Longterm use of marijuana has been found to cause physiological changes that can alter individual reproductive potential. The effects of marijuana depend on the dose and can include death from depression of the respiratory system. Longterm effects are however particularly hard to assess. Marijuana is absorbed rapidly and eliminated very slowly. The active principle, delta-9-tetrahidrocannabinol (delta-9-THC), is highly liposoluble and fixes to the serum proteins, passing to the lungs and liver for metabolization and to the kidneys and liver for excretion. As with estrogens, there is an enterohepatic circuit for reabsorption and elimination. 90% is eliminated in the feces, 65% within 48 hours. Because of the enterohepatic circuit and liposolubility, elimination requires 1 week for completion. The other important biotransformation of the active principle is hydroxilation; the hydroxilated derivatives are responsible for the psychoactivity of cannabis. Cannabis affects both neuroendocrine function and the germ cells. Studies on experimental animals have indicated that THC can cause a decline in the pituitary hormones follicle stimulating hormone, luteinizing hormone, and prolactin, and in the steroids progesterone, estrogen, and androgens. Human studies have shown that chronic users have decreased levels of serum testosterone. Because steroidogenesis can be restimulated with human chorionic gonadotropin, it appears that THC does not directly affect steroid production by the corpus luteum, but that its action is mediated by the hypothalamus. Because of its potent antigonadotropic action, THC is under study as an anovulatory agent. The same animal studies have shown that ovulation returns to normal 6 months after termination of use. High rates of anovulation and luteal insufficiency have been observed in women smoking marijuana at least 3 times weekly. THC accumulates in the milk. Animal studies have shown that THC depresses the enzymes necessary for lactation and causes a diminution in the volume of the mammary glands. In recent studies, significant amounts of the drug have been detected in both mothers\' milk and the blood of newborns. Animal studies indicate that THC crosses the placenta, achieving concentrations in the fetus as high as those in the mother. Animal studies also demonstrated increasing frequency of abortions, intrauterine death, and declines in fetal weight. The effects were probably due to an alteration in placental function. A human study likewise showed that marijuana use during pregnancy was significantly related to poor fetal development, low birth weight, diminished size, and decreased cephalic circumference. Congenital malformations have been observed in experimental animals exposed to THC. Declines in sperm volume and count and abnormal sperm motility have been observed in chronic marijuana users. In vitro studies show that THC produces a marked degeneration of human sperm.

A review of 127 infants with haemorrhagic disease of the newborn (HDN) is presented. The case definition of HDN used in the selection of patients was bleeding during the 1st week of life in a newborn with normal platelet count, normal peripheral blood smear and complete clinical response to parenteral vitamin K. Equivocal cases with respect to cause of bleeding were excluded. The eligible cases consisted of 0.9% of all admissions to the unit and the male:female ratio was 1.8:1. Most were from families of low economic status and poor educational background. Omission of vitamin K prophylaxis and exclusive breastfeeding were the commonest antecedents. The mean (SE) gestation and admission weight were 39.3 (0.2) weeks and 2981 (78) g, respectively. One hundred and two (80.3%) had classical HDN with a mean (SE) age at onset of 63 (4.4) hours. Gastro-intestinal bleeding was the commonest observation. Thirty-three infants (26%) died, most of them from exsanguination. There is a need for well designed work to determine the magnitude of the problem, including that of late-onset HDN, the antecedent risk factors, the preferred route for administering prophylactic vitamin K and a clear policy guideline on prevention of the disease.

Three new cases of placental candidiasis are reported. Two were associated with fetal cutaneous candidiasis and one with fetal systemic candidiasis. The systemic case was associated with an intrauterine contraceptive device. Infection of the placenta results in small \'granulomata\' under the surface of the cord and a diffuse chorioamnionitis of the membranes and chorionic plate. In reviewing the 24 previously reported cases it can be seen that systemic. Candida infection of the fetus results in prematurity and death, infection can occur across intact membranes, and systemic candidiasis in the fetus is likely to be associated with an intrauterine device.
Placental candidiasis is a rare condition; only 24 cases are reported in the literature. 3 additional cases are reported, 2 were associated with fetal cutaneous candidiasis and responded to administration of oral nystatin. Maternal vaginal cultures were positive in 1 of the 2 cases. In a 3rd case, systemic candidiasis was present. The child was delivered prematurely and died 90 minutes after delivery of severe respiratory distress. The mother had continuous vaginal candidiasis unresponsive to treatment throughout the pregnancy. In addition, an IUD was present. Other researchers have determined the criteria for Candida amniotic infection as: exclusive presence of Candida albicans in the different lesions, subacute or chronic specific lesions of fetal adnexae, and clinical manifestations in the newborn. The pathology of the placenta includes microscopic granulomata and presence of filaments or spores on the cord and histological change of the membrane or chorionic plate revealing intense chorioamnionitis with occasional focal granuloma. A review of the case reports indicates that 12 of the 27 infants were delivered after the 36th week and all but 1 were normal or recovered rapidly from cutaneous candidiasis. 15 of the 27 were delivered before the 36th week and only 1 survived. 6 were stillborn, and where histology was reported, systemic candidiasis was present. The 7 infants who died shortly after birth had Candida albicans. 1 infant was anencephalic. In only 5 cases did the membrane rupture more than 12 hours prior to delivery suggesting either Candida crosses the intact membrane or the possibility of a small leaking tear in the membrane. In 7 of the cases an IUD was present and the infection tended to be more overwhelming; all infants died from infection and septicemia, not complications of prematurity. The presence of the IUD is suspect for increased infection. The association of IUDs and Candida albicans-induced septicemia and fetal death warrants careful consideration of the advisibility of attempted removal of the IUD when Candida albicans is grown from the vaginal in the antenatal period.

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Unconfirmed epidemiologic studies suggest a possible increased risk of birth defects associated with Natural Family Planning (NFP) use, and an increased incidence of spontaneous abortion or frequency of chromosomal abnormalities in abortuses associated with conceptions outside the most \"fertile period\". The risk is approximately two- to four-fold, but the evidence is by no means conclusive. The implication for NFP depends on the frequency of method failures in user populations, but is not likely to constitute a major hazard. Further research could utilize a data bank of NFP charts.
Unconfirmed epidemiologic studies of adverse pregnancy outcomes associated with aging gametes have found a significant increased risk of spontaneous abortion and polyploid chromosomal abnormalities among abortuses and a nonsignificant risk of chromosomal defects at birth. These risks are generally between 2 and 4-fold. These findings raise concern about method failures associated with natural family planning (NFP). Contraceptions due to intercourse before the fertile period could arise from aged sperm, and conception after the fertile period could occur with a postovulatory aged ovum. However, risk estimates derived from unconfirmed studies must be interpreted with caution due to the problem of ascertaining whether a conception arose from aged gametes. Epidemiologic studies of birth defects are further complicated by the diverse etiology of the anomalies, the timing of observation, the confounding effects of factors such as maternal age or other potential teratogenic exposures, and the potential for bias in maternal recall. The implications of these findings for NFP depend on the frequency of method failure, which does not appear to be high. Resolution of the question of whether NFP is associated with an increased risk could be obtained through a review of NFP conception charts in which conceptions due to method or user failure were identified and the pregnancy outcomes were ascertained. The large sample size required for such a study could be attained by international collaboration among NFP organizations and establishment of a data bank of contraception cycles.

Seasonal cycles in the births of infants with certain congenital malformations have been reported by several investigators. There have been conflicting reports regarding months of greatest frequency of each group of defects. Congenital malformations of the cardiovascular system have been noted to vary with seasonal infections of mothers with rubella. Variations in other maternal infections during early pregnancy and the drugs given in treatment may be significant. Sex differences have been noted, with congenital malformations of the musculoskeletal system more common in females. Central nervous system malformations generally show a winter excess in frequency. Some cardiovascular malformations seem to have a summer or autumn peak and be more frequent in female infants.

Several large studies have established the usefulness of alpha fetoprotein (AFP) detection as a diagnostic test in patients suspected of having primary hepatoma. in the current study, 65% of patients from Hong Kong and 50% of eastern U.S. patients with hepatocellular carcinoma had AFP in their sera. AFP was not found in normal adult sera in any of the reported series. In this series, AFP was not detected in sera of patients with other hepatic diseases, often associated with AFP occurrence, or in sera of 6 patients with embryonal cell carcinoma of the testis though that disease has also been associated with AFP detection in sera. However, the occurrence of AFP in various tissue extracts was detected in 1/2 extracts of primary hepatoma and in 2/6 extracts of embryonal cell carcinoma of the testis, but not in other tumors. The hepatoma extract containing AFP was from a patient with AFP in serum; the serum from the other patients with hepatoma was negative. Sera from the patients with testicular cancer were not available for testing. Theories on the function of AFP and its relationship to carcinogenesis are also discussed.

Amniotic fluid concentrations of alpha-fetoprotein (AFP) in early normal pregnancy and pregnancy complicated by neural tube defects were investigated. The normal range of AFP values was determined from 163 samples obtained at 14-20 weeks of pregnancy. The relationship between AFP level and gestational age was represented by a linear regression (p less than .001). Regression lines for males and females differed significantly in position (p less than .01) but not in slope, the line for males 2.7 mcg/ml higher than that for females. No correlation was seen between maternal age and AFP level. 50 \'\'at risk\'\' cases, in whom there has been a history of previous anencephaly or spina bifida, were included in the noraml values. 6 of these patients had amniotic fluid AFP values outside the normal range and in 5 of the 6 cases, ultrasound examination of the fetus confirmed the diagnosis of an anencephalic type lesion and so termination was undertaken, All 5 fetuses had severe neural tube defects. The 6th fetus revealed an intact neural tube but clear-cut evidence of growth retardation and the placenta was small and infarcted.

Perinatal deaths occurring within the City of Harare, Zimbabwe, during 1983 were studied. Data were collected from all known deliveries within the city. This included exact numbers from three central maternity hospitals, and from referring midwife-run maternity clinics. An estimate was made of the number of births and perinatal deaths occurring within the city, but outside these official maternity facilities. All perinatal deaths were reviewed. The birthweight, the cause of death, and the antenatal care registration status of the mother were established. There were 2103 perinatal deaths from an estimated 53,665 total births. Deliveries include 50,138 (93.4%) in hospitals or clinics, 972 (1.8%) before arrival to the maternity service, and an estimated 2555 (4.8%) outside the city maternity services. One thousand seven hundred and fourteen (81.5%) perinatal deaths occurred in hospital or clinic delivered babies, and 134 (6.4%) from babies delivered before arrival at medical services. An estimated 255 (12.1%) of deaths occurred elsewhere. A total of 6380 (12%) patients did not register for antenatal care. There were 909 (43.2%) perinatal deaths in this unregistered group of patients. The overall perinatal mortality rate (PNMR) for infants weighing 500 g or more was 39.2/1000. For registered patients the PNMR was 25.3/1000 and for unregistered patients, 142.5/1000. For infants weighing 1000 grams or more the PNMR was 31.6/1000. The causes of death in the 2103 perinatal deaths were established and classified by clinical cause and by a simple pathological grouping with breakdown by birthweight.(ABSTRACT TRUNCATED AT 250 WORDS)
The survey purpose was to review as far as possible all of the perinatal deaths occurring in Harare, Zimbabwe. The maternity services within Harare consist of 3 maternity hospitals together with municipality-operated urban maternity clinics in the residential suburbs. All births taking place within the maternity services during 1983 were analyzed. An estimate of the number of patients giving birth within the city but outside these services was made after consultation with the City Medical Officer. All cases of perinatal deaths were analyzed to assess the cause of death, the registration status of the mother, and the birth weight of the baby. An estimate of perinatal deaths occurring outside the maternity services also was made from the City Medical Officer\'s annual report, newspaper reports of baby dumping, and after consultation with the City Social Services and the police. There were an estimated 53,665 total births and 2103 perinatal deaths in Harare during 1983. 94% of the births were delivered within the hospitals or clinics; 1.8% were born before arrival (BBA) to the maternity service. 4.8% were not born within the city maternity services. 1714 (18.5%) perinatal deaths occurred from babies born in the hospitals or clinics, and 134 (6.4%) from babies born before arrival at maternity services. An estimated 255 (12.1%) of deaths occurred elsewhere. Those infants born before arrival made up 1.8% of the total births and accounted for 6.4% of the total perinatal deaths. Of the 53,665 births within the City of Harare during 1983, 47,285 (88%) were booked for antenatal care at either a municipal clinic or hospital. 6380 (12%) patients did not register for antenatal care, and 909 (43.2%) perinatal deaths occurred in the unregistered groups of patients. The overall perinatal mortality rate (PNMR) was 39.2/1000. For registered patients the PNMR was 25.3/1000; it was 142.5/1000 for unregistered patients. 1685 (80.1%) perinatal deaths were in infants weighing 1000 g or more; 418 (19.9%) perinatal deaths occurred from infants weighing less than 1000 g. Unexplained stillbirth, immaturity, intrapartum asphyxia, and antepartum hemorrhage were the principal cause of death accounting for almost 60% of the total perinatal mortality.