s and untreated, maternal and fetal mortality amounts to 40-50% 2 3. Classically, physicians search for the tumour in hypertensive patients with paroxysmal symptoms such as headache, sweating or palpitations. However, our patient presented atypically and would have been left undiagnosed. Case presentation A 21-year-old presented after a fall at 24 weeks gestation, with loin pain on the contralateral side to the fall. This prompted an ultrasound scan that demonstrated a 9 cm 'haema-toma' above the right kidney. As she was claustrophobic, she declined magnetic resonance imaging (MRI). A repeat ultrasound was performed which showed the mass to be unchanged. Suspicion arose and an MRI under sedation was performed (as recommended to look for adrenal/renal mass in pregnancy 4). This confirmed an 8 cm × 7 cm mass superior to the right kidney. An endocrinologist reviewed her and serum and urine biochemistry investigations were performed. Her urinary 3-methoxytyramine and serum dopamine levels were raised 5 6 indicating possible phaechromocytoma. She did not need α-adrenoceptor blockade, as she remained asymptomatic throughout her pregnancy. She was referred to a tertiary hospital where an elective Caesarean section and surgical tumour removal were performed simultaneously. Conclusion Diagnosing phaeochromocytoma in an asymptomatic pregnant patient is challenging. However, when diagnosed, a multidisciplinary team approach (obstetrician, surgeon and endocrinolo-gist) is vital in the management of this rare disorder. RefeRences 1. Lenders JWM. Phaeochromocytoma and pregnancy: a deceptive connexion. Many haematological changes occur during pregnancy to accommodate maternal and fetal needs. Thus, monitoring of this patient groups' haematological indices are imperative. International guidelines recommend minimum haematological sampling at booking and 28 weeks. A prospective audit was conducted between January and April 2012. Postnatal patient charts were randomly sampled, and relevant data extracted. This was entered into a secure database. Haemato-logical indices from throughout pregnancy and within 1 week of the postnatal period were extracted from institutional laboratory systems retrospectively. 176 patients were included in our sample group, with a total of 757 samples taken. The average age of patients was 31. Within this sample, there were 100 vaginal deliveries and 76 caesarean PM.91 We present an unusual case of sepsis in a 23 year old lady of 14 weeks gestation (para 1 + 1) who presented with epigatric pain. Initial presentation was with bilious vomiting which became blood stained. She reported not opening bowels for 2 days however had passed flatus. There was no significant past medical history with only appendicectomy performed 5 years previously. On examination abdomen was slightly distended with tenderness in the epigas-tric region. Bloods were: WCC 2.5, Neut 1.5. Other bloods including amylase were normal. She was reviewed by the surgical team 'bili-ary colic' and an abdominal ultrasound performed, was normal. ...

Sotalol, a beta-adrenoceptor blocking drug, was administered to 12 hypertensive pregnant women. The concentration of the drug was assayed in samples of maternal plasma, amniotic fluid and mixed umbilical cord plasma at delivery and, in five mothers who elected to breast feed, in paired samples of maternal plasma and breast milk. Sotalol reduced blood pressure effectively at a mean daily dose of 433.1 & 54 * 1 mg but crossed the placental barrier. The mean maternal: fetal plasma concentration ratio was 1 : 1.05 and the mean amniotic fluid concentration was 7 * 0 & 2 * 7 pg/ml. Delivery occurred at mean gestational age of 37 * 7 I 0 * 7 weeks ; 12 infants were liveborn with a mean weight of 2 . 8 k O . l kg and eight of them had no significant neonatal problems. Of the other four, two died from severe congenital anomalies, one had perinatal asphyxia and one mild transient hypoglycaemia. High sotalol concentrations were found in breast milk (mean plasma : milk ratio was 1 : 5 -4) raising the possibility of pharmacological effect in the newborn infant. The results suggest that sotalol adequately controls blood pressure in hypertension complicating pregnancy but because, unlike results from the pregnant ewe, it crosses the human placental barrier it offers no apparent advantages over other beta-adrenoceptor antagonists.

A 23-year-old female presented with severe Cushing's syndrome in the 23rd week of pregnancy. Investigations showed plasma cortisol 770 nmol/l (08.00 h) and 850 nmol/l (23.00 h); plasma ACTH was 10 ng/l (08.00 h) and 27 ng/l (23.00 h); urinary free cortisol excretion was 2460 nmol/24 h. Dexamethasone 2 mg 6-hourly for 48 h suppressed the 08.00 h plasma cortisol only to 680 nmol/l. Abdominal C.T. scan showed a right adrenal adenoma. The patient was treated with metyrapone and a good clinical improvement ensued. Plasma cortisol was reduced to 300-500 nmol/l. Depsite ultrasonographic evidence of normal fetal growth, urinary oestriol excretion was markedly deficient. Prior to the spontaneous onset of labour, there was a marked rise in plasma cortisol despite continuous metyrapone treatment. A normal female infant was born at 37 weeks' gestation. The maternal adrenal adenoma was subsequently removed. The deficiency of oestriol synthesis during the pregnancy may be explained by metyrapone-induced inhibition of C19-hydroxylation.

Summary. Intravenous treatment with 10 mg of hydralazine or 100 mg of labetalol was randomly allocated to 30 hypertensive pregnant women. Umbilical artery flow velocity waveforms were recorded using a pulsed Doppler duplex scanner (ATL Mk V) and umbilical artery pulsatility index (PI) and fetal heart rate (FHR) were derived from these recordings. Maternal blood pressure decreased significantly after both drugs. Maternal pulse rate increased after hydralazine but did not change significantly after labetalol. FHR did not change significantly after hydralazine but decreased after labetalol. PI decreased after hydralazine and increased after labetalol‐most fetuses showed little change but a few in each group showed large changes in PI, as did two of five additional patients studied. We attributed the decrease in PI in some fetuses after hydralazine to vasodilation, and the increase in PI in some fetuses after labetalol to vasoconstriction in the fetoplacental circulation, suggesting that fetal beta‐blockade may occur after maternal treatment with labetalol.

Propranolol, a beta-adrenoceptor blocking drug, was administered to 6 healthy pregnant volunteers between 32 and 36 weeks gestation and when at least 6 weeks postpartum. On both occasions, subjects were given propranolol 120 mg orally or 10 mg intravenously in randomised order with a minimum washout period of 1 week. Propranolol was assayed in plasma by gas-liquid chromatography with electron-capture detection and the pharmacokinetic parameters were investigated. There were no significant alterations in elimination half-life, clearance or apparent volume of distribution per kilogram antenatally compared with postnatally: bioavailability was also unchanged. It is concluded that the disposition of propranolol is not altered during pregnancy.

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Sotalol, a beta-adrenoceptor blocking drug, was administered to 6 healthy pregnant volunteers between 32-36 weeks gestation and when at least 6 weeks post-partum. On both occasions, each volunteer was given sotalol 100 mg intravenously and 400 mg orally in randomised order with at least a 1 week washout period between. Plasma samples were analysed for sotalol using a fluorometric method and the pharmacokinetic profiles investigated. The systemic clearance of sotalol was significantly greater in the antenatal period (2.4 +/- 0.3 ml/min/kg) than in the post-natal phase (1.5 +/- 0.1 ml/min/kg). The apparent volume of distribution was similar in the two periods: the elimination half-life was 6.6 +/- 0.6 h ante-natally and 9.3 +/- 0.7 h post-natally after intravenous drug but the trend for faster elimination was not significant. The elimination half-life after oral administration (about 10 h) and bioavailability (about 90%) were not altered significantly by pregnancy. It is suggested that the more rapid clearance of sotalol in pregnancy may be due to increases in renal plasma flow and glomerular filtration rate.

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