Low Aboriginal Birth-weight-Prematurity or Intrauterine Growth Restriction?

EDITORIAL COMMENT: We accepted this paper for publication because it explores the important question of whether low birth-weight in infants of Aboriginal mothers is due to prematurity or fetal growth-retardation. This paper reviews the previous literature, provides some interesting new information, and shows that a prospective study with verification of fetal maturity is required to resolve the problem. Readers will realize the difficulties that exist in compilation of prospective data with sufficient numbers of cases to answer this question.
Summary: Two thousand, nine hundred and twenty-eight consecutive singleton public births at Cairns Base Hospital were studied retrospectively. Contrary to popular clinical belief, there was no statistically significant difference in the birth-weights, corrected for gestational age between Aboriginal babies and Caucasian babies. There was a highly significant excess of preterm Aboriginal births, when compared with Caucasian births. This study suggests that any attempt to reduce the high incidence of low birth-weight births in Aboriginal people should be directed at reducing the incidence of preterm birth, rather than the supposed high incidence of intrauterine growth restriction.     

Premedication for elective Caesarean section

Four coded, but otherwise unidentified, premedicants were prescribed in randomised order for 219 patients who were to undergo elective Caesarean section. Seventy-six (35%) of these patients affirmed at the pre-operative visit that they were not anxious. Diazepam 5 mg and lorazepam 1 mg appeared to be superior to the placebo and to 10-6 ml of 90% alcohol in inducing calmness and/or drowsiness, although the differences were not statistically significant. The incidence of awareness or unpleasant dreams was considerably higher in the placebo and alcohol series (6.2% and 7.5%) than in the diazepam and lorazepam series (nil and 2.1%). There was no remarkable difference in the condition of the immediate newly-born related to the premedicant received by the mother, any small differences being much less impressive than that related to the duration of the U-D interval. No notable differences were observed in the long term conditions between the infants in the placebo, alcohol and diazepam series but the incidence of "reluctance to feed". If relief from preoperative anxiety-and possibly a reduction in the likelihood of awareness-without undue effect upon the infant is considered desirable, diazepam 5 mg is the preferred choice from the four drugs investigated.     

Treatment of Cervical Incompetence by Transabdominal Cervicoisthmic Cerclage

Summary: Cervical incompetence is a condition traditionally treated by cervical cerclage which in most cases is inserted via the transvaginal route. However the insertion of a transabdominal cervicoisthmic suture is indicated in those patients with recurrent mid-trimester losses due to an incompetent cervix where it is not technically possible to insert a transvaginal suture. Between 1987 and 1996, 12 women at the Royal Women's Hospital, Melbourne were treated with transabdominal cervicoisthmic cerclage (TCC). Eight patients had cerclage in the nonpregnant state, and 4 were pregnant at the time. The completed pregnancies thus far have resulted in 10 surviving infants, a successful pregnancy rate of 69.2%. This compares favourably with a corrected preTCC successful pregnancy rate of only 13%. There were minimal intraoperative complications in our series. Bleeding, chorioamnionitis and premature rupture of the membranes have been reported elsewhere and occurred in 2 of our patients. Our results and a review of the literature confirms that TCC has an important role in carefully-selected patients.     

Large Meningioma Complicating Pregnancy

EDITORIAL COMMENT: This case report was accepted for publication because of the clinical lesson it delivers, namely that intracranial tumours, although rare in pregnancy, may as the authors state 'produce a wide variety of symptoms that are difficult to distinguish from the more common symptoms of pregnancy, including nausea, vomiting and headache'. This case suggests that examination of the optic fundi is essential in patients with neurological symptoms even when/especially when there is a history of psychiatric illness.     

Vaginal Dinoprostone Versus Oral Misoprostol for Predilatation of the Cervix in First Trimester Surgical Abortion

Summary: Prostaglandins are effective in predilatation of the cervix prior to first trimester surgical termination of pregnancy under local analgesia. A randomized open comparative trial was devised to compare the effectiveness and acceptability of vaginal dinoprostone with oral misoprostol. Two groups were randomized to control for age, parity and ethnicity. The operation was easier and less painful in older, parous, and Polynesian women. Both methods were effective with respect to ease of dilatation. Both were acceptable and equal with respect to the level of pain experienced by the woman during the operation. Vaginal dinoprostone is more gradual in its action, but it is more expensive, has to be refrigerated and self-insertion may sometimes cause problems. Oral misoprostol is considerably cheaper and does not require refrigeration, but it was associated with more preoperative nausea, cramping and occasional heavy bleeding.     

Implications of Liver Cirrhosis in Pregnancy

Summary: We present the case of a pregnant woman with alcohol-induced liver cirrhosis and a discussion of the clinically relevant issues of cirrhosis in pregnancy.