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Preterm birth — causes, prevention and management 2E
SELF-ASSESSMENT
pre-operatively. no place.
The anti-prostaglandin
tablets have
Answer 9 a) True b) False c) False d) False e) False Premenstrual syndrome is related to ovarian cycle and therefore hysterectomy with conservation of both ovaries is not a therapeutic option for PMS. Premenstrual syndrome is the disease of theories none of which has been proven. Studies have shown that compared with controls women who suffer from PMS may have lower, equal or even higher concentration of plasma progesterone in the luteal phase. The symptoms remain constant from cycle to cycle but may vary between individuals. The condition is usually deteriorating with age.
Preterm birth- causes, prevention and management 2E by Fuchs, Fuchs and Stubberfield, McGraw Hill, Price g67.00. ISBN O-07- 105409-X Whilst the outcome of babies born preterm has improved over the past 2 or 3 decades, this is arguably the result of advances in neonatal care since little impact has been made on preterm delivery rates. This is despite the advent of powerful drugs to abolish intense activity. Apart from outcome, another example of improvement in the area of preterm birth has been our understanding of its causes, prevention and management. These advances are many and varied and it is useful to have them collected into this one volume. The many developments which have taken place since the first volume of the book have been incorporated effectively and comprehensively. Topics include infection, cervical function, social factors and stress, multiple births, home uterine activity monitoring and the use of calcium channel blockers. In writing such a book it is difficult for the subject material to be up-to-date, yet it would appear that the contributors have succeeded well in this regard.
QUESTIONS:
MENSTRUAL
CYCLE
181
Answer 10 A(iv), B(iv), C(i) The absence of withdrawal bleeding indicates inadequate oestrogenic preparation of the endometrium. This finding in combination with normal prolactin and sub-normal gonadotrophin level is compatible with hypo-gonadotrophic hypo-gonadism. Hypothalamic/pituitary lesions such as vascular abnormalities or invasive tumours have to be excluded and therefore CAT scan is the most useful diagnostic measure. Resistant ovary syndrome is usually associated with menopausal levels of gonadotrophins and patients suffering from polycystic ovarian disease are usually well-oestrogenised. Mullerian agenesis can be excluded because of the secondary amenorrhoea. Clomiphene is not effective in a hypo-oestrogenised woman and bromocriptine is useless as hyperprolactinaemia is not a problem.
The only notable omission is any reference to Fibronectin. Excellently annotated and illustrated, I would recommend this book as an excellent and comprehensive reference source for those involved with both research and management of preterm birth. DAVID JAMES Fetal monitoring in practice by D. Gibb and S. Arulkumaran, Butterworth Heinemann, Oxford. Price &I5.95 ISBN o-7506-1099-9 ‘Education is the prime aim of this book’. There are no keener protagonists of intrapartum monitoring than these two authors. As a team they have toured the country giving seminars to doctors and midwives. Those who attended will not be disappointed. The uncertain position of FHR monitoring adds a dynamic to this book and the virtues of monitoring are eloquently argued at an early point. Didactic teaching is easy to criticise but has many advantages particularly where clear guidelines are needed. The book includes accounts of FHR terminology and the
pre-operatively. no place.
The anti-prostaglandin
tablets have
Answer 9 a) True b) False c) False d) False e) False Premenstrual syndrome is related to ovarian cycle and therefore hysterectomy with conservation of both ovaries is not a therapeutic option for PMS. Premenstrual syndrome is the disease of theories none of which has been proven. Studies have shown that compared with controls women who suffer from PMS may have lower, equal or even higher concentration of plasma progesterone in the luteal phase. The symptoms remain constant from cycle to cycle but may vary between individuals. The condition is usually deteriorating with age.
Preterm birth- causes, prevention and management 2E by Fuchs, Fuchs and Stubberfield, McGraw Hill, Price g67.00. ISBN O-07- 105409-X Whilst the outcome of babies born preterm has improved over the past 2 or 3 decades, this is arguably the result of advances in neonatal care since little impact has been made on preterm delivery rates. This is despite the advent of powerful drugs to abolish intense activity. Apart from outcome, another example of improvement in the area of preterm birth has been our understanding of its causes, prevention and management. These advances are many and varied and it is useful to have them collected into this one volume. The many developments which have taken place since the first volume of the book have been incorporated effectively and comprehensively. Topics include infection, cervical function, social factors and stress, multiple births, home uterine activity monitoring and the use of calcium channel blockers. In writing such a book it is difficult for the subject material to be up-to-date, yet it would appear that the contributors have succeeded well in this regard.
QUESTIONS:
MENSTRUAL
CYCLE
181
Answer 10 A(iv), B(iv), C(i) The absence of withdrawal bleeding indicates inadequate oestrogenic preparation of the endometrium. This finding in combination with normal prolactin and sub-normal gonadotrophin level is compatible with hypo-gonadotrophic hypo-gonadism. Hypothalamic/pituitary lesions such as vascular abnormalities or invasive tumours have to be excluded and therefore CAT scan is the most useful diagnostic measure. Resistant ovary syndrome is usually associated with menopausal levels of gonadotrophins and patients suffering from polycystic ovarian disease are usually well-oestrogenised. Mullerian agenesis can be excluded because of the secondary amenorrhoea. Clomiphene is not effective in a hypo-oestrogenised woman and bromocriptine is useless as hyperprolactinaemia is not a problem.
The only notable omission is any reference to Fibronectin. Excellently annotated and illustrated, I would recommend this book as an excellent and comprehensive reference source for those involved with both research and management of preterm birth. DAVID JAMES Fetal monitoring in practice by D. Gibb and S. Arulkumaran, Butterworth Heinemann, Oxford. Price &I5.95 ISBN o-7506-1099-9 ‘Education is the prime aim of this book’. There are no keener protagonists of intrapartum monitoring than these two authors. As a team they have toured the country giving seminars to doctors and midwives. Those who attended will not be disappointed. The uncertain position of FHR monitoring adds a dynamic to this book and the virtues of monitoring are eloquently argued at an early point. Didactic teaching is easy to criticise but has many advantages particularly where clear guidelines are needed. The book includes accounts of FHR terminology and the