Uterine artery Doppler flow velocity has limited diagnostic accuracy in predicting pre-eclampsia, intrauterine growth retardation and perinatal death.

Objective-To assess the delivery and acceptability of antenatal couple screening for cystic fibrosis. Carrier status was notified only when both members of a partnership had cystic fibrosis alleles and therefore a one in four risk ofhaving an affected child.Design-Mouthwash samples were tested when both partners participated. Results were returned only to positive couples.Setting-Two large maternity hospitals in Edinburgh.Subjects-Screening was offered to all couples who booked at one ofthe two hospitals.Main outcome measures-(a) The take up of screening, carriers and carrier couples identified, take up of prenatal diagnosis, and numbers of affected fetuses detected; (b) questionnaire measures ofpatient satisfaction and stress.Results-Screening was offered to 8536 couples.714 (8-4'V/o) were regarded as ineligible, usually because oflate booking or absence of a partner. 1900

A retrospective review of all women diagnosed with endometrial adenocarcinoma over a 5-year period was performed. One hundred and eleven women had not defaulted from follow-up and were thought to be disease-free following primary treatment. Seventeen (15.3%) of this group of women developed recurrent disease; four of these being detected in asymptomatic patients at routine follow-up visits. Women with asymptomatic recurrences had a significantly better survival than those presenting with symptoms (25% vs. 8%, P = 0.048). On the basis of previous findings, a limited hospital surveillance protocol was applied retrospectively to these patients with an estimated financial saving of over 2500 per annum. However, as one asymptomatic recurrence was detected by vault cytology during the 2 years after primary treatment, it may be worthwhile continuing to perform vault cytology during this period.

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The disadvantages of the fluid filled polythene catheter used for measuring intrauterine pressure have been overcome by designing a catheter with a pressure transducer at the tip. The information which it gives is accurate and reliable. The optimum method of use has been determined and clinical trials performed. There is no demonstrable morbidity from its use.

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Objective To evaluate the diagnostic prediction of intrapartum umbilical artery Doppler velocimetry for adverse perinatal outcomes using systematic quantitative overview of the available literature.Design Online searching of MEDLINE database (January 1966-September 1997, scanning of bibliography of known primary and review articles, review of recent journal issues and that from personal files. Study selection, assessment of study quality and data extraction were all performed in duplicate under masked conditions.Participants 2700 women (unselected, low, high, and combined low and high obstetric risk populations) included in eight studies selected for meta-analyses. Main outcome measuresLikelihood ratios (LRs) for positive and negative test results were generated for the following outcome measures: Apgar scores c 7 at 1 and 5 minute following delivery, small for gestational age fetus; intrapartum fetal heart rate abnormality, umbilical arterial acidosis at delivery; and caesarean section for fetal distress.Results For Apgar score c 7 at 1 minute following delivery, the pooled LR was 2.5 (95% CI 1.7-3.7) for a positive test and 1.0 (95% CI 0.9-1-1) for a negative test result. A positive test predicted an Apgar score < 7 at 5 minute following delivery with a pooled LR of 1.3 (95% CI 0.4-4-1) while a negative test had a pooled LR of 1.0 (95% CI 0.8-1.2). For the prediction of a small for gestational age fetus, the pooled LR was 3.4 (95% CI 2-3-5.1) for a positive test and 0.9 (95% CI 0-8-1.0) for a negative test. The prediction for fetal heart rate abnormality during labour was similarly disappointing: the pooled LR for a positive test result was 1.4 (95% CI 0.9-1.2) whereas a negative test result generated a pooled LR of 0.9 (95% CI 0.9-1 e0). With umbilical acidosis at delivery, the pooled LR was 1.6 (95% CI 1.1-2.5) for a positive test and 1.1 (95% CI 1-0-1.2) for a negative test. The LRs for the prediction of caesarean section for fetal distress were 4.1 (95% CI 2.7-6.2) for a positive test result and 0-9 (95% CI 0-8-1.0) for a negative test result.Conclusion Intrapartum umbilical artery Doppler velocimetry is a poor predictor of adverse perinatal outcomes.

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