Working With Parents Through a Devastating Experience-The Birth of a Mongoloid Child

The author believes that professional advice given the parents of a mongoloid infant determines their initial decision on institutionalization. Multidisciplinary counseling by the health team can help parents decide on a course of action that will prove satisfactory in the long run. Consultation should include health t e r n efforts to help parents work through the mourning process and presentation of a) an objective, comprehensive view of the child's condition, b) information on integrating a mongoloid into the family unit, and c) outside resources available to the parents. Deliberation with the parents to help them reach their own decision is essential.     

Phase II evaluation of bleomycin in patients with advanced epithelial ovarian cancer

Twenty-four patients received bleomycin twice weekly im. Treatment was given for 3 weeks initially, and if there was no evidence of disease progression treatment was given for another 3 weeks. Four patients had partial responses of 2, 4, 4, and 5 months' duration. Three patients had stable disease which did not progress for at least 4 months. There were ten patients with ascites; three of these showed a significant reduction in the amount of ascites present during treatment. There was a partial reduction of tumor in one of these patients. Toxicity was minimal with this regimen, and bleomycin deserves further study in the treatment of ovarian cancer.     

Propagation of stress fracture of the patella

Anterior knee pain in athletes is common and usually self limited. There should be a high index of suspicion and low threshold for special imaging in cases with acute onset and specific tenderness. The risk of propagation of stress fracture of the patella in athletes is highlighted. The case report presented illustrates the potential sequence of events.     

Women's experiences and preferences following Caesarean birth

AIMS: To seek women's views on their planned mode of birth in a subsequent pregnancy when they had a single prior Caesarean birth in the immediately preceding pregnancy. METHODS: This study was conducted at the Women's and Children's Hospital, Adelaide. Using a hospital maintained database, women were identified based on who had given birth by primary Caesarean section between December 2002 and June 2003 to a live born infant. The women were sent a questionnaire to assess their experiences related to their Caesarean birth and their plans for mode of birth in any subsequent pregnancy. RESULTS: A total of 319 eligible women were identified from the database and sent a questionnaire, with responses obtained from 208 women (65.2%). Most women were satisfied with their birth experience with a mean satisfaction score of 6.3 (+/- 2.8). The most common response when women were asked to indicate the aspects of their birth experience that they liked was those caring for them (153 women; 48%), followed by the reassurance provided about the health of their baby (106 women; 33%) and their own health (88 women; 28%). One fifth of women (63 women; 20%) indicated that they were glad that they had experienced labour. Eighty-five women (41%) indicated that they would in future plan for a vaginal birth, 48 women (23%) would plan for Caesarean section, and 72 women (35%) were unsure. CONCLUSIONS: A proportion of women have a strong preference for mode of birth in a subsequent pregnancy, which is established within 6 months of the woman's birth experience.     

Induction of labour for women with a previous Caesarean birth: a systematic review of the literature

AIMS: To compare the benefits and harms of planned elective repeat Caesarean section with induction of labour and to assess different methods of cervical ripening and induction of labour for women with a previous Caesarean birth who require induction of labour in a subsequent pregnancy. METHODS: The Cochrane controlled trials register and MEDLINE (1966-current) were searched using the following terms: vaginal birth after C(a)esare(i)an, trial of labo(u)r, elective C(a)esare(i)an, C(a)esare(i)an repeat, induction of labo(u)r, prostaglandins, prostaglandin E(2), misoprostol, prostaglandin E(1) analogs, mifepristone, oxytocin, Syntocinon, randomis(z)ed controlled trial, randomis(z)ed trial and clinical trial, to identify all published randomised controlled trials with reported data comparing outcomes for women and infants who have a planned elective repeat Caesarean section with induction of labour; and different methods of induction of labour, where a prior birth was by Caesarean section. RESULTS: There were no randomised controlled trials identified where women with a prior Caesarean birth, whose labour required induction in a subsequent pregnancy, compared elective repeat Caesarean section with induction of labour. There were three randomised controlled trials identified in which women with a prior Caesarean section were allocated to different methods of induction of labour - vaginal prostaglandin E(2) versus intravenous oxytocin; mifepristone versus placebo; and vaginal misoprostol versus intravenous oxytocin. These studies varied considerably in the methods used and meta-analysis was not appropriate. CONCLUSIONS: There is a paucity of safety information for induction of labour agents in the women with a scarred uterus, and caution should be exercised in their use.