Plasma total T4 (TT4), T3 (TT3), free T4 (FT4), free T3 (FT3), thyroxine binding globulin, hCG, and erythrocyte zinc content were measured in 43 women with uncomplicated pregnancy and in 71 patients admitted with hyperemesis gravidarum. Plasma concentration of thyroid hormones in hyperemesis subjects showed wide variability and 32% of subjects had high TT4 (higher than mean +2 sd of normal pregnant subjects), 33% had high FT4, 20% had high TT3, and 20% had high FT3. Red cell zinc content, a tissue marker of thyroid status, in the hyperthyroxinemic subjects was not different from that of normothyroxinemic hyperemesis subjects or of subjects with uncomplicated pregnancy. The elevated TT4 concentration decreased spontaneously in all but two of the hyperemesis subjects to normal pregnant levels. The plasma FT4 concentration at presentation correlated with plasma hCG in hyperemesis gravidarum (partial correlation coefficient r = 0.411, P< 0.01), but not in normal pregnancy (partial correlation coefficient r = 0.043) after allowing for the effect of gestational age. We conclude that approximately one third of hyperemesis subjects show transient hyperthyroxinemia and suggest that hCG or a molecular variant of hCG may stimulate the thyroid gland. Nausea and vomiting are common symptoms in pregnancy and occur in over 50% of pregnant women (Evans et al. 1986). Hyperemesis gravidarum, however, is relatively rare and occurs in about 0.2% of all pregnancies in Hong Kong (Chin et al.

Middle cerebral artery pulsatility index is better than amniotic fluid volume or umbilical artery pulsatility index in predicting the risk of thick meconium-stained liquor in labor in uncomplicated postdated pregnancy at 41 weeks.

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Experienced midwives with proper training can detect the majority of major structural abnormalities. Continuous audit and quality control plays a significant role in optimizing the fetal structural examination.

There was significant intermethod difference between the results obtained by 2D and 3D, as well as substantial interobserver variation in 3D measurement of fetal nasal bone length in the first trimester. Independent 3D measurement of nasal bone offers no additional advantages over 2D sonography.

is limited, the size of the ectopic gestational tissue must also be limited, otherwise it would be hard to remove the gestational tissue and trim the enlarged scar thoroughly.Fourth, the degree of adhesion between bladder and uterus cannot be evaluated by intraoperative cystoscopy. Therefore, cystoscopy would not reduce the risk of bladder injury, although it would enable its timely identification.Finally, the hospital stay of the women in our study was perhaps longer than strictly necessary, because transvaginal surgery for caesarean scar pregnancy was a new technique and, to be safe, we needed time to observe complete recovery of the women before discharge.More evidence is needed to demonstrate the effect and safety of transvaginal surgery for caesarean scar pregnancy and timing of this surgery needs to be explored further. We will be pleased to share our future data on this procedure in due course. j

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