The changes in the ratio between factor VIII-related antigen and factor VIII activity were compared in ten patients with normal pregnancies and in ten patients with severe pre-eclampsia. In the patients with pre-eclampsia, a highly significant increase in the ratio was observed during the third trimester. No difference in the ratio between the two groups was found on day 7 of the puerperium. In the pre-eclamptic patients, the highest ratios for factor VIII-related antigen to factor VIII activity were associated with either a perinatal death or with the delivery of a severely growth retarded infant. These findings are in keeping with an increased rate of thrombin production in women with pre-eclampsia, and suggest that the ratio of factor VIII-related antigen to factor VIII activity may reflect the severity of the effect of the disease process on the fetus.

Summary A retrospective study was made of the course and outcome of labour in 226 patients in whom a singleton fetus presented by the breech. Patients with macerated stillbirths or who were delivered before the 28th week of gestation had been excluded. Of the 226 patients, 101 received extradural analgesia, 79 received parenteral analgesia and 46 underwent elective Caesarean section. There was no difference in the incidence of breech extraction or emergency Caesarean section in the first two groups of patients. The length of both first and second stages of labour in multiparae was prolonged in the extradural group, but not markedly so. The Apgar scores of the infants delivered vaginally were not significantly different at one minute in both groups but the five minute Apgar score in the infants of primiparae was significantly higher in the extradural group. The Apgar score at one minute in the group delivered by emergency Caesarean section was significantly lower after extradural block but the difference was not significant at five minutes. This study suggests that the management and outcome of labour when the breech presents is not adversely affected by the provision of extradural analgesia.

Summary Maternal plasma levels of cortisol were measured serially by radioimmunoassay in two groups of 12 patients during induced labour and in the puerperium. One group was given continuous extradural analgesia throughout labour, the other group received pethidine and promazine in response to pain. Pre‐induction cortisol levels were significantly higher in patients who were to have extradural analgesia but the percentage increase in plasma cortisol during labour was considerably less than in patients with parenteral analgesia; in second stage labour, mean cortisol levels were the same in the two groups. This study suggests that patients who had chosen to have extradural analgesia may have been more anxious before labour than the other patients but continuous, extradural analgesia suppressed to some extent the percentage increase in mean cortisol levels found during labour in patients given parenteral analgesia. In the puerperium, there was no difference in mean cortisol levels in the two groups.

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