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summary Blood was collected from 53 normal women in the 38th week of pregnancy. The plasma concentration of unconjugated oestriol, total oestriol and oestriol sulphate was measured and also human placental lactogen and pregnancy specific β1 glycoprotein. The normal spread of the two proteins was found to be slightly smaller than that of the oestrogens. The concentrations of unconjugated and of total oestriol were related; otherwise these substances varied independently of one another. The concentration of these substances was not related to other obstetric parameters.

Ovarian hyperstimulation syndrome (OHSS) is a potentially fatal condition associated with the use of ovulation-inducing drugs. We describe a 28-year-old woman who presented with ascites, oliguria and vomiting. Over 2 weeks, the combination of intractable vomiting, intravenous rehydration, paracentesis, hypercatabolism and proteinuria led to severe hypoalbuminaemia with gross oedema and progressively worsening liver function. The patient's albumin dropped to 9 g/l with liver function abnormalities peaking at: alanine aminotransferase, 462 IU/l; alkaline phosphatase, 706 IU/l; bilirubin, 26 [mu]mol/l; and prothrombin time, 19 s. The judicious use of paracentesis and commencement of total parenteral nutrition coincided with a rapid clinical improvement. One month after discharge, the patient was asymptomatic with normal liver function. This case demonstrates the severity of malnutrition and liver dysfunction that can occur with severe OHSS. Increasing use of in-vitro fertilization techniques makes it mandatory for clinicians to be aware of the clinical features, complications and treatment of this condition, and we would suggest that patients with severe OHSS should be jointly managed by physicians and obstetricians.

1190 consecutive in vitro fertilization (IVF) treatment cycles from the Southampton University/BUPA Chalybeate unit, spanning a four year period, were studied retrospectively in order to assess the relationship between maternal age and implantation. Our aim was to evaluate the hypothesis that the number of transferred embryos can be determined by age alone.The cases were allocated to two age groups, Group 1 was composed of patients of less than or equal to 35 years of age and Group 2 of patients greater than 35 years of age.We found that the selection criteria used in our programme for abandoning treatment cycles led to significantly more older patients being excluded from oocyte collection (p0.001). The patients from both groups that progressed to oocyte collection and embryo transfer showed no significant difference in embryo implantation. The overall implantation rate (12.4%) and clinical pregnancy rate per embryo transfer (22.8%) were achieved by being able to transfer comparable numbers of embryos in both age groups and in spite of the younger age group having a significantly better quality of transferred embryos.Although advancing maternal age predisposes to a reduced chance of success from IVF treatment, maternal age alone was not a useful predictor of embryo implantation or endometrial receptivity in completed IVF treatment cycles.

A case of alveolar soft part sarcoma of the uterus is described. It presented as intermenstrual bleeding in a 47-year-old woman. This is a rare tumor, forming about 1% of soft tissue sarcomas. Several hundred cases have been described, mostly arising in the limbs. We believe this to be the 3rd case reported in the uterus and the 12th in the female genital tract. The other reported cases are reviewed, and further information about their outcome has been obtained from the authors.

Summary Serial measurements were made of the concentration of plasma oestriol in normal pregnancy. The mean curve and limits of normal variation have been defined. The mean curve was analyzed and the correlations between various features of the pregnancy and plasma oestriol concentrations at particular stages of gestation were examined. Serial plasma oestriol concentrations seemed to give a better indication of feto-placental function than serial urinary oestriol excretion values.

Summary Serial plasma oestriol values were measured in nine insulin-dependent diabetics during pregnancy. While the plasma oestriol values wete lower than those in uncomplicated non-diabetic pregnancy the curves were of similar shape. It is suggested that serial plasma oestriol determinations in assessing feto-placental function in diabetic pregnancy should be interpreted with caution.

To determine the relationship of plasma estriol and retarded intrauterine fetal growth, 14 primiparous and 4 multiparous pregnant women with suspected intrauterine growth retardation were studied by radioimmunoassay of weekly blood samples, and compared with 25 normal pregnant women as controls. The plasma estriol levels in all 4 hypertensive mothers who gave birth to infants of low birthweight were all much less than the normal averages. Estriol levels were also less than average, though not as significantly, in 7 of the 9 normotensive patients with low birthweight infants, and in the 5 patients with low weight gain but normal-weight infants. Thus, a dramatic reduction in estriol concentration occurs in hypertensive patients with intrauterine fetal growth retardation. No correlation was found between predelivery plasma estriol concentration and infant birthweight or incidence of fetal distress. Though both have growth retardation, hypertensive patients have a much higher incidence of fetal distress (75%) than normotensive patients (29%). Further research is being conducted on the relationship of plasma estriol and blood pressure in this regard.

Summary The concentration of unconjugated oestriol, of oestriol glucosiduronate and of oestriol sulphate was measured by a radioimmunoassay technique in the plasma of five normal primigravidae before and during labour. The only consistent changes in the concentration of any of oestriol fractions was a tendency for the concentration of unconjugated oestriol to rise to a peak immediately before the onset of labour.

Summary Plasma oestriol was measured serially in a group of patients considered likely to develop pre-eclampsia. In some the plasma oestriol curve deviated from normal before clinical signs of pre-eclampsia became apparent. Plasma oestriol values were abnormal in patients with pre-eclampsia, particularly if the condition was severe.

A radioimmunoassay technique has been used to measure unconjugated estriol, estriol sulfate, and estriol glucosiduronate. The distribution of these compounds in plasma, blood cells, and interstitial fluid has been studied. It was found that in the plasma roughly two thirds of each constituent was bound to protein. All three forms also occur in the interstitial fluid but in much lower concentration. The proportion of estriol in interstitial fluid not bound to protein was found to be larger than in plasma. Plasma volumes were measured and it was calculated that the total estriol contained in the interstitial fluid was somewhat more than in plasma. Small amounts of each form of the steroid were associated with the cellular elements in blood, the proportions being larger in the case of unconjugated estriol and estriol sulfate than with estriol glucosiduronate.