The relation of maternal body build to pregnancy outcome was studied in a prospectively collected one year cohort of singleton pregnancies in Northern Finland. Of the 9015 women, 11.0 per cent were thin (body mass index < 19) and 3.9 per cent obese (body mass 1 3 0 ) .Maternal thinness was most common among young nulliparous women who smoked and obesity among multiparous women of advanced age and lower educational status. Maternal thinness marginally increased the risk of pre-term delivery but had no other relation to the course of labour. It was also associated with the number of small for gestational age and low birth weight babies, whose morbidity was minor compared with similar babies of obese women. Obesity was associated with an increased risk of hypertensive and diabetic disturbances and complications of the course of labour. It was also associated with more macrosomic, large for dates babies and marginally with the number of babies who were transferred to the neonatal intensive care unit after birth.

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Objective To study the effect of daily treatment with 50 mg of aspirin (ASA) on the hypertensive pregnancy complications and on the production prostacyclin (PGI2) and thromboxane A2 (TxA2) in high risk pregnant women and their infants. Design Placebo controlled prospective study. Setting Departments of Obstetrics and Gynaecology, University of Helsinki, University of Oulu and Central Hospital of Middle Finland, Finland. Subjects Two hundred and eight pregnant women with pre‐existing hypertension or a history of severe preeclampsia in their previous pregnancy. Prostanoids were studied in a subgroup of 18 women. Interventions The women were randomised to receive ASA (50 mg/day, n= 103) or placebo (n= 105) from the mean of 15 weeks gestational age to delivery. The exacerbation of pre‐existing hypertension or the appearance of hypertension in previously normotensive women, the appearance of proteinuria and fetal growth were the main end points, but some other clinical characteristics were also recorded. Urinary excretion of PGI2 and TxA2 metabolites by mothers and infants and their production in umbilical arteries in vitro were also studied. Results Two women (one in both groups) had miscarriages, and one pregnancy was terminated for fetal anencephaly (ASA group). In addition, seven women discontinued the treatment due to urticaria (two women in ASA group), increased activity of aspartate amino tranferase in serum (one woman in both groups), or increased bleeding time (one woman in ASA group, two women in placebo group), and one woman in the placebo group was lost from follow‐up. Thus the end points could be assessed in 97 women taking ASA and 100 women taking placebo. ASA did not diminish the rate of the rise of blood pressure without (12 vs 14, respectively) or with proteinuria (9 vs 11), but fetal haemodynamic disturbances as assessed by Doppler equipment (1/44 vs 6/45 women studied, P= 0.05) and need for treatment in neonatal intensive care unit (10 vs 21, P= 0.04) were more rare in ASA group. ASA tended to increase the birthweight of the newborn (3348 ± 707 g vs 3170 ± 665 g, mean ± SD, P= 0.07), but two perinatal deaths occurred in ASA group. ASA prolonged the bleeding time of the mother (435 s, 210–998 s (geometric mean, range) vs 349 s, 210–690 s, P= 0.02), but caused no extra blood loss during delivery, nor affected neonatal hemostasis. In a subgroup of mothers (ASA, n = 10; placebo, n = 8), ASA inhibited more than 90% of platelet TxA2‐production, and caused a 65 to 80% decrease in the urinary excretion of TxA2 metabolites, but no decrease in the urinary excretion of PGI2 metabolites. Conclusions ASA did not prevent the rise of maternal hypertension, but improved fetal haemodynamic performance and reduced the need of intensive neonatal care. It inhibited strongly maternal thromboxane A2 but not PGI2 production and thus shifted the balance between PGI2/TxA2 to the dominance of the vasodilatory, anti‐aggregatory side.

An open, randomized, multicenter study was carried out to compare two oral contraceptives as regards their therapeutic efficacy in androgenization symptoms such as acne, seborrhea and hirsutism in women. The preparations used were the combination of 2 mg cyproterone acetate (CPA) with 0.035 mg ethinyl estradiol (EE) (Diane 35, Schering AG, Berlin-West) and 0.150 mg desogestrel (DG) with 0.03 mg ethinyl estradiol (Marvelon, Organon, Oss, The Netherlands). The duration of therapy was 9 months. The combination of CPA-EE was used by 83 patients for 658 cycles and the combination of DG-EE by 79 women for 618 cycles. No pregnancy occurred under either therapy. Both preparations are well tolerated. However, some side-effects, such as reduced libido, nervousness and breast tenderness, were observed more frequently (p less than 0.05) in the DG-EE group than among the users of the CPA-EE combination. The therapeutic outcome was better in the CPA-EE group, especially in cases of facial acne (p less than 0.05). Seborrheic symptoms also responded better to the CPA-EE therapy. The results show that the CPA-EE combination is superior to the DG-EE combination in the treatment of acne and seborrhoea.

Twenty-four cases with antepartal fetal death of one twin are reported. Of the stillborn fetuses 5 were delivered as a fetus papyraceus, 13 had severe and 6 no maceration. The cesarean section rate was 25%. The placenta was monochorionic in 12 cases. Structural defects were found in one monochorionic co-twin of a fetus papyraceus. Otherwise the neonatal morbidity of the liveborn co-twins was not increased if the low gestational age averaging 34 weeks, was taken into account. No manifestations of defective hemostasis were observed in the mothers.

The course and outcome of 23 monoamniotic (MA) twin pregnancies, delivered in Tampere University Central Hospital during the years 1964-1984, were studied retrospectively and compared to 1056 diamniotic (DA) twin pregnancies. The frequency of MA twins was 2.1% of twin pregnancies. Polyhydramnion complicated the pregnancy in 26% of MA vs 6% of DA pregnancies. Two cases were defined as acute polyhydramnion. Preterm labour was stated in 70% of MA pregnancies and deliveries before the 34th week were 4 times more common in MA than DA pregnancies. The cesarean section rate was more than double in MA pregnancies (39%). Entanglement of the umbilical cords was noted four times, and prolapse of the cord in three vaginally delivered cases. Perinatal mortality was 28% in MA vs 5% in DA twins. The most common causes of death were respiratory distress syndrome, congenital malformation and feto-fetal transfusion.

Changes in the management of 1120 twin pregnancies delivered in Tampere University Central Hospital during the years 1964-1985 were studied, together with changes in the pattern of perinatal deaths. Perinatal mortality decreased from 7.4% in 1964-68 to 3.5% in 1981-85. There were no significant changes in stillbirths. The decrease of perinatal mortality resulted from a reduction in early neonatal deaths, mainly those due to respiratory distress syndrome. Changes in obstetric management include earlier diagnosis by ultrasound, intrapartum monitoring, and an increase in cesarean section rate from 4% to 32%. There is still a need for a reduction in the number of very early preterm births, and for more effective intrauterine supervision of twin pregnancies.

Objective To investigate the relation between concentrations of endothelin and atrial natriuretic peptide (ANP) in maternal plasma and vasospasm in the uterine and umbilical arteries as detected by duplex pulsed colour Doppler ultrasonography in hypertensive pregnancies.Design An observational study.Subjects 32 women admitted consecutively to hospital with pregnancy induced hypertension (seven without proteinuria and 25 with proteinuria) and 78 healthy pregnant women examined at 28–0 weeks gestation.Main outcome measures Systolic/diastolic (S/D) ratio in flow velocity waveforms (FVWs) and plasma concentrations of endothelin and ANP in the 32 women with pregnancy induced hypertension; plasma concentrations of endothelin and ANP in 78 healthy pregnant women (controls).Results Pathological FVWs suggesting vasospasm in the uterine or umbilical artery, or both arteries, were found in 12 women with hypertension. Plasma ANP was significantly higher (P= 0.03) in the women with hypertension and pathological FVWs (median 23.0, range 10.1–52.8 pmol/1) than in those with hypertension and normal FVWs, (median 13.8, range 5.3–42.3 pmol/1) but corresponding plasma endothelin levels did not show any significant difference (median 1.63, range 0.51–3.33 pmol/1 and median 1.38, range 0.51–3.51 pmol/1, respectively).Conclusion Local release of endothelin from the vascular endothelium is thought to cause vasospasm in pregnancy induced hypertension but this does not seem to increase the concentration of endothelin in the maternal peripheral plasma, probably because of its rapid disappearance from the blood circulation. As ANP dilates the blood vessels, the increase of its release in hypertensive pregnancies may be a compensatory mechanism against vasospasm.