Pethidine blood concentrations at time of birth.

Pethidine levels in maternal and fetal blood were estimated at birth after variable periods of intramuscular administration--delivery intervals in forty pregnant women. The results suggest that maternal--fetal equilibrium occurs at a fast rate with a regression coefficient initially of 0.54. There appeared to be a tendency towards trapping of the drug in the fetal circulation resulting in a rise in the regression coefficient after 3 h reaching 0.85. The pharmacokinetics and the clinical significance of these observations are discussed.     

Significant thresholds for the 75-g oral glucose tolerance test in pregnancy

The significant threshold values for the 75-g oral glucose tolerance test (oGTT) during pregnancy have yet to be conclusively determined. This study aimed to identify the risk significance of various set thresholds for the oGTT result. Women undergoing a 75-g oGTT during the third trimester of pregnancy were classified into three groups: mild gestational impaired glucose tolerance (GIGT; 2-h postload glucose, 8.0–8.5 mmol/l; n=75), moderate-severe GIGT (8.6–10.9 mmol/l; n=167), and GDM (≥11.0 mmol/l; n=76). Outcome indicators of these three groups of women were compared to the parameters of the women with a presumed normal carbohydrate metabolism (n=12,185). The results show that with increasing oGTT thresholds, there was an increasing risk of maternal morbidity in the form of hypertensive disorders complicating pregnancy, as well as obstetric intervention such as induction of labor, cesarean delivery, and preterm delivery. The infant was also at increasing risk with increasing oGTT thresholds from respiratory distress, macrosomia, and associated shoulder dystocia. It would appear, therefore, that abnormal glucose tolerance in pregnancy, even as defined by the World Health Organization criteria, has proportionate risks to both mother and child.     

Labial Adhesions in Postmenopausal Women with Hip Joint Disease

Two cases of postmenopausal labial adhesions in patients with severe hip joint disease are presented. The aetiology of labial adhesions in the postmenopausal woman is discussed. Hip joint disease is shown to influence the formation of adhesions by interfering with perineal hygiene and decreasing sexual activity.     

Embryonal risks in gestational diabetes mellitus

Diabetes mellitus is generally associated with a higher incidence of early pregnancy loss and congenital anomalies, though this relationship should be strictly restricted to patients with previously existing diabetes. In gestational diabetes mellitus, which often develops during the third trimester, no such relationship should exist, though the birth of a previous infant with a congenital anomaly is often assumed to be a risk factor for gestational diabetes. OBJECTIVE: The study attempts to analyse the congenital anomaly rate in women with gestational diabetes and compare this to the rates in women known to have normal glucose tolerance. RESULTS: The prevalence of infants/fetuses with congenital anomalies born to women with gestational diabetes amounted to 4.48%, a rate similar to that recorded in women with normal glucose tolerance (4.54%). CONCLUSIONS: The development of gestational diabetes, in contrast to pre-existing diabetes, does not appear to be associated with an increased risk for teratogenesis.     

Maternal mortality in the Maltese Islands

Maternal mortality statistics from the Maltese Islands since 1935 are reviewed to show that there has been a marked decrease in maternal mortality rates. This decrease is probably related to reductions in family size and improvements in the perinatal care of mothers. Hypertensive disease is now the most important cause of maternal mortality.     

Lead and other metals in gestational hypertension.

OBJECTIVES: To identify any effects that lead, calcium, magnesium, and zinc may have on the development of gestational hypertension. METHODS: Third-trimester 110 normotensive and 33 gestational hypertension cases were assayed for various metal levels, using standard techniques, including atomic absorption spectrometry. RESULTS: Gestational hypertension cases showed significantly higher blood lead levels than normotensives. No differences were noticed regarding calcium (ionized and total), magnesium, and zinc levels. Blood lead was significantly related with blood pressure, even after correcting for the body mass indices and age. Blood pressure levels showed no relation to the other analyzed metals. However, the lead:ionized calcium ratio showed a stronger association with blood pressure, than lead alone. Blood lead showed a significant negative relationship with ionized calcium, but none with the other metals. CONCLUSIONS: Blood lead evidently influenced blood pressure increments and gestational hypertension development. This implies that all efforts should be made to reduce the population's exposure.