Impact of fetal growth restriction on pregnancy outcome in women undergoing expectant management for preterm pre-eclampsia

OBJECTIVES

To assess whether coexisting fetal growth restriction (FGR) influences pregnancy latency among women with preterm pre-eclampsia undergoing expectant management. Secondary outcomes assessed were indication for delivery, mode of delivery and rate of serious adverse maternal and perinatal outcomes.

METHODS

We conducted a secondary analysis of the Pre-eclampsia Intervention (PIE) and the Pre-eclampsia Intervention 2 (PI2) trial data. These randomized controlled trials evaluated whether esomeprazole and metformin could prolong gestation of women diagnosed with pre-eclampsia between 26 and 32 weeks of gestation undergoing expectant management. Delivery indications were deteriorating maternal or fetal status, or reaching 34 weeks' gestation. FGR (defined by Delphi consensus) at the time of pre-eclampsia diagnosis was examined as a predictor of outcome. Only placebo data from PI2 were included, as the trial showed that metformin use was associated with prolonged gestation. All outcome data were collected prospectively from diagnosis of pre-eclampsia to 6 weeks after the expected due date.

RESULTS

Of the 202 women included, 92 (45.5%) had FGR at the time of pre-eclampsia diagnosis. Median pregnancy latency was 6.8 days in the FGR group and 15.3 days in the control group (difference 8.5 days; adjusted 0.49-fold change (95% CI, 0.33-0.74); P < 0.001). FGR pregnancies were less likely to reach 34 weeks' gestation (12.0% vs 30.9%; adjusted relative risk (aRR), 0.44 (95% CI, 0.23-0.83)) and more likely to be delivered for suspected fetal compromise (64.1% vs 36.4%; aRR, 1.84 (95% CI, 1.36-2.47)). More women with FGR underwent a prelabor emergency Cesarean section (66.3% vs 43.6%; aRR, 1.56 (95% CI, 1.20-2.03)) and were less likely to have a successful induction of labor (4.3% vs 14.5%; aRR, 0.32 (95% CI, 0.10-1.00)), compared to those without FGR. The rate of maternal complications did not differ significantly between the two groups. FGR was associated with a higher rate of infant death (14.1% vs 4.5%; aRR, 3.26 (95% CI, 1.08-9.81)) and need for intubation and mechanical ventilation (15.2% vs 5.5%; aRR, 2.97 (95% CI, 1.11-7.90)).

CONCLUSION

FGR is commonly present in women with early preterm pre-eclampsia and outcome is poorer. FGR is associated with shorter pregnancy latency, more emergency Cesarean deliveries, fewer successful inductions and increased rates of neonatal morbidity and mortality. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Delivery outcomes in women with morbid obesity, where induction of labour was planned to prevent post-term complications

Morbid obesity and prolonged pregnancy are independently associated with adverse delivery and perinatal outcomes. We conducted a retrospective observational study on otherwise uncomplicated women with a body mass index (BMI) ≥ 40 kg/m² where, having reached term, induction of labour (IOL) was planned, to prevent prolonged pregnancy. The primary aim was to describe delivery outcomes and short-term maternal and perinatal adverse events. Of 117 cases included, 69 (59%) laboured spontaneously before the induction date, while 48 (41%) required an IOL. Of 48 patients that underwent an IOL, 22 (45.8%) achieved vaginal delivery, compared to 55 (79.7%) who laboured spontaneously (p = <.001). Twenty-two (18.8%) of the 117 babies weighed more than 4000 g, with 13 of these delivered vaginally. Overall, term patients with morbid obesity who laboured spontaneously before requiring induction, had a high rate of vaginal delivery. However, when IOL was required, the rate of caesarean delivery rose dramatically.Impact statementWhat is already known on this subject? Morbid obesity and prolonged pregnancy are independently associated with adverse delivery and perinatal outcomes. Induction of labour (IOL) increases the workload in busy units.What do the results of this study add? These results help inform accurate counselling on delivery outcomes, which is integral to respectful care, for the continuously increasing numbers of morbidly obese pregnant women.What the implications are of these findings for clinical practice and/or further research? It is preferable to avoid semi- or urgent caesarean deliveries in morbidly obese women after IOL. The outcomes of earlier induction of labour from 39- or 40-weeks' gestation requires investigation. Earlier induction may reduce the numbers of caesarean deliveries for abnormal cardiotocograph during the process.

The impact of an obstetrician-led, labor ward critical care unit: A prospective comparison of outcomes before and after establishment

OBJECTIVE

To investigate the outcomes of critically ill obstetric patients managed in a obstetric critical care unit in South Africa.

METHODS

Patients with severe maternal morbidity managed in the labor ward of Tygerberg Hospital were studied over three months before the establishment of the obstetrician-led obstetric critical care unit. One year later, patients managed in the obstetric critical care unit were studied using the same methods. The primary outcome measures were maternal morbidity and mortality.

RESULTS

In the before-obstetric critical care unit prospective audit 63 patients met criteria for obstetric critical care. During the second period 60 patients were admitted to the obstetric critical care unit. There were no significant differences between the groups in baseline characteristics, admission indications or Acute Physiology and Chronic Health Evaluation scores. Continuous positive airway pressure (p < 0.01) was utilized more in the second group. Seven deaths occurred in the first, but none in the second group (p = 0.01).

CONCLUSION

The establishment of an obstetrician-led obstetric critical care unit facilitated a decrease in maternal mortality.Trial registration: Not applicable.

A comparison between point-of-care testing and venous glucose determination for the diagnosis of diabetes mellitus 6-12 weeks after gestational diabetes

AIM

To evaluate point-of-care-testing (POCT) for the diagnosis of Type 2 diabetes mellitus 6-12 weeks post-partum in women with gestational diabetes (GDM).

METHODS

Post-partum glucose assessment (75-mg oral glucose tolerance test, OGTT) was performed prospectively in 122 women with GDM (1 November 2015 to 1 November 2017) at Tygerberg Hospital, Cape Town, South Africa. Individuals with known pre-existing diabetes were excluded. The accuracy and clinical utility of POCT (capillary finger-prick) were compared with laboratory plasma glucose (hexokinase and glucokinase methods). The OGTT consisted of two time points (fasting and 2 h) during which concurrent glucose samples (POCT and laboratory) were obtained. Bland-Altman plots and paired analysis were used to assess the analytical accuracy of POCT, whereas its diagnostic performance was determined using positive and negative predictive values to calculate specificity and sensitivity.

RESULTS

Spearman's ranked correlation analysis indicated a strong association between POCT and laboratory glucose values at both OGTT time points (fasting, r = 0.95, P < 0.0001; 2 h, r = 0.88, P < 0.0001). Thirty-six women were diagnosed with Type 2 diabetes based on gold standard laboratory glucose levels (fasting > 7 mmol/l; 2 h > 11.1 mmol/l). POCT correctly identified Type 2 diabetes in 78% of women (28 of 36) with a positive predictive value of 89.3% and a negative predictive value of 96.7% at the fasting time point. The sensitivity and specificity of POCT to diagnose Type 2 diabetes were 89% (fasting), 85.7% (2 h) and 96.7% (fasting), 98.5% (2 h) respectively. POCT proved less sensitive to diagnose pre-diabetes (69%) but displayed satisfactory specificity (92%) at both time points assessed.

CONCLUSION

POCT accurately identifies women with Type 2 diabetes 6-12 weeks after GDM.

The effect of calcium supplementation on blood pressure in non-pregnant women with previous pre-eclampsia: An exploratory, randomized placebo controlled study

BACKGROUND

Epidemiological findings suggest that the link between poverty and pre-eclampsia might be dietary calcium deficiency. Calcium supplementation has been associated with a modest reduction in pre-eclampsia, and also in blood pressure (BP).

METHODS

This exploratory sub-study of the WHO Calcium and Pre-eclampsia (CAP) trial aims to determine the effect of 500mg/day elemental calcium on the blood pressure of non-pregnant women with previous pre-eclampsia. Non-pregnant women with at least one subsequent follow-up trial visit at approximately 12 or 24weeks after randomization were included.

RESULTS

Of 836 women randomized by 9 September 2014, 1st visit data were available in 367 women of whom 217 had previously had severe pre-eclampsia, 2nd visit data were available in 201 women. There was an overall trend to reduced BP in the calcium supplementation group (1-2.5mmHg) although differences were small and not statistically significant. In the subgroup with previous severe pre-eclampsia, the mean diastolic BP change in the calcium group (-2.6mmHg) was statistically larger than in the placebo group (+0.8mmHg), (mean difference -3.4, 95% CI -0.4 to -6.4; p=0.025). The effect of calcium on diastolic BP at 12weeks was greater than in those with non-severe pre-eclampsia (p=0.020, ANOVA analysis).

CONCLUSIONS

There is an overall trend to reduced BP but only statistically significant in the diastolic BP of women with previous severe pre-eclampsia. This is consistent with our hypothesis that this group is more sensitive to calcium supplementation, however results need to be interpreted with caution.

The female sex pheromone of sugarcane stalk borer,Chilo auricilius identification of four components and field tests

Four pheromonal components have been detected in ovipositor washings and volatiles from female sugarcane stalk borers,Chilo auricilius Dudgeon (Lepidoptera: Pyralidae), using combined gas chromatography-electroantennography. The components have been identified as (I) (Z)-7-do-decenyl acetate, (II) (Z)-8-tridecenyl acetate, (III) (Z)-9-tetradecenyl acetate, and (IV) (Z)-10-pentadecenyl acetate by comparison of their gas chromatographic behavior with that of synthetic standards. In field tests carried out in northern India during 1982-1984, a combination of II, III, and IV in their naturally occurring ratio (8∶4∶1) was shown to provide a highly attractive synthetic source for trap use. (Z)-7-Dodecenyl acetate was found to reduce catches of maleC. auricilius, both when dispensed with the other three components and when released from dispensers surrounding a trap baited with the other three components.

Sex pheromones of rice moth,Corcyra cephalonica Stainton : I. Identification of male pheromone

Behavioral observations of the rice moth (Corcyra cephalonica, Pyralidae, Galleriinae) in the laboratory have shown that a male wing-gland pheromone induces attraction of female moths. This pheromone was identified as a blend of (E,E) and (Z,E)-farnesal. Wing-gland extracts or synthetic compounds were shown to be attractive to females by inducing walking.

Sex pheromones of rice moth,Corcyra cephalonica Stainton : II. Identification and role of female pheromone

Laboratory investigations of mating behavior in the rice moth,Corcyra cephalonica Stainton (Lepidoptera: Pyralidae; Galleriinae) showed that male moths are attracted at short range to live, virgin female moths and to female abdominal-tip extract. Volatiles collected from virgin female moths contained one component eliciting an electroantennographic (EAG) response from the male moth, and the chemical, spectroscopic, and Chromatographic data on this component were consistent with that of synthetic 6,10,14-tri-methyl-2-pentadecanol. This compound caused an EAG response from the male moth and attracted male moths in the bioassay. The pheromone is thought to play a role in courtship, and the synthetic material was shown to cause the male moths to search for a mate and attempt copulation.

Shoo fly, don't bother me! Efficacy of traditional methods of protecting cattle from tsetse

Studies were made of the efficacy of using smoke and housing to protect cattle from tsetse (Diptera: Glossinidae) in Zimbabwe. The efficacy of smoke was assessed by its effect on catches in Epsilon traps baited with a blend of acetone, 1-octen-3-ol, 4-methylphenol and 3-n-propylphenol. The efficacies of different types of kraal (enclosure) were gauged according to the catches of electrocuting targets (E-targets), baited with natural ox odour, placed within various designs of kraal. Smoke from burning wood (Colophospermum mopane) or dried cow dung reduced the catch of traps by approximately 50-90%. Kraals with a continuous wooden or netting wall, 1.5 m high, reduced catches of E-targets by approximately 75%. Arrangements of electric nets were used to assess the numbers of tsetse attacking live cattle within kraals and/or near sources of smoke. The results confirmed findings with traps and E-targets: kraals reduced the numbers of tsetse that fed by approximately 80% and smoke reduced the numbers attracted by approximately 70%; the use of both reduced overall attack rates by approximately 90%. The inclusion of 4-methylguaiacol, a known repellent for tsetse and a natural component of wood smoke, halved the catches of traps and E-targets and the numbers of tsetse attacking cattle. The practical benefits and difficulties of using repellents and/or housing to manage trypanosomiases are discussed.

Are early and late preeclampsia distinct subclasses of the disease--what does the placenta reveal?

OBJECTIVE

To compare histopathological differences in placentas from early- and late-onset preeclampsia, as well as late-onset preeclampsia and normal term deliveries.

METHODS

This prospective study was performed at Tygerberg Hospital, a secondary and tertiary referral center in South Africa. Placentas from 100 women, 25 each with early and late-onset preeclampsia, and an equal number of controls matched for gestational age, underwent routine preparation and were evaluated independently by two pathologists in a strictly predetermined, standardized manner.

RESULTS

Compared to late preeclampsia, placentas in the early preeclampsia group were smaller (p < 0.01), had more infarction (odds ratio [OR] = 4.03, 95% confidence interval [CI] = 1.2-13.5) and inappropriate maturation (OR = 16.62, 95% CI = 4.1-68.0). Placentas from the late-onset preeclampsia group showed increased decidual arteriopathy (OR = 5.09, 95% CI = 1.45-17.92) and abruptio placentae (OR = 5.41, 95% CI = 1.01-28.79) compared to controls.

CONCLUSIONS

The early- and late-onset preeclampsia placentas showed clear histopathological differences, whereas late-onset preeclampsia and normal term placentas differed less. These findings support the contention that early- and late-onset preeclampsia are different subclasses of disease.

Effect of progesterone on cervical shortening in women at risk for preterm birth: secondary analysis from a multinational, randomized, double-blind, placebo-controlled trial

OBJECTIVES

To determine whether progesterone supplementation alters cervical shortening in women at increased risk for preterm birth.

METHODS

We performed a planned secondary analysis from a large, multinational preterm birth prevention trial of daily intravaginal progesterone gel, 90 mg, compared with placebo in women with a history of spontaneous preterm birth or premature cervical shortening. Transvaginal cervical length measurements were obtained in all randomized patients at baseline (18 + 0 to 22 + 6 weeks' gestation) and at 28 weeks' gestation. For this secondary analysis, the difference in cervical length between these time points was compared for the study population with a history of spontaneous preterm birth and for a population with premature cervical shortening (< or = 30 mm) at randomization. Differences between groups in cervical length for the 28-week examination were analyzed using ANCOVA, including adjustment for relevant clinical parameters and maternal characteristics.

RESULTS

Data were analyzed from 547 randomized patients with a history of preterm birth. The progesterone-treated patients had significantly less cervical shortening than the placebo group (difference 1.6 (95% CI, 0.3-3.0) mm; P = 0.02, ANCOVA). In the population of 104 subjects with premature cervical shortening at randomization, the cervical length also differed significantly on multivariable analysis, with the treatment group preserving more cervical length than the placebo group (difference 3.3 (95% CI, 0.3-6.2) mm; P = 0.03, ANCOVA), with adjustment for differences in cervical length at screening. A significant difference was also observed between groups for categorical outcomes including the frequency of cervical length progression to < or = 25 mm and a > or = 50% reduction in cervical length from baseline in this subpopulation.

CONCLUSIONS

Intravaginal progesterone enhances preservation of cervical length in women at high risk for preterm birth.

Current patient perceptions on the menopause: a South African perspective

OBJECTIVE

To evaluate current patient perspectives on the postmenopausal period in South Africa.

METHODS

The study was conducted in a specialist private practice in Tygerberg, Cape Town, South Africa during 2004. All women with established postmenopausal status, seen over a period of 18 months, received a survey questionnaire by post. Of the 541 questionnaires that were posted, 421 were returned and 410 were used. Women gave written informed consent.

RESULTS

The average age of the women was 60 years, with almost half (49%) greater than 10 years postmenopausal, and 78.5% were using hormonal therapy (HT). Of note is that 42% had been on HT for more than 10 years. The doctor was the most important source of information (87%), the most frequent reason for initiation of, and the second most frequent reason for discontinuation of therapy. The most important advantages of HT given were skeletal protection (85%) and treatment of vasomotor symptoms (70%), while development of breast cancer was given as the most prominent disadvantage (79%).

CONCLUSION

This group of women was well informed regarding current indications and developments concerning HT. Despite their socioeconomic status, the doctor remained the key factor with regard to information and decision-making.

Progesterone vaginal gel for the reduction of recurrent preterm birth: primary results from a randomized, double-blind, placebo-controlled trial

OBJECTIVE

Preterm birth is the leading cause of perinatal morbidity and mortality worldwide. Treatment of preterm labor with tocolysis has not been successful in improving infant outcome. The administration of progesterone and related compounds has been proposed as a strategy to prevent preterm birth. The objective of this trial was to determine whether prophylactic administration of vaginal progesterone reduces the risk of preterm birth in women with a history of spontaneous preterm birth.

METHODS

This randomized, double-blind, placebo- controlled, multinational trial enrolled and randomized 659 pregnant women with a history of spontaneous preterm birth. Between 18 + 0 and 22 + 6 weeks of gestation, patients were assigned randomly to once-daily treatment with either progesterone vaginal gel or placebo until either delivery, 37 weeks' gestation or development of preterm rupture of membranes. The primary outcome was preterm birth at </= 32 weeks of gestation. The trial was analyzed using an intent-to-treat strategy.

RESULTS

Baseline characteristics were similar in the two treatment groups. Progesterone did not decrease the frequency of preterm birth at </= 32 weeks. There was no difference between the groups with respect to the mean gestational age at delivery, infant morbidity or mortality or other maternal or neonatal outcome measures. Adverse events during the course of treatment were similar for the two groups.

CONCLUSION

Prophylactic treatment with vaginal progesterone did not reduce the frequency of recurrent preterm birth (</= 32 weeks) in women with a history of spontaneous preterm birth. The effect of progesterone administration in patients at high risk for preterm delivery as determined by methods other than history alone (e.g. sonographic cervical length) requires further investigation.

Vaginal progesterone is associated with a decrease in risk for early preterm birth and improved neonatal outcome in women with a short cervix: a secondary analysis from a randomized, double-blind, placebo-controlled trial

OBJECTIVE

To investigate the efficacy of vaginal progesterone to prevent early preterm birth in women with sonographic evidence of a short cervical length in the midtrimester.

METHODS

This was a planned, but modified, secondary analysis of our multinational, multicenter, randomized, placebo-controlled trial, in which women were randomized between 18 + 0 and 22 + 6 weeks of gestation to receive daily treatment with 90 mg of vaginal progesterone gel or placebo. Cervical length was measured with transvaginal ultrasound at enrollment and at 28 weeks of gestation. Treatment continued until either delivery, 37 weeks of gestation or development of preterm rupture of membranes. Maternal and neonatal outcomes were evaluated for the subset of all randomized women with cervical length < 28 mm at enrollment. The primary outcome was preterm birth at </= 32 weeks.

RESULTS

A cervical length < 28 mm was identified in 46 randomized women: 19 of 313 who received progesterone and 27 of 307 who received the placebo. Baseline characteristics of the two groups were similar. In women with a cervical length < 28 mm, the rate of preterm birth at </= 32 weeks was significantly lower for those receiving progesterone than it was for those receiving the placebo (0% vs. 29.6%, P = 0.014). With progesterone, there were fewer admissions into the neonatal intensive care unit (NICU; 15.8% vs. 51.9%, P = 0.016) and shorter NICU stays (1.1 vs. 16.5 days, P = 0.013). There was also a trend toward a decreased rate of neonatal respiratory distress syndrome (5.3% vs. 29.6%, P = 0.060).

CONCLUSION

Vaginal progesterone may reduce the rate of early preterm birth and improve neonatal outcome in women with a short sonographic cervical length.

Low-loss passive alignment of single-mode fibers in low-temperature cofired ceramics using CO2 laser fabricated U-grooves

We report a step toward optoelectronic integration on low-temperature cofired ceramics substrates in the form of fiber alignment U-grooves. The precision of the CO2 laser machining of green state ceramic for this purpose is investigated. The groove-writing process with a speed of 1 mm/s was carried out in air at room temperature and ambient pressure. The process is to a large extent self-cleaning without any gas jet assist. By analysis of groove profiles after firing of a near-zero shrinkage green tape formulation, it is shown that the cutting accuracy is approximately 2 microm, which is at the fundamental limit set by the particle size (1-5 microm). We demonstrate low-loss butt coupling of <1 dB for single-mode fibers using the laser written U-grooves. The technique exhibits a potential for fabrication of low-cost fiber ribbon and fiber array connectors.

High-throughput sample handling and data collection at synchrotrons: embedding the ESRF into the high-throughput gene-to-structure pipeline

An automatic data-collection system has been implemented and installed on seven insertion-device beamlines and a bending-magnet beamline at the ESRF (European Synchrotron Radiation Facility) as part of the SPINE (Structural Proteomics In Europe) development of an automated structure-determination pipeline. The system allows remote interaction with beamline-control systems and automatic sample mounting, alignment, characterization, data collection and processing. Reports of all actions taken are available for inspection via database modules and web services.

Correction of beam errors in high power laser diode bars and stacks

The beam errors of an 11 bar laser diode stack fitted with fast-axis collimator lenses have been corrected by a single refractive plate, produced by laser cutting and polishing. The so-called smile effect is virtually eliminated and collimator aberration greatly reduced, improving the fast-axis beam quality of each bar by a factor of up to 5. The single corrector plate for the whole stack ensures that the radiation from all the laser emitters is parallel to a common axis. Beam-pointing errors of the bars have been reduced to below 0.7 mrad.

Postmenopausal hormone therapy and quality of life

OBJECTIVE

To evaluate whether hormonal therapy (HT) had any significant effect on quality of life (QoL) in a selected group of postmenopausal women.

METHODS

The study was conducted in a specialist private practice in Tygerberg, Cape Town, South Africa, over an 18-month period ending in July 2003. A questionnaire using the Utian Quality of Life (UQoL) scale was posted to all women with established postmenopausal status, seen over this period. 541 questionnaires were posted, 421 returned and 398 could be used. Women gave written informed consent.

RESULTS

The average age of the women was 60 years. 313 women (78.6%) were using hormone therapy (HT) while 275 women (69.1%) reported concomitant medical problems. HT users had significantly higher scores in three of the four QoL domains, namely, occupational (p=0.046), emotional (p=0.03), and sexual (p=0.009). There was no significant difference in the health domain (p=0.2).

CONCLUSION

This study found that post-menopausal South African women experienced that HT had a positive effect on global quality of life.

Localized CO2 laser damage repair of fused silica optics

A technique has been developed for the localized treatment of laser damage sites in fused silica optics by CO2 laser melt-flow smoothing, by using a 50 to 125 microm diameter beam in a regime that avoids mass removal by ablation. A detailed calibration of the laser irradiance for the threshold ablation of craters was carried out for a range of beam diameters and pulses in the 20 micros to 200 ms range. The results agree with a thermal model that also provides estimates of the melt depth for the different irradiation conditions. Smoothing trials for glass melting at irradiance values just below the ablation threshold irradiance were conducted to determine the optimum conditions and limits for the smoothing process. The technique has been found to remove damage pits up to a depth of 0.5 microm, while the small melt depth associated with localized treatment limits the smoothing to a <or=5 microm lateral size.

Identification of components of male-produced pheromone of coffee white stemborer, Xylotrechus quadripes

The coffee white stem borer, Xylotrechus quadripes Chevrolat (Coleoptera: Cerambycidae), is the foremost pest of arabica coffee in India, Sri Lanka, China, Vietnam, and Thailand. Previous work showed that female beetles were attracted to traps baited with male beetles. Analyses of volatiles from male X. quadripes of Indian origin by gas chromatography (GC) linked to electroantennographic (EAG) recording from a female beetle antenna showed three male-specific components comprising more than 90% of the volatiles, two of which elicited EAG responses. The major EAG-active component was produced at up to 2 microg hr(-1) insect(-1) and was identified as (S)-2-hydroxy-3-decanone (I) by comparison of GC data, and mass (MS), infrared, and nuclear magnetic resonance (NMR) spectra with those of synthetic standards. The second component was identified as 3-hydroxy-2-decanone (II) produced in part by isomerization of I under the conditions of the GC analysis, although the NMR spectrum suggested it is naturally produced at up to 7% of I. The minor component that elicited an EAG response, present at 7% of the amount of I, was identified as (S,S)-2,3-dihydroxyoctane (III) from GC and MS data. 2-Hydroxy-3-octanone (0.2-0.5% of I), 2,3-decanedione (2% of I), 2-phenylethanol (3% of I), and octanoic acid (4% of I) were also identified in volatiles from male beetles. A general, stereospecific synthetic route to the enantiomers of 2-hydroxy-3-alkanones from the enantiomers of ethyl lactate was developed. The enantiomers of III were synthesized from (E)-2-octene by Sharpless asymmetric dihydroxylation. (S)-(I) was attractive to male X. quadripes in laboratory bioassays, but addition of (S,RS)-(III) at 10% of I reduced attractiveness. In field trials carried out in India with sticky, cross-vane traps, (S)- and (RS)-(I) attracted male X. quadripes and addition of (S,S)-(III) at 10% of I reduced attractiveness. Significant numbers of female Demonax balyi Pascoe (Coleoptera: Cerambycidae) were sometimes caught in traps baited with (S)-(I) alone.

The effects of host physiology on the attraction of tsetse (Diptera: Glossinidae) and Stomoxys (Diptera: Muscidae) to cattle

In Zimbabwe, studies were made of the numbers of tsetse (Glossina spp.) and stable flies (Stomoxys spp.) attracted to cattle of different nutritional status, age and sex. Host odours were analysed to determine the physiological basis of these differences and improved methods are described for measuring rates of production of kairomones. Seasonal fluctuations in host weight, related to changes in pasture quality, had no significant effect on attraction of tsetse or Stomoxys. However, both attraction to different individuals and carbon dioxide production by these individuals were strongly correlated with weight, suggesting a possible link. Attraction to the odour from different types of cattle decreased in the order ox>cow>heifer>calf, and oxen were twice as attractive as calves of less than 12 months old. Lactation did not alter the relative attractiveness of cows. Calves less than six months old produced lower levels of carbon dioxide, acetone, octenol and phenols than oxen, but for older calves and cows, levels of production of known kairomones and repellents were similar to those of an ox. Carbon dioxide produced by cattle varied according to time of day and the animal's weight; cattle weighing 500 kg produced carbon dioxide at a mean rate of 2.0 l min(-1) in the morning and 2.8 l min(-1) in the afternoon compared to respective rates of 1.1 and 1.9 l min(-1) for cattle weighing 250 kg. Artificially adjusting the doses of carbon dioxide produced by individual cattle to make them equivalent did not remove significant differences in attractiveness for tsetse but did for Stomoxys. Increasing the dose of carbon dioxide from 1 to 4 l min(-1) in a synthetic blend of identified kairomones simulating those produced by a single ox, increased attractiveness to tsetse but not to the level of an ox. The results suggest that the main sources of differences in the attractiveness of individual cattle are likely to be variation in the production of carbon dioxide and, for tsetse, other unidentified kairomone(s). The biological and practical implications of these findings are discussed.

The care and nurture of undulator data sets

Undulator radiation is the X-ray source of choice for modern macromolecular crystallography beamlines. Here, the basic properties of undulator sources are described and it is indicated why they make such good X-ray sources for macromolecular crystallography. Collection of excellent data from these beamlines is not always straightforward; therefore, a number of rules are postulated for undulator data collection and guidelines are offered which will help to ensure a satisfactory experiment.

The attitudes of two groups of South African women towards mode of delivery

OBJECTIVE

To determine whether 2 specific groups of women prefer vaginal or abdominal delivery.

METHODS

Forty-six black and 54 colored (of mixed race, the predominant population group) primigravidas and 59 black and 62 colored multigravidas were interviewed between April 2003 and February 2004 at Tygerberg Hospital, Tygerberg, South Africa.

RESULTS

Among primigravidas, 89% of black women and 83% of colored women preferred vaginal delivery. Among the multigravidas, 86% of black women and 79% of colored women preferred vaginal delivery. Most women believed that they would recover more quickly (65%) and with less pain (32%) after vaginal delivery. Forty-one percent of all women viewed episiotomy as the greatest disadvantage of vaginal delivery, while 43% were unaware of any advantage to cesarean delivery.

CONCLUSION

Most colored and black women preferred vaginal over cesarean delivery. A challenge to healthcare personnel is to educate women about both routes.

Responses of Teretrius nigrescens toward the dust and frass of its prey, Prostephanus truncatus

Teretrius nigrescens is considered to be a specialized predator of Prostephanus truncatus, a serious pest of stored maize and dried cassava roots. Using a bait-bag behavioral bioassay, this investigation found T nigrescens to be strongly arrested by dust and frass produced by P. truncatus on maize, whereas responses to maize flour were weak. Attempts to increase the arrestiveness of flour by altering its physical properties (coarseness or particle size range) were unsuccessful. The arrestive property of dust/frass did not degrade with long-term storage nor did it volatilize or degrade with oven baking up to 150 degrees C. However, extraction with methanol and reapplication was successful in transferring the arrestive property from the dust/frass onto maize flour. The prey dust/frass also induced more oviposition than did maize flour, as judged by production of F1 offspring. The results provide strong evidence for the existence of a high boiling point compound(s) in P. truncatus dust/frass that acts as a contact kairomone for T nigrescens. This, or another compound(s) also seems to act as an oviposition stimulant for female T. nigrescens.

Investigation of Long-Range Female Sex Pheromone of the European Tarnished Plant Bug, Lygus rugulipennis: Chemical, Electrophysiological, and Field Studies

The European tarnished plant bug, Lygus rugulipennis, is an important pest of agricultural and horticultural crops throughout Europe. Adult male L. rugulipennis were previously shown to be attracted to traps baited with live virgin females, which suggests the females produce a sex pheromone. Volatiles produced by virgin female L. rugulipennis were shown to contain three components, hexyl butyrate, (E)-2-hexenyl butyrate, and (E)-4-oxo-2-hexenal which elicited electroantennographic (EAG) responses from males in analyses by linked gas chromatography-electroantennography (GC-EAG). They were produced in 1.5:1:0.08 ratio, respectively, by single females. Collections from 1, 2, or 4 virgin females showed the proportions of hexyl butyrate and (E)-4-oxo-2-hexenal to increase relative to that of (E)-2-hexenyl butyrate with increasing number of females. Although these compounds were found in body extracts of both male and female L. rugulipennis, they were not detected in volatiles released by virgin males. EAG dose-response studies showed that both males and females responded to these chemicals with minimal differences in sensitivity between the sexes or to the three components, except that males were more responsive than females to (E)-4-oxo-2-hexenal at the two highest doses tested. Release rates of the compounds from rubber septa, polyethylene vials, and polyethylene sachets were measured under laboratory conditions. Four field tests were carried out using sticky traps baited with all possible binary and tertiary combinations of the three chemicals using different combinations of dispensing systems. Catches of male L. rugulipennis in baited traps were similar to those in unbaited traps. Significantly fewer females were caught on traps baited with blends containing hexyl butyrate than on traps without hexyl butyrate or unbaited traps in one test and overall. The roles of the three compounds and possible reasons for their failure to attract males are discussed.

The profile and complications of women with placental abruption and intrauterine death

The aim of this study was to evaluate the profile and outcome of patients with placental abruption and intrauterine death. It was a retrospective study over 2 years from 1 January 1999 to 31 December 2000. All women (n = 96) presenting with placental abruption and intrauterine death at a tertiary referral center were identified from the records of weekly perinatal mortality meetings. Data were reviewed by a single researcher. Hypertensive disorders were diagnosed in 75 per cent (n = 72) women, most often at admission once intrauterine death had already occurred. Thirty-nine per cent had a previous history of hypertensive disease during pregnancy, placental abruption, intrauterine death, or preterm delivery. Twenty-two per cent of patients (n = 21) were unbooked. Major maternal complications occurred in 53 per cent of women. There were no maternal deaths. In conclusion, previous obstetric history and hypertensive disorders are important factors in women with placental abruption causing intrauterine death. Severe complications are common but careful management in a tertiary center can reduce their impact.

Phenotypic plasticity of Rhyzopertha dominica pheromone signaling: the effects of different hosts and presence of conspecific females on male produced aggregation pheromone

Male Rhyzopertha dominica (F.) (Coleoptera: Bostrichidae) release an aggregation pheromone consisting of a blend of two components, dominicalure 1 (D1) and Dominicalure 2 (D2). Pheromone from single insects, in different contexts, was collected and measured to determine if this signal is phenotypically plastic. Release rates were lowered when males were moved from maize grains to groundnut kernels or when moved from solitary occupation of maize grain to grain occupied by seven females. The pheromone release was increased again once these moves were reversed. The release of D1 was more affected than D2: thus, on groundnuts or in the presence of females, less pheromone was released and the proportion of D1 in the blend was lowered. Possible reasons for the modifications of the signal are discussed.

Minor components in the sex pheromone of legume podborer: Maruca vitrata development of an attractive blend

The legume podborer, Maruca vitrata (syn. M. testulalis) (F.) (Lepidoptera: Pyralidae) is a pantropical pest of legume crops. Sex pheromone was collected by gland extraction or trapping of volatiles from virgin female moths originating in India, West Africa, or Taiwan. Analysis by GC-EAG and GC-MS confirmed previously published findings that (E,E)-10,12-hexadecadienal is the most abundant EAG-active component with 2-5% of (E,E)-10,12-hexadecadienol also present. At least one other EAG response was detected at retention times typical of monounsaturated hexadecenals or tetradecenyl acetates, but neither could be detected by GC-MS. Laboratory wind-tunnel bioassays and a field bioassay of blends of (E,E)-10,12-hexadecadienal with (E,E )-10,12-hexadecadienol and a range of monounsaturated hexadecenal and tetradecenyl acetate isomers indicated greatest attraction of males was to those including (E,E)-10,12-hexadecadienol and (E)-10-hexadecenal as minor components. In subsequent trapping experiments in cowpea fields in Benin, traps baited with a three-component blend of (E,E)-10,12-hexadecadienal and these two minor components in a 100:5:5 ratio caught significantly more males than traps baited with the major component alone, either two-component blend, or virgin female moths. Further blend optimization experiments did not produce a more attractive blend. No significant differences in catches were found between traps baited with polyethylene vials or rubber septa, or between lures containing 0.01 and 0.1 mg of synthetic pheromone. Significant numbers of female M. vitrata moths, up to 50% of total catches, were trapped with synthetic blends but not with virgin females. At present there is no clear explanation for this almost unprecedented finding, but the phenomenon may improve the predictive power of traps for population monitoring.

Primipaternity and duration of exposure to sperm antigens as risk factors for pre-eclampsia

OBJECTIVE

To establish whether primipaternity and duration of unprotected sexual cohabitation is associated with an increased risk of pre-eclampsia.

METHOD

At a tertiary referral center, the study had a case and control group of 60 multigravid women each, as well as a case and control group of 50 primigravid women each. Information was compiled by means of a confidential questionnaire.

RESULT

After multiple logistic regression analysis using age, smoking, hypertension in previous pregnancies, change of paternity and duration of unprotected sexual cohabitation as predictors, the regression coefficients for change of paternity and sexual cohabitation of longer than 6 months in multigravid women were -0.4 (P = 0.15) and -1.4 (P = 0.03), respectively.

CONCLUSION

Multigravid women with a period of unprotected sexual cohabitation of longer than 6 months had a decreased risk of pre-eclampsia. Primipaternity was not a significant risk factor for pre-eclampsia.

Intermale variation in aggregation pheromone release in Prostephanus truncatus

Intermale variation in pheromone signaling has been confirmed and quantified by measurements of pheromone produced by single adult male Prostephanus truncatus (Horn) (Coleoptera: Bostrichidae). Males varied in both the amounts of the two components of their aggregation pheromone and the ratio of one component to the other. The mean rates of production of the pheromone components T1 and T2 were 1.9 and 0.5 microg/day, respectively. There were repeatable differences among males in the amounts of T2 produced and the proportion of T1 in the pheromone blend over two weeks. Of the 15 males studied, one released a large burst of pheromone in a short period, while the remainder, if they did release, did so over an extended period. This suggested that there may be two alternative release strategies and the significance of this is discussed.

Identification of methyl salicylate as the principal volatile component in the methanol extract of root bark of Securidaca longepedunculata Fers

Securidaca longepedunculata Fers (Polygalaceae) is commonly used as a medicine in many parts of Africa and shows promise for protecting stored grain against insect pests. Analysis of a methanol extract of the root bark by gas chromatography linked to mass spectrometry (GC/MS) showed a major component accounting for over 90% of the volatile material. This was identified as methyl 2-hydroxybenzoate (methyl salicylate) by comparison of the GC retention times and mass spectrum with those of synthetic standards. This conflicts with an earlier report that the major component is methyl 4-hydroxybenzoate. Two minor components had mass spectra characteristic of 2-hydroxybenzoate esters and were identified as methyl 2-hydroxy-6-methoxybenzoate and its benzyl analogue, again conflicting with an earlier report.

Urinary protein excretion and expectant management of early onset, severe pre-eclampsia

OBJECTIVE

To evaluate the importance of proteinuria in the expectant management of early onset, severe pre-eclampsia.

METHODS

In this prospective series of 340 women, 24-h urine collections were performed and monitored twice weekly in a high-care ward.

RESULTS

Seventy-four women with at least two 24-h urine collections were grouped into women with a proteinuria increase of > or =2 g (n=29) and with women whose proteinuria decreased, or increased by <2 g (n=45). Major maternal complications, prolongation of gestation, and perinatal outcomes were comparable. Fifty-six (75%) women experienced an increase in proteinuria. When patients with heavy proteinuria (n=83) were compared to those with moderate proteinuria (n=257), maternal and perinatal outcomes were comparable. More days were gained before delivery in the heavy proteinuria group than in the moderate (12 vs. 9; P<0.001).

CONCLUSION

Most patients experienced increased proteinuria. Neither the rate of increase nor the amount of proteinuria affected maternal and perinatal outcomes.

High-average-power Nd:YAG planar waveguide laser that is face pumped by 10 laser diode bars

A planar waveguide Nd:YAG laser is pumped with 430 W of power from 10 laser diode bars to produce a multimode output power of 150 W at an optical efficiency of 35%. Use of a hybrid resonator of the positive-branch confocal unstable type for the lateral axis and of one of the near-case I waveguide type for the transverse axis increased the laser brightness by a factor of ~26 with only 12% less power than in the multimode case.

The effects of inadvertent intramuscular injection of BCG vaccine

We report on a case of inadvertent intramuscular injection of BCG vaccine into an already tuberculin-sensitive individual which resulted in a severe and prolonged local reaction. There is no consensus on the best management of this complication, although in this case healing appeared to be hastened by anti-tuberculous chemotherapy.

The crystal and molecular structures of diferric porcine and rabbit serum transferrins at resolutions of 2.15 and 2.60 A, respectively

The serum transferrins are monomeric proteins with a molecular mass of around 80 kDa and are responsible for the transport of iron in vertebrates. The three-dimensional structures of diferric porcine and rabbit serum transferrin have been refined against X-ray diffraction data extending to 2.15 and 2.60 A, respectively. Data for both proteins were collected using synchrotron radiation at temperatures of 277 K. The porcine protein crystallizes in the space group C2, with unit-cell parameters a = 223.8, b = 44.9, c = 78.9 A, beta = 105.4 degrees with one molecule in the asymmetric unit. The structure was solved by molecular-replacement methods using rabbit serum transferrin as the search model. The structure was refined using REFMAC, with a final residual of 13.8% (R(free) = 18.2% for a 5% data sample) for all data to 2.15 A. The final model comprises 5254 protein atoms, two Fe(3+) cations and two CO(3)(2-) anions, one N-acetyl glucosamine moiety and 494 water molecules. The rabbit protein crystallizes in space group P4(3)2(1)2, with unit-cell parameters a = 127.2, c = 144.9 A and one molecule per asymmetric unit. The structure was solved using the method of multiple isomorphous replacement and refined using REFMAC to give a final residual of 18.6% (R(free) = 22.2% for a 5% data sample) for all data to 2.60 A. The final model comprises 5216 protein atoms, two Fe(3+) cations and two CO(3)(2-) anions, a Cl(-) anion and 206 solvent molecules; there is no clear indication of the carbohydrate moiety attached to Asn490 (rabbit serum numbering). Both molecules adopt a bilobal structure typical for members of the transferrin family. Each of the structurally homologous lobes contains two dissimilar domains with a single iron-binding site buried within the interdomain cleft. The porcine serum protein lacks an interdomain disulfide bridge close to the connecting peptide between the lobes, but this seems to have little effect on the overall orientation of the lobes. The N-lobes of both proteins possess lysine residues, one from each of the two domains, that lie in close proximity to one another to form the so-called dilysine trigger. The more acid-labile release of iron from serum transferrins than from lactoferrins is discussed.

RadA protein from Archaeoglobus fulgidus forms rings, nucleoprotein filaments and catalyses homologous recombination

Proteins that catalyse homologous recombination have been identified in all living organisms and are essential for the repair of damaged DNA as well as for the generation of genetic diversity. In bacteria homologous recombination is performed by the RecA protein, whereas in the eukarya a related protein called Rad51 is required to catalyse recombination and repair. More recently, archaeal homologues of RecA/Rad51 (RadA) have been identified and isolated. In this work we have cloned and purified the RadA protein from the hyperthermophilic, sulphate-reducing archaeon Archaeoglobus fulgidus and characterised its in vitro activities. We show that (i) RadA protein forms ring structures in solution and binds single- but not double-stranded DNA to form nucleoprotein filaments, (ii) RadA is a single-stranded DNA-dependent ATPase at elevated temperatures, and (iii) RadA catalyses efficient D-loop formation and strand exchange at temperatures of 60-70 degrees C. Finally, we have used electron microscopy to visualise RadA-mediated joint molecules, the intermediates of homologous recombination. Intriguingly, RadA shares properties of both the bacterial RecA and eukaryotic Rad51 recombinases.

Female sex pheromone of brinjal fruit and shoot borer, Leucinodes orbonalis blend optimization

The brinjal fruit and shoot borer, Leucinodes orbonalis is the major pest of eggplant in South Asia. Analysis of female pheromone gland extracts prepared from insects of Indian and Taiwanese origin confirmed (E)-11-hexadecenyl acetate (E11-16:Ac) as the major pheromone component with 0.8 to 2.8% of the related (E)-11-hexadecen-1-ol (E11-16:OH), as previously reported from Sri Lanka. The average quantity of E11-16:Ac extracted per female was estimated to be 33 ng, with a range of 18.9 to 46.4 ng when collected 2 to 3 hr into the scotophase. In field trials conducted in India, blends containing between 1 and 10% E11-16:OH caught more male L. orbonalis than E11-16:Ac alone. At the 1,000 microg dose, on white rubber septa, addition of 1% E11-16:OH to E11-16:Ac was found to be more attractive to male L. orbonalis than either 0.1 or 10% E11-16:OH. Trap catch was found to be positively correlated with pheromone release rate, with the highest dose tested, 3,000 microg, on white rubber septa catching more male moths than lower doses. Field and wind tunnel release rate studies confirmed that E11-16:OH released from white rubber septa and polyethylene vials at approximately twice the rate of E11-16:Ac and that the release rate of both compounds was doubled in polyethylene vials compared to white rubber septa. This difference in release rate was reflected in field trials conducted in Bangladesh where polyethylene vial dispensers caught more male moths than either black or white rubber septa, each loaded with the same 100:1 blend of E11-16:Ac and E11-16:OH in a 3,000 microg loading.

Delivery of patients with early onset, severe pre-eclampsia

OBJECTIVES

To compare the effects of induction/labor to delivery before labor in early onset, severe pre-eclampsia.

METHODS

Five-year prospective case series. Delivery course and neonatal outcome were examined for 335 women with viable singletons.

RESULTS

Induction was successful in 45% of attempts. Women exposed to labor had longer (5.5 days, P<0.0001) admissions to delivery periods and were more often delivered for maternal indications (RR=2.87, 95% CI=1.98-4.16). Their babies were born 1.6 weeks older (P<0.0001) and 352 g heavier (P<0.0001) than those delivered before labor. Babies exposed to labor needed intensive care less often (RR=0.4, 95% CI=0.27-0.58), had lower rates of severe hyaline membrane disease (RR=0.26, 95% CI=0.11-0.59) and sepsis (RR=0.56, 95% CI=0.33-0.93), and were discharged earlier (P<0.0001).

CONCLUSIONS

Exposure to induction/labor in selected patients is not detrimental to neonatal outcome in early, severe pre-eclampsia.