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Notes: Spontaneous fetomaternal haemorrhage at 14 to 20 weeks gestation resulted in raised serum alpha-fetoprotein (AFP) levels in 13 of 150 patients attending a genetic counselling clinic. In all 13 patients, the placenta was anterior or fundal in position. By allowing for a rise in serum AFP levels of 4 μg/l for each fetal cell seen in 30 high power fields (Kleihauer test), a 62·5 per cent reduction in the number of patients selected for amniocentesis because of raised serum AFP levels would have been achieved. The occurrence of fetomaternal haemorrhages at the time of amniocentesis can be detected by either the Kleihauer technique or the measurement of maternal serum AFP levels.

Notes: Laparoscopy with cytology of ascitic fluid or peritoneal washings was performed on 110 occasions in 62 patients with ovarian cancer to assess response to chemotherapy. Damage to bowel occurred on three occasions and complete visualisation of the peritoneal cavity was not possible in 14 patients. When tumour was seen and/or cytology was positive, the prognosis was poor; absence of macroscopic tumour with negative cytology did not preclude continuing disease. A group of patients was identified in whom a change of therapy based on laparoscopic findings after six months of treatment, might have proven beneficial. Laparoscopy has a limited place as a second-look procedure in patients undergoing treatment for carcinoma of the ovary.

Notes: Twelve anovulatory patients with normal serum prolactin values and six with elevated values were treated with bromocriptine and the effects on serum prolactin, FSH and LH levels were recorded. Ovulation resulted in one patient who had normal prolactin values and in all six who had raised values. No patient with normal basal prolactin values showed an increase in serum FSH during therapy with bromocriptine, whereas 5 of the 6 patients with elevated values showed significant increases. Similar results were obtained for LH. Although these differences were highly significant (P〈0·005) the majority of the serum FSH and LH values remained within the normal ranges. Five patients with normal basal prolactin values and one with elevated values were also treated with human pituitary gonadotrophin (HPG). An increase in ovarian responsiveness to HPG during therapy with bromocriptine was recorded in the one patient with initially elevated prolactin values. It was concluded that bromocriptine acts by allowing FSH to rise above threshold requirements for follicular stimulation.

Notes: Although episodes of FSH and LH secretion in four normal, fourteen anovulatory and one postmenopausal woman were confirmed by samples taken every 15 minutes for three hours, single plasma samples invariably provided a valid estimate of the current mean plasma FSH level, and of the current mean plasma LH level during the follicular phase of the ovulatory menstrual cycle and in anovulatory women with a mean plasma LH value of less than 0.8 mlU/ml. If the mean plasma LH value in anovulatory women exceeded 0.8 mlU/ml, the maximum difference between single and mean values was 28.3±4.7 per cent for four patients with oligomenorrhoea and 43.4±5.2 per cent for five patients with secondary amenorrhoea. Single plasma samples were collected from 26 patients with primary amenorrhoea, 95 patients with secondary amenorrhoea, 51 patients with oligomenorrhoea and 33 postmenopausal patients not on replacement therapy. In each group there were subjects with plasma FSH values in the postmenopausal range and they were unlikely to respond to ovulation induction. Those patients aside, plasma FSH values were similar in subjects with secondary amenorrhoea and oligomenorrhoea, but patients with oligomenorrhoea had significantly higher plasma LH values (p〈0.001); mean levels of neither FSH nor LH showed a significant correlation with response to treatment with clomiphene but in patients with secondary amenorrhoea an ovulatory response to clomiphene did not occur unless the individual's plasma FSH value was in excess of 1.4 mlU/ml. In patients with oligomenorrhoea, plasma LH levels below 0.8 mlU/ml precluded successful treatment with clomiphene.

Notes: Urinary oestrogen and pregnanediol excretion was measured daily (“daily monitoring”) for a complete cycle in 20 normally menstruating women, in one patient with an anovulatory cycle and for 28 days in a patient with secondary amenorrhoea. The measurements were also performed on urine specimens collected at weekly intervals for 4 to 6 weeks (“weekly tracking”) from 506 patients with evidence of abnormal ovarian function. These included 9 patients with primary amenorrhoea, 132 patients with secondary amenorrhoea, 138 patients with oligomenorrhoea and 227 patients with evidence of ovarian dysfunction and cycle lengths of 25 to 42 days. The results were subjected to statistical analysis. In the normal cycles, ovulation could be identified on the criteria of a rising pregnanediol value reaching or exceeding 2.0 mg. per 24 hours for a period of 7 days or more. Valid conclusions on the overall mean oestrogen and pregnanediol values for a complete cycle could be made from the results of weekly tracking, irrespective of which day the tracking commenced. Correlations were obtained by comparing the mean and maximum urinary oestrogen values and the variability of the values with the evidence of ovarian function indicated by the clinical classifications of the patients, the duration of the disorders and the subsequent occurrence of uterine bleeding. Mean oestrogen values of 10μ g. per 24 hours or less were associated with lack of ovarian function. For values higher than this a discriminant function based on both the mean oestrogen value and the variability of the oestrogen values was useful in predicting onset of spontaneous menstruation. A single urine specimen collected 4 to 8 days before onset of menstruation showing a raised pregnanediol value of 2.0mg. per 24 hours or more provided a valid test for ovulation in women with regular cycles, and a single urine specimen giving an oestrogen value of 10 pg. per 24 hours or less gave a valid indication of absent ovarian function in women with amenorrhoea for two years or more. In all other circumstances serial sampling at weekly intervals provided a valid assessment of ovarian activity. Application of these principles allows the greatest amount of information on ovarian function to be obtained with the greatest economy of effort.

Notes: Summary. Cytoplasmic oestrogen receptors were measured in 40 primary and four secondary ovarian tumours; of these, 43 tumours were also analysed for cytoplasmic progesterone receptors and 34 tumours for cytoplasmic androgen receptors. Serous tumours were significantly more likely to be oestrogen-receptor positive than mucinous tumours, but the incidence of positive progesterone and androgen receptors was similar in serous, mucinous and endometrioid tumours. The mean oestrogen receptor content of serous tumours was significantly higher than that of endometrioid tumours. Well-differentiated epithelial tumours were significantly more likely to be oestrogen-receptor and progesterone-receptor positive than less differentiated epithelial tumours. Two granulosa cell tumours were oestrogen-receptor positive and one of these was also progesteronereceptor and androgen-receptor positive. Four normal óvaries were also analysed for receptor content and two were found to be androgen-receptor positive. The presence of cytoplasmic receptors in ovarian tumours may explain their reported response to endocrine therapy.

Notes: Summary. A retrospective comparison was undertaken of 552 cases in which Kielland's forceps were used for rotation and delivery, 95 cases in which other forceps were used for rotation and delivery, and 160 cases in which manual rotation and forceps were used. There was no significant difference in maternal or fetal morbidity between the three groups, regardless of whether the indication for delivery was delay in the second stage of labour or fetal distress. When Kielland's forceps were used by junior staff, significantly more vaginal and cervical lacerations and primary postpartum haemorrhage occurred, but there was no increase in fetal morbidity.

Notes: Serum prolactin levels and urinary oestrogen and pregnanediol excretion were measured during early pregnancy in 12 hyperprolactinaemic subjects who became pregnant during treatment with bromocriptine. Prolactin levels were suppressed below normal whilst taking the bromocriptine, but rose significantly when this drug was stopped and by eight weeks of gestation reached values significantly higher than those observed in normal pregnancy. Further increases in prolactin levels were, however, not observed. Urinary oestrogen and pregnanediol excretion was initially normal but, following cessation of bromocriptine, urinary pregnanediol excretion decreased and was significantly less than normal at 11 to 14 weeks gestation. These results suggest that elevated prolactin levels affect corpus luteum function of early pregnancy. Because the effect is maintained until at least 14 weeks gestation, prolactin may also affect progesterone production by the placenta.

Notes: Six tubal ectopic pregnancies occurred in a series of 193 pregnancies following ovulation induced with human pituitary gonadotrophin (hPG) and human chorionic gonadotrophin (hCG). The ectopic pregnancy rate of 3.1 per cent is higher than quoted incidences in the general population and occurred in the absence of predisposing factors. There was an association between ectopic pregnancy and elevated urinary oestrogen excretion in the peri-ovulatory phases of the induced ovulatory cycles. A urinary oestrogen excretion of greater than 200 μg/24 hours on day 0 (the day after hCG was given) was associated with a 10 per cent chance of ectopic pregnancy (P 〈0.05).