In the Literature: Dispelling Hallucinations About Birthweight: How Hard Is It?

Birthweight is an important determinant of perinatal outcome and future health well into adulthood. Before weighing newborn infants became enshrined in practice, birthweights tended to be based on an educated guess or, as alleged by Roederer in 1753, on hallucination. Two centuries later, they led to a Babylonic confusion between weight and maturity at birth. Even nowadays, hallucinations about birthweight and its effect on infant health have not entirely disappeared. New hallucinations still emerge and remain as difficult to dispel as they once were. (BIRTH 39:3 September 2012)     

Spotted Fever Rickettsiosis Infection in a Traveler From Sri Lanka

A case is reported of travel-acquired tick-borne spotted fever rickettsiosis from Sri Lanka. Little is known about rickettsial disease in Sri Lanka and this case may be the first documented instance of travel-acquired spotted fever group rickettsiosis from that origin.     

Drugs for obstetric conditions

For many reasons, including the fear of fetal anomaly, the recognition of pregnancy being a normal physiological process and maternal choice, few drugs are prescribed and used during pregnancy. Nevertheless, there are certain common obstetric conditions that are associated with significant maternal and perinatal morbidity and mortality where drugs play an important and necessary part in treatment. These conditions include termination of pregnancy, threatened preterm labour, induction of labour and post-partum haemorrhage. This chapter deals with the role of drug therapy in these obstetric scenarios. A large amount of obstetric clinical trial research has been dedicated to the management of these conditions.     

Back to Basics Midwifery in Arawa, Bougainville, During 1998

Working in a country, which is suffering the aftermath of war, is a very professionally rewarding and at the same time, humbling experience. It highlights so many things that we in Australia take for granted. The importance of a safe water supply and an efficient sewerage system is vital for the well-being of a community. Illnesses that were important in Australia 30 or more years ago, were commonplace on Bougainville in 1998 and 1999. I was also reminded of how much reliance we place on modern technology as we practise obstetrics in Australia in 1999. In Bougainville clinical skills and common sense were all that the midwives had and they used them to great effect. Tribute should be paid to the men and women of the PMG (Peace Monitoring Group) for without their dedication and professionalism the improvement in the health of the people in Bougainville during the last 18 months would not have been possible.     

The five a's: What do patients want after an adverse event¿

After an adverse event, Five A's: A cknowledgment, A pology, A ll the Facts, A ssurance and A ppropriate Compensation, serve to meet the essential needs of patients and their families. This simple mnemonic creates a clear framework of understanding for the actions health professionals need to take to manage errors and adverse events in an empathic and patient‐oriented fashion. While not all patients demand or need compensation, most need at least the first four A's. Patient‐centered communication using this simple framework following an adverse event will foster a climate of understanding and frank discussion, addressing the emotional and physical needs of the whole patient and family.     

Sonographic Appearances of the Endometrium After Termination of Pregnancy in Asymptomatic Versus Symptomatic Women

Objective. The purpose of this study was to describe normal sonographic appearances of the endometrium in asymptomatic women after elective termination of pregnancy (TOP) and to determine whether sonographic findings are discriminatory in symptomatic women after TOP. Methods. Sonographic parameters were compared in prospectively recruited women after elective TOP. The first 38 were asymptomatic. In a later group, 105 had symptoms suggestive of retained products of conception (RPOC). Endometrial thickness, cavity irregularity, echogenicity of cavity contents, color Doppler flow, and resistive indices (RIs) were assessed. In the symptomatic group, sonographic findings were correlated with symptoms and histologic results. Results. There was a marked overlap in sonographic appearances between the groups. The endometrial cavity is commonly irregular and thickened and may show prominent color Doppler flow in women with an uneventful course as well as in women with histologically proven RPOC. Differences between asymptomatic and symptomatic women were only seen for: endometrial thickness (10.8 mm [range, 1–29 mm] versus 15.3 mm [range, 1.8–34 mm]; P = .0005), and cavity irregularity was greater in symptomatic women (P = .001). Color Doppler flow mean RIs were similar. Symptoms were similar in women proceeding to curettage versus no curettage; no significant relationship was found between individual symptoms and sonographic parameters. Chorionic villi were seen in 47 of 56 women (84%) with positive histologic results. Conclusions. Sonographic appearances and symptoms correlate poorly with each other and with histologic results. Sonography has limited benefits in triaging women with suspected RPOC after TOP in the first trimester. Our findings support a more conservative approach to suspected RPOC after TOP.     

Successful Zavanelli Manoeuvre for Shoulder Dystocia With An Occipitoposterior Position

EDITORIAL COMMENT: Readers are referred to a recent review(A) of reported results of the Zavanelli manoeuvre in 103 partially-born but undeliverable fetuses (92 cephalic, 11 podalic presentations). Although 7 mothers suffered trauma, including cases of lacerations to the lower uterine segment, and of uterine rupture, there were 'no maternal deaths or fetal injuries ascribed to the manoeuvre'.