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Objective To compare the impact of two different ultrasound methods for assessing amniotic fluid Design A prospective randomised controlled trial. Setting Liverpool Women's HospitalParticipants Five hundred women with singleton, uncomplicated pregnancies with gestational age I 290 days.Interventions Random allocation to fetal monitoring by either: 1. amniotic fluid index and computerised cardiotocography, or 2. maximum pool depth and computerised cardiotocography.Main outcome measures Primary: caesarean section. Secondary: the number of abnormal monitoring tests, induction of labour, intrapartum management and neonatal outcome. ResultsThe number of abnormal amniotic fluid indices was significantly higher than the number of abnormal maximum pool depths (10% vs 2.4%; OR 4.51, 95% CI 1.82-11.21; P = 0*0008) which resulted in more inductions for abnormal post-term monitoring in the amniotic fluid index group (14.8% vs 8.4%; OR 1.89; 95% CI 1.07-3.33; P = 0.0362) and more intrapartum electronic fetal monitoring (94.4% vs 88.4%; OR 2.21; 95% CI 1.13-4-29; P = 0-0255). There were no other statistically significant differences in outcomes related to labour and delivery, but there was a trend towards more caesarean sections in the amniotic fluid index group (18.8% vs 13*2%), in particular caesarean sections for fetal distress (8% vs 4%). There were no perinatal deaths and no statistically significant differences in perinatal outcome between the two groups.Conclusions Published reference ranges for amniotic fluid index overestimate the number of abnormal results in post-term pregnancies. Their use, when compared with maximum pool depth, is likely to increase the number of obstetric interventions with, as yet, an uncertain impact on perinatal mortality and morbidity. It is possible that antepartum fetal assessment in pregnancies where the risk of adverse perinatal outcome is very low may cause, rather than prevent morbidity.volume on the incidence of obstetric interventions in post-term pregnancies.

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1. To investigate the effect of the female reproductive hormones on muscle function, patients undergoing in vitro fertilization were tested during two phases of treatment. The first was following the downregulation of pituitary gonadotrophin releasing hormone (GnRH) receptors and the second after 9 days of gonadotrophin injections. 2. Maximal strength and fatiguability of the first dorsal interosseus muscle were assessed when oestrogen and progesterone were low, and less than 2 weeks later when oestrogen production reached supraphysiological levels. 3. There were no significant changes in either strength or fatigue resistance during acute, massive fluctuations in oestrogen. These results occurred at a time when progesterone levels remained relatively low. 4. Contrary to previous work, the present results suggest that oestrogen does not affect muscle strength.