Three different oxytocin challenge tests were used for the anssessment of placentar function in pregnant women at risk: For the oxytocin test after Ray et al. Oxytocin was given in continuity with rising doses. In the two other tests Oxytocin was given intermittently with identical doses. The test described by Ray et al. Proved useful for predicting respiratory insufficiency of the placenta. The two other intermittent tests are, according to our investigations, less suitable as tests of placentar function because their significance is limited or non-existent. The continuous oxytocin challenge test takes more time (one hour on average). Essential for exact interpretation are a careful technique and surveillance of the patient throughout the test by trained personel. In our opinion the indications for the continous oxytocin challenge test are pregnancies at risk, where antepartum cardniotocography shows suspect or hard-to-interprete results (e.g. non-classifiables decelerations, loss of fluctuation, absence of Braxton-Hicks contractions) or when other monitoring techniques indicate placentar insufficiency (e.g. low oestriol excretion). The test is not suitable in placenta previaprevia, threatened premature birth and premature ruptur of the membranes. In contrast to other authors we cannot decide with certainly whether patients with a positive oxytocin challenge test should in every case be treated with Caesarean section [9]. This decision will depend not only on the result of the test but on the assessment of all parameters, mainly on the clinical picture. In any case delivery of patients with positive oxytocin challenge tests will have to be carried out under strict technical and biochemical supervision.

In Victoria, in 1984, intrauterine hypoxia of unknown aetiology accounted for 59 of the 252 perinatal deaths of infants with a birth-weight of 2,500 g or more. These unexplained deaths occur in approximately 1 in 1,000 pregnancies near term, and in more than 90% of cases the infants are neither small nor large for dates (tables 1 and 2). In 27 of the 59 cases, a fetoplacental function test (oestriol assay, cardiotocography) had been performed, and in 6 glucose tolerance had been tested either before or after the fetal death occurred. We endorse recent recommendations that all pregnant women should be screened for gestational diabetes at approximately 24-28 weeks' gestation as a possible means of reduction in the number of intrauterine deaths of mature infants. Consideration of these cases indicates that induction of labour should not be deferred after 37-38 weeks' gestation in high risk pregnancies, merely because tests of fetoplacental function are normal--i.e. laboratory tests should not outweigh clinical judgment especially in high risk pregnancies! It is considered that the cost of identification of these infants at risk of 'unexplained death', if possible, is likely to be justified by the fact that they are mature and apparently normal.

Many clinicians are experiencing consumer resistance to the prescription of equine HRT (that is hormone replacement therapy which has been manufactured from mare's urine). In this paper I consider the ethical implications of prescribing these preparations. I decide that patients should have a right to refuse such treatment but also ask whether a prescribing doctor should choose one preparation over another on moral grounds. I determine that there is prima facie evidence to suggest that mares may suffer and that prescription of equine HRT (instead of synthetic oestrogen-oestriol) would therefore have to be justified in terms of either offering greater benefits to the women or offering greater value for money to the health service. I find that there is no substantial evidence to suggest that equine HRT offers unique advantages over and above oestriol. I conclude that it would be preferable for a doctor to recommend the synthetic oestrogen to women who want relief from the symptoms of the menopause and protection from osteoporosis and cardiovascular disease.

Eight women with primary failure of ovarian function and twelve women undergoing the climacteric were treated sequentially with oestradiol-oestriol and norethisterone acetate (Trisequens and Trisequens Forte, Novo). After a mean treatment period of 5 yr (range 3-8 yr) endometrial biopsies were taken on day 11 or 12 at the end of an oestrogen-only phase. All biopsies showed the presence of a proliferative endometrium without any signs of hyperplasia or carcinoma in situ. Although cyclic oestrogen therapy can cause hyperplasia, a small dose of a progestogen (norethisterone acetate 1 mg) for 10 days in a 28-day cycle can prevent hyperplasia of the endometrium during long-term treatment.

A rapid separation fluoroimmunoassay for serum or plasma levels of total oestriol in pregnancy was established, based on the use of fluorescein-labelled oestriol and sheep anti-oestriol serum covalently linked to magnetisable particles. Equilibrium was attained within 10 min, and the fluorescence of the bound fraction of labelled ligand was quantitated fluorimetrically after elution from the magnetisable particles. Results for pregnancy serum samples correlated well with an established radioimmunoassay technique and the sensitivity, precision and accuracy were appropriate for clinical use. Advantages of this system as compared with radioimmunoassay include the speed and simplicity of end-point detection, prolonged shelf-life of the labelled reactant and absence of any health hazard. The separation step enabled the removal of any endogenous fluorophores or other interfering factors present in biological samples.

Oestriol preparations were applied to 107 patients with genital decent or genital prolapse. The treatment was both presurgical and postoperative. Oestriol was found to have strong effects on the vaginal epithelium, and the absence of any proliferative effect upon the endometrium was confirmed. The defence position of both the vagina and the lower urinary pathways was improved by oestriol. Microcirculation in central and peripheral vascular zones was increased in response to the administration of oestriol preparations. The postoperative period was without any complications. Postsurgical hospitalisation was reduced from 18.6 +/- 1.5 to 15.6 +/- 0.7 days.

We performed in 113 patients at least three simultaneous determinations of serum-HPL and oestriol in 24-hour urine samples, as well as Doppler flow studies at the arcuate artery (AA), umbilical artery (UA), foetal aorta and internal carotid, because of suspicion of IUGR. The diagnostic value was studied with regard to IUGR, placental weight and mode of delivery. Concerning the detection of IUGR, the superiority of Doppler parameters (AA, UA) is shown. In the total number of patients, the rates for sensitivity and specificity for UA (78/91%) and AA (58/89%) exceed the hormone parameters. Oestriol, in particular, (13/63%) shows a marked difference, but even HPL (37/63%) cannot compete with respect to diagnostic value.