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Nineteen women attending a special multiple pregnancy antenatal clinic with a triplet pregnancy were randomly allocated to either bed rest in hospital from 24 weeks gestation onwards until delivery, or to continue conventional outpatient management. Conclusions are limited by the trial size, but the study suggests that routine hospitalization for bed rest decreases the incidence of preterm delivery and light-for-gestational age infants and reduces the need for intensive neonatal care. Although still compatible with change variation, the observations, if confirmed in a larger randomized study, would have considerable implications for clinical practice. The policy needs further evaluation in a large multicentered collaborative study.

Objective: To test whether a policy of hospitalization for bed rest, from 28-30 weeks gestation until delivery, lengthens the duration of gestation, improves fetal growth and decreases neonatal morbidity in twin pregnancy., Design: A randomized controlled trial., Setting: Harare Maternity Hospital, Zimbabwe., Subjects: 118 women with an uncomplicated twin pregnancy between 28 and 30 weeks gestation., Intervention: Hospitalization for bed rest. Encouraged to rest in bed as much as possible, although voluntary ambulation was allowed., Main Outcome Measures: Gestational age at delivery and number of infants delivered preterm (less than 37 weeks); birthweight and number of small-for-gestational age (SGA) infants; neonatal morbidity was assessed by number of infants requiring admission to the neonatal unit and the length of stay., Results: There was no effect on duration of gestation or the occurrence of preterm delivery. Mean birthweight was greater in the hospitalized group (t = -2.28, df 234, P = 0.02) and there were fewer SGA infants (OR 0.57, 95% CI 0.33-0.96). No differences were found in neonatal morbidity., Conclusions: Hospitalization for bed rest does not prolong pregnancy but can improve fetal growth, although this was not reflected in improved neonatal morbidity. Whether twin fetal growth can be enhanced similarly in other populations should be investigated.

This randomized controlled trial compared the use of magnesium sulphate with diazepam as anticonvulsant in 51 eclamptic women. The use of magnesium sulphate was associated with less serious morbidity (in terms of recurrence of convulsions, cardiopulmonary problems, disseminated intravascular coagulopathy, and acute renal failure) but the difference was not statistically significant (relative risk 0.6; 95% CI 0.3 to 1.2). The one maternal death occurred in the magnesium sulphate group. Convulsions recurred in five (21%) women in the magnesium sulphate group and seven (26%) women in the diazepam group. Urine output poor enough to prompt diuretic stimulation was less frequent in the magnesium sulphate group than in the diazepam group (RR 0.3; 95% CI 0.1 to 0.9). Significantly fewer infants born in the magnesium sulphate group had low Apgar scores (less than 7 at 1 min) compared with those in the diazepam group (RR 0.6; 95% CI 0.4 to 0.9). There were two early neonatal deaths in the magnesium sulphate group, and three stillbirths in the diazepam group. This study suggests that magnesium sulphate has advantages over diazepam for the mother and the infant in the treatment of eclampsia, but the trial is small and should be replicated on a larger scale.

The epidemiological characteristics of 34 cases of eclampsia treated at Harare Maternity Hospital during 1982 are described. Of these patients 70.6% had received antenatal care and the majority of these had had a normal blood pressure 7 days before their first convulsion. A seasonal variation in the incidence of eclampsia was noted. Factors important in reducing the incidence of eclampsia are discussed.

A gentamicin-resistant mutant of Pseudomonas aeruginosa PAO503 was selected after ethyl methane sulfonate mutagenesis. The strain, P. aeruginosa PAO2401 had increased resistance to all aminoglycosides tested but exhibited no change for other antibiotics. The mutation designated aglA (aminoglycoside resistance) was 50% cotransducible with the 8-min ilvB,C marker on the P. aeruginosa chromosome. It showed a marked reduction in cytochrome c(552) and nitrate reductase (Nar) and a change in terminal oxidase activity. Cytochrome c(552) is a component of the P. aeruginosa Nar. No changes in succinate and reduced nicotinamide adenine dinucleotide dehydrogenases, ubiquinone content, Mg(2+)/Ca(2+) membrane adenosine triphosphatase, and energy coupling of electron transport to adenosine 5'-triphosphate synthesis were detected. Transport of gentamicin and dihydrostreptomycin was impaired in PAO2401, but transport of proline, arginine, glutamine, glucose or the polyamine spermidine was not reduced. Ribosomes of PAO2401, and PAO503 bound dihydrostreptomycin equally well, and cell extracts did not inactivate gentamicin or dihydrostreptomycin. Strain PAO2401 is resistant to gentamicin and dihydrostreptomycin because of impaired transport of these compounds. The transport studies indicate a selective coupling of dihydrostreptomycin and gentamicin transport with terminal electron transport. This conclusion was supported by results from another mutant (PAO417-T2) with increased Nar activity, enhanced dihydrostreptomycin and gentamicin transport and a reduction in resistance to these drugs. These results are discussed in relation to a refined model for aminoglycoside transport and briefly relative to plasmid-mediated aminoglycoside resistance.

Perinatal deaths occurring within the City of Harare, Zimbabwe, during 1983 were studied. Data were collected from all known deliveries within the city. This included exact numbers from three central maternity hospitals, and from referring midwife-run maternity clinics. An estimate was made of the number of births and perinatal deaths occurring within the city, but outside these official maternity facilities. All perinatal deaths were reviewed. The birthweight, the cause of death, and the antenatal care registration status of the mother were established. There were 2103 perinatal deaths from an estimated 53,665 total births. Deliveries include 50,138 (93.4%) in hospitals or clinics, 972 (1.8%) before arrival to the maternity service, and an estimated 2555 (4.8%) outside the city maternity services. One thousand seven hundred and fourteen (81.5%) perinatal deaths occurred in hospital or clinic delivered babies, and 134 (6.4%) from babies delivered before arrival at medical services. An estimated 255 (12.1%) of deaths occurred elsewhere. A total of 6380 (12%) patients did not register for antenatal care. There were 909 (43.2%) perinatal deaths in this unregistered group of patients. The overall perinatal mortality rate (PNMR) for infants weighing 500 g or more was 39.2/1000. For registered patients the PNMR was 25.3/1000 and for unregistered patients, 142.5/1000. For infants weighing 1000 grams or more the PNMR was 31.6/1000. The causes of death in the 2103 perinatal deaths were established and classified by clinical cause and by a simple pathological grouping with breakdown by birthweight.(ABSTRACT TRUNCATED AT 250 WORDS)

During the 10-year period, 1975-1984, 105 triplet pregnancies were delivered at Harare Maternity Hospital, Zimbabwe, among 286,338 pregnancies in the Greater Harare Unit, giving an incidence of triplets of 1:2,727. The mean gestational age at delivery was 32.5 wk with 81 women (77.1%) delivering before 37 wk. Primigravidas delivered at a significantly earlier mean gestational age (P less than 0.05) and had a higher perinatal mortality (P less than 0.001) compared with grand multigravidas. Of the 315 babies, 277 (87.9%) weighed less than 2500 g. The overall perinatal mortality rate was 327%, with a perinatal mortality rate of 146% for infants weighing greater than or equal to 1000 g. Women hospitalised for bed rest during the antenatal period had fewer perinatal deaths compared with those diagnosed during the antenatal period, but not hospitalised for bed rest (P less than 0.02). No difference was found in the mean gestational age at delivery or the mean birth weights between these two groups. Among infants greater than or equal to 28 wk gestation there were fewer perinatal deaths in triplets delivered by cesarean section compared with triplets delivered vaginally (P less than 0.0004). This suggests that cesarean section may offer the optimal mode of delivery in triplet pregnancy.

There were 51 maternal deaths at Harare Maternity Hospital, Zimbabwe, during 1983, 25 among patients from the greater Harare area and 26 among patients referred from peripheral hospitals or clinics. The overall maternal mortality rate among patients within the greater Harare area was 56/100 000 (including deaths related to abortion). Among 'booked' patients the maternal mortality rate was 29/100 000. Puerperal sepsis, haemorrhage, post-abortal sepsis and hypertensive disease accounted for 78.4% of the deaths. Avoidable factors, considered to be present in 34 cases (66.7%), are discussed.

Patients attending a twin pregnancy antenatal clinic underwent cervical palpation at each visit to calculate a cervical score by subtracting dilatation from length. Prediction of the onset of labor by cervical assessment was studied in 223 already parous women with twin pregnancies who ultimately labored spontaneously. The lower the score, the shorter was the mean time until delivery, although there existed a subgroup of patients who had ripe cervices for several weeks before the onset of labor. The cervical score itself appeared to give better prediction of labor than did changes in the score. Cervical assessment identified a group of twin pregnancies at especially high risk of preterm labor, in that 76% of patients with a score of -2 or less at or before 34 weeks delivered preterm. There was no evidence that labor was precipitated by vaginal examination, although this requires further study.

There were 1,563 known perinatal deaths among 45,343 births during 1983 in the Greater Harare Obstetric Unit area. The perinatal mortality rate was 34.5/1,000 for infants weighing greater than or equal to 500 g, and 26.9/1,000 for infants weighing greater than or equal to 1,000 g. The perinatal mortality rate for booked patients was 20.9/1,000 for infants weighing greater than or equal to 1,000 g. All the perinatal deaths were analysed. Immaturity was the leading known cause of perinatal death, accounting for 19.3% of the cases. Areas requiring further study to establish preventable factors in perinatal deaths are highlighted.

There were 799 deliveries of twins at Harare Hospital during 1983. Of the 1598 infants 155 died, giving a perinatal mortality rate for twin pregnancy of 97/1,000, 3 times higher than the rate for singleton pregnancies. The most common cause of death was immaturity. The perinatal mortality rate was higher for second twins than for first twins. Factors important in decreasing perinatal mortality in twin pregnancy are discussed with reference to the literature.

Women attending a twin pregnancy antenatal clinic underwent cervical palpation to calculate a cervical score by subtracting dilatation from length. Those with a score of -2 or less at or before 34 weeks are at especially high risk of preterm labour. A total of 139 such women were randomly allocated either to receive bed-rest in hospital or to continue conventional outpatient management. No beneficial effect of bed-rest could be identified in prolonging twin pregnancy or improving fetal outcome.

Inhibin is a gonadal hormone involved in the non-steroidal regulation of follicle stimulating hormone (FSH) secretion. Using the cDNAs coding for bovine inhibin A and B subunits we have identified inhibin genes within the human genome using Southern blot hybridisation techniques. The genes are likely to be present as single copies. Cloning and sequencing inhibin genes obtained from lambda libraries of human genomic DNA provide structural and sequence data on the human A and B genes. Comparison of the known inhibin gene sequences showed, in particular, that the B subunits have identical sequences in man, pigs and cattle thus demonstrating a remarkable evolutionary conservation in these genes.