Psychological Medicine

placenta przevia in the Royal Maternity Hospital and in private practice. During the years 1937-1949 there were 275 cases. There were two maternal deaths, a mortality rate of 0.73 per cent. The fcetal mortality was 20.4 per cent., and, if deaths from foetal abnormalities were excluded, the corrected figure was 17.1 per cent. These figures were compared with those of the Royal Maternity Hospital in 1932-1936. In these years there were seventy-six cases, with a maternal mortality of 2.6 per cent. and a foetal mortality of 51.3 per cent. The speaker consideredl that the results vindicated the use of conservative treatment in placenta prwvia. Prematurity, with its associated foetal mortality, had been reduced without increasing the maternal risk. He emphasised, however, that conservative treatment must be employed intelligently and that each case required consideration by a senior obstetrician. Dr. A. S. Majury read a paper entitled "Pregnancy Complicated by Diabetes Mellitus." He reviewed fifty-four pregnancies occurring in thirty-nine diabetic patients in the Royal Maternity Hospital during 1938-1948. This represented an incidence of 1 in 313 pregnancies. Hydramnios occurred in 26 per cent. of the cases, while pre-eclamptic toxaemia occurred in 52 per cent. Coma and eclampjsia were the principal hazards for the diabetic mother and caused three deaths, a mortality of 5.5 per cent. In spite of insulin therapy, the foetal mortality remained high, being 42.6 per cent. The speaker reviewed the possible causes, namely, ketosis and toxwmia in the mother, dystocia, with birth injury, and maternal hormonal imbalance. He considered that, as suggested by Priscilla White, cestrogen and progesterone deficiency might be the most important factor, although no patient in the series received oestrogen and progesterone therapy. He found that caesarean section was performed nineteen times, resulting in a healthy child on eighteen occasions, and made a plea for more frequent use of this method bf delivery in diabetic patients.