The spiral arteries at the level of the decidual-myometrial junction in the placental bed were examined histologically in 93 biopsies. Of these, 23 originated from normal uncomplicated pregnancies, 30 from pre-eclamptic and 40 from otherwise complicated pregnancies. The association of the 'physiological changes' of the spiral artery with uncomplicated pregnancy and their absence in pre-eclampsia, as noted by Brosens and others, has been confirmed. In addition, in pregnancies without pre-eclampsia, these changes were significantly more often absent with fetal growth retardation. The hypothesis is put forward that hypertension of pregnancy is a compensatory mechanism to ensure an adequate blood supply to the placenta when the 'physiological changes' fail to occur.

Objective To study the effects of addition of 3 g eicosapentaenoic acid daily to the diet, on recurrence rate of intrauterine growth retardation and pregnancy induced hypertension in a high risk population. Design Prospective, double blind, randomised multicentre study. Eicosapentaenoic acid or placebo were given from 12 to 14 weeks of gestation onwards. Setting University Hospital and regional hospitals in the north of the Netherlands. Subjects Sixty‐three women with a history of intrauterine growth retardation (birthweight < 10th centile) with or without pregnancy induced hypertension in the previous pregnancy. Main outcome measures Birthweight centiles and signs of pregnancy induced hypertension in current pregnancy. Results One‐third of the women developed pregnancy induced hypertension and one‐third of the infants had a birthweight below the 10th centile. There were no differences between eicosapentaenoic acid and placebo group. Conclusion Addition of 3 g eicosapentaenoic acid daily does not prevent recurrence of intrauterine growth retardation or pregnancy induced hypertension in a high risk population.

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Summary The unstressed antepartum cardiotocogram (CTG) is principally judged by two aspects: baseline irregularity, and reaction to Braxton Hicks contractions and fetal movements. A classification into normal, sub‐optimal, decelerative, and terminal CTG was devised. The ominous significance of the terminal CTG was confirmed in 26 patients; nine of the fetuses died in utero and the other 17 were delivered by elective Caesarean section; only one newborn was neither small‐for‐dates nor acidaemic. The significance of the other three categories was evaluated in 428 patients in whom labour was induced. All patients with repeated decelerative antepartum CTG showed signs of fetal distress during labour and most of them required Caesarean section; patients with a normal or sub‐optimal CTG rarely showed signs of fetal distress during labour. The incidence of growth retardation was 41 per cent in the combined decelerative and sub‐optimal groups against 9 per cent in the normal group. In comparing these results with studies of the oxytocin challenge test, it was concluded that, except in the case of a sub‐optimal CTG, the oxytocin challenge test has no place in obstetrics.

SUMMARY A prospective study was carried out on 747 infants: 147 neurologically abnormal, 300 with mild neurological abnormalities and 300 normal infants. They were re‐examined at nine years of age, with special attention being paid to minor neurological dysfunction (MND). Extensive data on obstetrical abnormality, risk factors contributing significantly to later handicap were low one‐minute Apgar scores, a disturbed neonatal course, low social‐class and interval complications: obstetrical events were conspicuous by their absence. Two aetiologically and clinically distinct kinds of MND were distinguished on the basis of a neurological cluster profile: MND‐1 (one or two abnormal clusters) was only associated with a birthweight below the 2·3 centile and male gender, and MND‐2 (more than two abnormal clusters) was associated with neonatal neurological findings, social class, obstetrical optimality score and gender. RÉSUMÉ Corrélats péri‐nataux des dysfonctions neurologiques majeures et mineures à l'âge scolaire: analyse multivariée Une étude prospective a été entreprise chez 747 nourrissons: 147 neurologiquement anormaux, 300 avec des anomalies neurologiques mineures et 300 nourrissons normaux. Ils furent réexaminés à l'âge de neuf ans, une attention toute spéciale étant accordée aux dysfonctions neurologiques mineures (MND). Des données nombreuses sur l'histoire obstétricale, l'évolution néo‐natale et les complications intercurrentes furent recueillies. Il ne fut pas trouvé de déficiences neurologiques dans le groupe des nouveaux‐nés normaux. En dehors des anomalies neurologiques dans le groupe des nouveaux‐nés normaux. En dehors des anomalies neurologiques néo‐natales, les facteurs de risques contribuant significativement à un handicap ultérieur ont été un score d'Apgar bas à une minute, une évolution péri‐natale perturbée, une classe sociale défavorisée et des complications intercurrentes; les événements obstétricaux nocifs ne se mainfestaient que par l'effet bénéfique de leur absence complete. Deux sortes de MND distinctes étiologiquement et cliniquement pouvaient être distinguées sur la base du profil de groupement neurologique: MND‐1 (une ou deux anomalies) était associè seulement à un poids de naissance au dessous des 2,3 centiles et au sexe masculin, et MND‐2 (plus de deux anomalies) était associéà des manifestations neurologiques néo‐natales, la classe sociale, le score d'optimalité obstétricale et le sexe. ZUSAMMENFASSUNG Perinatale Korrelate für sch were und leichte neurologische Dysfunktionen im Schulalter: eine Multivariationsanalyse Bei 747 Kindern wurde eine prospektive Studie durchgeführt: 147 waren neurologisch auffällig, 300 hatten geringe neurologische Befunde und 300 waren normal. Die Kinder wurden im Alter von neun Jahren nachuntersucht, wobei mit besonderer Sorgfalt auf Hinweise fur eine minimale neurologische Dysfunktion (MND) geachtet wurde. Es wurden ausführliche Daten über die geburtshilfliche Anamnese, die Neugeborenenzeit und zwischenzeitlichen Komplikationen gesammelt. In der Gruppe der n...