent types. Analysis of the cardiac beat‐to‐beat variation showed an arrhythmia, not previously described in the human fetus, that may be related to fetal breathing.

Whigham, Kathryn A. E.; Howie, P. W.; Drummond, A. H.; Prentice, C. R. M.

doi: 10.1111/j.1471-0528.1978.tb15820.xpmid: 623722

Platelet behaviour was studied in groups of women suffering from mild and severe pre‐eclampsia, and compared with normal pregnant and non‐pregnant controls. Platelets from women with severe pre‐eclampsia were less responsive than normal to a variety of aggregating agents, and this impairment was significant in response to collagen and vasopressin. Women with severe pre‐eclampsia had raised plasma adenine nucleotide levels and lowered platelet 5‐hydroxytryptamine levels compared with the controls. Platelets from women with mild pre‐eclampsia showed only a slight difference from normal. These findings may be the result of platelets having undergone aggregation and disaggregation within the circulation, and suggest that platelets may be involved in the pathogenesis of pre‐eclampsia.

Wallenburg, H. C. S.; Kessel, P. H.

doi: 10.1111/j.1471-0528.1978.tb15821.xpmid: 623723

A nonradioisotopic technique for determination of platelet lifespan was applied to 19 healthy women whose gestational ages were between 32 and 40 weeks. Nine non‐pregnant women and five men were also studied. Platelet counts were performed in all subjects. No significant difference was demonstrated between platelet lifespan in pregnant women (9·2 days), in non‐pregnant women (9·7 days) and in men (9·2 days). There was no significant difference between platelet counts in men and in non‐pregnant women, but the mean number of platelets in pregnant women was significantly lower. It is concluded that no significant changes in platelet behaviour appear to occur in normal pregnancy.

Condie, R.; Campbell, Doris

doi: 10.1111/j.1471-0528.1978.tb15822.xpmid: 75019

Components of the haemostatic mechanism were measured at intervals throughout pregnancy in 11 patients with twins and compared with a group of 21 patients with singleton pregnancies. Mean plasma fibrinogen levels were consistently (but not significantly) elevated in the mothers of twins while other parameters showed no differences.

Shukla, P. K.; Sharma, D.; Mandal, R. K.

doi: 10.1111/j.1471-0528.1978.tb15823.xpmid: 623724

Assessment of liver damage by estimation of serum enzymes including lactate dehydrogenase (LDH) and its hepatic fraction, LDH5, was made in 60 normal pregnant women, 20 patients with pre‐eclampsia and 10 with eclampsia. Definite evidence of damage was found in patients with pre‐eclampsia and eclampsia and was related to the severity of the disease.

Williams, Christine; Coltart, T. M

doi: 10.1111/j.1471-0528.1978.tb15824.xpmid: 623725

In vitro adipose tissue lipolysis was investigated in pregnant and non‐pregnant women. Basal and hormone‐stimulated rates of lipolysis were significantly higher in the pregnant group. Human placental lactogen (HPL) was shown to be lipolytic on adipose tissue from both pregnant and non‐pregnant women; the response being more marked in the pregnant group. We postulate that HPL is responsible for this increased lipolytic sensitivity in pregnancy, the result of which is the elevation in levels of plasma free fatty acids in the third trimester.

Garrioch,, D. B.

doi: 10.1111/j.1471-0528.1978.tb15825.xpmid: 623726

The spontaneous activity of human myometrial strips obtained during the proliferative and secretory phases of the menstrual cycle and during the early and late stages of pregnancy was studied. Both prostaglandin F2α (PGF2α) and oxytocin caused contractions which were superimposed on a low level of spontaneous activity but only PGF2α was seen to affect high levels of activity. Spontaneous contiactions were ultimately abolished by the addition of indomethacin. The strips remained responsive to PGF2α but not to oxytocin.