DiscussionNewborn infants of diabetic mothers are at risk of developing severe hypoglycaemia. Good control of maternal diabetes during pregnancy increases the fetal survival rate.3 Recent reports4 support the hypothesis that neonatal hypoglycaemia is due to islet-cell hyperplasia, which in turn may be caused in utero by maternal hyperglycaemia. Since perfect control of maternal blood glucose is aimed at during pregnancy, it is logical to avoid excessive stimulation of fetal insulin secretion immediately before delivery.5The combined infusion of insulin and glucose is a simple way of controlling the maternal blood glucose concentration during labour. It also permits adequate hydration of the mother and prevents starvation ketosis. At the same time the stomach may be kept empty, so that a general anaesthetic can be given without delay.Infused insulin is cleared extremely rapidly from the plasma, and by means of an insulin infusion the maternal plasma insulin concentration may be readily adjusted to achieve more-constant blood glucose concentrations. Immediately after delivery maternal insulin requirements fall, and the infusion rate of insulin may be lowered accordingly.Measurement of blood glucose with Dextrostix and the reflectance meter is simple and may be performed by nurses on capillary blood samples obtained by finger-prick at the bedside. The result is available within two minutes and compares favourably with estimations performed by a standard laboratory method. Repeated estimations may be performed without undue discomfort to the patient. (During one premature labour over 100 capillary blood samples were taken in 48 hours.)Provided that simple rules are observed and equipment is properly standardised, management of diabetes during labour with this method becomes a simple procedure suitable for all obstetric units.We thank Mr M Cameron for the obstetric care of these patients, and the labour ward staff and Sister Susan Judd and the house physicians of the medical unit for help with management of the infusions.

The results of the diagnostic accuracy of breast fine needle aspiration specimens taken by the pathologist in a joint surgical clinic are compared with those taken by a surgeon. In the joint clinic the complete sensitivity rose by 15% and the number of missed malignancies fell by half.

No abstract

Preoperative hair removal by a depilatory cream was compared with routine shaving. Although the incidence of wound infection was similar in both groups, cream depilation was found to be better. It was effective, atraumatic, non-toxic, and could be self-administered. Furthermore, it could be used safely on granulating

BRITISH MEDICAL JOURNAL 31 JULY 1971 279 that prostaglandin E2 is more effective in inducing labour must be considered with caution, for though the patients were selected at random the groups were not identically matched. The differences found in these studies may be partly explained by essential differences in the plan of each investigation and the exact protocol undertaken. Beazley and Gillespie (1971) started the infusion of prostaglandin E, at 0-21 [Lg/min and oxytocin at 2 1 mU/min. These rates were doubled every hour until contractions were effective and then usually maintained at a fixed rate. In addition some patients' membranes were ruptured artificially when labour was established. Our approach was basically different in that rapid titration regimens were used to induce an early onset of regular contractions in each group, as we considered it was impossible to know that the stimulatory effect of doubling the infusion rates of prostaglandin E2 was quantitatively equivalent to doing the same with oxytocin. It is therefore not surprising that the results were different.By using the titration regimens an initial uterine response occurred at a comparable time with both substances, though regular contractions of similar amplitude generally occurred earlier with oxytocin. Despite this fact prostaglandin E2 was more effective in dilating the cervix, and it is our impression that this substance had a greater stimulatory effect on the uterus than oxytocin in the dose range used. One feature tending to confirm this impression was the finding that while prostaglandin E2 invariably resulted in spontaneous rupture of the membranes, this occurred before dilatation of the cervix had reached 6 cm in eight out of 15 patients. With oxytocin this was so in only two out of the nine successes. With both agents basically two types of response were elicited. One resembled normal labour in that progressive cervical dilatation occurred with time, while in the other little or no change in dilatation resulted for many hours, usually until the onset of spontaneous membrane rupture. About one-third of the successes in each group were in this latter category.With regard to the practicality of using oxytocin to induce labour in the presence of intact membranes, we feel that a greater success rate could probably be achieved if the infusion rate were increased above that required to induce contractions which appear "optimum" on an external tocograph. In effect oxytocin titration would be against cervical dilatation rather than contractions. The limitation of such a policy is a possibility of causing uterine hypertonus, though oxytocin infusions in doses ranging from 2 to 128 mU/min. We feel, however, that there are possible dangers of pursuing a similar policy of increasing the dose of prostaglandins above that required to induce optimum contractions. Besides maternal disturbance caused by possible vomiting and soreness of the arm it is our impression that fetal distress may be provoked, for contractions of excessive frequency or str...