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Notes: Objective To demonstrate similarities and differences between the various instruments used by clinical trialists for measurement of premenstrual syndrome to encourage development of consensus of measurement to aid future research.Design Computer and manual searches of all trials of drugs used for premenstrual syndrome supplemented by retrieval of all questionnaires and scales cited. Letters were sent to the main manufacturers to identify trials not in the public domain.Main outcome measures Number of scales in current use for classifying premenstrual syndrome; the symptoms included within them; their organisation of symptoms into clusters; the numerical values used in the scaling; the most frequently used items; and the extent of overlap in the criteria used.Results Three hundred and fifty clinical trials of 115 different drugs were identified. The most common symptoms or signs used in the scales were (frequency in square brackets) irritability [44], headache or migraine [40], depression [37], tearfulness [34], tension [31], anxiety [31], breast tenderness [31], mood swings or lability [30], back pain [30], weight gain [29], abdominal bloating [28], lack of concentration [28], food craving [28], and increased appetite [26]. Sixty-five different questionnaires or scales were used to classify premenstrual syndrome and for assessing entry eligibility and treatment outcomes; of these 65, 47 included sufficient details for a formal analysis and 18 scales grouped the symptoms or items into clusters or subgroups.Conclusion There is wide diversity in the scales used for assessing entry eligibility and treatment outcomes in premenstrual syndrome. This makes comparative evaluation of possible treatments extremely complex and difficult. It is recommended that authorities and organisations involved in conducting trials of treatments for premenstrual syndrome develop a consensus statement about the best instrument to be used. Regulatory authorities could perhaps provide guidance to which scales they would accept when clinical trials of drugs for premenstrual syndrome are submitted to them for assessment. This would ensure that industry-sponsored trials provide objective data. Consensus is required given the poor performance of most current treatments of premenstrual syndrome.

Notes: The effect on pregnancy outcome of transplacental needle insertion was studied in 401 consecutive women attending for early amniocentesis between 10 and 14 completed weeks of pregnancy. Transplacental early amniocentesis was associated with a significantly higher incidence (P 〈 0.001) of blood-stained amniotic fluid taps but a lower incidence (not significant; P 〉 0.05) of pregnancy loss and miscarriages. Women in the nontransplacental early amniocentesis group had a significantly higher (P 〈 0.01) incidence of late procedure-related antenatal complications, such as preterm rupture of membranes or preterm labour. Our study showed that transplacental early amniocentesis is a safe procedure; contrary to present recommendations, the study also showed that avoiding the placenta during early amniocentesis is an unnecessary practice.

Notes: Summary. The rate and regularity of fetal breathing movements (FBM) were determined in 14 women with uncomplicated singleton pregnancies, eight of whom were between 30 and 33 weeks gestation and six between 37 and 40 weeks gestation. Similar observations were made in 19 women with pregnancies complicated by severe intrauterine growth retardation, 11 of whom were between 30 and 33 weeks and eight between 37 and 40 weeks. In normal pregnancy recordings of breath-to-breath intervals showed that FBM became more regular with advancing gestational age, and the rate [breaths/min, mean (SEM)] slowed from 57.2 (1.3) at 30–33 weeks to 47.9 (0.8) at 37–40 weeks. FBM in the growth-retarded group were regular at each gestation studied and the rate was even slower than in the normal group at term, being 41.9 (1.2) at 30–33 weeks and 41.1 (1.0) at 37–40 weeks. Hyperoxia and hypercapnia aeared to have no consistent effect on fetal breathing rate. Fasting for 〉12 h considerably reduced the rate of FBM in the normal fetus but only marginally so in those with growth retardation. It is concluded that the pattern of FBM provides more information about the fetus than the amount of time spent breathing, particularly when growth is retarded.

Notes: Summary. Between 1970 and 1983, 519 pregnancies in 405 women with heart disease were managed at the Royal Maternity Hospital, Belfast, Northern Ireland, a rate of 1·3 per 100 deliveries. In 312 (60%) the heart disease was of rheumatic origin, in 161 (31%) congenital, and the remaining 46 (9%) were a miscellaneous group that included arrhythmias, ischaemic heart disease and cardiomyopathies. The New York Heart Association (NHYA) grading was no greater than 1–2 in 445 (86%) pregnancies antenatally. Three maternal deaths occurred, all in the group whose antenatal NYHA grade was 3–4. Heart failure was present in 96 (18%) pregnancies antenatally, and six others developed failure during labour or in the puerperium. Prophylactic antibiotics were not used routinely and infective endocarditis did not occur. The perinatal mortality rate was 19/1000, and the rate of congenital malformations was not raised in the reviewed group.

Notes: Summary. The effect on fetal breathing movements (FBM) of maternal breathing of 50% oxygen was examined. The procedure caused a two-fold rise in maternal arterial Po2 and did not alter FBM in normal pregnancy. In pregnancy complicated by intrauterine growth retardation (IUGR) a substantial increase in the incidence of FBM was recorded during hyperoxia (control 29.8.3.9%, hyperoxia 68.2+3.6). No such change was observed in pregnancies where IUGR was suspected but not proven at delivery.