Biomedical subjects

J J Morrison

Publications and source records attributed to J J Morrison.

At least 19 recordsLinked to original sources

PubMed2004

Effects of thyrotropin-releasing hormone on human myometrium and umbilical vasculature in vitro.

OBJECTIVE: The purpose of this study was to investigate the direct effects of thyrotropin-releasing hormone on isolated human myometrium that was obtained during pregnancy and on human umbilical vasculature in vitro. STUDY DESIGN: Isolated human myometrial strips were dissected from biopsy specimens that were obtained at elective cesarean delivery and suspended for isometric recording under physiologic conditions. The effects of cumulative additions of thyrotropin-releasing hormone (10(-9)-10(-4) mol/L) on oxytocin-induced myometrial contractility were evaluated. The effects of thyrotropin-releasing hormone (10(-9)-10(-4) mol/L) on umbilical vessel (artery and vein) resistance in vitro were investigated with the use of isolated ring preparations. RESULTS: Thyrotropin-releasing hormone exerted a significant concentration-dependent relaxant effect on pregnant human myometrial tissue, which ranged from 3.54% (10(-9) mol/L, P=.935) to a net cumulative total of 21.06% (10(-4) mol/L, P<.001). Thyrotropin-releasing hormone also exerted a concentration-dependent relaxant effect on human umbilical vasculature that ranged from 12.51% (10(-9) mol/L, P=.994) to a net cumulative total of 23.27%+/-4.87% (SEM, 10(-4) mol/L, P<.01) in umbilical artery. For umbilical vein, the relaxant effect ranged from 1.80% (10(-9) mol/L, P=.998) to a net cumulative total of 14.64% (10(-4) mol/L, P<.009). CONCLUSION: Thyrotropin-releasing hormone exerts a significant relaxant effect in human myometrium and in human umbilical vasculature and highlights a potential physiologic role for this neuropeptide in these tissues. These findings have clinical implications for the therapeutic use of thyrotropin-releasing hormone antenatally.

Adult↗

PubMed2004

Fetal cortisol in relation to labour, intrapartum events and mode of delivery.

We set out to measure fetal cortisol in the human umbilical vein in relation to onset of labour, intrapartum complications and mode of delivery. Umbilical cord venous samples were obtained after delivery from 98 infants and serum total cortisol was measured. The onset of spontaneous labour, induction of labour, elective caesarean section, spontaneous vaginal delivery, emergency caesarean section in labour, instrumental delivery, the presence of meconium staining of the liquor and umbilical artery pH were examined in relation to serum fetal cortisol. Spontaneous onset of labour, mode of delivery, meconium staining of the liquor and gestational age were independent predictors of umbilical venous cortisol levels. Those infants delivered by elective caesarean section had the lowest cortisol levels, while the highest levels were recorded in those infants following instrumental delivery. Fetal cortisol is significantly elevated in association with spontaneous human parturition and is highest Its among babies born by instrumental delivery.

Adult↗

PubMed2003

Surgically relevant structure on the ascending aorta.

We have examined the transverse vascularized ridge observed on the anterior surface of the intra-pericardial aorta during cardiac surgery. The ridge was a consistent feature of 20 consecutive cardiac patients and 11 cadavers no more than 2 days post-mortem. The aortic ridge was absent, however, in four of five embalmed cadavers additionally examined, probably due to the embalming process. Histological examination showed the ridge to be well vascularized, well innervated and composed of adipose tissue. This structure has surgical relevance as a possible source of post-operative hemorrhage, sometimes necessitating re-sternotomy.

Adipose Tissue↗

PubMed2003

Attitudes towards routine prenatal diagnostic investigations in obstetric practice in the Republic of Ireland.

The aim of this study was to evaluate the attitudes of pregnant women towards prenatal diagnosis in the Republic of Ireland. A questionnaire was administered to all women attending the antenatal clinic at University College Hospital, Galway between January and May 1999. 1042 women participated in the study and 1012 (97%) questionnaires were completed correctly. The majority of women, 763 (75.4%) and 748 (73.9%) respectively, would avail of a fetal anomaly scan or biochemical screening if available. However, confusion exists about the purpose of ultrasound scans currently available. The majority of respondents (71%) thought that the purpose of the currently available scan was to detect fetal abnormality. In reality, the primary purpose of the scan currently available is for other purposes and the detection of fetal abnormality is performed opportunistically rather than systematically. This confusion may reflect poor provision of information to our antenatal patients and should be addressed within by the obstetric service.

Adolescent↗

PubMed2002

Ultrasound detection and perinatal outcome of fetal trisomies 21, 18 and 13 in the absence of a routine fetal anomaly scan or biochemical screening.

OBJECTIVES: To determine the prenatal detection rate of abnormality (fetal anomaly or growth restriction) in pregnancies complicated by fetal trisomies 21, 18 and 13 in an obstetric population managed without routine biochemical or sonographic screening tests and to assess the perinatal outcome of these pregnancies. SUBJECTS AND METHODS: This was a retrospective analysis of obstetric and neonatal data pertaining to infants born with trisomy 21, 18 or 13 (n = 82) diagnosed between 1989 and 1997 (23 762 deliveries). RESULTS: Antenatal suspicion of aneuploidy, based on the detection of growth restriction or fetal anomaly, was present in 18.3% (11 of 60) of fetuses with trisomy 21, in 81.2% (13 of 16) of fetuses with trisomy 18, and in 83.3% (five of six) of fetuses with trisomy 13. The antenatal detection rates for growth restriction were accurate whereas the antenatal detection rates for fetal anomalies were poor. Intrauterine fetal death occurred in 18.8% of fetuses with trisomy 18 (three of 16) and in 50% (three of six) of cases of trisomy 13. For babies born alive with trisomy 18 or 13 the neonatal mortality was 93.8% (15 of 16). All cases of trisomy 21 fetuses survived beyond the perinatal period and the antepartum and intrapartum details of these pregnancies were unremarkable. CONCLUSION: In obstetric practice without routine biochemical or sonographic screening tests the detection of findings suggestive of aneuploidy is low for trisomy 21, but is high for trisomies 18 and 13. These findings provide information for counseling about the antenatal, intrapartum, and neonatal course of these trisomies.

Adult↗

PubMed2002

Expression of mRNA transcripts for ATP-sensitive potassium channels in human myometrium.

The molecular mechanisms regulating human uterine quiescence and parturition are poorly understood. Potassium channels are central to regulation of cell membrane potential and contractility of smooth muscle. The aim of this study was to examine the expression of ATP-sensitive potassium channel (K(ATP) channel) subunits in human myometrium, and to investigate for possible differential expression of these subunits in myometrium obtained from three different functional states: (i) non-pregnant (NP); (ii) late pregnant not in labour (PNL); and (iii) late pregnant in labour (PL). RT-PCR detected the presence of mRNA for four subunits of K(ATP) channels (Kir6.1, Kir6.2, SUR1 and SUR2B) in the three tissue types. Quantitative analysis of these subunits was achieved with real-time RT-PCR using Lightcycler(TM) technology. This analysis showed that there were significantly higher levels of Kir6.1 and SUR2B transcripts in NP myometrium compared with those measured in myometrium obtained during pregnancy (P < 0.001). Lower levels of Kir6.2 and SUR1 mRNA expression were found, although higher transcript levels in NP myometrium (P < 0.05) were still observed. Our results indicate that the major K(ATP) channel expressed in human myometrium is composed of Kir6.1 and SUR2B, and that down-regulation of this channel may facilitate myometrial function during late pregnancy.

ATP-Binding Cassette Transporters↗

PubMed2002

Expression and modulation of Rho kinase in human pregnant myometrium.

There is little information outlining the role of Rho kinase, RhoA, and calcium sensitization in regulation of human uterine contractility during pregnancy. The aims of this study were to investigate the expression of RhoA, and the Rho kinases ROCK I and ROCK II in human pregnant myometrium, to evaluate the effects of Rho kinase inhibition on pregnant human myometrial contractility in vitro, and to compare these effects with those of the calcium channel blocker nifedipine. RT-PCR using primers for RhoA, ROCK I and ROCK II was performed on mRNA isolated from human pregnant myometrium. Isometric recording was performed in isolated myometrial strips obtained at Caesarean section. The effects of the Rho kinase inhibitor Y-27632 (1 nmol/l to 10 mmol/l), and nifedipine (1 nmol/l to 10 mmol/l), on oxytocin (0.5 nmol/l) induced contractions were measured and compared. Expression of RhoA, ROCK I and ROCK II mRNA was identified in human pregnant myometrium (n = 3). Y-27632 exerted a potent relaxant effect on myometrial contractility with a pD(2) value (+/- SEM) of 7.63 +/- 0.38 (n = 6). The maximum net relaxant effect (+/- SEM) was 72.3 +/- 6.1% (n = 6). Corresponding values for nifedipine were 7.24 +/- 0.48 (n = 6; P = 0.469) and 93.40 +/- 3.1% (n = 6; P = 0.028). Rho A/Rho kinase-mediated calcium sensitization may play role in the physiology of human parturition, and pharmacological inhibition of this pathway may therefore provide a novel approach to tocolysis for pre-term labour.

Adult↗

PubMed2002

Corticosteroids and fetal vasculature: effects of hydrocortisone, dexamethasone and betamethasone on human umbilical artery.

OBJECTIVE: To investigate the direct effects of corticosteroids on human umbilical artery resistance, in vitro. DESIGN: Prospective laboratory study. SETTING: University teaching hospital. SAMPLES AND METHODS: Umbilical artery samples were obtained following normal, term deliveries (n = 50) and dissected rings were suspended for isometric recording under physiological conditions. The effects of hydrocortisone (10(-9) - 10(-4) M), dexamethasone (10(-9) - 10(-4) M) and betamethasone (10(-9) - 10(-4) M) on umbilical artery resistance were measured in vitro. MAIN OUTCOME MEASURES: Changes in umbilical artery resistance, in vitro. RESULTS: Hydrocortisone (n = 12) exerted a vasodilatory effect on human umbilical artery at all concentrations studied compared with vehicle control experiments (n = 12) (P < 0.0001). The mean net relaxant effect of hydrocortisone ranged from 11.77% (10(-9) M) to 57.01% (10(-4)). Both exogenous compounds, dexamethasone (n = 12) and betamethasone (n = 12), similarly exerted a significant relaxant effect on human umbilical artery tone (P < 0.05-0.01), compared with vehicle control experiments (n = 12). The mean net relaxant effect of dexamethasone ranged from 14.43% (10(-9) M) to 38.12% (10(-4)) and that of betamethasone ranged from 6.02% (10(-9) M) to 42.30% (10(-4)), in a cumulatively increasing fashion. There was a non-significant trend towards a greater vasodilatory effect of dexamethasone than betamethasone at lower bath concentrations studied. CONCLUSION: Corticosteroids exert a direct and potent vasodilatory effect on human umbilical artery resistance in vitro, thus providing an explanation for the previously unexplained vascular effects associated with antenatal administration of corticosteroids.

Adolescent↗

PubMed2001

Uterine relaxant effects of cyclooxygenase-2 inhibitors in vitro.

OBJECTIVE: To compare the effects of three cyclooxygenase-2 (COX-2) inhibitors: nimesulide, meloxicam, and celecoxib, which exhibit varying COX-2 selectivity, on contractile activity in pregnant (before and after labor) and nonpregnant human myometrial tissue in vitro. METHODS: Isometric tension recording was performed under physiologic conditions in isolated myometrial strips obtained from 33 women undergoing hysterectomy or either elective or emergency cesarean section. The effects of cumulative additions of nimesulide, meloxicam, and celecoxib (between 1 nmol/L and 100 micromol/L) on myometrial contractility were measured, and values for -log(10) EC(50) and mean maximal inhibition were compared. RESULTS: Nimesulide, meloxicam, and celecoxib exerted significant relaxant effects on contractility in nonpregnant, pregnant nonlabor, and pregnant labor myometrial strips. Values for -log(10) EC(50) values (+/- standard error of the mean) were as follows: nimesulide (nonpregnant) 5.14 +/- 0.93 (n = 6), (pregnant nonlabor) 4.91 +/- 0.75 (n = 6), and (pregnant labor) 5.84 +/- 0.35 (n = 6); meloxicam (nonpregnant) 6.53 +/- 0.57 (n = 6), (pregnant nonlabor) 4.80 +/- 0.71 (n = 6), and (pregnant labor) 5.62 +/- 0.21 (n = 6); celecoxib (nonpregnant) 6.15 +/- 0.99 (n = 6), (pregnant nonlabor) 7.08 +/- 0.98 (n = 6), and (pregnant labor) 7.25 +/- 0.99 (n = 3). Celecoxib exhibited greater potency than nimesulide or meloxicam (P < .01). The range of maximal relaxation values achieved in the three tissue types were as follows: nimesulide 68-70% (n = 18; P < .01), meloxicam 69-84% (n = 18; P < .01), and celecoxib 69-77% (n = 15; P < .01). CONCLUSION: COX-2 inhibitors exert significant relaxation in human myometrium with a similar potency in nonpregnant and pregnant (before and after labor onset) tissues. Celecoxib, a COX-2 specific inhibitor, was more potent than nimesulide or meloxicam, COX-2 preferential inhibitors.

Adult↗

PubMed2001

Effect of parathyroid hormone-related peptide on human and rat myometrial contractility in vitro.

OBJECTIVES: The aims of this study were primarily to investigate the effects of parathyroid hormone-related peptide (human fragment 1-34) on human nonpregnant and pregnant (nonlabor and labor) myometrial contractility in vitro and secondarily to compare these effects with those of parathyroid hormone-related peptide on rat myometrial contractility. STUDY DESIGN: Isometric tension recording was performed under physiologic conditions in isolated myometrial strips obtained at hysterectomy and cesarean delivery and from Sprague-Dawley rats. The effect of cumulative additions of parathyroid hormone-related peptide (1, 10, and 100 nmol/L) on myometrial contractility was measured and the significance of results was assessed by 2-way analysis of variance. RESULTS: Parathyroid hormone-related peptide exerted a statistically significant net relaxant effect on myometrial contractility in human nonpregnant myometrium (34.71%; P<.01), in human pregnant myometrium obtained before (18.27%; P <.05) but not after (10.32%; P>.05) the onset of labor, and in rat tissue (31.60%; P<.01). CONCLUSIONS: Parathyroid hormone-related peptide exerts a relaxant effect on human and rat myometrial tissue. In human myometrium, sensitivity to parathyroid hormone-related peptide is reduced in pregnancy and abolished by the onset of labor.

Adrenergic alpha-Agonists↗

PubMed2001

Amino-terminal pro-brain natriuretic peptide in normal and hypertensive pregnancy.

OBJECTIVES: To investigate serum levels of amino-terminal pro-brain natriuretic peptide (Nt pro-BNP) as an index of left-ventricular function in normal pregnancy and pregnancies complicated by hypertension and also to investigate levels in both primigravid and multigravid women. METHODS: Women with hypertension in pregnancy (at least two readings of systolic blood pressure > 140 mm Hg and diastolic blood pressure > 90 mm Hg) (n = 24) and normotensive women (n = 42) were included in the study. Serum Nt pro-BNP was measured using an enzyme-linked immunosorbent assay technique. RESULTS: The median serum Nt pro-BNP level in pregnancies complicated by hypertension was 420 fmol/L, which was significantly greater than that measured in samples obtained from normotensive women in pregnancy (340 fmol/L) (p = 0.03). There was a nonsignificant trend toward increased levels in proteinuric as compared to nonproteinuric hypertension in pregnancy. Multigravida had higher Nt pro-BNP levels (n = 26; median Nt pro-BNP = 358 fmol/L) than primigravida (n = 16; median Nt pro-BNP = 278 fmol/L) (p = 0.01) in association with normal pregnancy. Multigravida also demonstrated a dramatic rise in serum Nt pro-BNP levels in association with hypertension in pregnancy (n = 13; median Nt pro-BNP = 572 fmol/L) as compared to normal pregnancy (n = 26; median Nt pro-BNP = 358 fmol/L) (p = 0.009). CONCLUSION: Serum Nt pro-BNP is elevated in women with hypertensive disorders of pregnancy, indicating elevated left-ventricular filling pressures. Measured serum levels in both normal and hypertensive pregnancy are higher in multigravida than in primigravida.

Adult↗

PubMed2001

Beta-3 versus beta-2 adrenergic agonists and preterm labour: in vitro uterine relaxation effects.

OBJECTIVE: 1. To investigate the effects of the selective beta-3 adrenoreceptor agonist, BRL 37344, on human pregnant myometrial contractility in vitro. 2. to compare these effects with those of the beta-2 adrenoreceptor agonist, ritodrine. METHODS: Isometric tension recording was performed under physiological conditions in isolated myometrial strips from biopsies obtained at elective caesarean section. Following pre-incubation with oxytocin (10(-9) M), the effects of cumulative additions of BRL 37344 or ritodrine (10(-8)-10(-3.5) M) on myometrial contractility were investigated. Results were expressed as -log EC50 (pD2) and mean maximal inhibition achieved for both drug compounds. RESULTS: BRL 37344 exerted a concentration dependant relaxant effect on myometrial contractions in all strips exposed [pD2, 7.26 (0.48) (SEM); mean maximal inhibition 61.98 (4.89%); n = 6]. Similarly, ritodrine exerted a concentration dependant inhibition of myometrial contractility in all strips exposed [pD2 = 7.40 (0.28); mean maximal inhibition 59.49 (3.97%); n = 6]. There was no significant difference between calculated pD2 values (P = 0.65) or mean maximal inhibition achieved (P = 0.79). CONCLUSIONS: The beta-3 adrenoreceptor agonist BRL 37344 induced relaxation of human myometrial contractions with similar potency to that of the most commonly used tocolytic agent ritodrine. This raises the possibility that the novel beta-3 adrenoreceptor agonists may have potential as therapeutic agents for human preterm labour. In view of their reported reduced cardiovascular side effects their potential clinical use requires further evaluation.

Adrenergic beta-Agonists↗

PubMed2001

Human chorionic gonadotrophin inhibition of pregnant human myometrial contractility.

OBJECTIVE: To evaluate the effect of human chorionic gonadotrophin (hCG) on pregnant human myometrial contractility in vitro and to determine whether the hCG-elicited effect was oestrogen dependant. METHODS: Isometric tension recording was performed under physiological conditions in isolated myometrial strips from biopsies obtained at elective caesarean section. The effect of cumulative additions of hCG (0.001, 0.01, 0.1, 1.0 and 10 iu/mL) on myometrial contractility was evaluated. Secondarily, the contractile activity of pregnant myometrium following hCG exposure was investigated in tissue pre-treated with beta-oestradiol. RESULTS: hCG exerted a statistically significant relaxant effect on pregnant human myometrial tissue. The relaxant effect increased with increasing concentrations of hCG from 8.96% (SEM 2.06) (0.001 iu/mL hCG: P < 0.01 ) to a net cumulative total of 58.50% (SEM 3.74) (10 iu/mL hCG; P < 0.01). The relaxant effect was also time-dependant, increasing in magnitude throughout the duration of experiments. Beta-oestradiol did not significantly affect the response of myometrial tissue to hCG. CONCLUSIONS: These results clearly demonstrate that hCG exerts a significant concentration-dependant relaxant effect on human myometrial tissue obtained rate in pregnancy. These findings outline an inhibitory physiological role of hCG on human myometrial contractility and raise the possibility of its potential use as a tocolytic.

Adult↗

PubMed2001

Severe HELLP syndrome remote from term.

A 27 year-old nulliparous woman was admitted to University College Hospital Galway with severe preeclampsia at 21 weeks 'gestation. In addition, there was evidence of HELLP syndrome with renal failure. A decision was made to end the pregnancy to save the mother's life. Labour was induced with misoprostol and vaginal delivery of a male stillborn fetus weighing 250 g was achieved after 19 hours. The condition of the patient improved gradually following delivery. Renal impairment, however, persisted postpartum. HELLP syndrome is a life-threatening complication of pregnancy which can only be cured by delivery. Other therapeutic modalities are only palliative but may improve the outcome for the very premature viable fetus. Conservative management is not an option when HELLP syndrome occurs long before fetal viability has been reached.

Abortifacient Agents, Nonsteroidal↗

PubMed2000

Cardiac troponin I in pre-eclampsia and gestational hypertension.

OBJECTIVE: To investigate serum cardiac troponin I, a sensitive marker of cardiac myocyte damage, in normal pregnancy and pregnancies complicated by hypertension with and without significant proteinuria. DESIGN: Prospective cross sectional study. SETTING: University hospital delivery suite. SAMPLE: Serum samples obtained from women in normal pregnancy and in pregnancies complicated by hypertension with and without significant proteinuria. METHOD: Women with hypertension in pregnancy (at least two readings of systolic blood pressure > 140 mmHg and diastolic blood pressure > 90 mmHg) (n = 26) and normotensive women (n = 43) were included in the study. Serum cardiac troponin I was measured using Beckman Access immunoassay. MAIN OUTCOME MEASURE: Serum cardiac troponin I level in the pregnancies complicated by hypertension (with and without significant proteinuria) compared with the levels measured in normotensive women. RESULTS: The median serum cardiac troponin I level in pregnancies complicated by hypertension was 0.118 ng/mL (n = 26) which was significantly greater than that measured in samples obtained from normotensive women in pregnancy (0.03 ng/mL; n = 43) (P < 0.0001). There were higher median serum cardiac troponin I levels in hypertensive women with significant proteinuria (0.155 ng/mL; n = 6), compared with those without proteinuria (0.089 ng/mL; n = 20; P = 0.03). CONCLUSION: Serum cardiac troponin I is elevated in women with hypertensive disorders of pregnancy indicating some degree of cardiac myofibrillary damage in these disorders.

Adult↗

PubMed2000

Development of an optimized feeding technology for dairy cows: improvement in resistance to ruminal proteases in the de novo-designed protein MB-1.

We have previously reported on MB-1, a designer protein with potential application in animal nutrition. Having a high content of selected essential amino acids, MB-1 should provide limiting nutrients for animals and promote growth and production. However, the protein was found to have marginal conformational and proteolytic stability, and, thus, strategies for stabilizing MB-1 were elaborated. We discuss the synthesis of MB-1-Cys dimer, a protein with an intermolecular disulfide bridge. This mutant was exposed to Pronase E protease preparation as well as to proteases extracted from ruminal microbes. It was found that in both cases, MB-1-Cys dimer had a better resistance to proteolytic degradation than MB-1. Denaturation and hydrophobic dye binding studies revealed that this enhanced stability was not owing to conformational stabilization, but rather to changes in surface exposure as a consequence of dimerization. In particular, it was found that binding of ANSA to MB-1-Cys dimer was comparable to that observed for native, compact, natural proteins. We discuss the implications of these results for the design of transgenic protein production systems.

Anilino Naphthalenesulfonates↗

PubMed2000

Perinatal factors and preterm delivery in an Irish obstetric population.

The aim of this study was to ascertain the incidence of preterm delivery, the associated etiological factors and consequent perinatal mortality in an Irish obstetrical population. All deliveries between 24 + 0 and 36 + 6 weeks of gestation that occurred during the five year period 1992-1996 were included in the study. The overall group of preterm deliveries was also analyzed separately as an early preterm group (24 + 0-31 + 6 weeks gestation) and a late preterm group (32 + 0-36 + 6 weeks gestation). The overall incidence of preterm delivery was 5.5% (n = 683) with 1% (n = 122) occurring in the early preterm group and 4.5% (n = 561) in the late preterm group. The etiological factors contributing to preterm delivery in our population together with their frequency of occurrence in both early and late preterm groups are outlined. Spontaneous unexplained preterm delivery, multiple pregnancy, and hypertensive disorders of pregnancy were the commonest etiological factors for preterm delivery. The perinatal mortality rate (PMR) was 57 per 1000 (n = 39) in the preterm group overall with a 213/1000 PMR in the early preterm group and a 23/1000 PMR in the late preterm group.

Chorioamnionitis↗

PubMed1999

Prenatal diagnosis of lethal fetal malformation in Irish obstetric practice.

The diagnosis of lethal fetal malformation prenatally has profound implications for the pregnancy, the expectant couple and the medical care provided. The aim of this study was to investigate these implications and the medical factors pertaining to prenatal diagnosis of lethal fetal abnormality in current obstetric practice in Ireland. Data was collected prospectively from all cases of lethal fetal malformation diagnosed at the Fetal Medicine Unit, University College Hospital Galway from December 1997 to June 1998 inclusive. Diagnosis was made on the basis of ultrasound findings and invasive procedures (amniocentesis and chorionic villus sampling). Thirteen cases of lethal fetal abnormality were diagnosed: Edward's syndrome, Patau's syndrome, bilateral multicystic renal dysplasia, Potters sequence, hypoplastic left heart, anencephaly with craniorrhachischisis, lethal osteogenesis imperfecta and non-immune hydrops. Intrauterine death occurred in four cases. Four women had preterm complications e.g. preterm premature rupture of membranes, preterm labour, placental abruption, coagulopathy and severe pre-eclampsia. Three pregnancies progressed to term, two of which had a vaginal delivery and one had an elective caesarean section for malpresentation, all of which were early neonatal deaths. Three women chose to travel abroad in order to obtain a termination of pregnancy. Obstetric and neonatal dilemmas in management of lethal fetal malformation are discussed.

Abnormalities, Multiple↗