SummaryRationale: The haemoglobin concentration (Fib) has limitations in the diagnosis of iron deficiency in pregnancy.Objective: The objective of this study was to assess the validity of the accepted cut off points of the other commonly measured haematological indices in either detecting or excluding iron deficiency as determined by the serum ferritin (SF) assay. Design:A cross sectional study was carried out on two groups of women in the second and third trimesters of pregnancy.Setting: University Antenatal Clinic, Faculty of Medicine and Kyoto Medical Centre Galle. Method:The Hb, haematocrit (Hct), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemo globin concentration (MCHC) and red blood cell count (RBCC) were estimated by an automated haematology analyser and compared with the SF levels measured by immunoradiometric assay, in 156 women in the second trimester (T 2 ) and 47 women in the third trimester (T } ) of pregnancy. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and the Kappa statistic were calculated for the accepted cut off points for diagnosis of anaemia, for each haematological index, using a SF<12/ig/L as the diagnostic criterion for iron deficiency. Results:The Hct, MCV and MCHC had a high specificity (96-100%) but a very low sensitivity (10-38%). Only the MCH had a high sensitivity (92% in T 2 ,86% in T 3 ) but it had a low specificity (21-24%). The MCHC had the best accuracy (71% in T3) but its accuracy in T 2 was only 64%. Only the MCHC in T 3 showed some agreement with SF (Kappa 0.41, p=0.00). Conclusion:A single haematological index per se has a poor ability of detecting or excluding iron deficiency in pregnancy. Although the best index is the MCHC, its accuracy is only 64% in the second trimester. Therefore several indices should be evaluated before deciding on a diagnosis of iron deficiency and subsequent supplementation or therapy during pregnancy.

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Objective:To determine the role of lower genital tract microflora and antenatal maternal risk factors in pre term labour (PTL). Design:A prospective cohort study.Setting: University obstetric unit and the Subjects: Two hundred and one pregnant women with periods of gestation (POG) less than 25 weeks, presenting for antenatal care.Method: Antenatal maternal risk factors for PTL were documented and swabs from posterior vaginal fornix and endocervical canal were obtained at the booking visit and at a POG of 32 weeks. The microbiological findings at booking and at a POG of 32 weeks, and the antenatal maternal risk factors in each subject were correlated with the occurrence of PTL. Results and Conclusions:Colonisation of the lower genital tract with probable anaerobic gram negative bacilli at booking and possibly at a POG of 32 weeks was a high risk factor for the occurrence of PTL. Teenage and low socio economic status were also high risk factors associated with PTL. Current multiple pregnancy showed a possible association with the occurrence of PTL.