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SummarySerum progesterone, oestradiol, human chorionic gonadotrophin (hCG) and human placental lactogen (hPL) were determined serially throughout 27 pregnancies in insulin‐dependent diabetic patients from Newcastle (UK), 15 such patients from Stockholm (Sweden) and in 69 normal women having uncomplicated pregnancies. Mean progesterone, oestradiol and hCG concentrations were somewhat higher in the diabetic women during the third trimester but hPL values were not different from normal. The increased hormone concentrations did not relate to the increased birthweights or placental weights in the diabetic women. It is suggested that the usual physiological endocrine changes during normal pregnancy are relatively undisturbed by insulin‐dependent diabetes or the degree of diabetes control achieved.

Serial measurements of serum progesterone, oestradiol, human chorionic gonadotrophin (hCG) and human placental lactogen (hPL) have been determined in 33 women experiencing early pregnancy failure and compared with the values of the same hormones in 72 healthy women having uncomplicated pregnancies. Steroid production by the corpus luteum seemed similar in both groups up to 6 weeks gestation but thereafter placental steroidogenesis was not evident in those women in whom spontaneous pregnancy losses occurred. Placental production of the two protein hormones, hCG and hPL, did take place, and whereas the circulating levels were not as high as in normal pregnancies, levels did usually increase before clinical evidence of miscarriage occurred. hCG was not a sensitive discriminator of subsequent failure. In these women there were no significant hormone differences between those with evidence of a fetus and those without.

This paper focuses on parents' emotional needs after perinatal loss and ways in which health care professionals can meet those needs. Parents must be educated about the grieving process and have their feelings acknowledged and validated. Health professionals can support parents by being available and listening, giving clear medical information, addressing parents' concerns, acknowledging the special situation, limiting the use of tranquilizers, providing follow-up, making referrals to support groups or for psychologic counseling, and learning what is helpful to say to bereaved parents. To be able to approach parents and offer support, . ealth professionals must be aware of their own reactions to the death of a baby, loss, and grief. Receiving staff support better enables them to offer effective emotional support to bereaved parents. (BIRTH 15:4, December 1988) Hospital-based intervention is necessary and helpful to parents who experience stillbirth or death of a newborn (1,2). By encouraging bereaved parents to express their feelings, hospital staff can be crucial in facilitating their grief, particularly if parents lack supportive friends or family (3-5). Furthermore, support from medical staff can significantly improve a family's chances for healthy functioning after perinatal loss (6).Traditional hospital practices have not been supportive for parents who are grieving stillbirth or neonatal death. This lack can be partly attributed to the fact that many people are uncomfortable talking about perinatal death. Friends and relatives do not know what to say and have difficulty understanding the parents' grief, and hospital staff are not immune to this reaction. Physicians and nurses have a high Deborah Davis is with the Part-time faculty of

Following the shootings at Columbine High School on April 20, 1999, the Denver Psychoanalytic Society provided both immediate and long-term interventions to those closely impacted by the tragedy. In this effort, analytically trained volunteers faced many personal challenges and role adjustments. To address these issues a reflective study group was formed twenty months after the traumatic event. Group discussions revealed a surprising number of residual symptoms from secondary trauma, as well as opportunities for shared coping among analysts. Little has been written about the very human and subjective responses of analysts in such circumstances. These experiences may be helpful to others in today's world of terrorism and unexpected violent events.