counselling should differ accordingly, but few clinicians appear to tailor the information they give: of 15 post-membership obstetricians we surveyed, none were aware of the lower detection rate in younger women. We suggest that the main benefit of serum screening is not that it can be applied to women of all ages but that it gives an option for women of 35 years or more to avoid invasive testing (and miscarriage of a normal fetus). Mark James, Obstetrics Registrar Robert Fox, Consultant Obstetrician (Vol 103, January 1996)l. We have also observed a menstrual cycle-related difference in skin vascular reactivity in a group of 15 normal healthy women studied during the mid-follicular (days 5-9) and mid-luteal (days 19-23) stages of confirmed ovulatory cycles under standardised conditions. Skin blood velocity (SBV) was measured by a laser Doppler probe placed on the skin over the pulp of the toe. The change in SBV in response to 40" headup tilt was used as an index of the peripheral vasoconstrictor reflex. This reflex is locally and centrally mediated, being activated by an increase in venous pressure and a reduction in venous return respectively2. In our study an overall reduction in SBV was observed in response to the tilt (median percentage change -39.6 %, range 0 to -95) during the follicular phase of the cycle, suggesting functioning reflex. However, the median change in SBV increased significantly during the luteal phase (+ 6 6 %, range -83 to + 144). This change was significant (P = 001, Wilcoxon matched pairs signed rank test) and suggests that there is an attenuation of the reflex vasoconstrictor response during this phase of the menstrual cycle. The authors obtained a significant difference only in the skin of the forearm. Measurements derived from finger pulp showed a wide range of responses with no difference between the phases of the cycle, a result attributed to the presence of A-V anastomoses. In contrast, we have shown the presence of a significant difference in reactivity in the skin over the pulp of the toe. In addition, the range of responses increased significantly in the luteal phase of the cycle (P < 001, F test for variance). This suggests that there is not only an attenuation of vascular reflex response in the luteal phase, but also a greater variability in the response during this phase of the cycle. Although the actual mechanisms being tested may differ in these two studies, the results of our study also support a cycle-related difference in vascular response. These findings also suggest that ovarian hormones are likely to affect the systemic circulation in a fashion analogous to that known to occur within vessels of the reproductive tract3t4.The differences in results may be a reflection of differences in methodology and challenge. Firstly, the mechanisms behind the hyperaemic response and the vasoconstrictor reflex are likely to be different. The former is probably mediated by both chemical and local myogenic mechanisms whilst the latter appears to have both a sympathetic nerve-mediated ...