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The effects of intravenous metoclopramide (Maxolon) on the lower oesophageal sphincter (LOS) were studied in three groups of patients, one group being normal control and the other two being pregnant females, one without heartburn and the other with. Metoclopramide increases the LOS pressure 20.5, 15.2 and 10.2 cm H2 O respectively (p These findings suggest that for patients undergoing elective or emergency obstetrical anaesthesia, intravenous metoclopramide may help reduce the incidence of regurgitation of gastric contents.

Gastric (GP) and lower oesophageal sphincter pressures (LOSP) were measured in non-pregnant female volunteers (group I) and pregnant women with (group III) or without (group II) heartburn. Patients in early pregnancy had greater gastric pressures than group I. Mean barrier pressure (LOSP-GP) was significantly decreased in pregnant patients complaining of heartburn (group III) compared with groups I and II.

The effects of intravenous hyoscine 0·4 mg and atropine 0·6 mg on lower oesophageal sphincter tone were studied in normal human subjects. Hyoscine and atropine both decreased the lower oesophageal sphincter (L.O.S) pressure by approximately 11 cm H2 O (p These findings are relevant to the preoperative preparation of patients presenting for emergency obstetrical anaesthesia; since gastro-oesophagus reflux and pulmonary aspiration of acid gastric content continues to be a significant cause of morbidity and mortality.

Intraluminal gastroesophageal pressure and pH studies have been performed on 8 nonpregnant women, 10 pregnant women with heartburn, and 10 pregnant women without heartburn. Each patient was tested under resting conditions and after intravenous injection of 0.6 mg atropine. In both groups of pregnant patients the intragastric pressure was found to be higher than that of the nonpregnant subjects. The stomach to lower esophageal sphincter pressure (LESP) gradient under resting conditions was least in the pregnant patients with heartburn. After the administration of atropine, a fall in the LESP occurred in all 3 groups of patients which was most profound in the nonpregnant subjects and in the pregnant patients without heartburn. These changes and the pH recordings of the lower esophagus indicate the adverse effect that atropine has on the competency of the LESP both in pregnancy and in the nonpregnant state. Atropine should therefore be used with caution as a premedicant and preferably combined with metoclopramide (Maxolon).

In the 5-year period 1964–68, 16 cases of jaundice in pregnancy were encountered in the Queen Mother's Hospital, Glasgow—an incidence of one in 853 deliveries. The cases, classified according to clinical and biochemical findings, showed considerable variation in type. Infectious hepatitis and intrahepatic cholestatic jaundice were the commonest varieties but there were cases associated with acute urinary tract infection, with prolonged vomiting, and due to extra-hepatic biliary obstruction. One patient had afibrinogenaemia, and Factor VII deficiency was present in 5 patients. Liver biopsy during pregnancy was not considered necessary. There were no maternal deaths although many of the patients had a severe illness and one proceeded to develop signs of cirrhosis. The two foetal deaths in the series were in infants delivered before the 30th week of gestation. Premature labour is a risk in jaundice as in any other acute illness in pregnancy.

A significantly greater rise in carboxyhaemoglobin concentration in response to smoking a single cigarette was shown in pregnant (3-9% increase) as opposed to non-pregnant (2-1% increase) women. This was more pronounced when anaemia was present (5-0% increase) and appeared to be inversely related to the haemoglobin concentration. We suggest that the risks to the fetus may be particularly increased when anaemia complicates pregnancy in women who smoke cigarettes.