Summary A consecutive series of 46 patients (110 tests) was studied to determine the relationship between the oestriol/creatinine ratios of 24‐hour and single urine specimens. A satisfactory correlation was found between the 2 ratios (correlation coefficient 0.86, P < 0.001). The single specimen urinary oestriol/creatinine ratio may have a place in the prediction of placental function, particularly at the onset of labour.
In view of the reliance that is now placed on the level of urinary oestrogen in complicated pregnancies, it is important to record extraneous factors which may significantly alter laboratory findings. One substance which appears to act in this way is the urinary antiseptic drug, methenamine mandelate (Mandelamine). The effect of this drug is illustrated in the following 2 case reports which were collected within a short time of one another.
Summary A series of 164 ovarian tumours diagnosed during pregnancy or the puerperium is presented. The commonest were the benign cystic teratoma (45 cases) and the mucinous cystadenoma (40 cases). Rapid growth of the tumour during pregnancy was observed in 5 of the 41 patients (12%) in whom assessment was possible; in none of these was the lesion malignant. The incidence of malignancy was 2.4% (4 of 164 cases) or 10 times less than that of ovarian tumours in non‐pregnant patients. This difference was accounted for by the variation in age distribution in pregnant and non‐pregnant patients with ovarian tumours. There were 21 patients with tumours 15 cm. or more in diameter. In this group the incidence of malignancy was 5% and the commonest complications were torsion (5 patients) and infection during the puerperium (4 patients).
Summary In a consecutive series of 182 cases of hydrops fetalis 33 (17·6 per cent) were due to causes other than blood group incompatibility, the incidence of non‐immunological hydrops fetalis being 1 in 3538 deliveries. Of the 33 cases, 13 were idiopathic, 6 were associated with twin pregnancies, 7 had major malformations and the remaining 7 had a variety of associated diseases. The high incidence of polyhydramnios, pre‐eclampsia and prematurity in cases of idiopathic hydrops was confirmed, and the series included one case of eclampsia. The subsequent obstetric performance of these patients was very different to what occurs with rhesus immunization and 21 of 22 further pregnancies were uncomplicated, the other resulting in a surviving hydropic infant. There is an association (3 of 13 cases) between severe maternal anaemia and idiopathic hydrops. This association is more significant than that between hydrops fetalis and any fetal malformation other than adenomatoid hamartoma of the lung. No relationship between diabetes and of fetal hydrops was found. Urinary oestriol excretion was low in two cases of idiopathic hydrops in which this test was performed indicating that hydrops probably represents chronic feto‐placental dysfunction rather than an acute episode of circulatory failure. In non‐immunological hydrops the placental weights are of the same order as those seen in erythroblastosis. Fetal anaemia was not found in any case nor were fetal plasma protein levels consistently low. In the twin transfusion syndrome the exsanguinated twin can become hydropic and both twins may be affected. It is concluded that hydrops is unlikely to have a single aetiology and that the pathogenesis cannot be explained by such simple considerations as fetal anaemia.
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Summary
A series of 164 ovarian tumours diagnosed during pregnancy or the puerperium is presented. The commonest were the benign cystic teratoma (45 cases) and the mucinous cystadenoma (40 cases). Rapid growth of the tumour during pregnancy was observed in 5 of the 41 patients (12%) in whom assessment was possible; in none of these was the lesion malignant. The incidence of malignancy was 2.4% (4 of 164 cases) or 10 times less than that of ovarian tumours in non-pregnant patients. This difference was accounted for by the variation in age distribution in pregnant and non-pregnant patients with ovarian tumours.
There were 21 patients with tumours 15 cm. or more in diameter. In this group the incidence of malignancy was 5% and the commonest complications were torsion (5 patients) and infection during the puerperium (4 patients).
Summary: The patterns of maternal urinary oestriol excretion in 115 pregnancies in which the fetuses were malformed are presented. The incidences of antenatal complications, fetal distress in labour and Caesarean section are analysed and compared with those in a control series of 693 pregnancies in which the fetuses had similar malformations. Major fetal malformations were associated with high incidences of low oestriol excretion (61%) and intra‐uterine growth retardation (46%). Hydrocephaly was characterized by low oestriol excretion but not to the extent found with anencephaly. The fetus will have a major abnormality in approximately 1 in 30 pregnancies in which maternal oestriol excretion is subnormal. X‐ray of the fetus should precede Caesarean section for a fetal indication when maternal oestriol values are low.
In 1,000 consecutive patients the incidence of gestational diabetes was 1·0%. In the group of 182 patients with abnormal glucose tolerance the Incidences of large-for-dates infants and major fetal malformations were not increased in comparison with the total series. Of the accepted indications for performing a glucose tolerance test in pregnancy only maternal age over 30 years was found to have a significantly increased incidence of an abnormal result.
Summary The clinical results and patterns of urinary oestriol excretion in 139 consecutive patients with antepartum haemorrhage are presented. The perinatal mortality rate was 14.8% in the 54 patients with low oestriol excretion and was 4.7% in those with normal oestriol excretion. Persistently low oestriol values indicated the advisability of delivery before 37 weeks of gestation in 2 of the 36 patients with placentae praevia. In abruptio placentae the incidence of low oestriol excretion was quadruple that of a normal population, and 12 of 43 patients had consistently low oestriol values. Induction of labour was carried out because of low oestriol values alone in only 2 of 60 patients in whom the cause of bleeding was undetermined. Urinary oestriol estimation is of value in selecting the optimum time for delivery in patients with mild to moderate antepartum haemorrhage.
Summary : Subnormal urinary oestriol excretion was present in an apparently normal pregnancy and it is suggested that a rare combination of fetal anomalies including diabetes insipidus, absence of the septum pellucidum and optic nerve hypoplasia was the explanation.
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