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In a randomised controlled trial of mothers in labour intramuscular pethidine 150 mg, repeated ifnecessary, was compared with self-administered intravenous pethidine (0.25 mg/kg available at 10-min-intervals) . Each mother agreed to have either method ofpain relief and could opt for epidural block. The intramuscular group had significantly more pethidine than the intravenous group (mean diflerences, primipara 29 mg; multipara 16 mg) . Ratings by mothers of the pain of Ist, 2nd stage and overall (analogue scores and gradings) were consistently better for the intravenousgroup although not significantly different. There were no differences in mean Apgar scores between the babies in thegroups. In mothers who do not choose epidural block, similar pain relief is afforded by adequate intramuscular pethidine or self-demand intravenous pethidine; however, intravenous self-administration is more ejicient since the pain relief is achieved with a lower dose of pethidine.

Summary In a randomised controlled trial of mothers in labour intramuscular

SUMMARY In order to investigate the possible contribution of maternal emotional stress to the aetiology of infantile pyloric stenosis, 100 mothers of affected infants, 100 'normal' controls who had not sought medical advice at any time concerning feeding problems, and 50 mothers of children with spina bifida were interviewed. All completed the Life Events Inventory, which gives a quantitative measurement of stressful life events during a given period. In addition, the subject mothers and 'normal' controls completed form A of the Eysenck Personality Inventory, the Multiple Affect Adjective Check list, and Linear Analogue Scales for the subjective measurement of satisfaction with feeding and distress caused by feeding problems.A highly significant difference was found between the number of items given a heavy weighting on the Life Events Inventory experienced by the subjects and both control groups. This was particularly marked during the last trimester of pregnancy. Personality assessment was very similar in all groups, but maternal anxiety scores were higher in the subjects than in the controls. It is concluded that hypertrophic pyloric stenosis occurs unduly frequently in infants of normal mothers who have been subjected to particularly stressful events during pregnancy.

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