Summary. Symphysis fundus heights (SF) were measured approximately 15 times during pregnancy in a consecutive series of 2941 women with regular menstrual cycles and known last menstrual period. A reference SF chart from 17 to 40 weeks of pregnancy was derived from measurements in 1350 of these women who were healthy, and heights and pre‐pregnancy weights within the 10th and 90th centiles and were delivered vaginally of healthy infants with a birthweight/length ratio within ±2SD. The reference chart was used to predict fetal growth deviations in the unselected series of pregnancies. The effectiveness of SF measures to detect fetuses with an infant birthweight/length ratio below −2SD or a birthweight below the 10th centile was low; the sensitivity was only 16·7 and 26·6% and the predictive value of positive screening result was 1·8 and 18·0%, respectively. Corresponding values for fetuses with an infant birthweight/length ratio above +2 SD or a birthweight above the 90th centile were 31·8 and 37·5% and 3·3 and 24·5%, respectively. Symphysis fundus (SF) measurement has thus been found to be of limited value as a screening method to detect abnormal size at birth.

The frequency of cornu-fundal implantation of the placenta in association with breech presentation was investigated in the following study. In a series of 124 women with breech presentation, and 125 women with cephalic presentation at or near term, the implantation site of the placenta was demonstrated by ultrasonography. It was found that with breech presentation the placenta was implanted in the cornual region in 72.6% of the cases, as compared with 4.8% in cephalic presentation. The placental implantation site may therefore have a determining effect upon the presentation of the foetus.

During the 6-year period 1970-1975 5 cases of late intrauterine death caused by group B streptococcal infection were seen in two obstetrical departments in the Stockholm area. During the same period 17 638 infants were born in the two departments, and in 117 cases intrauterine death occurred. Hematogenous spread of the infection from the mother was the most likely cause in the 5 cases. This figure should be compared with a carrier rate of 15-20% in pregnant women in the Stockholm area.

The frequency of cornu-fundal implantation of amniotic sac determines the polarity of the sac inthe placenta in association with breech presentation was investigated in the following study. In a series of 124 women with breech presentation, and 125 women with cephalic presentation at or near term, the implantation site

As a consequence of a preliminary study (2) it has been suggested that the fetus accommodates itself to the shape of the amniotic sac, the smaller fetal pole occupying the smaller pole of the sac and vice versa. Thus a cornuo-fundally implanted placenta, reducing the upper pole of the amniotic sac, may render attempts at external version unsuccessful. MATERIAL AND METHODSIn a series of 74 primary breech presentations, regularly followed up at the antenatal care unit at the University Department of Obstetrics and Gynecology at Sabbatsberg Hospital in Stockholm during the period January 1976-December 1977, the result of attempts at cephalic versions were studied.Roentgenologic pelvimetry, prenatal estimation of the fetal weight and placental localization by ultrasonography were carried out in all the patients examined, representing cases from consecutive hospital admissions. Only pregnancies complicated by some disorder in either mother or childe.g. placenta praevia, contracted pelvis, accidental hemorrhage, toxemia, elderly primiparaand cases when elective cesarean section was intended. have been excluded. External version was attempted when the fetus presented as a breech in patients of 35 (or more) weeks of gestation. There were 39 primiparae and 35 multiparae.All the 74 attempts at external version were made without anesthesia and in each case only one attempt was perform-ed. No maternal or fetal death followed the attempted versions. In no case did spontaneous version take place after the attempted version.To analyze satisfactorily the results obtained in this series the breech presentations have been divided into two groups, according to the localization of the placenta. In Group I the placenta was located in one of the cornuo-fundal regions, while in Group I1 it was located on the anterior or posterior wall of the uterus. RESULTSThe incidence of successful or temporarily successful version in this series of 74 cases was 65 per cent. This is similar to the results reported by others (1,3,4, 5). The overall incidence of successful versions in Group I (placenta located in one of the comufundal region) was 44.4 per cent, compared with 96.6 per cent in Group I1 (placenta located on the anterior or posterior wall of the uterus).It is interesting to note that there were no reversions in Group 11, while seven cases reverted following initial success (35 per cent) in the first group. The overall reversion rate was 14.6 per cent (Table). No complication occurred in any of the 41 cases of successful version and all were delivered vaginally in vertex presentation. Table I. Results of external cephalic version with reference to the placental position. Successful versions Failed attempts Reversion Total Location of placenta No. % No. or0

Decidual and intramyometrial spiral arteries from 18 insulin-dependent diabetic and 18 non-diabetic women were compared histologically. All women were normotensive and none had signs of pre-eclampsia. None of the infants in either group had intra-uterine growth retardation. Metabolic control in the diabetic women was assessed by pregnancy glucose level from the last trimester of pregnancy and by C-peptide in amniotic fluid and cord blood as a measure of the fetal beta-cell function. The intramyometrial and decidual parts of the spiral artery were normal in the non-diabetic group. None of the diabetic patients showed pathological changes in the intramyometrial part of the spiral artery. Two of the 18 diabetic patients had pathological changes (intramural fibrosis) in the decidual portion of the spiral artery. These two women had signs of diabetic angiopathy (White's class D and F) and in one of them, the background diabetic retinopathy progressed markedly during pregnancy. The pregnancy glucose level was above normal (greater than 6.2 mM/l) in 3 of 18 diabetics. The C-peptide values in amniotic fluid and cord blood were above normal in 11 of 17 and in 5 of 17, respectively. Both patients with spiral artery lesions had pregnancy glucose levels in the upper range, 5.86 and 5.98 mM/l, respectively and the highest value of C-peptide in the amniotic fluid and cord blood, suggesting exaggerated fetal beta-cell function.

During the years 1953-1967, 17 women with endometriosis of the urinary bladder were treated with extirpation of the endometrial tissue, including partial or total resection of the trigone. In all cases the endometriosis had followed vaginal hysterotomy for legal abortion. Urethrocystoscopy was performed and the residual urine and bladder capacity were measured in all the patients one month and one year after the bladder operation. At follow-up in 1978 only 4 of the 17 women were available for urodynamic studies. Combined urethrocystometry, recording of the urethral pressure profile and measurement of the maximal urethral pressure in supine and standing positions were performed in these four patients, using the technique of Ulmsten et al. In all cases in the series, including those with trigone extirpation, all the tested parameters were normal. The writers therefore conclude that even total trigone resection can be done without disturbance to the bladder function.

Summary. Amniotic fluid (AF) volumes were determined by sodium paminohippurate (PAH) diloution in a consecutive series of 24 diabetic women at 34–35 weeks gestation. AF and maternal venous blood samples were analysed for C‐peptide immunoreactivity (CPR). When the patients were subgrouped according to the presence (n=17) or absence (n=8) of neonatal morbidity, AF volumes (1340±236 ml vs 807±130 ml; mean ±SEM), AF concentrations of CPR (l.38±0.54 nmol/1 vs 0.61±0.14 nmol/1) and maternal blood glucose levels (5.3±0.2 mmol/1 vs 4.8±0.3 mmol/1) during the last trimester of pregnancy were not different. The total content of CPR was significantly (P<0.05) greater in pregnancies with neonatal complications (1.25±0.31 nmol) compared with that in pregnancies without neonatal complications (0.54±0.18 nmol). AF volumes were significantly (P<0.02) larger in pregnancies where feeding problems occurred (1546±307 ml, n=9) compared with that in pregnancies without such problems (957±188 ml,n=16). These findings indicate an impact of fetal hyperinsulinism on the functional maturation of the fetus. When the patients were subgrouped according to the presence or absence of detectable maternal plasma CPR, i.e. >0.05 nmol/1, and to insulin dependent and gestational diabetes no differences of AF volumes, AF concentrations of CPR or total AF contents of CPR were found.