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Objective : To study the relationship between induced labour, quantitative levels of fibronectin and the Bishop score. Study design : Vaginal fibronectin/Bishop score were estimated in 33 nulliparous women undergoing induction of labour for post-dates at the Department of Obstetrics and Gynaecology, Guy’s and St. Thomas’ Hospital London. Results : There was no significant relationship between either the fibronectin level or Bishop score and the duration of the latent phase ( R 2 =0.001; P =0.86 and R 2 =0.12; P =0.08, respectively). There was no relationship between the total prostaglandin dose and fibronectin level ( R 2 =0.03; P =0.39) nor any significant correlation between either the Bishop score or fibronectin level and the induction to delivery time ( R 2 =0.13; P =0.11 and R 2 =0.0006; P =0.97, respectively). Significant relationships were observed inversely between the total prostin dose and Bishop score ( R 2 =0.33; P =0.002), between the total prostin dose and latent phase ( R 2 =0.54; P =0.000009) and between Bishop score and the fibronectin levels ( R 2 =0.19; P Conclusions : Quantitative foetal fibronectin is not a useful test for inducibility at term.

Objective: There is no information on ultrasonographic visualisation of the upper airways in the sheep fetus, but this species permits to examine the accuracy of ultrasonography in measuring the inner tracheal diameter. This was the aim of our study. Methods: Transabdominal ultrasonography to visualise the trachea was attempted in 16 unsedated Welsh Mountain ewes with a singleton pregnancy at 70 (SD 2) days gestation (term 148 days). The ultrasonographically measured inner tracheal diameter was compared with the actual inner tracheal diameter obtained by stereomicroscopy post-mortem. Results: High-resolution ultrasonography permitted clear imaging of the fetal trachea in 87% (14/16) of the cases analysed. The ultrasound measurements were smaller than the corresponding stereomicroscopic measurements, the mean ± SD difference between the measurements being 0.40 ± 0.12 mm. Conclusions: Improvements in ultrasound have led to increased interest in the assessment of the trachea in human fetuses. Our study in the ovine fetus at mid gestation shows that optimal views of the fetal trachea allowing accurate measurements can be obtained in almost all the cases.

To evaluate the effect of structured hands-on training for midwives performing perineal repair.The training was performed using models and ox tongues. A total of 719 midwives completed an anonymous questionnaire prior to and immediately after training. Out of 300 participants, 151 completed a follow-up questionnaire 4 months later. Participants rated their knowledge and skills in the domains of instrument handling, knot tying, and subcuticular perineal repair.Compared with the situation before receiving the training, there was a significant increase in the use of the recommended evidence-based technique for perineal repair 4 months after training (28% vs 100%; P0.001), and in the mean scores for knowledge and skills in all the domains (P0.001). Participants believed that their patients were happier with the new technique.Structured hands-on training is an effective way of improving the skills of midwives performing perineal repair and leads to modification of clinical practice.

Although uncommon, aneurysmal subarachnoid haemorrhage (SAH) in pregnancy can be devastating for both mother and baby. It is the leading cause of other indirect maternal death in England and Wales accounting for 60 deaths in the decade 1988-1999. No single obstetric or neurosurgical unit has sufficiently large database or experience in managing this condition in pregnancy. With significant improvements in antenatal care and management of deliveries, non-obstetric causes of maternal death such as aneurysmal subarachnoid haemorrhage are likely to become increasingly significant. The clinical features of aneurysmal subarachnoid haemorrhage closely resemble those of other commoner conditions seen in pregnancy. It is therefore imperative that awareness by obstetricians and other frontline staff is increased so that a high index of suspicion is maintained when pregnant women present with unique headaches. Prompt neurosurgical referral is vital and early involvement of an experienced neuroradiologist essential. It is only when an early diagnosis is made and an aggressive treatment instituted that the bleak case-fatality figure associated with aneurysmal subarachnoid haemorrhage in pregnancy can be improved. This review, by a multidisciplinary and multicenter team, provides a comprehensive update on the epidemiology, aetiology, clinical presentation, diagnosis and the complexities of the multidisciplinary management of this serious and potentially fatal condition when it occurs in pregnancy.

AIMS: We wanted to investigate whether experimental dietary manipulations during early pregnancy influence placental growth and subsequently the cardiovascular system as assessed non-invasively by ultrasonography in the sheep fetus. METHODS: 21 ewes bearing singletons of uniform age were randomly assigned for the first half of pregnancy to one of the following study groups: fed 100% of their nutritional requirements (i.e. controls), global reduction in total intake by 30% (i.e. 70% global) and reduction in protein intake by 30% (i.e. 70% protein). RESULTS: Placentas from the 70% protein group had significantly more small placentomes, but significantly fewer large placentomes compared to the 70% global group. However, there were no significant differences between the three dietary groups for either the aortic or the umbilical Doppler velocimetry parameters and the fetal heart rate or heart size. CONCLUSIONS: The present study shows that early mild maternal undernutrition produces subtle changes in cotelydonary weight. However, Doppler and echocardiographic parameters were not affected by these changes.