S u rn m a r yAdding a particular Alert Line to the cervicographs of Rhodesian African primigravidae has simply and effectively screened normal patients from those with reduced pelvic size and inefficient uterine action. The method can be applied by midwives working in isolated areas. This paper describes the derivation of the line and the results of a prospective study of 624 consecutive patients, whose management in labour was based on its use. The Alert Line would have relevance to practice elsewhere.

Summary The application of an Action Line drawn four hours to the right of the Alert Line on the cervicograph of Rhodesian African primigravidae, with an active form of management for those whose cervicograph crossed the Action Line, has efficiently differentiated patients requiring Caesarean section for cephalopelvic disproportion or incorrectable inefficient uterine action from those who can be safely delivered vaginally. The regime outlined in this paper has reduced the Caesarean section rate, the incidence of prolonged labour and the perinatal mortality rate.

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Uterine activity was measured in 29 nulliparous African women, who were in the active phase of spontaneous labour, and who were delivered vaginally without supplementary oxytocin. A fluid-filled intrauterine catheter, an external strain gauge and a pressure-curve integrator were used t o quantitate uterine activity. The rate o f dilatation of the cervix from entry to the study t o full dilatation of the cervix was > 1 cm/h; this constituted normal labour progress. In nulliparous African women the minimum level of uterine activity likely to be associated with a cervical dilatation rate o f 1 cm/h was 1200 k P a s / l 5 min and the median uterine activity level in the active phase of normal labour was 1824 k P a d l 5 min.

SummaryA total of 132 twin pregnancies first seen at less than 36 weeks gestation were studied prospectively to determine the epidemiological, and anthropomorphic factors associated with single or dual fetal growth retardation; the clinical, biochemical and ultrasound serial measurements that are predictive of single or dual fetal growth retardation, and to design scoring systems for the prediction of fetal growth retardation. A number of factors were associated with an increased risk of fetal growth retardation, but the highest risk was present when there was an abnormality in both plasma oestriol and placental lactogen, and the biparietal diameter growth rates were divergent. Scoring systems were derived using multivariant discriminant analysis for three clinical situations: the patient seen for the first or second time; where only clinical facilities exist and the patient was seen on three or more occasions; and where facilities exist for the biochemical tests of placental function and ultrasonic measurement of the biparietal diameters. The scoring system for the last situation had the highest predictive rate and the lowest false positive rate.

Aims To investigate the prevalence, pain catastrophizing and other predictive factors and clinical course of persistent pain/discomfort associated with teeth displaying periapical healing following nonsurgical root canal treatment (NSRCT). Methodology One hundred and ninety‐eight patients (264 teeth) who had NSRCT were reviewed at 5–14 months, postoperatively. Teeth with persistent post‐treatment pain or discomfort, plus evidence of periapical healing were further monitored 0.5, 4 and 10 years later. Pain Catastrophizing Scale (PCS) and Short Form of the McGill Pain Questionnaire (SF‐MPQ) were completed. Predictive factors were investigated using logistic regression models. Results Twenty‐four per cent (60/249) of teeth displaying periapical healing at first review were associated with persistent pain or discomfort. Fifty‐five teeth monitored 6–7 months later were associated with reduction in pain (17/30) or discomfort (7/25). Cone beam computed tomography (CBCT) of eight teeth with persistent symptoms and complete periapical healing (by conventional radiographs) revealed distinct, small apical radiolucencies (n = 3) or root apex fenestration through the buccal plate (n = 2). History of chronic pain (headache, temporo‐mandibular joint, masticatory muscle, neck, shoulder or back pain; P = 0.005), preoperative pain (P = 0.04), responsive pulp (P = 0.009), tooth crack (P = 0.05) and small periapical radiolucency (P = 0.005) were significant predictive factors. The PCS revealed 16 patients (22 teeth) were catastrophizers (PCS ≥ 30), but this had no influence on post‐treatment symptoms (P = 0.5). Conclusions Persistent pain or discomfort associated with teeth showing periapical healing at the first review after NSRCT, decreased in intensity in most cases over the following 6 months. Longer‐term follow‐up revealed spontaneous improvement or symptom resolution in the majority of those with confirmed radiographic the absence of periapical disease. Five predictive factors (history of chronic pain, teeth with responsive pulps, association with pain, diagnosis of tooth crack before treatment and diameter of preoperative radiolucency) were identified.

Summary. A total of 132 twin pregnancies in black African women were studied prospectively after 30 weeks gestation. Delivery occurred before 37 weeks in 32%. There was a trend (0.1 > P > 0.05) towards a higher preterm delivery rate in nullipara (57%), in women under the age of 20 years (60%) and in those with a height/weight ratio of >2.5 (50%). The cervix was assessed with a score based on the length of the canal minus the dilatation of the internal os. In both term and preterm labour there was a significant relation between a cervical score of 0 or a decrease in cervical score and the onset of labour within the subsequent 14 days (P < 0.001). By these criteria to predict impending labour, 60% of all labours that ensued within 14 days of the assessment would have been predicted with a 20% false positive rate. When nulliparae were excluded the predictive value of cervical assessment for preterm labour was 80% with a false positive rate of < 5%. Plasma oestriol levels were significanty higher in the preterm labour group but had no clinical prognostic value.

We investigated the effect of head compression and acidaemia during labour in 25 African primigravidae. Evidence that head compression had occurred during labour was confirmed by both clinical and radiological means at the end of a trial of labour. No significant difference could be demonstrated in the quantity of fetal electroencephalogram (EEG) abnormality that occurred in the groups with marked head compression as compared to the groups without marked head compression. Deterioration in the fetal EEG to a flat record known as electrocerebral silence (ECS) was associated with the development of acidaemia. As fetal heart rate (FHR) decelerations appeared the percentage of ECS in the fetal EEG record increased significantly (P < 0.05), and likewise, as fetal acidaemia developed a highly significant increase in ECS in the fetal EEG was demonstrated (P < O*OOl). We concluded that in the management of trial of labour there was no significant deleterious change in the fetal EEG as a result of head compression, unless fetal acidaemia supervened. However, in the majority of these cases a significant increase in ECS to more than 20 per cent occurred in association with only moderate acidaemia (pH 7.25 to 7.30).CEPHALOPELVIC disproportion remains a major obstetrical hazard in developing countries and contributes significantly to perinatal death rates. In many cases disproportion and fetal asphyxia co-exist and make the exact cause of death difficult to determine. Perinatal statistics from Harare Hospital, Salisbury reveal that between 15 to 20 per cent of perinatal deaths are due to 269