Summary. Objective menstrual blood loss measurements (in ml) were compared with the score obtained from a pictorial blood loss assessment chart (PBAC) which took into account the degree to which each item of sanitary protection was soiled with blood as well as the total number of pads or tampons used. Twenty eight women used the chart during 55 menstrual cycles and a single observer assessed 122 cycle collections in a similar manner. A pictorial chart score of 100 or more, when used as a diagnostic test for menorrhagia, was found to have a specificity and sensitivity of >80%. Demonstration of the relation between self assessed pictorial chart scores and the objective measurement of blood loss enables us to provide a simple, cheap and reasonably accurate method of assessing blood loss before embarking upon treatment.

Estrogen withdrawal in women leads initially to rapid bone loss caused by increased numbers or activity of osteoclasts. We previously have noted apoptosis of lacunar osteocytes associated with conditions of high bone turnover. Therefore, in this study, we investigated whether the increased bone loss associated with GnRH analogue (GnRH-a)-induced estrogen withdrawal affects osteocyte viability in situ in a way that would be directly contrary to the effect of estrogens on osteoclast viability. Transiliac biopsies were obtained from six premenopausal women, between 30–45 yr old, diagnosed as having endometriosis. Biopsies were taken before and after 24 weeks of GnRH-a therapy. Biopsies were snap-frozen and cryostat sectioned. Osteocyte viability, determined by the presence of lactate dehydrogenase (LDH) activity, was reduced in all but one subject after treatment. Furthermore, in every subject, the proportion of osteocytes showing evidence of DNA fragmentation typical of apoptosis increased, as demonstrated using in situ DNA nick translation (P = 0.008). Gel electrophoresis of extracted DNA and morphological studies of chromatin condensation and nuclear fragmentation confirmed that changes typical of apoptosis were affecting the osteocytes. It was concluded that GnRH-a therapy caused a higher prevalence of dead osteocytes in iliac bone, probably caused by the increase in the observed proportion of osteocytes showing apoptotic changes. The capacity of bone to repair microdamage and to modulate the effects of mechanical strain is currently believed to be dependent on osteocyte viability. Our findings have therefore revealed a possible mechanism whereby estrogen deficiency could lead to increased bone fragility with or without an accompanying net bone loss.

The purpose of the study was to describe the impact of false-positive results from initial maternal serum alpha-fetoprotein (MS-AFP) screening. The analyses compared two groups of women, those receiving a negative result (n = 346) and those receiving an initial positive result (n = 26), over four time points--prior to testing, immediately after testing, later in pregnancy, and in the post-partum period. Receiving an abnormal result was associated with high levels of anxiety which were reflected in increased worry about the baby's health and a more negative attitude towards the pregnancy and the baby. Women who had an initial abnormal result were offered a variety of further tests. Those women who went on to have amniocentesis were less worried about their baby's health in the third trimester and also less anxious post-partum than those who did not have amniocentesis. In view of the increasing number of screening tests available, it is necessary to establish whether and how these levels of distress can best be reduced.

Recommendations on dose for managing hypertension suggest starting with carvedilol 12-5 mg daily, with subsequent increases to achieve control of the blood pressure. On the basis of our results, however, a lower starting dose may be needed in elderly hypertensive patients to avoid first dose postural symptoms. Similar caution is probably necessary in other groups of patients likely to be sensitive to combined x , blockade-namely, those taking diuretic drugs or in heart failure. This study was supported by Boehringer Mannheim GMBH, Germany. Women completed questionnaires after a consultation with either a midwife or an obstetrician; during the consultation routine antenatal screening tests, including serum screening for Down's syndrome, were offered. Their knowledge was assessed by using a multiple choice questionnaire with nine items. The internal reliability of the questionnaire was measured by using Cronbach's (x, which gave a coefficient of0 66. The amount of variance in knowledge predicted by demographic variables was assessed by performing discriminant function analyses for each item of the questionnaire. The demographic variables were age, number of children, socioeconomic class, and ethnicity. The table shows the proportions of women giving correct responses to the nine items and the variance predicted by the demographic variables. CommentThough women in this sample were knowledgeable about practical aspects of undergoing the test, they were less well informed about aspects of the test that could inform their decisions about whether to undergo testing and prepare them for possible adverse outcomes such as being recalled with a high risk result or giving birth to an affected child after a result indicating low risk.The demographic variables were weak predictors of the variance in knowledge, particuarly items on which fewer than half the women gave the correct answer. The pattem of women's knowledge reflects the observed emphasis of midwives and obstetricians when routinely informing women about prenatal screening': information about the practical aspects of the test is emphasised, whereas information about the likelihood and implications ofpossible results is rarely given.These results highlight the extent to which prenatal screening programmes are falling short of the counselling standards that have been set.' In addition to the setting of guidelines, effective staff training is needed to teach health professionals how to present prenatal screening tests in ways that will lead to informed decision making by patients.4

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