Self-reported snoring is common in pregnancy, particularly in females with pre-eclampsia. The prevalence of inspiratory flow limitation during sleep in pre-eclamptic females was objectively assessed and compared with normal pregnant and nonpregnant females.Fifteen females with pre-eclampsia were compared to 15 females from each of the three trimesters of pregnancy, as well as to 15 matched nonpregnant control females (total study population, 75 subjects). All subjects had overnight monitoring of respiration, oxygen saturation, and blood pressure (BP).No group had evidence of a clinically significant sleep apnoea syndrome, but patients with pre-eclampsia spent substantially more time (31±8.4% of sleep period time, mean±sd) with evidence of inspiratory flow limitation compared to 15.5±2.3% in third trimester subjects and <5% in the other three groups (p=0.001). In the majority of pre-eclamptics, the pattern of flow limitation was of prolonged episodes lasting several minutes without associated oxygen desaturation. As expected, systolic and diastolic BPs were significantly higher in the pre-eclamptic group (p<0.001), but all groups showed a significant fall (p≤0.05) in BP during sleep.Inspiratory flow limitation is common during sleep in patients with pre-eclampsia, which may have implications for the pathophysiology and treatment of this disorder.

No abstract

HELLP syndrome is a rare but potentially serious complication of pregnancy. Correlation with laboratory data and early intervention are vital in achieving a favorable outcome for both mother and fetus.

Cephalopelvic disproportion (CPD) is a recognised obstetric problem with potential risk to both mother and infant. Identification of those mothers at risk of CPD is difficult and has concentrated in the past on such measurements as maternal shoe size and height. Our objective in this study was to examine new anthropomorphic parameters as indicators of CPD. This was a case controlled study of sixty consecutive women, and their partners, who had caesarean section performed for CPD and 60 case matched controls. Measurements included maternal and paternal head circumference, height, shoe-size, body mass index (BMI), infant weight and head circumference. Parity, gestation at delivery, and mode of onset of labour were recorded. Data were analysed using Stata Release 6. Prognostic factors were tested for association with CPD using conditional logic regression. The most important anthropomorphic risk factors for CPD were maternal head circumference in relation of height (P < 0.001), and paternal head to height ratio (P = 0.017). Head to height ratio is taken as the head circumference in centimeters divided by the height in metres. Body mass index was higher in CPD cases (maternal case mean = 27.1, control mean = 25.5; paternal case mean = 27.2, control mean = 26.2). Infant head circumference was not a predictor. Primiparity was an important independent predictor (P<0.001), regardless of the mode of onset of labour. Maternal or paternal shoe-size, induction of labour and gestation at delivery were not predictors. The risk profile for CPD which emerges is one of a tall father where both mother and father have large head-to-height ratios.

Renal transplantation with CyA use is not a contraindication to pregnancy, but it is associated with increased risk, especially when the serum creatinine is > 175 mumol/L.

No abstract

This study aimed to evaluate the morbidity and pregnancy outcome of myomectomy in infertile women with uterine fibroids. This was a cross-sectional study. Records were reviewed for 100 consecutive women in the Rotunda Hospital who underwent myomectomy in the years 1995-1996. A questionnaire regarding subsequent fertility was sent. The study was carried out in the infertility unit at the Rotunda Hospital, Dublin, Ireland. Seventy-five women responded. Multiple myomectomy was performed in 52 (70%). Mean fibroid size was 6.8 cm (range 2-14.5 cm). Nine women (12%) developed complications; five had menstrual problems, two had wound discomfort and two had abdominal discomfort. Twenty-five women (33%) became pregnant. Seven (28%) were IVF pregnancies. Overall six (24%) miscarried. In 19 of 25, pregnancy occurred where fibroids were the only identifiable cause of infertility. We conclude that abdominal myomectomy is associated with a favourable outcome in infertile women particularly if no other confounding variable is present.

Sir;We read with interest the findings by Otterblad Olausson et al. (Vol 106, February 1999) '. We have studied 2228 teenage pregnancies delivered in 1992-1996 in the Rotunda hospital, 17.2% of the total teenage population delivered in the Republic of Ireland'. The teenagers were divided into two groups, < 17 years of age and 2 17 years, in a manner similar to those of the authors. Our findings were similar to those of Otterblad Olausson et al. in that prematurity increased when all teenagers were compared with a group of mothers aged 20-25 years. However, unlike the Swedish study, when mothers younger than 17 years of age were compared with those 17 years old or older there was no significant different in the rate of premature deliveries. We investigated admission rates to the neonatal intensive care unit as a measure of early neonatal wellbeing because our figures were too small to interpret infant mortality. We found that only 2.7% of babies born to teenage mothers were admitted. The main reason for admission was low birthweight (72% of all cases), a possible reflection of prematurity. Another factor may be a tendency identified over the study period of an increasing number of low birthweight babies born to teenage mothers independent of gestation.Our study therefore disagrees with that of Otterblad Olausson et al. in that the younger teenager as being at risk of adverse obstetric or neonatal outcomes. Indeed, the incidence of caesarean section in our 14-15 year olds was 5 5 % , compared with 13.5% in 19 year olds. Geraldine Connolly AUTHORS' REPLY Sir;We are grateful for the comments by Drs Connolly and Byme. In contrast to our investigation', Connolly et aL2 did not find that the risk of preterm delivery was higher among younger compared with older teenagers. The result of our investigation, including information from more than 12,000 births to mothers aged 17 years or less, agrees with many previous investigations including the study of Fraser et al.' who studied 15,000 births to mothers aged 17 years or less, also in a relatively homogenous population. The study by Connolly et al. included only 224 younger teenagers (of whom about 35 delivered preterm). Moreover, multiparity was more common among older than younger teenagers (12% versus 3%), and this was not account for in the analysis. We think our investigation, as well as the study by Fraser et al., supports the hypothesis that the underlying mechanism of increased risk of preterm deliveries among younger teenagers may be different from that of older teenagers; biological immaturity may be more important among the younger teenagers while social and lifestyle related factors may be more important among older teenagers. As nutritional factors may lie in the causal pathway between young maternal age and preterm delivery, we therefore, unlike Connolly et al., feel strongly that the influence of such factors should not be adjusted for in the analysis. Although Connolly et al. found teenagers to be at increased risk of preterm delivery, they did not find t...