Platelet activity (microaggregate formation, ADP-aggregation and beta-thromboglobulin release), coagulation activity (fibrinogen level and factor VIII related antigen/coagulant activity), and rheological factors (plasma viscosity, whole-blood viscosity and erythrocyte deformability) were studied serially in 14 healthy pregnancies to determine the effect of gestational age. Fourteen patients with pre-eclampsia, each matched for stage of gestation with a normal pregnancy, showed normal rheology of circulating blood and normal aggregability of circulating platelets, but there was a significant increase in platelet release of beta-thromboglobulin and a shorter platelet production time, indicating a shorter life-span. The results suggest that localized platelet activation within the utero-placental microvasculature, rather than a rheological abnormality, is a likely contributory factor to the occlusive vascular lesion of pre-eclampsia and fetal growth retardation.

Summary The platelet count in 550 patients with gestational hypertension was significantly lower and the mean platelet volume significantly higher than in normal pregnant women. Both the platelet count and volume became increasingly abnormal when hypertension was accompanied by oedema, proteinuria or both, and women with severe pre‐eclampsia or eclampsia had the lowest platelet counts and the highest mean platelet volume. The proportion of patients with thrombocytopenia and/or macrothrombocytosis also varied with the severity of the clinical presentation. Fibrinogen degradation products were found mainly in fully developed preeclampsia. These findings confirm the concept of a rapid platelet turnover caused by low‐grade disseminated intravascular coagulation in gestational hypertension. The platelet pattern in essential hypertension is similar to that seen in normal pregnancy.

No abstract

A retrospective review is presented of 89 patients with glandular dyskaryosis in order to formulate a management protocol. Fifteen patients had cervical intraepithelial neoplasia (CIN) without glandular abnormality (17%). One patient had adenocarcinoma in situ of the cervix and one patient had vaginal intraepithelial neoplasia (VAIN) grade III. Twenty-two patients had endometrial carcinoma (24.5%) and 11 patients had cervical carcinoma (12.5%). Of the patients presenting with post-menopausal bleeding as well as having glandular dyskaryosis, 69% had a gynaecological malignancy. In conclusion, colposcopy and out-patient endometrial sampling are recommended in all cases. Patients with abnormal endometrial sampling require hysteroscopy. Cone biopsy is necessary to exclude occult glandular disease if cytology remains abnormal despite negative colposcopy and sampling.

No abstract