Notes: Summary. A detailed analysis of 2632 consecutive pregnancies in white, black and Asian women, who were delivered during the period 1978 to 1980, found significant differences between the three ethnic groups. Asian primiparae had the longest first and second stages of labour, with the highest incidence of prolonged latent phase (14%) and primary dysfunctional labour (30%). Black primiparae and multiparae had the highest incidence of secondary arrest in the first stage of labour (10% and 4% respectively) and of primary dysfunctional labour, with the greatest recourse to emergency caesarean section (13% and 4% respectively). The mean birthweight for singletons born between 37 and 42 weeks was 3.37 kg for white babies, 3.25 kg for black babies and 3.14 kg for Asian babies. There was no racial difference in perinatal mortality or morbidity in this survey.

Notes: Summary. From a study of 2000 consecutive labours, the outcome of 847 multigravid patients admitted in spontaneous labour was examined. Labour was classified according to the cervimetric pattern, and response to oxytocin given according to a strict protocol with the use of a nomogram and partogram. The mean ‘observed first stage’ was 3·4 h, and the caesarean section rate 1·4%. Normal labour occurred in 88·5%, with a vaginal delivery rate of 99·5% in this group. Stimulation was indicated in 98 patients (11·6%), augmentation improving the rate of progress in 86 (87·8%) of these, with vaginal delivery occurring in all but one. Successful accelerated labour was not associated with any increase in neonatal morbidity as judged by Apgar scores, intubation or transfer to the special care baby unit. Twelve patients did not have improvement following augmentation and seven were delivered by caesarean section, including one following a potentially preventable uterine rupture. The greatest neonatal morbidity was in the group with primary dysfunctional labour that did not improve with augmentation. It may be that this was related to the mode of delivery rather than augmentation, as there was no significant difference in neonatal condition between normal and abnormal labour if vaginal delivery occurred.

Notes: Summary. The smoking habits of 2000 consecutive pregnant women have been analysed in relation to their race, social features and obstetric results. Only 60% of white patients were non-smokers compared with 80% of blacks and 90% of Asians, and whereas 20% of white patients smoked heavily only 3% of blacks or Asians did. Smokers booked later and were more frequently unsure of their dates, unemployed, unmarried and defaulters from the antenatal clinic. The incidence of antepartum haemorrhage was doubled amongst the heavy smoking multigravid patients in spite of a slightly decreased incidence of hypertensive disease. More non-smokers required induction of labour for raised blood pressure, and more smokers for fetal distress. The most significant differences between the smokers and non-smokers were the decrease in mean birth-weight associated with increased smoking (3.31 kg for non-smoking primi-gravidae compared with 3.14 kg for heavy smokers) and the threefold increased incidence of small-for-dates babies amongst the heavy smokers. There was no significant difference in the perinatal mortality.

Notes: Summary. A prospective controlled study of 2000 patients to determine the incidence of postmaturity and the effect of a policy of non-induction of labour in prolonged pregnancy is reported.‘Certain postmaturity’ was identified in 4% of the patients and was associated with an increased incidence of babies with Apgar scores of 〈5 at 1 min; induction of labour at 42 weeks gestation did not affect the neonatal outcome compared with that in patients allowed to go into spontaneous labour. Induction of labour in patients designated as‘certain postmature’ and‘uncertain postmature’ reduced the number of vaginal deliveries and increased the caesarean section rate from 9.6 to 26.7 and from 2.2 to 31.2% respectively. The failure to improve the perinatal outcome does not support or justify induction of labour for uncomplicated postmaturity.

Notes: Summary. From a study of 2000 consecutive labours the outcome of the 684 primigravid patients admitted in spontaneous labour has been examined according to their cervimetric progress during the first stage of labour. A partogram and labour stencil were used to identify dysfunctional labour which was treated with a standard protocol of augmentation by oxytocin. This policy achieved labours with a mean‘observed first stage’ of 6.3 h and a caesarean section rate of 8.7%. There was one stillbirth due to multiple congenital abnormalities and no increase in perinatal morbidity. Our data show that the type of first stage cervimetric pattern is helpful in predicting the outcome of labour. A normal cervimetric pattern resulted in a vaginal delivery rate of 98.4%; primary dysfunctional labour, which could be improved by oxytocin, had a 93.8% incidence of vaginal delivery, but if there was no improvement in the rate of cervical dilatation when this was administered the vaginal delivery rate was only 22.7%. A prolonged latent phase was associated with a caesarean section rate of 16.7% and the incidence of neonatal intubation was nearly as high as that found in uncorrected primary dysfunctional labour. The neonatal asphyxia in secondary arrest was minimal with an overall caesarean section rate of 28.4%; there was no increased incidence of neonatal morbidity with this cervimetric type.

Notes: The incidence of fetal breathing movements (FBM)*, fetal trunk movements (FTM), and total fetal activity (TFA) was assessed in 100 normal pregnancies between 28 weeks and term. One 30-minute recording was made from each patient between 0900 and 1700 hours. The mean incidences of FBM, FTM and TFA were respectively 37±26 (SD) per cent, 18±10 per cent, and 53±24 per cent. The mean breathing rate was 48±12 per minute, and the mean number of movements per 30-minute study period was 29±15. There was a slightly higher incidence of FBM postprandially, but this failed to reach statistical significance. The mean incidence of FBM was lower before 31 weeks and after 40 weeks, compared to that between 31 and 40 weeks, when the values of FBM and FTM were constant. The breathing rate was directly related to gestational age. The mean number of movements per 30-minute study period was inversely related to gestational age, but the duration of movements increased progressively towards term, so that the incidence of FTM was constant throughout the third trimester. There was only one recording of TFA below 10 per cent.

Notes: Background:  Human Immunodeficiency Virus (HIV) infection is associated with oral manifestations of diagnostic and prognostic importance. With the advent of Highly Active Anti-retroviral Therapy (HAART) there is anecdotal evidence to suggest that the prevalence of oral lesions has declined. The number of prevalence studies, carried out in the era of HAART is, however, meagre. Our aim was to study the prevalence of the oral manifestations of HIV in a population, predominantly on HAART, attending a Genito-Urinary Medicine Centre in South London.Methods:  This cross sectional study included 203 adult volunteers, comprising 76% males and 24% females. One third of the subjects were from the predominantly African or Afro- Caribbean ethnic minority groups resident in London. The relationship between the prevalence of oral lesions and demographic variables, therapeutic regimes, viral load and CD4 counts were evaluated.Results:  One hundred (49%) of the patients had no detectable oral lesions. Oral lesions detected most frequently included oral hairy leukoplakia (9.9%), HIV associated periodontal diseases (9.9%) and oral candidiasis (4.9%). Three subjects had multiple papillomatous growths. Most cases (n = 17/20) of oral hairy leukoplakia were in individuals with a detectable (〉 400 copies/ml) plasma RNA viral load. The majority (n = 8/10) of our patients with oral candidiasis had a plasma RNA viral load 〉 10,000 copies/ml and half (n = 5/10) had a CD4 count 〈 200 cells/mm3. Logistic regression analysis suggested that the presence of an oral lesion was not associated with any demographic features except for periodontal diseases which were associated with tobacco smoking (P = 0.023).Conclusions:  The prevalence of so called ‘strongly associated’ oral lesions of HIV is low in this South London HIV-infected population on HAART, and the relative frequency is different from that cited in the literature from the pre-HAART era. The oral lesions detected were found mostly in people with low CD4 counts and high HIV-1 RNA viral loads, suggesting they were very immunocompromised, not on, or declining therapy, or that their therapy was failing.