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Three patients, aged 14, 16, and 32 years respectively, with congenital adrenal hyperplasia (21-hydroxylase deficiency) are described. Excessive adrenal activity and ACTH secretion could not be suppressed with doses of corticosteroids sufficient to cause iatrogenic Cushing's syndrome, even though part of the steroid dosage was administered in the late evening. The resistance to feed-back suppression was of the same order as that seen in Cushing's syndrome. Adrenalectomy was performed in the 16-year-old girl, and was followed by a menarche. Adrenalectomy was considered inadvisable in the other two patients.

By combining uterine activity data with an "inductograph" it is possible to distinguish between normal progress and at least three different types of delayed progress during the early stage of stimulated labour. Delayed progress may be associated with optimal, insufficient or, sometimes, excessive uterine activity. The patterns described facilitate early recognition and management of clinical problems such as cephalopelvic disproportion, undue cervical resistance, inadequate myometrial activity, and impending fetal distress.

A new method of real-time computer surveillance during labour is described with a commercially available "low-cost' microcomputer and integral video display unit (VDU). The fetal monitoring program gives accurate and reliable information on eight parameters of fetal and maternal wellbeing, four of which may be displayed simultaneously, with the facility of instant data recall. Emphasis is on simplicity of operation, and clarity of data display in the form of horizontal bar graphs updated at 5-min intervals, with most recent information in numerical form. Flexibility of the system enables program modification with relative ease, and adaptation to two unmodified commercial electronic fetal monitors.

A prospective study of 1353 labours and the relevant newborn failed to reveal any significant difference between the incidence of neonatal hyperbilirubinaemia (defined as a level of 12 mg. or more per 100 ml.) following spontaneous labour, and after labour induced or accelerated by oxytocin. The incidence of unexplained neonatal hyperbilirubinaemia after spontaneous labour was 6-3 per cent. Following induced labour however there was a highly significant (P less than 0-001) association between the mean total dose of oxytocin used for induction and the incidence of neonatal hyperbilirubinaemia. The proportion of babies who developed hyperbilirubinaemia increased in direct relation to the total dose of oxytocin used for the induction. In this series the incidence of hyperbilirubinaemia increased sharply when the total dose of oxytocin exceeded 20 units as it did hyperbilirubinaemia and birthweight, or duration of spontaneous labour. When labour was induced, however, the proportion on newborn babies with hyperbilirubinaemia increased with the duration of labour. The significance of these findings is discussed.

In 50 women who had five successive pregnancies the difference was studied between the mean maternal weight at the 20th week of gestation and six weeks post partum. The difference changed from a weight loss to a weight gain in the fourth and fifth pregnancies. The maximum weight increment occurred between the end of the first pregnancy and the 20th week of the second, especially in obese multiparae.

The construction of an 'inductograph' is described which defines the rates of progress of the latent phase of labour in 80 per cent of a group of patients selected from a 'low risk' category. A standard induction regime was used, and changes in the uterine cervix were assessed quantitatively by a modified form of the Bishop scoring system.

A prospective study of 447 labours and the resulting newborn failed to reveal any significant difference between the incidence of neonatal hyperbilirubinaemia, defined as a level of at least 205 mumol/l (12 mg/100 ml), following spontaneous labour and after labour induced or accelerated with prostaglandin E2 (PGE2). The incidence of unexplained neonatal hyperbilirubinaemia after spontaneous labour was 4-5 per cent. There was no significant association between the incidence of neonatal hyperbilirubinaemia and the total dose of PGE2 used for induction. None of the babies of the six mothers who required more than 1-5 mg of PGE2 to induce labour developed hyperbilirubinaemia. No association was demonstrated between neonatal hyperbilirubinaemia and birth weight or the duration of labour. The implications of these findings are discussed.

A prospective study of 447 labours and the resulting neonates failed to reveal a significant difference between the mean serum bilirubin concentrations on the third and sixth day following spontaneous, accelerated or induced labour. A similar incidence of neonatal jaundice (bilirubin concentrations of 10 mg/100 or more) was found in the studied groups. However, there was a tendency for neonates born after accelerated or induced labour to have slightly higher bilirubin levels than those born after spontaneous labour. No strong dose dependent effect on the level of bilirubin concentration following Prostaglandin E2 induced labour was demonstrated.

The uterine activity of women during induced labour was analysed with a real-time Commodore PET 2001 series microcomputer. The active contraction area was measured in torr-min (1 torr = 0.133 kPa) per 10 min epochs [uterine activity unit (UAU)/10 min]. Surgical induction was followed immediately by administration of a geometric oxytocin infusion and all patients received epidural analgesia. Twenty-eight primigravidae for whom inductographic and partographic progress were normal had a mean 'stable phase' uterine activity of 118 +/- 2 SD 43 UAU/10 min (identical to 942 +/- 2 SD 343 kPas/10 min) whereas 15 multiparae had a mean 'stable phase' of 83 +/- 2 SD 34 UAU/10 min (identical to 662 +/- 2 SD 271 kPas/10 min). This difference was significant (P less than 0.01). The construction of uterine activity charts is described and their clinical application discussed.

In 160 women large but variable amounts of intravenous oxytocin were needed to induce labour within a reasonable time interval to 5 cm cervical dilatation. Thereafter 7 mU of oxytocin/min would maintain progress. Since large maintenance doses may cause obstetric problems it is recommended that a maintenance regimen should be used once labour has progressed to this stage.

Oral glucose tolerance and insulin response to glucose were analysed in 124 pregnant women during the fourth quartile of pregnancy. Employing different criteria for the detection of glucose intolerance, 9% to 21% of women were abnormal, and using the H index 43% would have been declared "diabetic". There was no evidence of a progressive change in the glucose curve detectable by the H index within the fourth quartile of pregnancy. There was no association between actual or potential fetal morbidity and any of the interpretative criteria employed. It is concluded that the oral glucose tolerance test should be interpreted with caution if non-pregnant criteria of abnormality are employed.

In planned delivery it is often advantageous to be able to monitor the early course of stimulated labour. This paper describes the construction of a graph which defines the rate of progress of the latent phase of augmented labour in 307 women, which represented 80% of a group of patients in a "low risk" category obstetrically.

The accuracy of predicting fetal maturity by ultrasound cephalometry, radiology, and liquor studies in patients with unknown confinement dates has been compared. The best prediction was given by ultrasound cephalometry. Liquor studies were least helpful.

The method of estimating gestational age from the height of the fundus uteri during pregnancy has been investigated. Such wide variations occur in the length of the maternal abdomen and umbilical position and in the level of the uterine fundus at each gestational age that the method is not reliable. Assessment of uterine size by pelvic examination in the first trimester of pregnancy correlates more closely with gestational age than assessments made by abdominal palpation of the uterus at a later time.