No abstract

Summary. Between 1970 and 1983, 519 pregnancies in 405 women with heart disease were managed at the Royal Maternity Hospital, Belfast, Northern Ireland, a rate of 1·3 per 100 deliveries. In 312 (60%) the heart disease was of rheumatic origin, in 161 (31%) congenital, and the remaining 46 (9%) were a miscellaneous group that included arrhythmias, ischaemic heart disease and cardiomyopathies. The New York Heart Association (NHYA) grading was no greater than 1–2 in 445 (86%) pregnancies antenatally. Three maternal deaths occurred, all in the group whose antenatal NYHA grade was 3–4. Heart failure was present in 96 (18%) pregnancies antenatally, and six others developed failure during labour or in the puerperium. Prophylactic antibiotics were not used routinely and infective endocarditis did not occur. The perinatal mortality rate was 19/1000, and the rate of congenital malformations was not raised in the reviewed group.

Summary A 10 mg dose of diazepam was given intravenously to mothers at 15 to 205 minutes before delivery, and plasma diazepam concentrations were measured by gas‐liquid chromatography in mothers and infants at delivery and again 24 hours later. The plasma levels in the infants were always significantly higher than in the mothers but there was no evidence to suggest that the newborn were unable to metabolize the drug. All infants had a good Apgar score at birth.

incarceration at the site of laparoscope insertion that resulted in intestinal obstruction, and claimed that this was the first report of this complication of laparoscopy. Both patients eventually needed small bowel resection, 14 and 21 days after laparoscopy. These two patients, and the one described above, were initially well after laparoscopy and then started to vomit on the third and the sixth days after laparoscopy. Thompson and Wheeless' reported that burns or traumatic injury typically present between the third and seventh post-laparoscopic day and then need urgent surgical treatment. They recorded 11 bowel injuries in a series of 3600 laparoscopic sterilisations. Thus, obstructive symptoms occurring a week or more after laparoscopy may be due to bowel incarceration at the site of laparoscope insertion. Herniation may occur at the site of laparoscopic insertion, and Bishop and Halpin5 reported protrusion of omentum through an infraumbilical laparoscopy incision. This occurred on the third post-laparoscopy day after a coughing bout. These three reports of herniation and one of protrusion at the site of laparoscope insertion were all associated with either 11 or 12 mmdiameter instruments. These rare complications might be eliminated if smaller diameter instruments, which are available, were used.

After amniotomy for induction of labour prostaglandin E, (PGE,) was administered orally to two similar groups of 25 patients. Intrauterine pressure recording was begun in all patients prior to the administration of the prostaglandin and continued throughout labour. Labour was successfully induced in all the patients in both groups and, in the second group, the induction-delivery interval and the duration of labour were reduced by one-third by varying the prostaglandin dosage according to the uterine response. The incidence of maternal side effects was high in both groups but none was severe. No fetal complications occurred.