In the hope of reducing perinatal risks associated with retardation of intrauterine growth a previously described two stage ultrasound screening schedule was evaluated by a controlled trial in 877 women with low risk single pregnancies. The two stages of ultrasound examination were an assessment of gestational age during early pregnancy followed by measurement of length from crown to rump and area of trunk at between 34 and 36 weeks' gestation. The product of crown to rump length and trunk area was calculated.The sensitivity of this schedule in identifying in advance 94% of babies who were small for dates at birth, with 90% specificity, and the speed and simplicity of measurement confirmed the accuracy and feasibility of two stage ultrasonography as a screening procedure. The controlled trial did not, however, show any benefit from its routine application in these low risk pregnancies.

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Adapting Sir Dugald Baird's concept of primary obstetric causes of perinatal mortality, a revised clinico-pathological classification has been evolved to take account of new knowledge and developments, and to direct attention to potentially avoidable deaths and to where intensified efforts and investigation are needed. Categories highlighting the importance of intrauterine growth retardation, unexplained intrauterine death and spontaneous premature labour have been introduced, intrapartum hypoxia is separated from birth trauma, and infection again has its own category. Regular perinatal audit at one obstetric hospital, since 1979, has shown that the new system provides a workable and useful means for classifying not only perinatal deaths, but also late abortions, late neonatal deaths and perinatally related infant deaths. The rate of total perinatally related wastage, defined in this way, was almost twice that for perinatal mortality (22-8 compared with 11.9 per 1000 births). The former is advocated as a more realistic index for the audit of perinatal care. The revised and extended system is put forward as a contribution to the current debate on classifying and reporting such wastage, in the hope that it may be tested as a model for regional as well as hospital surveys.Perinatal mortality should be classified in several ways-epidemiological, by time in relation to birth (stillbirths and first week neonatal deaths; or antepartum, intrapartum and postpartum), obstetric, neonatal and pathological. Each has

Summary A new method of estimating fetal weight from the circumference of the fetal trunk, measured by ultrasound, is described. Comparison of weights estimated in this way with the actual birth weights of 50 fetuses, delivered not more than 48 hours later, shows a mean error in prediction of only 75 g, and in 94 per cent the error was less than 145 g. With such accuracy, the method is of clinical value, particularly in anticipating difficult delivery and in monitoring growth of the fetus at risk.

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To find an effective routine screening method for small-for-dates fetuses 474 women with singleton pregnancies participated in a two-stage ultrasonic examination schedule. At the first-stage examination, which was conducted in early pregnancy, fetal crown-rump length or biparietal diameter was measured for an accurate assessment of gestational age, which was essential for interpreting the results of the second-stage examination. The second-stage examination was performed at 34-36 weeks and entailed measuring seven fetal variables, the results of which were assessed singly and in combination after delivery to identify the best indicator of small-for-dates fetuses. Fetal head measurements proved to be the least sensitive indicators of growth retardation, correctly identifying only 56-59% of cases. Measurements of trunk area and circumference, however, correctly identified 81% and 83% of cases respectively, but the most effective screening index was the product of crown-rump length and trunk area: with this index 34 out of 36 small-for-dates fetuses (94%) were correctly identified. Calculating the product of crown-rump length and trunk area from ultrasonic displays is quick and simple, and combined with the first-stage examination is a highly reliable screening method for small-for-dates fetuses.

estimated risk of thrombotic stroke in users of second versus third generation pills. The United Kingdom and the continental countries had similar findings. These odds ratios should be assessed against the backdrop of the small absolute risk they entail and in the context of the clear benefits of use of oral contraceptives for women of reproductive age. The annual event rate is between 1-1.6 stroke events per 10 000 women aged 25-44-that is, 1 stroke per 12 000 women. Three strokes per 100 000 women per year may be attributable to the use of oral contraceptives. This risk could be controlled by avoiding prescription of the pill in women who have important cardiovascular risk factors such as high blood pressure and might be lessened by appropriate management of these risk factors.The investigators were accountable only to the Scientific Reference Board (members listed in reference 1).

Summary. Blood viscosity and several of its determinants (packed cell volume, plasma viscosity, plasma fibrinogen and erythrocyte deformability) and several haemostatic variables (platelet count, serum fibrin degradation products and plasma soluble fibrin) were measured in 106 women during normal third‐trimester pregnancy, 12 patients with moderate pre‐eclampsia, nine patients with severe pre‐eclampsia and 16 patients with confirmed fetal growth retardation. Blood viscosity was measured at high and low shear rates (94.5 and 0.94 s−1), with and without correction to a standard packed cell volume of 0.45. In normal pregnancy low‐shear blood viscosity increased significantly towards term, associated with significant increases in packed cell volume and plasma viscosity (but not fibrinogen); there was no change in high‐shear blood viscosity at native packed cell volume and a decrease in viscosity after correction for packed cell volume, associated with a significant increase in erythrocyte deformability. Significant decrease in the platelet count and significant increases in serum fibrin degradation products and plasma soluble fibrin suggested a degree of haemostatic activation in normal third‐trimester pregnancy. In moderate pre‐eclampsia blood viscosity was significantly lower at low shear rate, due to a significantly lower packed cell volume and despite a significantly elevated plasma viscosity. In severe pre‐eclampsia high‐shear blood viscosity was significantly elevated after correction for packed cell volume, associated with a significantly reduced erythrocyte deformability; plasma fibrinogen levels were reduced, but other variables were not significantly abnormal. In fetal growth retardation blood viscosity was significantly increased at both shear rates, despite a reduced packed cell volume: this was also associated with a significant reduction in erythrocyte deformability. In general there was little correlation between blood viscosity factors and haemostatic variables, but in normal‐term pregnancy soluble fibrin levels correlated with blood viscosity at both shear rates. We suggest that increased blood viscosity and decreased erythrocyte deformability may play a role in the placental insufficiency of severe pre‐eclampsia and fetal growth retardation.