Summary
In 92 women complaining of heavy but regular periods for which no cause was found, the relation was studied between measured menstrual blood loss during two consecutive periods and the patient's subjective assessment of blood loss, the number of days of bleeding, and the number of sanitary pads and tampons used. There was no correlation between menstrual blood loss and these parameters. In many women these parameters are not a reliable indicator of the volume of menstrual blood loss. In 40 of the 92 women, who subsequently had a hysterectomy because of their complaint of menorrhagia, the uterus was weighed and the endometrial surface area measured. The view that menorrhagia is associated with a large uterus or a large endometrial surface area could not be confirmed.
Summary
In women with menorrhagia of unknown cause, the efficacy of the drug danazol in reducing heavy menstrual blood loss was investigated making objective measurements of menstrual blood loss. Drug regimens tested were daily administration of 200 or 100 mg danazol for 12 weeks and daily danazol given in the luteal phase or during menstruation. The results suggest that 200 mg danazol daily is the most acceptable regimen clinically since it significantly reduced menstrual blood loss and was associated with a relatively low incidence of side effects. In 16 women on this dose menstrual blood loss was suppressed from a mean pre‐treatment loss of 183±25ml to 38±11 ml (p<0.01) in the second, and 26±9 ml (p<0.01)in the third treatment months. The majority of women had regular episodes of bleeding with no alteration in cycle length and a reduction in the number of days of bleeding. Although 100 mg daily suppressed menstrual blood loss, particularly by the third month of treatment, it increased the number of episodes of bleeding in some women which they found unacceptable. Both 200 mg and 100 mg relieved dysmenorrhoea in the majority of women presenting with the symptoms. Danazol taken daily in the early follicular or luteal phase of the menstrual cycle did not significantly alter menstrual blood loss. There was no effect of placebo therapy on measured menstrual blood loss in a single blind trial in eight women with menorrhagia.
A retrospective study was undertaken to document immediate morbidity and mortality associated with low Apgar scores (5 or less) at 5 min in singleton term babies (37 weeks or more). From October 1986 to February 1987, 84 term babies had low Apgar scores, giving an incidence of 15/1000 live births. Overall mortality in these patients was 42%, and in those in whom Apgar scores remained 0-3 at 5 min, mortality was 77%. Evidence of severe-to-moderate hypoxic-ischaemic encephalopathy was noted in 44 (52%) and 17 (20%) failed to establish spontaneous respiration within the 1st few hours of life. Meconium aspiration syndrome was diagnosed in 29 (35%). A control group of 141 term babies with 5-min Apgar scores of 7 or more were identified and the presence of possible risk factors associated with low Apgar scores was assessed. Primiparity and prolonged second stages of labour in all parities were found to be significantly associated with low Apgar scores. Improved obstetric care and appropriate management of the newborn at delivery and in the neonatal period may help to reduce mortality and morbidity in some term babies.
A prospective randomized, controlled trial involving 640 singleton breech presentations after 30 weeks gestation was conducted to assess the value of external cephalic version. In 310 patients external cephalic version was attempted; the other 330 patients in whom version was not attempted constituted a control group. There were three perinatal deaths directly attributable to external cephalic version. No significant differences were found between the study and control groups respecting the incidence of vaginal breech delivery, caesarean section rate, perinatal mortality and morbidity. Our results suggest that there is no place for external cephalic version before 36 weeks gestation.
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