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30 patients for whom an epidural injection using local anaesthesia was hazardous (deformed spine) or contra-indicated (allergic to local anaesthetic agents) received an injection of 0.008 mg cm-1 of morphine chlorhydrate intrathecally. Residual pain scored from 0 to 5 was 2.5 after 10 minutes and 1.5 after 25 minutes. Thereafter there was only a simple ache which was well tolerated right up to the time of delivery. Uterine action was not changed, which allowed 27 labours to be completed vaginally, of which 23 were without forceps. There was no haemodynamic change or respiratory depression, either immediately of later, in the mother nor in the infant (there were 26 Apgar scores of 9 or more). The ratio of plasma concentrations of morphine between the mother and the fetus using radio-immunological assays was inverted as time passed. These were at 6 mg ml-1 or less, which explains the medullary characteristic of the analgesia and the absence of general repercussions. The safety that is offered by the poor diffusion of substance between the fetus and the mother and the ability to prevent secondary effects (pruritus and headache) are features that make intrathecal analgesia and interesting alternative to a conduction block in labour.

Amniotic fluid was obtained per vagina from 228 mothers with premature rupture of the membranes and examined bacteriologically. The aim was to assess the importance of amniotic fluid contamination and the risk of foetal infection in the absence of systematic antibiotic therapy in the mothers. The incidence of amniotic fluid contamination was apparently greater in those mothers who had received antibiotics although the proportion of neonates with a true infection (3%) was almost identical. The absence of selection of resistant organisms is indicated by the marked preponderance of streptococci and the scarcity of Gram negative enterobacteriacae. Thus it is reasonable not to give systemic antibiotics but to culture the amniotic fluid. Infection can then be anticipated and in affected neonates the appropriate therapy started immediately.

Twenty-five healthy women in labour received morphine 1-1.75 mg in normal saline intrathecally. The residual pain was evaluated on a scale from 0 to 5 at 10 min (score 2.5) and at 25 min (score 1.5). After delivery the maternal and fetal plasma morphine concentrations were measured by radioimmunoassay in 14 parturients. Twenty-three women of 25 had vaginal deliveries, 20 of them without forceps. The maternal and fetal plasma concentrations of morphine were 6 ng ml-1 or less. The intrathecal (but not extradural) administration of morphine is effective and could provide an interesting alternative for pain relief in labour.

Levels of plasma 17 beta oestradiol, FSH and LH, were carried out on the 7th, 14th, 21st and 28th day of the cycle in three studies in order to evaluate the residual ovarian secretions under the influence of low-dose pills (30 micrograms of ethinyl-oestradiol and 150 micrograms of levonorgestrel). The studies consisted of: a preliminary study involving 5 women under the oestrogen/progestogen pills over more than 1 year; a comparative study of the three first cycles on the same preparation against a control cycle (5 women); a comparative crossover study of one cycle of the minidose oestrogen/progestogen preparation and one cycle of oestrogen/progestogen preparation with 50 micrograms of ethinyl-oestradiol (10 women). The results of these trials show that minidose oestrogen/progestogen preparations have a braking effect on the hypophysio-ovarian axis similar to that exerted by the higher dose pills.

Perforations of the uterus by intra-uterine devices (I.U.D.) are still at present serious complications. Their incidence is very varied and diverse because they are often asymptomatic. Pregnancy of a frequent circumstance under which they are discovered, as well as the more general way, which is the disappearance of the strings, which should always give rise to the suspicion that perforation has happened. There are two types to be distinguished from one another: Immediate perforation due to a faulty technique in insertion, secondary perforation due to gradual wearing down of the uterine wall. The factors predisposing to the occurrence of these accidents are numerous but notable among them are the date in the cycle when the insertion was done and above all the time in relationship to the last pregnancy, parity, the position of the uterus and the experience of the operator. Diagnosis of perforation is not always easy and may require not only radiological investigation without preliminary preparation but also hysterography, ultrasound examination and hysteroscopy. Withdrawal of a device that has perforated the uterus is advisable even if its migration has not given rise to any clinical symptoms. The technique for removing it varies often from case to cause between laparoscopy, laparotomy and culdotomy. Prevention of perforations should not only take into account the contra-indications to insertion but also knowledge of favourable factors, of a rigorous technique for insertion as well as clinical supervision in order to screen for secondary perforations.

601 antenatal chromosome tests were carried out by culturing amniotic liquor. The fetal caryotype was abnormal in 18 cases (3.1 per cent). Most of the examinations were carried out because of advanced maternal age and they gave rise to the diagnosis of 15 abnormalities (3.3 per cent). It should be possible to carry out this kind of screening of patients over the age of 38.

Menopausal disorders coincide with the onset of luteal insufficiency and the resulting relative hyperestrogenism. At this stage the risks to be assessed are mainly related to a worsening of the menstrual syndrome (heaviness of the legs, abdominal distention, water retention, mastodynia, depressive syndrome), cycle changes, or various genital types of hemorrhage requiring investigation for detection of a possible fibroma, hyperplasia, endometriosis, or genital cancer. Once the menopause is settled a reduction in estrogen levels comes with reactive increases in FSM and LM levels, and the principal risk is the development of a cancer. The role of endogenous (obesity, diabetes, Stein-Leventhal, adenomatous hyperplasia) or exogenous (prolonged estrogen therapy alone) estrogens has to be evaluated in endometrial cancer. Cancer of the vulva also appears to be more frequent in menopausal women (natural or artificial), as well as cervical cancer and cancer of the breast. There is an apparent increase in cardiovascular risks in untreated menopausal women, but this is still discussed, as to the benefits of estrogen therapy.

The results of an experimental and clinical study on the benzydamine binding and distribution in vaginal mucosa are presented, employing benzydamine solution for gynaecological use. When applied first to rats, the mean amount of the drug in their vaginal mucosa became 3.65 +/- 2.99 micrograms/g of fresh tissue with a significant difference between control and treated animals, without detectable amounts in the plasma. When applied to humans, the mean amount of benzydamine assayed in 17 specimens of vaginal mucosa was 9.72 +/- 6.24 micrograms/g. It was greater than the range of animal anti-inflammatory concentration (2-8 micrograms/g) established by pharmacological studies on this drug and justified the local benefits from benzydamine treatment of vaginal inflammation. Benzydamine assayed in seven volunteers with healthy vaginas showed that the drug cannot be detected in the plasma.

102 patients at high risk of pre-eclampsia and/or fetal growth retardation were randomly allocated to treatment with 300 mg dipyridamole and 150 mg aspirin daily from 3 months' gestation onwards (group A) or to the control group (group B, no treatment). Group A was twice as likely as group B to have a normal pregnancy. Pre-eclampsia occurred in 6 patients in group B and none in group A. Major complications (fetal death or severe growth retardation) occurred in 9 patients in group B and none in group A. Platelet count and plasma volume were significantly higher in group A than in group B throughout pregnancy. The treatment did not produce serious adverse effects. Antiplatelet therapy given early in pregnancy to high-risk patients may thus protect against pre-eclampsia and fetal growth retardation.

Genital herpes is the frequent localization of a viral disease, the consequences of which on pregnancy are rather ill-known, resulting in excess. The author stresses the advantage of Acyclovir and specifies the management of this problem.

23 cases of contamination with streptococcus group B have been seen after premature rupture of the membranes. Mothers and fetuses have been affected. The systematic study of swabs or liquor or cervical discharge carried out on the mother since the time her membranes had ruptured show that in 74 per cent of cases studied contamination existed within the first 24 hours. Giving antibiotics to the mother before delivery gave very variable results. These multiple tests, before and around the time of birth, made it possible to detect the children at risk of infection and to start antibiotic therapy with a narrow spectrum antibiotic of the type Penicillin G. The clinical progress of these children, which is usually favourable, gives no reason for postponing prophylactic cover antibiotic treatment when the membranes have ruptured prematurely.

We selected 100 patients at high risk for having preeclampsia and/or intrauterine growth retardation, on the basis of their past obstetrical history. At three months, they were randomly allocated to treatment group (group A) receiving dipyridamole (300 mg/day) and low dose aspirin (150 mg/day) until delivery, or control group (group B). Age and parity were similar in both groups. 90 patients have delivered at this time. The pregnancy was normal in 54% of patients in group A and 23% in group B (p less than 0.01). Preeclampsia occurred in 6 patients in group A, none in group B (p less than 0.01). Fetal loss occurred in 5 patients in group B, none in group A (p less than 0.01). Duration of pregnancy, as well as fetal and placental weights were significantly higher in group A, and IUGR significantly less frequent. It is concluded that inhibition of platelet aggregation, when used early in pregnancy, may have a significant protective effect against preeclampsia and IUGR in high risk subjects.

Solubacter was prescribed, in combination with etiological treatment, for local application in 275 women with vulvovaginitis by 19 gynecologists in general practice as part of an open, multicentre study. The condition most frequently being treated was candidosis. A rapid improvement in vulvar symptoms was observed, right from the first few days of treatment. The treatment was well accepted by the patients and showed good tolerance, both in the judgement of the patients as well as that of the doctors. Solubacter thus proved to be a suitable additional aid in the treatment of vulvovaginitis.

Bacteriologic study of amniotic fluid was undertaken in 300 cases of prolonged rupture of the membranes to evaluate the risk of infection without systematic administration of prophylactic antibiotics to the mother. The rate of amniotic contamination was 8.3 per cent within the first 12 hours following rupture of the membranes, it increased with time to reach 52 per cent, after 48 hours. In 90 per cent of the cases, contamination was caused by streptococci and anaerobes, Streptococcus B alone being responsible for 50% of the contaminations. Antibiotics administered to the mother were effective, but they needed a 6 hour-minimum delay to sterilize a contaminated amniotic fluid. Although the overall percentage of contamination was 23 per cent, infection occurred in only 4 per cent of the infants. The outcome was satisfactory in every case. Those results do not seem to discredit the suppression of prophylactic cover antibiotic therapy following the premature rupture of the membranes.