Objectives An ultrasound study to establish the nature and limits of fetal growth in a low risk population from 22 weeks of gestation until term. Design Prospective, longitudinal ultrasound study of 274 low risk pregnancies involving organised scanning schedules with all measurements performed by one observer using the same equipment.Results Growth velocity charts have been created for a number of ultrasound parameters including estimated fetal weight, by applying appropriate statistical methods to the serial data. The rates of growth of the biparietal diameter, femur length, abdominal area and estimated weight each have characteristic patterns demonstrating maximal growth rates at different gestations. Conclusions Appropriately derived and calculated ultrasound fetal growth velocity standards have been established. These data are suitable for the evaluation of ultrasonically estimated fetal growth rates in the prediction of adverse perinatal outcome and the further investigation of the role of the intrauterine environment in the origin of adult disease.been highlighted6. This study was designed to establish such standards of growth velocity for a number of fetal measurements in a low risk obstetric population. METHODSThree hundred and thirteen women attending the antenatal clinic at our hospital were enrolled into the study. Entry criteria were gestational age of less than 85 days confirmed by crown-rump length measurement and the absence of recognised risk factors for accelerated or retarded fetal growth (previous SGA or IUGR pregnancy, existing medical disorder or heavy smoking (> 20 cigarettes per day)). All the subjects were scanned for fetal anomaly at 18 weeks of gestation, which is routine practice in our department. Thereafter, the subjects were sequentially entered into one of the four scanning schedules (n = number continuing in the study). weeks (n = 67).These schedules gave weekly coverage of pregnancy from 22 weeks onwards. All ultrasound 60 0

The protein-energy malnutrition classification schemes of Waterlow and McLaren, although similar in other respects, assess the weight-for-height of children in quite different ways. The drawbacks of their two methods are described, and an alternative method is presented which overcomes them. The new index is called weight/height2-for-age, and consists of the ratio weight/height2 expressed as a percentage of the same ratio for a reference child of the same age. Although the index is not age independent, it is insensitive to all but the grossest errors in age for children over 12 months old. The index is equally appropriate for the assessment of obesity. A slide-rule based on the Tanner standard is available to do the calculation.

Objective To establish whether there is an association between preterm delivery and either group B streptococcal urinary infection or the presence of urinary antibodies to group B streptococcal or E. coli antigens.Design A prospective study with urine culture and antibody measurement performed at the first antenatal visit and at 28 weeks gestation.Setting Ninewells Hospital, Dundee.Subjects Two thousand and forty-three women registering consecutively at an antenatal clinic.Main outcome measure Delivery at less than 37 weeks gestation. ResultsNo increase in preterm delivery was observed in women with positive urine cultures for group B streptococci either at booking or at 28 weeks, even when confirmed by positive repeat cultures. Preterm delivery was more common in women with elevated urinary antibodies to E. coli antigens at booking (relative risk 1.81, 95% CI 1.22-2.68, P = 0.005) and at 28 weeks (relative risk 2.36, 95% CI 1-60-3-48, P < 0.0001) and to group B streptococcal antigens at 28 weeks (relative risk 2-24, 95% CI 1.46-3.43, P = 0.0003). Conclusions These data do not support previous reports that positive urine cultures for group B streptococci are associated with an increased risk of preterm delivery. Our report of an association between elevated levels of urinary antibodies and preterm delivery is a new finding consistent with the possibility that a local inflammatory response to uro-genital infection may be important in stimulating the onset of preterm labour. The results suggest that screening for urinary antibodies at 28 weeks gestation might help to identify a group of women at increased risk of prematurity.Infection with many different organisms may play a role in the pathogenesis of preterm delivery. Several studies have suggested an association between colonisation of the genital tract by group B streptococci and both preterm delivery and premature rupture of membranes (Regan et al. 1981;Alger et al. 1988;McDonald et al. 1989). However, other investigators (Hastings et al. 1986) have

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Assays of first morning urine samples for oestrone-3-glucuronide, LH and pregnanediol-3-glucuronide, were used to study endocrine function and return to ovulation in 18 subjects following spontaneous miscarriage. On the basis of the endocrine data, ovulation occurred in all 18 women in the cycle prior to first menses at a mean of 29 days post-partum (range 13-103 days) with one subject conceiving in that cycle. Compared with the second cycle, the first cycle after spontaneous abortion had similar levels of follicular phase peak ovulatory oestrone excretion but lower levels during the late luteal phase (P less than 0.02), lower levels of peak LH (50.5 IU/g creatinine (C) cf. 68.8 IU/g C; P less than 0.04) and lower late secretory peak pregnanediol (4.6 mg/g C cf. 6.1 mg/g C; P less than 0.02). The mean luteal phase length of 12.9 days in the first cycle was shorter than the mean of 14.4 days in the second cycle (P less than 0.02). These data show that, although there is some disturbance of endocrine function in the first cycle after spontaneous abortion, the majority of women have a rapid return to ovulation, making the early use of contraception necessary for those wishing to avoid conception.

SUMMARYIn a cross sectional sample of 655 Glasgow babies the mean birthweight, after adjusting for other factors, of those with unemployed fathers was 150 g less (P<0.02) than for babies whose fathers were employed. A longitudinal study of 107 babies from 2 contrasting areas in Glasgow one of which was a socially deprived area was carried out concuriently. The deficit in length of 2-6% for infants from the deprived area at age 12 months was completely explained by adjusting for length at 1 month, father's height, and father's employment status (P<0 01). The effect of unemployment on the babies' birthweight was not affected by adjustment for sccial class. Unemployment may be related to poor infant growth in inner city areas and a national study is needed to see if the recent rise in unemployment has affected this association.