No abstract

O f 149 infants with ultrasound evidence of gestational age, born in Ninewells Hospital a t between 20 and 28 weeks gestation o v e r a 5-year period, 50 were alive at birth. O f these infants, 21 died within 1 week, a further three died within 1 month and a further t w o within 18 m o n t h s . Of the 24 survivors, 8 (33%) have significant handicap. T h e obstetric factors leading to delivery and t h e m o d e of delivery are discussed.

The records of 93 women who presented with invasive squamous cell carcinoma were searched for evidence of cervical cytology during the years preceding this diagnosis; a search was also made through the files of local laboratories and contact was made with general practitioners and relevant hospital departments. Only 26 (28%) of these 93 women had had a cervical smear at any time before the diagnosis of invasive cancer, and only 11 (12%) had had regular cytological survcillance. Fifteen (60%) had had a smear taken and reported as negative within the previous 5 years, six (6%) within the previous year. Eleven of these 15 slides were obtained for review: three were regarded as positive and three more were re-classed as too scanty for conclusive assessment. In nine of the 67 women who had never had a smear, a gynaecological or obstetric examination was known to have been performed or indicated within the previous 5 years, thereby representing a missed opportunity for screening. In three patients cytological abnormalities had been reported within the previous 3 years but no action had been taken.

Daily urine samples were obtained from 38 women of proven fertility, who were attempting to conceive, to assess the frequency of clinically unsuspected 'biochemical pregnancies' on the basis of late luteal phase rises of hCG. In 25 clinically confirmed conception cycles, the earliest pregnancy-induced hCG rises from baseline occurred 8 days after the endocrinologically defined date of ovulation (mean 11.1 days, SD 1.3). Urine samples obtained throughout 50 non-conception ovulatory cycles provided no evidence of any 'biochemical pregnancies' on the basis of late luteal phase rises of hCG occurring 8 or more days after the endocrinologically defined date of ovulation. If, as in previous studies, the date of ovulation had been estimated on the basis of menstrual cycle length and only the relatively non-specific NIH antiserum had been used in RIAs, 7 of the SO (14%) cycles would have been classified as resulting in biochemical pregnancies on the basis of hCG >50 m-i.u./ml on one occasion or >20 m-i.u./ml on two or more occasions after day 20 of the cycle. These levels of 'hCG' occurred at or soon after ovulation and could be explained by LH cross-reacting in the RIA. The rises of -hCG' were not confirmed when the urine samples were retested with an antiserum (Wellcome 895) of very high specificity f o r hCG. These results raise the possibility that the frequency of clinically unsuspected 'biochemical pregnancy' may have been substantially overestimated.Several studies have been published suggesting that many women miscarry pregnancies at such an early stage that neither they nor their attendants recognize that a pregnancy has occurred. In most studies the subjccts have been women attending infertility clinics, and samples have been obtained following stimulation of ovarian function with or without in-vitro fertilization