SummaryThe aggregation of platelets collected from maternal/neonatal pairs (n = 240) at the time of childbirth, was studied in response to multiple doses of ADP, collagen, arachidonic acid and ristocetin. Similar responses were obtained from healthy nonpregnant adult controls for comparison. The lag phase, slope of the aggregation curves as well as maximum aggregation (MA%) were recorded and analysed. Neonatal and adult platelets exhibited more enhanced responses to decreasing doses of ADP, arachidonic acid and ristocetin, than maternal platelets. These enhanced responses were exhibited more consistantly in the slopes of the aggregation curves than in MA%. Although neonatal platelets have shown longer lag phase in their responses to collagen, the rate of the aggregation reaction was significantly faster than maternal platelets, with no differences in MA%. These results contradict many previous reports suggesting impaired aggregation responses of neonatal platelets to these agonist. The possible reasons for these contradictions were discussed.

Sixty-four patients with severe postpartum hemorrhage (PPH) required surgical intervention during the years 1983 to 1987. Bilateral hypogastric artery ligation (HAL) was the initial surgical approach in 45% (29/64) and hysterectomy in 55% (35/64). HAL successfully controlled hemorrhage in 65% (19/29), and failed in 35% (10/29) where hysterectomy was required as a life saving procedure. Failure of HAL was more evident in atonic PPH than in other situations. Complications were more following hysterectomy; six (6/45) patients required re-exploration for intraperitoneal hemorrhage and two (2/45) patients died following hysterectomy. HAL was found to be a relatively easy, safe and successful procedure to be attempted as an initial surgical approach for all severe PPH, specially where uterine conservation was desired.

A detailed radiologic and anatomic study of a 20-week-old fetus is presented. In addition to conventional radiography, various contrast medium injection techniques were used. The findings were followed up at autopsy. The fetus showed multiple congenital abnormalities comprising phocomelia, horseshoe lung, horseshoe kidney, urethral stenosis with megacystis, bilateral hydronephrosis, hydrourcters, imperforate anus, and a single tracheo-esophageal tube· (persistent esophago-trachea). The association of horseshoe lung with persistent esophago-trachea, microurethra, megacystis, bilateral hydroureters, hydronephrosis and phocomelia is, we believe, the first ever to have been recorded in the literature. Twenty-one cases of horseshoe lung have been reported in the literature. These cases were reviewed and a comparison with the present case is presented. The embryologic basis for these anomalies is also briefly discussed.

Analysis of 8000 cesarean births in the Maternity and Children's Hospital, Riyadh, Saudi Arabia documents an increase in the cesarean section (CS) rate from 3.9% in 1979 to 9.9% in 1984. This increase is mainly attributed to indications such as repeat section (37.2%) and fetal distress (28.5%). Increase in the diagnosis of fetal distress was related to the introduction of electronic fetal monitoring and this diagnosis was not substantiated by Apgar score of the neonate. Because of the social preference for large families in Saudi Arabia, over-use of cesarean section should be avoided. For this reason, critical analysis of fetal distress and adequate trial of labor for patients with previous cesarean section is mandatory.