Objective To assess the outcome of a modified laparoscopic‐assisted Doderlein hysterectomy. Define A prospective clinical study. Setting Women's Endoscopic Laser Foundation, South Cleveland Hospital, Middlesbrough, Cleveland. Subjects Twenty consecutive women with indications for hysterectomy and unsuitable for vaginal approach. Intervention Laparoscopic‐assisted Doderlein hysterectomy with modification to make the technique cost effective. Main outcome measures Operative time, uterine weight, blood loss, hospital stay, intra‐operative complications and post‐operative complications. Results The median operative time was 93 minutes, the uterine weight was 168 g, blood loss minimal. The median hospital stay was three days. There were no intra‐operative complications and minimal post‐operative complications. Conclusions The modified laparoscopic‐assisted Doderlein hysterectomy is a safe, rapid procedure which allows the patient to achieve all the benefits of laparoscopic surgery with simple and inexpensive laparoscopic and vaginal techniques.

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The role of the maternal-fetoplacental hormonal system in the maintenance of pregnancy and in the onset of labor was studied by measuring the serum progesterone level in the maternal vein, the umbilical vein and artery at term (n = 34) and in the case of premature births (n = 74). Our results show: 1) During the 28th-40th weeks the serum progesterone concentration in the umbilical vein is greater than in the maternal vein (p less than 0.01) and in the umbilical artery (p less than 0.01), and greater in the umbilical artery then in the maternal vein (p less than 0.01). 2) No correlation was found between the serum progesterone concentration in the maternal and fetal vessels, whereas a close correlation was found between the serum concentration in the umbilical vein and artery. 3) The progesterone concentration of the maternal serum increased during the 28th-40th weeks, but increased only during 28th-36th week in the umbilical vein and artery and fell significantly by the 40th week. From this it appears that the maternal and the fetal progesterone concentrations are interdependent. The progesterone concentration of the umbilical vessels falls before term but it is not an essential factor in the onset of labor.

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The authors compared the serum DHAS and cortisol level in 53 vaginal deliveries with those of 21 caesarean sections prior to the onset of labour at the 28th to 36th weeks. They also compared 18 vaginal deliveries with 16 elective caesarean sections at the 40th week. The serum hormone concentrations were measured in the maternal vein, the umbilical vein and the umbilical artery. The results indicate that the serum DHAS and cortisol level was higher after vaginal delivery than after caesarean section in the maternal vein, umbilical vein and umbilical artery at the 28th to 36th and also at the 40th week. The authors suggest that, although the role of the fetal adrenal cortex is not so definitive as in the case of some species in the onset of labour, it may be presumed that the increase in adrenal cortical activity cannot be explained exclusively by maternal stress.

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Anti-D antibody-dependent cellular cytotoxicity of peripheral blood mononuclear cells was measured against O, Rh (D)-positive erythrocytes in 20 healthy pregnant women (chosen from all trimesters), and in 16 toxemic patients; it was then compared to the cytotoxic activities of 20 women 3 months after parturition and to that of 42 nonpregnant women. The application of an enzyme-like kinetic model for measurement of maximal cytotoxic function has permitted sensitive determination of the K cell function. It was found that during normal pregnancy maternal K cell activity did not change, whereas it was significantly decreased in preeclampsia.