Non-closure of the visceral and parietal peritoneum at lower segment cesarean section is associated with fewer postoperative complications, is more cost effective and is simpler than the traditional operative technique of closing both peritoneal layers.

No abstract

The outcome of 635 pregnancies in 197 women before and after conization is reported. After conization a significant increase in premature deliveries occurred in young women (age 21-25), nulliparae representing the highest risk. The rate of premature deliveries in this age group was 4.4% before conization and 30.6% after conization. No such increase could be found in any other age group. Labor was notably short in non-parous women and in parous women it started with rupture of the membranes significantly more often after conization. In addition, a significant increase in the frequency of cervical stenosis was observed, but this was of clinical significance in only one case. Treatment in the form of prophylactic cerclage did not reduce the incidence of either premature delivery or of late spontaneous abortion.

In breech presentations at term vaginal delivery can be achieved in 85% of grandmultiparas without significant neonatal morbidity. Elective cesarean section is associated with increased maternal morbidity compared with planned vaginal delivery.

Summary The attitude of the fetal head was determined in 445 women with breech presentations. Thirty‐three women (7.4 per cent) were found to have a fetus with the head in various degrees of hyperextension. Of these 26 were born vaginally and seven by Caesarean section. At follow‐up (2 to 4 years) five of the vaginally born infants (22 per cent) had neurological sequelae referable to spinal, supraspinal and cerebellar injuries but all infants born by Caesarean section were normal. The results emphasise the value of an abdominal X‐ray examination of all women with breech presentations. Caesarean section is recommended if the fetal head is hyperextended.

Using a filter method, levels of free (unbound) and protein-bound progesterone in blood samples were measured serially from the 23rd week of pregnancy until delivery in 16 healthy women. In addition, total estrogen and progesterone concentrations were determined by radioimmunoassay. The levels of both free and total progesterone increased steadily until the end of pregnancy. Free progesterone increased with advancing pregnancy more in proportion to the total progesterone, as it rose from 6% (of total) at week 24 to 13% at week 40. Both free and total progesterone decreased markedly very soon (2 h) after delivery. However, the corresponding decrease in the level of free progesterone was considerably less, with the result that it rose to 19% of the total, the greatest proportion of free progesterone observed at any time. The levels of both total estrogen and progesterone in plasma increased with advancing pregnancy, and at no time, prior to delivery, was there a significant fall in progesterone or an abrupt rise in estrogen.

Lee, R. A. & Symmonds, R. E. (1972) Surgical repair of posthysterectomy vault prolapse. Am J Obster Gynecolll2,953-956. Mengert, W. F. (1936) Mechanics of uterine supporl and position. I. Factors influencing uterine support. Am J

Summary. Nine women suffering from vaginal vault prolapse had an abdominal sacropexy between 1972 and 1983. Marlex mesh was used to anchor the vaginal vault to the promontory of the sacrum and was completely buried retroperitoneally. The women had all had previous attempts at surgical correction. There were no intra‐ or post‐operative complications. No recurrences of vault prolapse occurred during a mean follow‐up period of 3.9 years. One woman developed a moderate cystocoele 4 years after sacropexy.