Elevated maternal levels of alphafetoprotein (AFP) in midtrimester are believed by some to be a useful screening test for premature labour, low birthweight and low birthweight for gestation. In a prospective study on 887 randomly selected pregnant women we found that although there was an association between low birthweight and elevated AFP, the test would miss five out of every six cases of low birthweight and there would be nine false-positives for every case correctly identified. The test is not therefore sufficiently predictive of low birthweight to be of value as a screening test for this condition.

Summary. The outcome of 313 mature singleton breech deliveries, covering a 3‐year period at the Queen Charlotte's Hospital, is reviewed. Maternal and fetal outcome were analysed by the intention to deliver vaginally compared with planned caesarean section. There was no serious fetal morbidity or mortality in either of these groups despite considerable mechanical difficulty with vaginal delivery of the head in one patient. One woman in this group required hysterectomy for haemorrhage after an emergency caesarean section. Planned caesarean sections were carried out in 125 cases (40%). Trial of vaginal delivery was abandoned in 59 (40%) of the 149 women where this was attempted. Epidural analgesia appears to increase the duration of the second stage of labour in those who were delivered vaginally. Younger women and those with smaller babies were more likely to succeed with a trial of vaginal delivery but there was no relation between birthweight and the radiological obstetric conjugate and success or failure of trial of labour.

The ability to effectively define disease status in ovarian cancer after initial therapy or to selectively screen high-risk populations remains a major challenge for in vivo monoclonal antibody (mAb)-targeted approaches. Antitumour murine mAbs (HMFG1, HMFG2, H317, and H17E2) and the reshaped human antibody Hu2PLAP (against placental alkaline phosphatase; PLAP), labelled with indium-111 and iodine-123, were evaluated for their ability to localise ovarian tumours in sequential studies of our group. Thirty patients with ovarian cancer, aged 40–78 years (median 60 years) were studied with HMFG1/G2: 11, and H317/H17E2: 19 murine mAbs. Six patients with ovarian cancer aged between 36 and 65 years (median 49 years) were studied with the reshaped human Hu2PLAP mAb (5 patients) or the murine H17E2 mAb (2 patients) labelled with ¹¹¹In via a new macrocyclic chelating agent (DOTA). One of these was imaged twice, with H17E2- and Hu2PLAP-DOTA-¹¹¹In, respectively. In 20 out of 22 patients with radiologically measurable ovarian cancer, the presence of tumour was confirmed by the murine mAb scan and correlated well with the findings of conventional radiology diagnostic methods. One of these patients with a negative H17E2 scan and a large abdominal mass at laparotomy was found to have a PLAP-negative tumour on immunohistochemistry. Additionally, the antibody scan revealed the presence of active disease, confirmed at laparotomy/laparoscopy, in 6 out of 8 patients considered to be in clinical complete remission. Best images were obtained at 24 and 48 h after the ¹²³I and ¹¹¹In mAbs, respectively. Successful imaging with the reshaped human antibody, Hu2PLAP, was seen in 2 patients with PLAP-positive tumours. Antibodies to DOTA developed in 2 patients. In conclusion, immunolocalisation of ovarian tumours is feasible with both murine and reshaped human mAbs. The sensitivity and specificity of the method appear very high in this pilot study, and in view of the absence of toxicity, the diagnostic contribution of this approach should be evaluated prospectively. Given the low number of patients without surgically detectable disease in the present study, future investigations should include more patients with no evidence of disease in order to provide more meaningful estimates of specificity.

In earlier studies elevated maternal levels of placental protein 5 in the middle trimester were shown to be predictive of preterm labour. In a prospective study on 893 randomly selected pregnant women we were unable to confirm this association despite our own previous positive findings.