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Carbohydrate and lipid metabolism was evaluated in 31 women before and after 1 year's use of a progesterone-releasing intrauterine device. The studies involved measuring blood glucose and plasma insulin levels during a 3-hour oral glucose tolerance test and also measuring fasting cholesterol and triglyceride levels. There was no change in the cholesterol levels, whereas the triglyceride concentration was lower at the 1-year test. The blood glucose values were unchanged at four of the time periods, whereas the 3-hour value was elevated at the 1-year test. The plasma insulin values were increased in the fasting, 0.5-, and 3-hour samples at the 1-year test. The increased insulin secretion needed to maintain the blood glucose concentration suggests that the released progesterone may have a systemic effect.

The effects of an acute blood glucose increase on the capacity of the pituitary gland to release gonadotropins (luteinzing hormone [LH] and follicle-stimulating hormone [FSH]) were studied in 21 women. Each woman received two intravenous challenges of 100 microgram of gonadotropin-releasing hormone (GNRH). Between these injections the blood glucose level was increased in 10 of the women by orally adminstering 100 gm of glucose. Although there were significantly higher blood glucose and plasma insulin levels in the latter group, the LH and FSH response to the second GNRH injection was not different. There was also no significant relationship between the basal blood glucose level and the gonadotropin (LH and FSH) response to GNRH. Acute elevations of blood glucose do not appear to alter the ability of the anterior pituitary cells to release gonadotropins.

Seventy-eight amniotic fluid samples were obtained by transabdominal amniocentesis and were analyzed for their L/S ratio and optical density at 400 and 650 nm. The L/S ratio was considered to be mature if the values were greater than 2.0. The optical density of the fluids decreased with prolonged refrigeration. With freshly centrifuged samples, the OD650 reading of greater than 0.15 gave the best correlation with the mature L/S ratio. There were 3.8% false positive results and 14.1% false negative results. The study confirms that the OD650 test on fresh amniotic fluid is a rapid and inexpensive way to determine fetal maturity. All samples with values of less than 0.15 must, however, also be tested for their L/S ratio since some of the infants with these values may also be mature.

Prospective studies of carbohydrate metabolism were performed by means of an oral glucose tolerance test in 29 women. The studies were performed before and after 3 months of treatment with an oral contraceptive that contained 0.035 mg of ethinyl estradiol and 0.4 mg of norethindrone. The 24 women with a "normal" control test had no significant alteration in any of their blood glucose and plasma insulin values, except that the fasting glucose level decreased with treatment. Three of these women (12.5%) had a slight deterioration of their glucose curves into a "borderline abnormal" grouping during treatment. There were five women with "borderline abnormal"control glucose curves, and in four of these (80%) the curves returned to "normal" during treatment, whereas one curve stayed "borderline abnormal." These data suggest that this low-estrogen oral contraceptive has minimal short-term adverse effects on the carbohydrate metabolism.

Fetal movements were directly visualized with a real-time ultrasound unit, and they were recorded after the random intravenous administration of either glucose or saline solution to the mother. A significant increase in fetal activity was seen 1 hour after the administration of glucose.

Transabdominal amniocenteses were performed on both sacs of 14 sets of twins. In each instance one sac was marked with methylene blue to correctly identify the fluids. The lecithin/sphingomyelin ratio was determined on each fluid, and the correlation coefficient between the two sets of fluids was 0.86. There was no significant difference in the fluids' L/S ratios. The importance of this in terms of understanding the variables affecting fetal lung maturation and in clinically managing twin pregnancies is stressed.

A 3-hour oral glucose tolerance test was conducted in "normal" women before and after 12 months of contraceptive treatment with daily 0.25-mg ethynodiol diacetate tablets. There was no significant change in the subjects' weight between the two tests. All but the 3-hour individual group glucose values were significantly elevated at the 1-year test, and 16.7% of the tolerance curves became "borderline abnormal". The group plasma insulin values for the 0.5-, 1-, and 2-hour samples during the 1-year test were also significantly elevated. There was a significant decrease in the group fasting triglyceride levels but no change in the fasting cholesterol levels. These data suggest that some of the 19-norprogestogens may adversely affect carbohydrate metabolism.

Sixteen women volunteers with menstrual irregularities were studied with an intravenous injection of 100 microgram of gonadotropin-releasing hormone (GNRH). Serial blood samples were obtained for 2 hours after the injection and assayed for their concentration of glucose, insulin, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). There was a significant increase in the levels of both gonadotropins following the injection, with the peak for LH occurring at 30 minutes and the peak for FSH occurring at 90 minutes. There was a slight decrease in the glucose level at 45 minutes and in the insulin levels at 60 and 120 minutes. Because GNRH causes only minor changes in these parameters of carbohydrate metabolism, it would appear to be safe to use in women with ovulatory abnormalities secondary to diabetes mellitus.

Serum human placental lactogen levels were measured after 36 weeks' gestation in 264 serum samples from 109 women with normal pregnancies and in 137 serum samples from 70 women with pregnancies complicated by fetal intrauterine growth retardation (IGR). The fetal and placental weights were significantly lower in the IGR groups while the maternal ages were not different. There was a significantly lower hPL value at each week from 36 to 41 (except for the 39th) in the IGR group. Sixty percent of the women with IGR had hPL values less than 6 mug/ml, and 18.6% were less than 4 mug/ml. It is suggested that a low serum hPL value obtained during the last month of pregnancy should alert the physician to the possibility of intrauterine problems, including IGR.

Metabolic studies were done on 41 women who were using an inert plastic intrauterine device (IUD). They each had a three-hour oral glucose tolerance test done after the IUD was inserted and then again one year later. The fasting plasma triglyceride and cholesterol levels were also measured. The fasting blood glucose value was slightly elevated after one year (82.4 +/- SEM 1.3 vs 89.3 +/- SEM 2.2 mg/dl) of IUD use, but all of the other glucose and lipid levels were unchanged. These data provide baseline studies for comparison of the metabolic effects of other contraceptive agents studied over one year's time period.

Fifteen women with prior twin pregnancies and 20 women with prior singleton pregnancies were investigated in the luteal phase of their menstrual cycles. Measurements were made of their basal LH, FSH, estradiol, progesterone, testosterone and dihydrotestosterone levels as well as their LH and FSH responses to serial graded (0.5 microgram, 5.0 micrograms and 50.0 micrograms) intravenous injections of gonadotropin-releasing factor. The women with prior twin pregnancies were heavier and had a higher parity. Their basal serum progesterone and testosterone levels were not different, but they had lower basal serum estradiol levels and higher basal serum dihydrotestosterone levels. No differences were noted between either the basal or the stimulated gonadotropin (LH and FSH) levels. Thus, no identifiable pituitary trophic factors associated with or causing twinning could be identified in the population studied.

A detailed study was made of 150 women delivered of their infants within 72 hours of an amniocentesis where the lecithin/sphingomyelin (L/S) ratio was 2.0 or greater. There were nine neonates with respiratory distress (6.0 per cent). There were two neonatal deaths, both due to severe congenital heart disease. A mature amniotic fluid L/S ratio predicts a newborn infant who will not have respiratory distress syndrome (RDS) in most pregnancies. There is a significantly increased risk of RDS in neonates with a mature L/S ratio if the mother has insulin-dependent diabetes or if there is a resulting low Apgar score. The method of delivery (cesarean section or vaginal) does not affect the frequency of RDS where the L/S ratio is 2.0 or more.

Twenty-eight women were tested with a standard three-hour oral glucose tolerance test before and after three years of using a combination-type oral contraceptive containing mestranol and ethynodiol diacetate (Ovulen). At the three-year test time there was a significant elevation of the patients' weights and their 1-, 2-, and 3-hour blood glucose and 2- and 3-hour plasma insulin values. Pretreatment control tests had shown no "abnormal" blood glucose curves, whereas at the three-year test 17.2% of the curves were "abnormal". Serial follow-up studies in two women after stopping the medication showed that the abnormal glucose curves reverted to their pretreatment status within 12 months.

A prospective study of the effects of a conjugated estrogen (Premarin, 1.25 mg.) was performed in 36 women over a 1 year period. Each subject received a 3 hour oral glucose tolerance test before starting the medication and another after 1 year of use. The blood glucose levels were similar at five times during the two tests except for a significant elevation of the 1 hour value at the 1 year test. There were no changes in the plasma insulin, growth hormone, or fasting triglyceride levels. These results suggest that the cyclic administration of this estrogen does not alter lipid or carbohydrate metabolism.

Carbohydrate metabolism was evaluated in 24 women with a twin pregnancy and 24 women with a singleton pregnancy. The groups were of similar age, parity, weight, and gestational age. In each woman an intravenous glucose tolerance test was done using a 25-g glucose load in the last half of gestation. Both blood glucose and plasma insulin levels were measured and statistically compared. The plasma human placental lactogen levels were significantly higher in the women with the twin gestation (7.3 +/- 0.7 versus 4.7 +/- 0.3 microgram/ml). Although the glucose disappearance rates (K) were not different, there was a significantly lower fasting as well as 5- and 15-minute blood glucose value in the twin pregnancy group. There was also a significantly lower 15-minute insulin level in the twin group. The importance of these findings to the clinical management of twin pregnancies and to the understanding of the metabolic changes in pregnancy is discussed.

A prospective study of carbohydrate metabolism was carried out on seven women by using an oral glucose tolerance stimulation test and measuring blood glucose and plasma insulin values over a 3-hour time period. The test was performed before and after 6 months of treatment with a "low-estrogen" oral contraceptive containing 0.4 mg of norethindrone and 35 micrograms of ethinylestradiol. There was no change in the weight or diastolic blood pressure of the women, but there was a slight elevation of the systolic blood pressure with treatment. There was no significant change in the plasma insulin values or in four of five blood glucose values. The 1-hour blood glucose value was significantly lower after 6 months of treatment. These results suggest that the "low-estrogen" oral contraceptives may reduce the secondary effects on carbohydrate metabolism seen with regular oral contraceptives.

Three-hour oral glucose tolerance tests were done before and after one year of use of a low-estrogen-type oral contraceptive (OC) in 14 women. The drug contained 0.035 mg ethinyl estradiol and 0.4 mg norethindrone. Both blood glucose and plasma insulin were measured. During the year there were no significant changes in the subjects' weights, whereas their blood pressures decreased. The results showed a significance decrease in the fasting blood glucose level after one year for women with a "normal" control test while the remainder of the values remained unchanged. For women with a "borderline" abnormal control test there was a significant decrease in the two-hour glucose level. There were no significant changes in the plasma insulin levels. These results confirm that this low-estrogen-type oral contraceptive produces minimal changes in the carbohydrate metabolism of users.

Blood glucose and plasma insulin levels were measured during an oral glucose tolerance test in 18 women before and after 3 months' use of a low-estrogen oral contraceptive containing 0.035 mg of ethinylestradiol and 0.5 mg of norethindrone. There was no significant change in either of these two metabolic parameters. In addition, the blood pressures and weights of the women were unchanged during that time. Although these are only preliminary data, they are encouraging, for similar studies with higher-dose preparations often showed significant alterations in carbohydrate tolerance.

Three perinatal health indicators (serum human placental lactogen [hPL] levels, serum free estriol [E3] levels, and OCT) were simultaneously completed in 149 high-risk women who were more than 34 weeks pregnant. There was a significant correlation between the hPL and E3 results (r = 0.28, p less than 0.01). There was a 15.4% positive OCT result rate and the blood hormone values for the negative and positive OCT groups were compared. There was a significantly lower hPL value in the positive OCT group (4.7 +/- S.E.M. 0.4 vs. 6.2 +/- S.E.M. 0.2 micrograms/ml for positive and negative groups, respectively), whereas the free E3 levels were not different in these two OCT groups (14.8 +/- S.E.M. 1.5 vs. 16.3 +/- S.E.M. 0.7 ng/ml for positive and negative groups, respectively). The free E3 value did not help in predicting the OCT result as the low free E3 subgroup had the same frequency of positive OCT result as did the over-all group. There was a highly significant increase in the positive OCT results (42.9%) in women with a low hPL value (p less than 0.01). In those women with an hPL value of 6.0 microgram/ml or more there were only 8% positive OCT's. It is concluded that on hPL test at about 34 weeks of gestation could be used to screen pregnant women, and if the value were low (less than 4.0 microgram/ml) an OCT evaluation test would be indicated, for there is a very high frequency of positive results in that subgroup of women.

Studies of carbohydrate metabolism were conducted before and after 18 months of daily use of a 0.075-mg norgestrel preparation by 50 "normal" women. Each study involved a 3-hour oral glucose tolerance test. There was a significant increase in the weights of the women over the time of study. In addition, all of the plasma insulin values and all of the blood glucose values were significantly elevated at the 18-month test. All of the control glucose tolerance tests were normal initially, but eight (16%) of the glucose curves were abnormal at the 18-month test. These data suggest a systemic metabolic effect of norgestrel which may play a role in accelerating atherogenesis.

Fetal head biparietal (BP) measurements by ultrasonic techniques and amniotic fluid lecithin-sphingomyelin (L/S) ratios were simultaneously determined (within 2 days) on 84 occasions in 72 women. Using the criteria for maturity of an L/S ratio of 2.0 or more or a BP measurement of 9.0 cm or more, there was agreement between these test results in 66.7% of the cases. The BP incorrectly predicted the L/S ratio 33.3% of the time, with a false positive rate of 27.3% and a false negative rate of 6.0%. If an L/S ratio of 1.5 were used as the critical determinant, the BP false positive rate remained high (9.5%). A high false negative error (21.4%) occurred if a BP value of 9.3 cm was used. These results suggest that ultrasonic BP measurements should not be used as the only criteria of fetal maturity in the management of high-risk pregnancies.

In order to evaluate the carbohydrate metabolic effects of certain drug therapies used in treating the toxemia syndrome, 75 term pregnant women were studied with two intravenous glucose tolerance tests performed 1 week apart. During the 2-hour tests, both blood glucose and plasma insulin were measured. The women were randomly assigned to three treatment groups, and during the week between tests they received:a) no drugs (control or C group);b) Diuril, 500 mg/day (Dgroup); or c)Dilantin, 100 mg, t.i.d. (DL group). Each group was of similar age, weight, and gestational age. There were no significant changes in any of the glucose curves. Both drug-treated groups demonstrated insulin changes. In contrast to the C group, the D group showed an elevation of the plasma insulin values during the second test, and the DL group had a lowering of plasma insulin levels in the second test. Thus, both drugs had minor effects on carbohydrate metabolism during short-term use. However, a more marked metabolic effect of these drugs must be considered when using them at higher dosages or for a longer duration.

A questionnaire was sent to all chairpersons in obstetrics and gynecology departments in United States Medical Schools in the fall of 1977 seeking information on the school's support of that department for the year 1977 in terms of space and dollar commitments. A total of 113 schools were contacted; 106 responded (93.8%) and the data were tabulated. There were no significant differences between the private and state school resources. The average space commitment was 9,277 +/- SEM 709 square feet and the average school budget was 441,023 +/- SEM 24,265 dollars/year. These data were adjusted for class size and provide the first data base for assessing the adequacy of a medical school's commitment to a department of obstetrics and gynecology.

A prospective study of lipid and carbohydrate metabolic parameters was made in 22 women who had taken a daily oral dose of 0.5 mg of megestrol acetate for contraception for 1 year. Studies of the fasting blood cholesterol and triglyceride levels demonstrated no significant change. A 3-hour oral glucose tolerance test was performed before and after 1 year of treatment. After therapy, the fasting blood glucose levels were normal but the 0.5- and 2-hour levels were elevated. All but one of the plasma insulin levels were elevated at the 1-year test. Since body weights and the fasting levels of plasma growth hormone were unchanged, they were probably not involved in the carbohydrate alteration. These results point out the need for long-term studies and the necessity for investigating the metabolic effects of all progestogen contraceptives.

The lymphocyte HLA types were determined for 13 women, who were then separated into a subgroup of those having a "high" risk for insulin-dependent diabetes mellitus (B8, B15, AW30) and a "low-risk" subgroup (B7, BW35). A 3-hour oral glucose tolerance test was conducted on each woman before starting on oral contraceptives (OC) and then 6 months after using them. Both blood glucose and plasma insulin levels were measured. The OC contained 0.035 mg of ethinylestradiol and 0.4 mg of norethindrone. There was a significantly higher 0.5-hour glucose value in the control test in the "high risk" group. There was a significant elevation of the 1-hour plasma insulin value in the 6-month test for the "high-risk" group. The usefulness of the HLA prescreening of women prior to use of OC needs more study.

Serial serum samples (162) were drawn weekly from normal pregnant women (53) during the last month of gestation and measurements were made of the human placental lactogen (HPL) content. The women were interviewed as to their smoking habits and divided into nonsmokers (32) and smokers of from one to two packages of cigarettes per day (21). The infant birth weight and placental weights were not significantly different. The HPL levels were elevated in the women who smoked and the differences were significant at the thirty-sixth and thirty-eighth weeks. The importance of this in interpreting HPL as a placental function test and in terms of the biology of placental function and the control of protein hormone synthesis is emphasized.

Forty-four women were prospectively evaluated with a 3-hour oral glucose tolerance test while they used a new weekly oral contraceptive drug, R2323. The blood tests were carried out before the drug was administered and again 3 months after its use. Both blood glucose and plasma insulin levels were measured. In the 40 women with a "normal" control glucose tolerance test, it was found that only the 1-hour blood glucose value was significantly elevated after 3 months of drug use and the plasma insulin values were unchanged. The tests of three of the four women with borderline abnormal to abnormal control test curves converted to normal with 3 months of treatment and that of one remained unchanged. The fasting plasma cholesterol and triglyceride levels were unchanged over the 3 months' time. These results suggest that this steroid contraceptive has no effect on lipid metabolism. It also has minimal adverse effects on normal carbohydrate metabolism and may possibly improve abnormal metabolism.

Thirty-five women with menstrual abnormalities were given 100 microng of luteinizing hormone-releasing hormone (LHRH) by bolus intravenous injection in an attempt to simplify and quantitate the usefulness of this test in clinical management. Peak and total gonadotropin responses are highly correlated. Peak and total LH are significantly related to basal LH but no similar relationship could be established for follicle-stimulating hormone (FSH). There is no association between gonadotropin response and prolactin levels or body weight. Basal estradiol levels are inversely related to FSH response but not to LH response. It is concluded that the use of an intravenous 100-microng bolus of LHRH is of little use as a clinical test for the gynecologic endocrine patient.

Twenty-nine menstrual age women who had a hysterectomy and oophorectomy were treated cyclically with 80 micrograms of mestranol per day for 2 yr. Their carbohydrate metabolism was evaluated prospectively by doing a 3 hr oral glucose tolerance test after a 100 g glucose load and measuring both blood glucose and plasma insulin levels. The tests were performed before drug treatment and after 2 yr of drug use. Those women that had a "normal" predrug test had some carbohydrate metabolism changes at the 2 yr test with significant elevations of the fasting, 1 and 2 hr blood glucose values, and also significant elevations of the 2 and 3 hr plasma insulin values. Those women with a "borderline abnormal" predrug test had no significant change in either parameter of carbohydrate metabolism however a trend toward similar changes was noted.

A survey of 108 departments of obstetrics and gynecology in United States medical schools was completed for 1975, and a statistical evaluation of their resources was made. The mean data showed that the student core clerkship had a duration of 6.9 weeks and an enrollment of 17.8 students. The departments had 11.3 full-time faculty members, 69.5 obstetric beds and 56.9 gynecologic beds. There were 3,891 deliveries, 1,846 minor gynecologic operations and 1,418 major gynecologic operations performed. These results should provide a data base upon which to compare the changes in departments in the future.

A prospective, detailed study of both lipid and carbohydrate metabolism was carried out in 35 women who used a progesterone-T type intrauterine device (IUD). A 3-hour oral glucose tolerance test was performed in each woman before the IUD was inserted and again after 6 months of use. There was no change in the patients' weight or in the fasting glucose, cholesterol, or triglyceride levels. There were significant increases in the 3-hour glucose and the fasting, 0.5-, and 3-hour plasma insulin values in the 6-month tests. These values were less than those found after 6 months of systemic progestogen use, but do suggest some systemic effect of the released progesterone.

Seventy-one women with menstrual irregularities were investigated by measurement of basal plasma estradiol, prolactin, and gonadotropin levels. They were each given an intravenous injection of 100 microgram of gonadotropin-releasing hormone (GnRH), and both luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were measured for two hours. The women were divided into three groups on the basis of the prolactin levels: "normal," "mild elevation," and "severe elevation." For each prolactin group there was no difference in age or estradiol or basal LH and FSH levels. The pituitary response to the GnRH injection was also similar for the three groups. These data suggest that elevated prolactin levels do not interfere with pituitary gonadotropin cell function.

Representatives of 108 departments of obstetrics and gynecology completed a written questionnaire in 1976 designed to assess the changes that had occurred in the teaching resources of the departments for the years 1965, 1970, and 1975. There was a statistically significant increase in the number of students per clerkship during that decade. In addition, there was an increase in the numbers of full-time faculty members, residents, beds, and patients. As a consequence, the teaching ratios improved. This might explain in part the increased numbers of medical students selecting obstetrics and gynecology as a career.

Twenty-seven men attending an infertility clinic received detailed studies of their ejaculate and carbohydrate metabolism. The latter was done using a 3-hour oral glucose tolerance test with a 100-gm glucose load and measuring both blood glucose and plasma insulin levels. There was no significant difference in either the blood glucose or the plasma insulin values between the men with normal sperm counts and those with abnormal sperm counts. These data suggest that mild subclinical states of carbohydrate abnormalities do not routinely alter male fertility.

Twenty-four women were prospectively evaluated for their carbohydrate metabolic status before and after six months of using an oral contraceptive containing 0.035 mg ethinyl estradiol and 0.4 mg of norethindrone. At each testing, a 100-gm oral glucose load was administered and blood glucose and plasma insulin values were measured over a three-hour period. Nineteen women with "normal" control tests demonstrated a significant decrease in their fasting glucose values and two of these women (10.5%) had a slight deterioration of their glucose curves. There were no other significant glucose or insulin changes. They had no change in weight and there was a significant reduction in their blood pressure during the treatment time. Five women had "borderline abnormal" control glucose tests, and four of these (80%) improved during the six months of treatment, and two of them (40%) became "normal." Thus, there is no evidence of an adverse effect of this low-estrogen oral contraceptive on carbohydrate metabolism during six months of therapy.

Twenty-nine women with premature labor were randomly assigned to a ritodrine (N = 14) or placebo (N = 15) drug group. The 2 groups were of similar age, parity, weight, gestational age, and cervical change at the onset of treatment. They were treated sequentially with intravenous, intramuscular, and oral drugs and monitored carefully during therapy. There was a significant increase in both the maternal and fetal heart rates during ritodrine treatment, and also a significant decrease in maternal blood pressure. Ritodrine-treated women often complained of palpatations. There was no significant difference in the extension of pregnancy, birth weight, or infant survival for the ritodrine group. Although the 1-minute Apgar scores in the ritodrine group were higher, the 5-minute scores were similar in both groups.

A prospective study of carbohydrate metabolism was done in 12 normal women over 1 year's time while they were using the low-estrogen type of oral contraceptive Brevicon, which contains 0.035 mg of ethinyl estradiol and 0.5 mg of norethindrone. The women had a 3-hour oral glucose tolerance test before starting the drug and then in 12 months, both blood glucose and plasma insulin levels were measured. After 1 year, there was no significant change in weight, blood pressure, or plasma insulin levels. There was a slight decrease in the fasting blood glucose value after 1 year's use (67.5 +/- 1.5 versus 63.2 +/- 1.3 mg/dl). The other glucose values were unchanged. The importance of these data in terms of mechanisms of action of the steroids on metabolism and the safety of oral contraceptive usage is discussed.

A prospective study of pituitary gonadotropin response to gonadotropin-releasing factor (GnRF) was made in women before and after 3 months of use of a low-estrogen type oral contraceptive containing 0.035 mg of ethinylestradiol and 0.4 mg of norethindrone. A series of three intravenous GnRF injections (0.5, 5.0, and 50.0 micrograms) was given in each test and 10 blood samples were obtained and analyzed for their luteinizing hormone (LH) and follicle-stimulating hormone (FSH) content by radioimmunoassay. The results show that there was no significant effect of the contraceptive steroids on either basal or stimulatable FSH or LH levels. These data are different from those for higher-estrogen types of oral contraceptives, and the possible clinical importance of these findings is discussed.

Twenty-nine women in premature labor were randomly assigned to a ritodrine (N = 14) or placebo (N = 15) treatment group. Thirteen serial blood samples were drawn during the first 12 hours of therapy by intravenous drug infusion and they were analyzed for a variety of metabolic substances. There was a significant increase in the blood glucose level in the ritodrine group after one hour and this persisted for the 12 hours of intravenous drug treatment. Plasma insulin levels similarly did not increase in the placebo but significantly rose in the ritodrine group by 30 minutes, peaked at 2 1/2 hours, and remained elevated throughout the infusion. There were no significant differences between levels of plasma glucagon, cholesterol triglyceride, human placental lactogen, or human chorionic gonadotropin in the two treatment groups. Ritodrine caused significant maternal and fetal tachycardia. Its use in women with carbohydrate abnormalities should be monitored carefully. The increased glucose levels may lead to an increased fetal weight.

Serum human placental lactogen (HPL) levels were measured in high-risk pregnancies. A retrospective analysis of 101 gestations with a perinatal loss showed that the 71 stillbirths had abnormally low fetal-danger zone (F-D zone) HPL levels (50.7%) before the fetus died (normal smaller than 1%). With severe hypertension, 85.7% of the cases had F-D zone HPL values prior to fetal death. Abnormal low F-D zone HPL values were found in 20% of the 30 neonatal deaths. A 3 year randomized controlled treatment series was done with 2,7333 women (1,362 treatment and 1,371 control) who had serial serum HPL measurements performed at each prenatal visit. The frequency of F-D zone HPL values was similar (8.6% treatment and 8.2% control). The results showed that although the neonatal mortality rates were similar, the HPL treatment group had a significantly lower fetal death rate (2.6 vs. 14.2%) and thus perinatal mortality rate (3.4 vs. 15.0%). This study supports the usefulness of routine prenatal HPL measurements in the management of high-risk pregnancies.