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Thirty pregnant women in the third trimester of pregnancy in whom fetal movements were reduced up to cessation, for at least 12 hours, were monitored for FHR. The FHR 12-48 hours after the cessation of fetal movements was pathological in 21 cases and normal in 9 cases. The most frequent pathological FHR changes were loss of beat to beat variation and variable decelerations. In the following 48 hours another four cases showed pathological FHR changes. One to four days before the reduced fetal movements only six out of 15 cases showed pathological FHR changes which were L.B.B.V. Meconium was found in only 50% of the cases. It is suggested that pregnant women, especially high risk cases, should record fetal movements as a screening method. FHR monitoring is also a valuable method for detecting antenatal fetal distress, and should be used as an adjunct to fetal movements recording. When acute fetal distress has been established by MAS alone or with FHR change, the fetus should be promptly delivered.

The rate of fetal heart rate accelerations associated with fetal movements to total fetal movements of twin pregnancies was found to be significantly lower than that of pregnancies with singleton infants. The number of fetal heart rate accelerations was similar. As fetal heart rate accelerations are reflective of fetal movements, the results indicate increased fetal activity in twins that is related to an additive effect of two normally active fetuses.

The problem of retrograde seeding of endometrial tissue fragments to the peritoneum was investigated by injecting fluids through the cervical canal into the uterus before and after curettage. Fluid samples were collected from the peritoneal cavity through a laparoscope. Endometrial glands were detected in almost all of the fluids samples, and seeding was greater after curettage than before. It is concluded that any procedure in which fluids are pushed through the uterus may cause peritoneal seeding of endometrium.

Leukocyte alkaline phosphatase (LAP) activity increases progressively during pregnancy, returning to non-pregnant levels 6 weeks post-partum. This enzymatic activity is under the influence of placental steroid hormones, thus reflecting placental function. LAP activity is thus a reflection of the dynamic relations between estrogenic, progestational and corticoid activity during pregnancy. LAP activity was studied in 60 women and in their 61 newborn infants at delivery and during the first five days of the puerperium. The Kaplow cytochemical technique was employed. The average maternal LAP score as well as the average newborn infant LAP score was considerably higher than the LAP score of the normal adult. The level of the enzyme in the maternal granulocytes was significantly higher than that of the newborn (Tab. I). During the first five days after labor, there was progressive decrease in the LAP score in the maternal and the newborn blood; on the fifth day the LAP scores of both were only slightly above the normal adult score (Figs. 1, 2). An inverse relation between the LAP score and the birth weight of the infant was found (Tab. III). These results confirm the view that LAP activity in the fetus in utero, are dependent on placental steroid function. The lower LAP values in the newborn, as compared to those of the mother are probably dependent on the lower newborn hormone levels. The significance of the relation between LAP scores and the infants birth weight is not clear.

Traumatic intrauterine adhesions are known to be reversible. In some cases, following lysis of adhesions we find residual adhesions on hysterography. We have studied 11 cases in whom new adhesion formation, of different type and location have recurred following curettage for lysis of adhesions or in subsequent pregnancy. In each case there were between two and five different forms of intrauterine adhesions during the course of study. In all 11 cases hypomenorrhea was a prominent symptom. On premestrual curettage a scanty amount of endometrium was removed. Their obstetric history was characterized by sterility (four cases) and repeated early abortions, spontaneous or missed. Treatment consisted of repeated curettage and placement of an IUD. Four patients who subsequently become pregnant carried pregnancy to term or near term. Intrauterine adhesions may be considered as a localized manifestation of more generalized process of endometrial fibrosis. This may explain this syndrome of recurrent intrauterine adhesions and the paradoxical phenomenon of limited adhesions being associated with amenorrhea and hypomenorrhea.

A case of rhesus isoimmunization with spontaneous improvement in severity of erythroblastosis with advancing parity is presented. The isoimmunized pregnant woman after having 3 perinatal deaths all due to severe hydrops fetalis, subsequently delivered 2 Rh-positive surviving infants. In her last pregnancy, the timing of delivery was indicated by cessation of fetal movements, followed by a sinusoidal fetal heart rate pattern. The newborn, needing 5 exchanging blood transfusions, subsequently did well.

The present retrospective study investigates the effect of premature rupture of membranes on fetal neurocardiac maturation as reflected by the fetal heart rate (FHR) pattern. The FHR tracings of 41 cases involving premature rupture of membranes of at least 48 hours' duration at 24 to 37 weeks' of gestation were studied. Fifty-two cases of normal pregnancy who were matched for gestational age served as controls. The results demonstrate similar baseline FHR and variability in the study and control group. The incidence of FHR accelerations of 15 beats/min was significantly greater in cases of premature rupture of membranes, and their onset was detected at an earlier gestational age. In addition, the mean amplitude of FHR accelerations was significantly greater in the study group compared with the control group. As a result, patients with premature rupture of membranes have a reactive nonstress test at an earlier gestational age than do control patients. These findings support the concept that premature rupture of membranes causes accelerated neurocardiac fetal maturation, as reflected by FHR pattern, possibly by inducing a stressful intrauterine environment.

A sinusoidal fetal heart rate pattern, associated with Kell incompatibility, severe fetal anaemia, maternal hypertension and intrauterine fetal growth retardation, is described. The mechanism and management are discussed.

Three antenatal monitoring tests--fetal movement acceleration test (FMAC-test), fetal heart rate-nonstress test (FHR-NST), and daily fetal movement recording (DFMR) were evaluated in 212 high risk pregnant women. While in 196 cases all three tests were normal, in 16 patients one to three tests showed pathological results. In the latter group, there was a significantly higher incidence of perinatal mortality, low Apgar score and growth retardation. Since false positives are known to occur in these tests, at least two should be pathological to warrant delivery in am attempt to prevent fetal death in utero. The sequence in which the pathology appears in the deteriorating fetus is as follows: the first to become non-reactive is the FMAC-test, followed by decreased fetal movements till cessation, and, finally, severe changes in the FHR-NST take place. The importance of this sequence of events is discussed.

Blood pressure measurements were recorded in 95% of the men and 97% of the women aged 30 to 59 years in a small Israeli village populated by Jews of Kurdish origin and in which a high incidence of toxemia of pregnancy was previously observed. The prevalence of hypertension in the men, as well as in the women, was significantly higher in all age groups studied than in a sample of the general population. These findings support the hypothesis that toxemia of pregnancy is an expression of a preexisting hypertensive state rather than an etiological factor in the development of later hypertension in women.

High levels of serotonin and 5-HIAA were found in the urine of a group of 102 oligospermic and azoospermic men. These levels were significantly higher than those of normal fertile men.

A dietary history was obtained from 180 patients with preeclampsia and eclampsia, representing 92% of all cases occurring in the pregnant population of West Jerusalem over a defined period. The intake of nutrients and 78 items of diet was compared for each patient and two healthy control subjects who were matched for country of origin, parity, month of delivery, age, year of immigration and years of schooling. All diagnoses were made by the same research team and dietary histories were elicited by one of two experienced dieticians. Comparisons between the 180 patients and their respective control pairs showed a significantly reduced intake of calories, proteins and fats and an increase in consumption of sugar and sweets by the patients. The food items involved, including cheese, eggs, olives and nuts, did not appear consistently, however, in population subgroups defined by age, period of immigration and country of origin. Sixty-six patients reported not having changed their diets during pregnancy and these showed no significant differences in consumption of any of the foods or nutrients at the 1% level, when compared with their matched control subjects. All differences observed were confined to the 114 patients who, for one reason or another, had changed their diets. It is concluded that the differences in diet between patients and control subjects are the result, and not the cause, of the toxemia of pregnancy. Supporting and contradictory evidence in the literature is analyzed, and possible sources of the discrepancies are pointed out.

The Ypsilon intrauterine device (IUD), which consists of stainless steel covered with silicone rubber, was studied in 209 women. In the 3,169 woman-months of use, there were 21 pregnancies, nine expulsions, and in 24 instances the Ypsilon IUD was removed for medical reasons (side effects). The net cumulative pregnancy rate in the 12 months after insertion was 6.4% and the expulsion rate was 3.8%; the medical removal rate was 9.0%. No perforations or tubal pregnancies occurred. The comparatively low medical removal rate renders the Ypsilon IUD a fairly good device for clinical use, although the pregnancy rate is rather high.