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OBJECTIVE: To determine whether changes in primary and secondary care service delivery could prevent antenatal eclampsia. METHOD: One intervention (St. Catherine) and two control (St. Ann, Manchester) parishes were chosen. The health system in St. Catherine was restructured. Primary antenatal clinics had clear instructions for referring patients to a high-risk antenatal clinic or to hospital. Guidelines were provided to high-risk clinics and the antenatal ward for appropriate treatment of hypertension and preeclampsia when induction of labor should occur. Antenatal eclampsia incidence was monitored before and during the intervention and compared with control parishes (no intervention). Each eclampsia case was investigated to identify inadequacies in the system. RESULTS: The process resulted in better identification of women at risk. Antenatal eclampsia incidence dropped dramatically as care improved. Compared with control areas, by completion of the study, the rate was significantly lower than at the start: OR 0.19 (95% CI: 0.13-0.27; p<0.001 trend). Antenatal admissions for hypertensive disorders declined significantly, and the number of bed days halved. CONCLUSION: Reorganization of maternal care can have major public health benefits and cost savings; however, women need to be alerted to recognise and act upon signs of impending eclampsia.

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Monoclonal antibody 59D8 developed by Hui et al., binds to fibrin but not fibrinogen. An 111In-labeled Fab fragment of 59D8 was studied in vitro and in animal models to evaluate its potential for imaging thrombi and emboli in man. Rabbits and dogs were used as models for studying thrombus uptake in vivo. Thrombi and emboli up to 4 days old were successfully visualized at 4-24 hr postinjection in five of eight rabbits. In dogs, 0.5-hr-old and 24-hr-old thrombi were successfully imaged at 24 hr in six of eight animals, and 3/6 of these were positive at 3-4 hr postinjection. Thrombus-to-blood ratios in the dogs averaged 7.1 +/- 1.3. The findings suggest this antibody may be useful for imaging thrombi in man.

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The cases of rupture of the gravid uterus occurring at the Victoria Jubilee Hospital over a 5-year period (July 1965-June 1970) were analysed. During this period there were 75,100 deliveries amongst which were 22 cases of ruptured uterus resulting in an incidence of 1:3,409 cases. The maternal mortality was 12.6 percent and the foetal mortality 64 percent. The cases of ruptured uterus were classified as those associated with previous uterine scars (23 percent), spontaneous rupture of the intact uterus (61) and traumatic rupture (16 percent). Only 56 percent of the cases of rupture of the uterine scar received antenatal care. The diagnosis was made early in 39 percent of the cases and delayed in 61 percent of the cases. All 3 maternal deaths occurred among the cases in which the diagnosis was delayed. The presence of persistent post-partum haemorrhage (3 cases), accidental haemorrhage (5 cases) and pelvic infection (3 cases) contributed to delay in reaching a correct diagnosis. The average parity of the patients varied between 21 and 44 years. The average age of the group was 31 years. This is higher than the average age of patients delivered at Victoria Jubilee Hospital - 24 years. The elderly grandmultipara was most liable to rupture her uterus. The main clinical features were abdominal pain (72 percent), generalized abdominal tenderness (66 percent), shock (44 percent) and antepartum haemorrhage (38 percent). Total hysterectomy was performed in 47 percent of cases, in which the total length of stay in hospital was 14 days. 47 percent of patients had sub-total hysterectomy, and 6 percent repair of the uterus with bilateral tubal ligations (AU)

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Fourteen cases of malignant mesenchymal tumours of the uterine bidy, observed over a 13 year period (1953-1966), have been reviewed. There were 9 examples of leiomyosarcoma, 1 endometrial stromal sarcoma and 4 malignant mixed mesodermal tumours. These tumours are uncommon in that they accounted for only 3 percent of uterine malignancies, and 0.6 percent of all female cancers in Jamaica. Seven of the 9 cases of leiomyosarcoma arose in previously benign fibroids, making the incidence of malignant transformation in benign fibroids 0.42 percent. Mixed mesodermal tumours constituted 0.72 percent of all uterine malignancies and 8 percent of the corporeal cancers. The prognosis was uniformly poor (AU)

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The clinical and pathological findings in 35 cases of endometrial carcinoma observed over a 13-year period (1953-1966) at the University Hospital of the West Indies are described. The study has confirmed the impression that carcinoma of the uterine body is a relatively uncommon form of malignancy in Jamaica, accounting for only 2 per cent of female malignancies and 6 per cent of uterine cancers. The clinical and pathological data are compared with those of other reported series, and found to be essentially similar. Malignant change in polyps was observed in 14 per cent of cases. Extended total hysterectomy and bilateral salpingo-oophorectomy produced the best results. Local recurrences were significantly reduced when surgery was combined with post-operative radiation. All six cases with adenoacanthoma showed myometrial invasion, and the squamous component (metaplastic and neoplastic) was associated with glands of varying degrees of differentiation (AU)

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A clinical trial of syntocinon administered by the buccal route to 43 patients in the University Hospital of the West Indies is described. Buccal syntocinon seems to be convenient, safe, and effective as a means of inducing labour, providing its administration is closely supervised (AU)

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This paper deals with the clinical and pathological behaviour of 35 cases of endometrical carcinoma observed over a period of 13 years (1953-1966) at the University Hospital of the West Indies. This type of malignancy accounted for 1.8 percent of all cancers in Jamaica and 2.9 percent of malignant neoplasms in Jamaican women. Furthermore, it constitued 6.4 percent of all uterine cancers and 71 percent of malignant tumours arising in the corpus uteri. The ratio of cervical cancer to fundal carcinoma was 14:1. The disease occurred most commonly in the sixth decade of life. A late onset of menopause was observed in 64 percent of cases. There was a higher incidence in nulliparous than in parous women with a tendency to decrease inversely with parity. The most frequent presenting symptoms was pos-menopausal bleeding. Diabetes mellitus occurred in 32 percent of cases, obesity in 29 percent, hypertension in 60 percent uterine fibroids in 53 percent, endometrial hyperplasia in 48 percent and uterine adenomvosis in 6 percent. Extensive diffuse growths filling and distending the uterine cavity were observed in 68 percent of patients; in the remainder the tumours were confined to a small area of the endometrium. In 74 percent of the uteruses examined there were friable, polypoid proliferative messages. Sessile, ulcerated plaques were present in the remaining number of cases. In 57 percent of patients, the tumours were confined to the body of the uterus when the initial treatment was carried out. Histological examination revealed, in 73 percent of cases, either a pure tubular pattern or a combined tubular and papillary structure. Pure papillary growths were observed in only 13 percent of cases. There was no absolute correlation between the degree of differentiation and invasiveness of the tumours. Malignant change in previously benign polyps was demonstrated in 13 percent of cases. Extended hysterectomy with bilateral salpingo-oophorectomy produced the best results irrespective of the stage of the disease when this treatment was carried out. The period of follow-up of our patients is too short to assess the efficacy of surgery combined with irradiation therapy. Following treatment, local recurrences in the vaginal vault or the vulva or spread beyond the uterus but limited to the pelvis occurred in 31 percent of cases. Three patients presented with disseminated cancer. Four patients came to autopsy, and in 3 death was due individually to vaginal haemorrhage, pulmonary embolism and widespread metastases in lymph nodes, liver and bone. In the fourth case the tumour was an incidental autopsy findings. There were five patients with adeno-acanthoma in whom the prognosis was no better than in those with adenocarcinoma. Both the squamous and glandular elements demonstrated neoplastic characteristics with nyometrial infiltration generally to deep levels and occasionally, with extension beyond the uterus (AU)

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