Diet in late pregnancy and glucose-insulin metabolism of the offspring 40 years later

OBJECTIVE

To determine how diets of women in pregnancy influence the glucose-insulin metabolism of their offspring in adult life.

DESIGN

A follow up study of men and women born during 1948-1954 whose mothers had taken part in a survey of diet in late pregnancy.

SETTING

Aberdeen, Scotland.

POPULATION

One hundred and sixty-eight men and women born in the Aberdeen Maternity Hospital.

MAIN OUTCOME MEASURE

Plasma glucose and insulin concentrations, fasting and after a standard oral glucose challenge.

RESULTS

The offspring of women who had high intakes of fat and protein in late pregnancy had a reduced plasma insulin increment between fasting and 30 min with a 7.0% decrease in increment (P = 0.007) per 10 g increase in protein intake and a 4.9% decrease (P = 0.002) per 10 g increase in fat intake. This was independent of the mother's body mass index or weight gain in pregnancy. A low maternal body mass index in early or late pregnancy was associated with a raised fasting plasma insulin concentration with a decrease of 2.4% (P = 0.05) per 1 kg/m2 increase of maternal body mass.

CONCLUSION

High intakes of protein and fat during pregnancy may impair development of the fetal pancreatic beta cells and lead to insulin deficiency in the offspring. The offspring of thin mothers tend to be insulin resistant.

Cyclophosphamide and water retention: mechanism revisited

We describe an 8 year-old girl with established diabetes insipidus who developed cyclophosphamide-associated antidiuresis. The patient had received cyclophosphamide as part of a high-dose chemotherapy regimen for recurrent suprasellar dysgerminoma prior to autologous bone marrow transplantation. Urinary output decreased and specific gravity increased shortly after a 1 hour i.v. infusion of 50 mg/kg cyclophosphamide and the effect lasted some 5 hours. No other drug could be implicated. This response, occurring in a patient with no ability to secrete vasopressin, suggests a direct tubular effect of one or more cyclophosphamide metabolites. Administering i.v. cyclophosphamide requires careful monitoring of fluid balance in order to avoid water intoxication. Further research is warranted both into the mechanism of this effect and the metabolite responsible for it.

The effect of smoking on pre-eclampsia in twin pregnancy

OBJECTIVE

To assess the effect of smoking on the incidence of pre-eclampsia and on perinatal outcome in twin pregnancy.

DESIGN

Retrospective study using Aberdeen Maternity and Neonatal Databank.

SETTING

Grampian, Orkney and Shetland.

POPULATION

All 1,575 twin pregnancies delivered in the years 1969-1971 and 1976-1997 (when smoking data were available).

METHODS

In all twin pregnancies the effects of smoking on pre-eclampsia were analysed by parity and gestation at delivery. The effect of smoking upon late miscarriage and perinatal outcome was analysed without subdivision.

MAIN OUTCOME MEASURES

Pre-eclampsia and perinatal outcome.

RESULTS

Primiparae had significantly higher rates of pre-eclampsia than multiparae and were delivered significantly earlier. The incidence of pre-eclampsia in smokers was significantly lower only in multiparae. Length of gestation was significantly shorter in multiparous smokers. The effect of smoking on pre-eclampsia appeared to be direct in multiparae but possibly indirect in primiparae (by causing earlier delivery). Smokers had a higher late miscarriage rate than nonsmokers.

CONCLUSIONS

In twin pregnancy the apparent protective effect of smoking against pre-eclampsia is significant only in multiparae, suggesting that in primiparae the smoking effect is overwhelmed by the other reasons for the development of pre-eclampsia. Smoking in twin pregnancy is not recommended due to the worse fetal outcome rates.

The effect of timing of intravenous muscle relaxant on the quality of double-contrast barium enema

AIM

To determine whether the timing of buscopan administration during double-contrast barium enema examination (DCBE) affects diagnostic quality.

MATERIALS AND METHODS

In a prospective setting, 100 consecutive adult out-patients referred for DCBE received 20 mg buscopan (hyoscine-N-butylbromide) intravenously, either before infusion of barium suspension (Group A) or after barium infusion and gas insufflation (Group B). A subjective assessment of ease of contrast medium infusion was made at the time of examination and the films subsequently analysed by two radiologists unaware of the mode of relaxant administration, who noted the quality of mucosal coating and made subjective and objective measurements of segmental distension.

RESULTS

There was no significant difference in screening times, infusion difficulty or colonic contrast medium coating between the two groups. Subjective assessment of distension of the caecum, ascending colon, transverse colon and rectum were not significantly different. Patients receiving intravenous relaxant after barium and gas infusion had less subjective descending (P = 0. 05) and sigmoid (P = 0.04) colon distension, but there was no significant difference with respect to maximal bowel diameter in any of the segments measured.

CONCLUSION

The timing of intravenous administration during DCBE is likely to have no significant effect on the diagnostic quality of the study.

Underlying causes of recurrent pneumonia in children

OBJECTIVES

To determine the relative frequency of underlying factors for recurrent pneumonia and the proportion of patients in whom the underlying illness diagnosis was known prior to pneumonia recurrence.

METHODS

Retrospective medical record review for a 10-year period from January 1987 through December 1997 at The Hospital for Sick Children in Toronto, Ontario, a tertiary care pediatric hospital. Recurrent pneumonia was defined as at least 2 pneumonia episodes in a 1-year period or at least 3 during a lifetime.

RESULTS

Of 2952 children hospitalized with pneumonia, 238 (8%) met criteria for recurrent pneumonia. An underlying illness diagnosis was identified in 220 (92%). Of these, the underlying illness was diagnosed prior to pneumonia in 178 (81%), with the first episode in 25 (11%), and during recurrence in 17 (8%). Underlying illnesses included oropharyngeal incoordination with aspiration syndrome (114 cases [48%]), immune disorder (24 [10%]), congenital cardiac defects (22 [9%]), asthma (19 [8%]), pulmonary anomalies (18 [8%]), gastroesophageal reflux (13[5%]), and sickle cell anemia (10 [4%]). Clinical clues to diagnosis were recurrent infections at other locations and failure to thrive in the cases of an immune disorder, recurrences involving the same location in those with underlying pulmonary pathology, the association of respiratory symptoms with feeding in those with gastroesophageal reflux, or recurrent wheezing in asthmatic children.

CONCLUSIONS

Recurrent pneumonia occurs in fewer than one tenth of all children hospitalized with pneumonia. Most of them have a known predisposing factor. The most common cause was oropharyngeal incoordination.

Preeclampsia in twin pregnancies: incidence and outcome

OBJECTIVES

To confirm the increased incidence of preeclampsia in twin pregnancy and to determine the relationship to zygosity and placentation; to consider the perinatal outcome of twin pregnancies in this condition.

METHODS

Retrospective study of all twin pregnancies (n = 2473) identified from the Aberdeen Maternity and Neonatal Databank to women resident in the Grampian Region of Scotland for the period 1950-1995.

RESULTS

The increased relative risk for gestational hypertension, preeclampsia, and eclampsia in twin pregnancies compared to singleton pregnancies has been confirmed as significant both in primiparas and multiparas with little variation in rates over the time period under review. Neither the sex of the offspring nor zygosity influences the incidence of hypertensive disease, whereas preeclampsia is more common in association with monochorionic placentation. As the birth weight was lower and placental weight greater in MzMc twins compared to either MzDc or DzDc, there was a higher placental index in such cases. No difference in the birth weights of individual twins, the difference in birth weights between the twins, placental weight, or placental index were found in relation to hypertensive disease. Gestation at delivery was earlier in normotensive twin pregnancies than in those women who developed a hypertensive problem. This leads to a higher perinatal death rate and lower survival rate for the babies in normotensive women with a twin pregnancy.

CONCLUSION

Although gestational hypertension, preeclampsia, and eclampsia all occur more commonly in twin pregnancy, this does not lead to significant growth retardation nor discordant fetal growth and a poor outcome for the twins. Although the incidence of preeclampsia is higher in twin pregnancies with monochorionic placentation, this does not seem to be mediated by deficiencies in placental development as assessed in this study.

The use of 0.25% isoflurane premixed in 50% nitrous oxide and oxygen for pain relief in labour

The addition of 0.25% isoflurane to 50% nitrous oxide in oxygen provides more effective pain relief in labour than 50% nitrous oxide alone. This study was carried out to determine whether self-administration by demand valve of 0.25% isoflurane in 50% nitrous oxide in oxygen premixed in cylinders at 13.7 MPa (IN2O) was practical and safe during labour. Two hundred and twenty-one mothers used IN2O in labour after 50% nitrous oxide had become inadequate for pain relief. Data on IN2O use was recorded during labour and details of the course of labour and opioid usage were taken from the clinical notes. The duration of IN2O use was 0.1-12.35 h (median 2.3). Thirty-two mothers (14.5%) required an epidural and intolerance to IN2O was seen in a maximum of 17 cases (7.7%). One hundred and twenty-six cases were primiparous and 93 parous with 151 deliveries being spontaneous and 70 interventional, of which 12 were by Caesarean section. Maternal blood loss was 20-1500 ml (median 200 ml). Apgar scores at 1 and 5 min were unaffected by IN2O use although a positive correlation was found between the use of opioids and the number of neonates with a 1-min score below 8 and the number requiring resuscitation. Six neonates had an Apgar score below 8 at 5 min, but their condition was adequately explained by factors other than the sedative technique used. Self-administered IN2O was found to be a safe and practical technique for sedation in labour when 50% nitrous oxide alone had become inadequate.

Developing a successful call center: one hospital's story

As our call centers continue to respond to changes in the healthcare industry and to customer demand, we understand that it is constantly necessary to reinvent8 ourselves. The call center industry, is, after all, only about 20 years old. It is constantly responding to technological advances. Medical call center managers must also respond to changes in healthcare delivery. We must keep a vigilant eye on industry trends. While we welcome information on other call centers to help us reformulate our targets, we must always customize information to our local market.

Comparison of various in vitro susceptibility methods for testing Stenotrophomonas maltophilia

A total of 57 clinical isolates were screened by disk diffusion for a related pharmacodynamic study. Testing was performed using National Committee for Clinical Laboratory Standards guidelines, except that results were interpreted at 16 to 18 h and 48 h. Of the 57 isolates, 19 were randomly chosen for additional comparative susceptibility testing of five methods (disk diffusion, Etest, Alamar colorimetric broth microdilution, Vitek, and MicroScan) and an in-house broth microdilution method. The two diffusion methods (disk and Etest) had the closest correlation. The commercial broth microdilution methods and the in-house microdilution method generated inconsistent results for all agents except trimethoprim-sulfamethoxazole. Vitek compared poorly with both diffusion and microbroth dilution methods. The most significant discrepancies were evident with all methods when the incubation period was extended to 48 h. When results were interpreted at 48 h, the incidence of resistance for all bactericidal agents was approximately double the resistance observed at 16 to 18 h. The bacteriostatic agents, trimethoprim-sulfamethoxazole and doxycycline, demonstrated the greatest in vitro activity and were least influenced by extended incubation with diffusion methods. Because correlative in vivo and in vitro studies have not revealed an effective therapeutic regimen for serious S. maltophilia infections, susceptibility results with all testing methods should be interpreted with caution when choosing therapy for patients with life-threatening infections. Susceptibility testing for this heterogeneous group remains controversial and routine testing, with the possible exception of doxycycline (or minocycline) and trimethoprim-sulfamethoxazole, should be avoided. Our data support that if testing is done with bactericidal agents, consideration should be given to interpretation after 48-h incubation.

Blood cultures positive for coagulase-negative staphylococci: antisepsis, pseudobacteremia, and therapy of patients

A blood culture cohort study investigating issues related to isolation of coagulase-negative staphylococci (CoNS) and other skin microflora is reported. Data were collected over 12 weeks to determine the incidence of significant CoNS bacteremia versus that of pseudobacteremia (contaminants) and to evaluate drug therapy in patients with cultures positive for CoNS. In addition, the effectiveness of 0.2% chlorine peroxide as a bactericidal disinfectant was compared to that of 10% providone iodine. A total of 3,276 cultures of blood from 1,433 patients were evaluated in the study. Eighty-nine cultures were positive for skin flora, with 81 of 89 (91%) involving CoNS. The incidence of significant CoNS bacteremia was 20 of 81 (24.7%), that of indeterminate bacteremia was 10 of 81 (12.3%), and that of contamination was 59 of 81 (72.8%). The incidence of significant bacteremia involving CoNS was double the 10 to 12% rate based on previous estimations at our institutions. In tests with the two bactericidal disinfectants, 22 of 1,639 cultures (1.3%) in the chlorine peroxide group versus 37 of 1,637 (2.3%) in the providone iodine group were considered contaminated (P = 0.065). Rates of contamination for venipuncture versus catheter collection were not significantly different (P = 0.46). The overall contamination rate was 59 of 3,276 (1.8%), which is consistent with the lower end of published quality assurance benchmark standards. The low rate was believed to be due to the professional phlebotomy staff in our institutions. There was excellent agreement between retrospective analysis by reviewers, when formal criteria were used, and the attending physicians' intuitive clinical impressions in the classification of significant bloodstream infections (100% agreement) or contamination (95% agreement). However, physicians still used antimicrobial agents to treat nearly one-half of the patients with contaminated blood cultures, with vancomycin being misused in 34% of patients. In addition, 10% of patients with significant bacteremia were treated with inappropriate agents. There were no significant adverse events or prolonged hospital stays due to the unnecessary use of vancomycin; however, the additional costs of treating patients whose cultures contained CoNS contaminants was estimated to be $1,000 per patient. Measures to limit the unnecessary use of vancomycin (and other agents) are important.

Environmental risk factors for sporadic Escherichia coli O157 infection in Scotland: results of a descriptive epidemiology study

The objective of the study was to obtain detailed descriptive epidemiological information on sporadic verocytotoxin-producing Escherichia coli O157 infection in Scotland in relation to transmission routes and host-related risk factors. Using a standardized questionnaire, the study was carried out throughout Scotland over an 18-month period from July 1992 and co-ordinated at the Communicable Diseases and Environmental Health (Scotland) Unit, Glasgow (CDEH(S)U). The subjects were laboratory-confirmed cases of Escherichia coli O157 infection, of whom 138 met the criteria for inclusion in the study. The most important findings were the high proportion of cases who had been exposed to environmental factors such as farm animals and/or their by-products; or who had participated in gardening or garden-play; or who had suspected or confirmed household water supply problems, prior to the onset of illness. The frequency and relative importance of environmental risk factors requires further quantification and study in order to assess where control measures can be directed most effectively. The implications for the NHS in preventing this crippling, life-threatening infection are considerable, not least in relation to hospitalization, dialysis and renal transplantation costs.

Postpartum fecal incontinence is more common in women with irritable bowel syndrome

PURPOSE

Anal sphincter damage can occur during vaginal delivery and may lead to impairment of fecal continence. The aim of this study was to determine the influence of irritable bowel syndrome on symptoms of fecal incontinence following first vaginal delivery.

METHODS

A prospective, observational study was performed before delivery, six weeks, and six months following delivery in primiparous women. A bowel function questionnaire was completed, and anal vector manometry, mucosal electrosensitivity, pudendal nerve terminal motor latency, and anal endosonography were performed. A total of 208 women were assessed before and after delivery, and 104 primigravid women were studied after delivery only. A total of 34 of 312 (11 percent) had an existing diagnosis of irritable bowel syndrome.

RESULTS

The prevalence of abnormal manometry or endosonography was similar in women with and without irritable bowel syndrome. However, six weeks after delivery, women with irritable bowel syndrome had a higher incidence of defecatory urgency (64 percent) and loss of control of flatus (35 percent) compared with those without (urgency, 10 percent, P < 0.001; flatus, 13 percent, P = 0.007). The incidence of frank fecal incontinence was similar in the two groups. Women with IBS had increased mucosal sensitivity to electrical stimulation of the upper anal canal both before and after delivery.

CONCLUSION

Women with IBS are more likely to experience subjective alteration of fecal continence postpartum compared with the healthy primigravid population, but they are not at increased risk of anal sphincter injury.

Significant antenatal factors in the development of lumbar spinal stenosis

STUDY DESIGN

Adverse factors during pregnancy may permanently stunt the growth of the spinal canal. Subsequently, even in an optimal environment the canal cannot catch up in growth with the trunk and long bones because of its early maturation. The degree of retardation in canal size depends on the severity and timing of the adverse effect. The catch-up growth of the long bones mask the narrow canal, because the latter does not have growth potential, resulting in an adult of sufficient height and good proportions, but with a canal at risk for stenosis.

OBJECTIVES

To investigate the influence of the antenatal environment on the growth of the lumber spinal canal.

SUMMARY OF BACKGROUND DATA

To date, little is known about the effects of an adverse environment on the growth of the spinal canal, and no data have been reported on antenatal influencing factors.

METHODS

Lumbar magnetic resonance imaging scans from 58 patients were examined. Dimensions of the central spinal canals were measured by computerized image analysis and compared with the subjects' obstetric data from their mothers' pregnancies.

RESULTS

The L3 canal was found to be the most sensitive to the influence of the examined factors. Gestational age was the most significant factor; if short, it resulted in small adult canal. Small placental weight, greater maternal age, primiparity, low socioeconomic class, and low birth weight were also found to be significant in affecting the growth of the canal.

CONCLUSIONS

An adverse antenatal environment does have a permanent, retarding effect on the growth of the lumbar spinal canal.

Simplifying implant prosthetics

This article presents a method of restoring an anterior single-tooth implant using the less complicated, less costly and less time-consuming method of a cement-retained restoration. With this method, the restorative dentist needs only the normal crown and bridge supplies.

Contribution of voltage-dependent potassium channels to the somatic shunt in neck motoneurons of the cat

The specific membrane resistivity of motoneurons at or near the soma (Rms) is much lower than the specific membrane resistivity of the dendritic tree (Rmd). The goal of the present experiments was to investigate the contribution of tonically active voltage-dependent potassium channels at or near the soma to the low Rms. These channels were blocked with the use of intracellular injections of cesium. Input resistance (RN), Rms/Rmd, a conductance representing voltage-dependent potassium channels on the soma, GK, and a conductance attributed to damage caused by electrode impalement, GDa, were estimated from voltage responses to a step of current. The effect of intracellular injections of cesium on electrotonic structure was determined with the use of two strategies: 1) a population analysis that compared data from two groups of motoneurons, those recorded with potassium acetate electrodes (control group) and those recorded with cesium acetate electrodes after the motoneurons were loaded with cesium; and 2) an analysis of changes in electrotonic structure that occurred over the course of multiple injections of cesium or during similar periods of time in control cells. RN of control and cesium-loaded motoneurons was similar. Over the course of the recordings, RN of control cells usually increased and this increase was associated with a hyperpolarization. In contrast, increases in RN after successive injections of cesium were closely linked to a depolarization. At corresponding membrane potentials, Rms/Rmd of cesium-loaded motoneurons was greater than Rms/Rmd of control motoneurons. Over the course of cesium injections, Rms/Rmd increased and the membrane potential depolarized. In contrast, increases in Rms/Rmd observed during the course of recordings from control cells were associated with a hyperpolarization. Compared with control cells at corresponding membrane potentials, GK was less in cesium-loaded cells. Increases in GK that occurred over the course of recordings in control cells were closely coupled to a depolarization. In cesium-loaded cells, GK usually decreased as the cell depolarized during the injections. In control cells, increases in GDa that occurred during the recording period were closely coupled to a depolarization. In contrast, changes in GDa that occurred during cesium injections were not related to the change in membrane potential and did not explain the corresponding changes in Rms/Rmd and membrane potential. The results of this study indicate that voltage-dependent potassium channels contribute to the somatic shunt (low Rms) in neck motoneurons and provide a voltage-dependent mechanism for the dynamic regulation of motoneuron electrotonic properties.

Stenotrophomonas maltophilia: emergence of multidrug-resistant strains during therapy and in an in vitro pharmacodynamic chamber model

Emergence of Stenotrophomonas maltophilia as a nosocomial pathogen is becoming increasingly apparent. Pleiotropic resistance characterizes S. maltophilia. Furthermore, a slow growth rate and an increased mutation rate generate discordance between in vitro susceptibility testing and clinical outcome. Despite original susceptibility, drug-resistant strains of S. maltophilia are often recovered from patients receiving beta-lactams, quinolones, or aminoglycosides. Given the disparity among various in vitro susceptibility methods, this study incorporated a unique pharmacodynamic model to more accurately characterize the bacterial time-kill curves and mutation rates of four clinical isolates of S. maltophilia following exposure to simulated multidose regimens of ceftazidime, ciprofloxacin, gentamicin, and ticarcillin-clavulanate. Time-kill data demonstrated regrowth of S. maltophilia with all four agents. With the exception of ticarcillin-clavulanate, viable bacterial counts at the end of 24 h exceeded the starting inoculum. Ciprofloxacin only reduced bacterial counts by less than 1.0 log prior to rapid bacterial regrowth. Resistant mutant strains, identical to their parent strain by pulsed-field gel electrophoresis, were observed following exposure to each class of antibiotic. Mutant strains also had distinct susceptibility patterns. These data are consistent with previous reports which suggest that S. maltophilia, despite susceptibility data that imply that the organism is sensitive, develops multiple forms of resistance quickly and against several classes of antimicrobial agents. Standard in vitro susceptibility methods are not completely reliable for detecting resistant S. maltophilia strains; and therefore, interpretation of these results should be done with caution. In vivo studies are needed to determine optimal therapy against S. maltophilia infections.

Endosonographic assessment of postpartum anal sphincter injury using a 120 degree sector scanner

Obstetric injury is the principal cause of faecal incontinence in women. We describe use of a 120 degrees sector ultrasound probe to assess integrity of the anal sphincters in primigravid women. Eighty-eight women were successfully studied 6 weeks following vaginal delivery. Anal vector manometry and pudendal nerve studies were abnormal in 54 (61%), of whom 41 (71%) were symptomatic (urgency of defaecation, incontinence to flatus or faeces). The sonographic pattern of the anal sphincters described with a 360 degrees probe was reproduced. Forty-eight abnormal scans were reported by two radiologists with a kappa statistic of 0.65. Sphincter defects were found in 11 asymptomatic women. We conclude that anal endosonography has an important role screening for and diagnosis of postpartum anal sphincter defects. Use of a 120 degrees sector ultrasound probe may prove a cost-effective means of increasing the availability of this technique.

Diet in pregnancy and the offspring's blood pressure 40 years later

OBJECTIVE

To determine how diet of the mother in pregnancy influences the blood pressure of the offspring in adult life.

DESIGN

A follow up study of men and women born during 1948-1954 whose mothers had taken part in a survey of diet in late pregnancy.

SETTING

Aberdeen, Scotland.

POPULATION

Two hundred and fifty-three men and women born in Aberdeen Maternity Hospital.

MAIN OUTCOME MEASURE

Systolic and diastolic blood pressure.

RESULTS

The relations between the diet of mothers and their offsprings' blood pressure were complex. When the mothers' intake of animal protein was less than 50 g daily, a higher carbohydrate intake was associated with a higher blood pressure in the offspring (a 100 g increase in carbohydrate being associated with a 3 mmHg increase in systolic pressure (P = 0.02)). At daily animal protein intakes above 50 g, lower carbohydrate intake was associated with higher blood pressure (a 100 g decrease in carbohydrate being associated with an 11 mmHg rise in systolic blood pressure (P = 0.004)). These increases in blood pressure were associated with decreased placental size.

CONCLUSION

Mothers' intakes of animal protein and carbohydrate in late pregnancy may influence their offsprings' adult blood pressure. This may be mediated through effects on placental growth.

Fertility and pregnancy outcome following large loop excision of the cervical transformation zone

OBJECTIVE

To determine if large loop excision of the transformation zone affects subsequent fertility and pregnancy outcome.

DESIGN

A case-control study.

SETTING

A teaching hospital serving a regional population.

SUBJECTS

One thousand women who had undergone large loop excision of the transformation zone (LLETZ) for the treatment of cervical intraepithelial neoplasia (CIN) between 1989 and 1991. Two controls were matched for each of the 149 women who had a singleton pregnancy progressing beyond 20 weeks of gestation following treatment, with regard to age, parity, height, husband's or partner's social class and smoking habits to account for common independent risk factors for adverse obstetric outcome and cervical intraepithelial neoplasia.

MAIN OUTCOME MEASURES

Intention to conceive, number of pregnancies, gestation, low birthweight, mean birthweight, mode of delivery, and duration of labour.

RESULTS

Out of a cohort of 1000 women who underwent LLETZ for the treatment of CIN, 653 women replied to a postal questionnaire. When asked up to 54 months after treatment, 130 women (19.9%) had become pregnant and 47 (7.2%) had tried to become pregnant. A total of 199 pregnancies from 178 women was identified from the cohort of women. For the 149 women from the case cohort, the mean birthweight was 3380 g compared with 3373 g in the control group (P = 0.88). The incidence of low birthweights in pregnancies progressing to at least 37 weeks of gestation was 3.1% in the treated group, compared with 3.2% in the control group (P = 0.98). Following LLETZ, 9.4% of deliveries were preterm (< 37 weeks of gestation), compared with 5.0% in the control group (p = 0.12). There was no significant difference in mean gestation, mode of delivery, indication for caesarean section or duration of labour between the women who had undergone LLETZ and the controls.

CONCLUSION

When socio-epidemiological factors associated with the development of cervical intraepithelial neoplasia are controlled for, LLETZ does not appear to exert an independent adverse effect on subsequent pregnancy outcome.

The changing pattern of cerebral palsy in Avon

The overall rate of cerebral palsy excluding post-neonatal cases, has remained relatively constant, varying between 1.93 and 2.27 per 1000 births over the 20-year period between 1969 and 1988 in Avon. The rate of the subgroup of spastic cerebral palsy varied from 1.40 to 1.78 per 1000 births over the same time period. In singletons the corresponding figures were 1.80-2.17 per 1000 births and 1.28-1.67 per 1000 births, and in multiple births the figures were 7.12-8.80 per 1000 births and 7.12-8.44 per 1000 births. Although the overall rates have remained fairly constant there was an increase in incidence in the later years among children with low birthweight and short gestation.