Objective To assess the clinical and financial impact, and identify the problems, of providing routine antenatal RhD immunoglobulin prophylaxis for Rhesus D negative nulliparae.Design A retrospective (198G1986) and prospective (1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996) comparison between two similar populations, one population with nulliparae offered routine RhD immunoglobulin 500 IU prophylaxis at 28 and 34 weeks of gestation part way through the study period, and the other population not offered prophylaxis at any time.Setting Obstetric units in two counties (three health districts) with similar annual numbers of matemities and the Regional Blood Transfusion Service antenatal serology laboratory.Participants Non-sentisitised Rhesus D negative pregnant nulliparae.Interventions Intramuscular RhD immunoglobulin 500 IU at 28 and 34 weeks of gestation to eligible women booked for confinement in one county; the intervention not offered in the other county.Main outcome measures 1. Rhesus D sensitised second pregnancy rate; 2. success in providing prophylaxis to eligible women; 3. serology laboratory activity changes; 4. potential savings from the prophylaxis programme.Prophylaxis significantly reduced iso-immunisation in the next pregnancy when compared with historical (OR 0.28, CI 0,14453; P < 0.0001) and contemporary controls (OR 0.43, CI 0.22486; P = 0.02). However, success at achieving comprehensive prophylaxis was disappointing, with only 89% of eligible women receiving the first injection, 74% both injections, and for only 29% were both at the correct gestation. Fifty-two percent of women delivered after 40 weeks of gestation, beyond the period of adequate prophylaxis protection. The savings in antenatal interventions, neonatal care and possible long term ill-health that result from very preterm birth should be considerable.Routine prophylaxis for nulliparae significantly reduces the incidence of sensitised next pregnancies with consequent savings, and its adoption nationwide should be encouraged. A programme offering antenatal prophylaxis for all Rhesus D negative women is unlikely to be economic. Improvement in uptake of prophylaxis is needed; alternative administration strategies should be explored.

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In a 2-year period 667 sera from approximately 70000 (0.95%) antenatal patients were found to contain 726 atypical red blood cell antibodies. Overall, 66% of the immunized mothers were rhesus (D) positive. Apart from four antibody specificities to rhesus system antigens, knowledge of the rhesus (D) group gave no guide to the ability of the patients to form any of the remaining 21 specificities encountered. Of the 726 antibodies 221 (30%) were not detected in the initial sample tested and 50 of the 92 patients who produced antibodies during pregnancy had not developed detectable antibody when they were sampled at 28 weeks. The significance of these late onset antibodies is discussed both in relation to the risk of haemolytic disease in the newborn and transfusion reactions in the mother. An optimum protocol for testing is defined which takes account of antibody production during the pregnancy and use of this protocol constitutes an attempt to combine maximum clinical safety with minimal consumption of resources.The Regional Blood Transfusion Centre, John Radcliffe Hospital, Headington, Oxford OX3 9DU specificity and potency, and the corresponding blood type of the consort.

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These results lend weight to the suggestion that women in this age group should receive a specific invitation for breast cancer screening.

SYNOPSIS Forty-one specimens taken from lesions in the post-cricoid region of patients with the Paterson-Kelly syndrome have been examined. Most Forty-one specimens were obtained from post-cricoid lesions in 39 patients. The specimens were mostly small and contained epithelium and subepithelial elements superficial to the main muscular layers. In five instances, the biopsies consisted of epithelium alone. Deeper tissues were present in specimens from four necropsies, but in only one biopsy.Paraffin sections were stained by haematoxylin and eosin, periodic acid-Schiff (P.A.S.) for the detection of glycogen with control sections pretreated with salivary diastase at 37°C. for non-glycogen polysaccharides; Perls's reaction to identify haemosiderin, and van Gieson's stain for collagen. In post-mortem tissue, Luxolvan Gieson's stain was also used to demonstrate nerve and muscle changes.Arrangement of the material into the following three groups facilitates interpretation of the histological appearances in the different lesions.WEBS Twenty-six specimens were derived from postcricoid webs. The 22 women and two men were aged 29 to 74 years (mean 53 9 years) and their mean duration of dysphagia was 9 0 years. Nineteen patients had never required dilatation; five had had one previous dilatation, and the group includes as separate specimens tissues taken on the first occasion in two of these. All but four patients were anaemic either at the time of biopsy or before then. STRICTURES There were nine women with upper oeso-