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Health professional associations, especially those from countries with the highest maternal death burden, have vital roles to play in improving maternal and newborn health and in achieving the Millennium Development Goals 4 and 5. Possessing the knowledge, skills, and influence to positively impact practice at the service delivery level, they can also advocate for change at the policy level and lobby for higher priority and greater investment in the maternal and newborn health field at the national level. The ability of professional associations to assume this leadership is nevertheless contingent on their institutional capacities to achieve planned goals and objectives in support of their organizational mission and strategic priorities. Since 1998, the Society of Obstetricians and Gynaecologists of Canada (SOGC) has been supporting the capacity development efforts of peer professional associations in low-resource countries. SOGC's work in this specific area has led it to develop and pilot an Organization Capacity Improvement Framework (OCIF) that guides professional associations, incrementally, in successive cycles of capacity development. Building on capacity developed within previous capacity-building cycles, this article summarizes and reports on the recent outcomes of the Asociación de Gynecoloígia y Obstetricia de Guatemala's (AGOG) organizational development efforts and the impact they have had in positioning the association as an important contributor in national efforts to improve maternal and newborn health outcomes in the country. [ABSTRACT FROM AUTHOR]

C -Nitroso compounds (RNO, R = alkyl and aryl) are byproducts of drug metabolism and bind to heme proteins, and their heme-RNO adducts are isoelectronic to ferrous nitroxyl (NO - /HNO) complexes. Importantly, heme-HNO compounds are key intermediates in the reduction of NO to N 2 O and nitrite to ammonium in the nitrogen cycle. Ferrous heme-RNO complexes act as stable analogs of these species, potentially allowing for the investigation of the vibrational and electronic properties of unstable heme-HNO intermediates. In this paper, a series of six-coordinate ferrous heme-RNO complexes (where R = iPr and Ph) were prepared using the TPP 2- and 3,5-Me-BAFP 2- co-ligands, and tetrahydrofuran, pyridine, and 1-methylimidazole as the axial ligands (bound trans to RNO). These complexes were characterized using different spectroscopic methods and X-ray crystallography. The complex [Fe(TPP)(THF)(iPrNO)] was further utilized for nuclear resonance vibrational spectroscopy (NRVS), allowing for the detailed assignment of the Fe-N(R)O vibrations of a heme-RNO complex for the first time. The vibrational properties of these species were then correlated with those of their HNO analogs, using DFT calculations. Our studies support previous findings that RNO ligands in ferrous heme complexes do not elicit a significant trans effect. In addition, the complexes are air-stable, and do not show any reactivity of their RNO ligands towards NO. So although ferrous heme-RNO complexes are suitable structural and electronic models for their HNO analogs, they are unsuitable to model the reactivity of heme-HNO complexes. We further investigated the reaction of our heme-RNO complexes with different Lewis acids. Here, [Fe(TPP)(THF)(iPrNO)] was found to be unreactive towards Lewis acids. In contrast, [Fe(3,5-Me-BAFP)(iPrNO) 2 ] is reactive towards all of the Lewis acids investigated here, but in most cases the iron center is simply oxidized, resulting in the loss of the iPrNO ligand. In the case of the Lewis acid B 2 (pin) 2 , the reduced product [Fe(3,5-Me-BAFP)(iPrNH 2 )(iPrNO)] was identified by X-ray crystallography.

Nitroxyl, HNO/NO - , the one-electron reduced form of NO, is suggested to take part in distinct signaling pathways in mammals and is also a key intermediate in various heme-catalyzed NO x interconversions in the nitrogen cycle. Cytochrome P450nor (Cyt P450nor) is a heme-containing enzyme that performs NO reduction to N 2 O in fungal denitrification. The reactive intermediate in this enzyme, termed "Intermediate I ", is proposed to be an Fe-NHO/Fe-NHOH type species, but it is difficult to study its electronic structure and exact protonation state due to its instability. Here, we utilize a bulky bis-picket fence porphyrin to obtain the first stable heme-HNO model complex, [Fe(3,5-Me-BAFP)(MI)(NHO)], as a model for Intermediate I , and more generally HNO adducts of heme proteins. Due to the steric hindrance of the bis-picket fence porphyrin, [Fe(3,5-Me-BAFP)(MI)(NHO)] is stable (τ 1/2 = 56 min at -30 °C), can be isolated as a solid, and is available for thorough spectroscopic characterization. In particular, we were able to solve a conundrum in the literature and provide the first full vibrational characterization of a heme-HNO complex using IR and nuclear resonance vibrational spectroscopy (NRVS). Reactivity studies of [Fe(3,5-Me-BAFP)(MI)(NHO)] with NO gas show a 91 ± 10% yield for N 2 O formation, demonstrating that heme-HNO complexes are catalytically competent intermediates for NO reduction to N 2 O in Cyt P450nor. The implications of these results for the mechanism of Cyt P450nor are further discussed.

On average 16%-53% of maternal deaths are from postpartum haemorrhage (PPH), with confidence intervals for Eastern Asia reaching beyond 60%. Success in preventing PPH mortality across many large low-resource populations has been fairly limited. Niger's government and an international non-governmental organization (NGO) have developed a model aiming to rapidly reduce primary postpartum haemorrhage mortality, combining relatively new technologies, misoprostol, condom tamponade, and non- inflatable anti-shock garment, with systematic measurement of blood loss and a set of traditional public health tools that constitute the Catalyst Approach to Public Health, with action steps for each phase if haemorrhage occurs. This paper describes each component and testing of the hypothesis that the model can effectively reduce PPH mortality on a national scale. The Niger model is a 'complex intervention' aiming to maximise impact from existing health system resources even in remote areas. The broad applicability of Niger's approach to address a serious global public health problem, and its innovative nature warrant describing the model itself, with results to be published separately. Combining this set of individually proven technologies and a set of organisational tools from disease eradication settings as a single 'complex intervention', has to our knowledge not been described before.

Objective: To review the clinical aspects of postpartum hemorrhage (PPH) and provide guidelines to assist clinicians in the prevention and management of PPH. These guidelines are an update from the previous Society of Obstetricians and Gynaecologists of Canada (SOGC) clinical practice guideline on PPH, published in April 2000., Evidence: Medline, PubMed, the Cochrane Database of Systematic Reviews, ACP Journal Club, and BMJ Clinical Evidence were searched for relevant articles, with concentration on randomized controlled trials (RCTs), systematic reviews, and clinical practice guidelines published between 1995 and 2007. Each article was screened for relevance and the full text acquired if determined to be relevant. Each full-text article was critically appraised with use of the Jadad Scale and the levels of evidence definitions of the Canadian Task Force on Preventive Health Care., Values: The quality of evidence was rated with use of the criteria described by the Canadian Task Force on Preventive Health Care., Sponsor: The Society of Obstetricians and Gynaecologists of Canada., Recommendations: Prevention of Postpartum HemorrhageTreatment of PPHRecommendations were quantified using the evaluation of evidence guidelines developed by the Canadian Task Force on Preventive Health Care (Table 1)., (Copyright © 2018. Published by Elsevier Inc.)

Objectif: Analyser les aspects cliniques de l'hémorragie postpartum (HPP) et fournir des lignes directrices visant à guider les cliniciens pour ce qui est de la prévention et de la prise en charge de l'HPP. La présente directive clinique est une mise à jour de la directive clinique précédente de la Société des obstétriciens et gynécologues du Canada (SOGC) sur l'HPP, publiée en avril 2000. RéSULTATS: Des recherches ont été menées dans Medline, PubMed, la Cochrane Database of Systematic Reviews, le ACP Journal Club et le BMJ Clinical Evidence afin d'en tirer les articles pertinents, en portant une attention particulière aux essais comparatifs randomisés (ECR), aux analyses systématiques et aux directives cliniques publiées entre 1995 et 2007. Chaque article a été analysé en vue d'en assurer la pertinence et nous avons fait l'acquisition du texte intégral, lorsque cela s'avérait pertinent. Chacun des articles intégraux a fait l'objet d'une évaluation critique en fonction de l'échelle Jadad et des définitions de qualité des résultats émises par le Groupe d'étude canadien sur les soins de santé préventifs., Valeurs: La qualité des résultats a été établie en fonction des critères décrits par le Groupe d'étude canadien sur les soins de santé préventifs., Commanditaire: La Société des obstétriciens et gynécologues du Canada., Recommandations: Prévention de l'hémorragie postpartum., (Copyright © 2018. Published by Elsevier Inc.)

Reduction in maternal mortality is a key Millennium Development Goal (MDG 5). In an effort to contribute toward achievement of MDG 5, FIGO's Safe Motherhood and Newborn Health Committee worked with associations of obstetricians, gynecologists, and midwives in 10 low- and middle-income countries between 2006 and 2011. Contributions were made by professional associations in high-income countries through a structured north-south mentoring program. Each project focused on identified needs within each country and resulted in varied approaches and targets, ranging from clinical training, protocol development, and implementation of clinical audit through to legislative and policy change. Significant and largely sustainable results were achieved, particularly in relation to the relatively small-scale funding available. This resulted in direct improvements to maternal and newborn health outcomes. The capacity of both FIGO and national professional associations was also substantially strengthened in project design, management, and implementation, leading to opportunities to further support international development efforts in the future., (Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

The Society of Obstetricians and Gynaecologists of Canada (SOGC) advocates that drugs used during pregnancy be tested exclusively in women. The SOGC holds the opinion that drugs to be used exclusively in men or in women should not be tested in a small number of men and women. The SOGC, always cautious with the choice of pharmacological treatments recommended for use during pregnancy, welcomes the increased options resulting from the introduction of generic formulations of drugs shown to be bioequivalent to currently available brand name products. These formulations provide less expensive options to Canadian women in need of drug therapy. However, the Society does not believe that drugs should be substituted without the patient and the physician both agreeing to such a change. Generic substitutions of some products may mean a potentially clinically significant difference in drug dose, possibly resulting in a changed patient effect. Furthermore, substituting a product on the basis of price alone is not acceptable.The SOGC, as an organization with the role of advising its members on clinical practice, calls on Health Canada to review its guideline on testing of drugs for vulnerable populations, especially pregnant women.

Objectives: We wished to gain insight into Canadian hospital policy changes between 2000 and 2007 in response to (1) the initial results of the Term Breech Trial suggesting delivery by Caesarean section was preferable for term breech presentation, and (2) the trial's two-year follow-up and other research and commentary suggesting that risks associated with vaginal breech delivery and delivery by Caesarean section were similar. We also wished to determine the availability of vaginal breech delivery and the feasibility of establishing breech clinics and on-call squads, and whether these could include midwives., Methods: In 2006, we sent surveys to the 30 largest maternity centres in Canada asking about their changes in practice in response to results of the initial Term Breech Trial and the subsequent two-year follow-up and the possibility of establishing breech clinics and on-call delivery squads and whether they could include midwives., Results: Of the 30 surveys sent, responses were received from 20 maternity centres in six provinces. Hospitals were almost five times more likely to adopt a policy of requiring Caesarean section for breech delivery when current evidence suggested that it decreased risk for the neonate than they were to reintroduce the option of vaginal breech delivery when it did not. A breech clinic was considered possible, feasible, and desirable by only one centre, and forming a breech squad was similarly regarded by only two hospitals; 70% of respondents, however, did not entirely dismiss either possibility., Conclusions: The weight of epidemiologic evidence does not support the practice developed in Canadian hospitals since the Term Breech Trial that recommends delivery by Caesarean section for all breech presentations. Obstetric and midwifery bodies will require creative strategies to make clinical practice consistent with current national and international evidence.

Objective: To review the clinical aspects of postpartum hemorrhage (PPH) and provide guidelines to assist clinicians in the prevention and management of PPH. These guidelines are an update from the previous Society of Obstetricians and Gynaecologists of Canada (SOGC) clinical practice guideline on PPH, published in April 2000., Evidence: Medline, PubMed, the Cochrane Database of Systematic Reviews, ACP Journal Club, and BMJ Clinical Evidence were searched for relevant articles, with concentration on randomized controlled trials (RCTs), systematic reviews, and clinical practice guidelines published between 1995 and 2007. Each article was screened for relevance and the full text acquired if determined to be relevant. Each full-text article was critically appraised with use of the Jadad Scale and the levels of evidence definitions of the Canadian Task Force on Preventive Health Care., Values: The quality of evidence was rated with use of the criteria described by the Canadian Task Force on Preventive Health Care., Sponsor: The Society of Obstetricians and Gynaecologists of Canada., Recommendations: Prevention of Postpartum Hemorrhage 1. Active management of the third stage of labour (AMTSL) reduces the risk of PPH and should be offered and recommended to all women. (I-A) 2. Oxytocin (10 IU), administered intramuscularly, is the preferred medication and route for the prevention of PPH in low-risk vaginal deliveries. Care providers should administer this medication after delivery of the anterior shoulder. (I-A) 3. Intravenous infusion of oxytocin (20 to 40 IU in 1000 mL, 150 mL per hour) is an acceptable alternative for AMTSL. (I-B) 4. An IV bolus of oxytocin, 5 to 10 IU (given over 1 to 2 minutes), can be used for PPH prevention after vaginal birth but is not recommended at this time with elective Caesarean section. (II-B) 5. Ergonovine can be used for prevention of PPH but may be considered second choice to oxytocin owing to the greater risk of maternal adverse effects and of the need for manual removal of a retained placenta. Ergonovine is contraindicated in patients with hypertension. (I-A) 6. Carbetocin, 100 microg given as an IV bolus over 1 minute, should be used instead of continuous oxytocin infusion in elective Caesarean section for the prevention of PPH and to decrease the need for therapeutic uterotonics. (I-B) 7. For women delivering vaginally with 1 risk factor for PPH, carbetocin 100 microg IM decreases the need for uterine massage to prevent PPH when compared with continuous infusion of oxytocin. (I-B) 8. Ergonovine, 0.2 mg IM, and misoprostol, 600 to 800 microg given by the oral, sublingual, or rectal route, may be offered as alternatives in vaginal deliveries when oxytocin is not available. (II-1B) 9. Whenever possible, delaying cord clamping by at least 60 seconds is preferred to clamping earlier in premature newborns (< 37 weeks' gestation) since there is less intraventricular hemorrhage and less need for transfusion in those with late clamping. (I-A) 10. For term newborns, the possible increased risk of neonatal jaundice requiring phototherapy must be weighed against the physiological benefit of greater hemoglobin and iron levels up to 6 months of age conferred by delayed cord clamping. (I-C) 11. There is no evidence that, in an uncomplicated delivery without bleeding, interventions to accelerate delivery of the placenta before the traditional 30 to 45 minutes will reduce the risk of PPH. (II-2C) 12. Placental cord drainage cannot be recommended as a routine practice since the evidence for a reduction in the duration of the third stage of labour is limited to women who did not receive oxytocin as part of the management of the third stage. There is no evidence that this intervention prevents PPH. (II-1C) 13. Intraumbilical cord injection of misoprostol (800 microg) or oxytocin (10 to 30 IU) can be considered as an alternative intervention before manual removal of the placenta. (II-2C) TREATMENT OF PPH: 14. For blood loss estimation, clinicians should use clinical markers (signs and symptoms) rather than a visual estimation. (III-B) 15. Management of ongoing PPH requires a multidisciplinary approach that involves maintaining hemodynamic stability while simultaneously identifying and treating the cause of blood loss. (III-C) 16. All obstetric units should have a regularly checked PPH emergency equipment tray containing appropriate equipment. (II-2B) 17. Evidence for the benefit of recombinant activated factor VII has been gathered from very few cases of massive PPH. Therefore this agent cannot be recommended as part of routine practice. (II-3L) 18. Uterine tamponade can be an efficient and effective intervention to temporarily control active PPH due to uterine atony that has not responded to medical therapy. (III-L) 19. Surgical techniques such as ligation of the internal iliac artery, compression sutures, and hysterectomy should be used for the management of intractable PPH unresponsive to medical therapy. (III-B) Recommendations were quantified using the evaluation of evidence guidelines developed by the Canadian Task Force on Preventive Health Care (Table 1).

In collaboration with member national professional associations, the International Federation of Gynecology and Obstetrics (FIGO) has been conducting a Saving Mothers and Newborns Project in 10 low- and middle-resource countries. The project aims to achieve the objectives set out in Millennium Development Goals 4 and 5 related to child survival and maternal mortality and to develop organizational capacity among member associations. Projects are developed in response to the needs of the local country, through a twinning of professional associations between high- and low-resource countries.

In response to the direct and indirect consequences of removing birthing practices from communities, Canada is exploring new initiatives to return childbirth to Aboriginal communities. Lessons learned and insights into this major problem can be used internationally to plan efforts to reduce maternal mortality in low-resource countries around the world.

Over the last decade, the Société haïtienne d'obstétrique et de gynécologie (SHOG) has positioned itself as a key player in the maternal and neonatal health agenda in the country. This transformation arose from the association's commitment to strengthening its organizational capacities in order to enhance its operations and consolidate its contribution to the national efforts to reduce maternal and infant mortality. The SHOG benefited from the SOGC's technical assistance to reinforce its organizational capacities, support that it received as part of the SOGC Partnership Program from professional associations working in low-income countries. We describe the results of the SHOG's organizational assessments in 2008 (in the middle of the five-year cycle) and in 2006, according to the organizational capacity development approach promoted by the SOGC. A comparison of the 2008 and the 2006 assessment results shows that the SHOG progressed substantially during that period, shifting from "basic-moderate" to "moderate" regarding its organizational capacity, its operational capacities and its relationships with other organizations, including the way it is perceived by interested parties involved in the maternal and neonatal health agenda. The SHOG's experience shows that the SOGC's approach to capacity development can assist professional associations committed to reinforcing their organizational capacities in a tangible way. This will enhance their contribution to the national efforts pertaining to maternal and newborn health in their country.

Through international partnerships, FIGO has been delivering safe motherhood and newborn health (SMNH) projects in a number of low-income countries. The projects aim to achieve the objectives set out in the ICPD Programme of Action and the Millennium Development Goals 4 and 5, which are related to child survival and maternal mortality. Each project is developed in response to the needs of the intervention region and can be organized around the following themes: provision of maternal and newborn health care services to underserved and hard-to-reach areas; improvement and provision of quality basic emergency obstetric care; establishment of functional clinical and perinatal audits; development of new maternal and newborn health care protocols; community education and sensitization to women's rights in sexual and reproductive health; and reducing the risk of unsafe abortion.

Objective: Past studies indicate that despite a wide range of contraceptive options, Canadian women tend to use a narrow selection of contraceptive methods. New contraceptive methods have recently been introduced in Canada. The objective of this research is to characterize Canadian women's current contraceptive choices and adherence to contraceptive regimens., Methods: A national cross-sectional survey was conducted in November 2006. A standardized, confidential, Internet questionnaire was administered to female members of a previously recruited national market research panel. Percentages of current contraceptive use and consistency of use were calculated by age group, marital status, and province and were weighted according to age and region. Chi-square test was used to detect within-group differences for consistency of contraceptive use, oral contraceptive (OC) use, and condom use. Multivariate logistic regression analyses predicting consistent contraception use, OC use, and condom use were performed., Results: Of 5597 survey respondents, 3253 were eligible for data analysis. Of these women, 2751 had had vaginal intercourse in the previous six months, were not trying to conceive, and reported whether they or their partner had used contraception. Of these 2751 women, 410 (14.9%) never used contraception. Among contraception users, the most frequently used methods of contraception were condoms (54.3%), OCs (43.7%), and withdrawal (11.6%). Newer contraceptive methods were used by less than 4%. Choice of contraceptive method varied by age. Only 65.2% of respondents who were sexually active and not trying to conceive "always used" contraception. Multivariate logistic regression analyses found significantly higher odds of no contraception use in women over 40 years of age, without higher education, living in PEI or Newfoundland, married or living common-law, or having annual household incomes under $100,000., Conclusion: Despite many contraceptive options, Canadian women continue to use a narrow range of contraceptive methods and to use contraception inconsistently. Consistent contraceptive use is influenced by a number of independent social variables. Future public health initiatives should focus on raising awareness of contraception options, increased access to a variety of contraceptive methods, and assisting with contraceptive adherence.

Through its partnership program with professional obstetrics and gynaecology associations in resource-poor environments, the Society of Obstetricians and Gynaecologists of Canada has developed a model for capacity assessment and development. The use of this model in Guatemala, Haiti, and Uganda has demonstrated its potential for facilitating cultural shifts in the perception of reproductive care, for providing clinical expertise in promoting educational activities, for enabling enhanced technical capacity, for political engagement, and for broad-based community and professional engagement.

Through capacity-building initiatives with obstetrics and gynaecology organizations in Guatemala, Haiti, and Uganda, the Society of Obstetricians and Gynaecologists of Canada has developed the organization capacity improvement framework (OCIF), a model for strengthening associations' essential organizational capacities. The OCIF focuses on capacity development within the organization over time, rather than on individual training and short-term outcomes. A cycle of assessing, planning, implementing, and measuring improvement builds rigour into the process while encouraging participation, understanding, and commitment to sustainable capacity development.

The Society of Obstetricians and Gynaecologists of Canada has played a leadership role in advancing patient safety at the national level with the launching of their obstetric patient safety program 'Managing Obstetric Risks Efficiently' (MORE(OB)). Developed over a 2-year period and launched as a pilot in 2002, the program has extended to 126 hospitals in five provinces that provide care for 48% of the births in Canada. The end-point for the program is to change the culture of blame to a focused and sustained patient safety culture, where patient safety is everyone's responsibility, with observed reductions in events and improved quality of care. The program has integrated the principles of high reliability organizations (HROs), systems error theory, team function, and communities of practice (CoPs) as values for the work environment. In this chapter we describe how the program was developed, the role of the national specialty society in the development, and the funding, structure and implementation of the program, and we report on the impact of the program over the first 3 years. In these first 3 years, knowledge enhancement in all disciplines and in all practice environments, with a significant reduction in variance among the disciplines, has been demonstrated. Culture change has occurred in all practice settings and has continued to improve over time. Using liability claims information from the hospitals, a reduction trend has been observed in liability carrier (hospital) incurred costs.

Objectives: To determine the availability in Canada of different types of hormone replacement therapy (HRT) products, and to compare the availability of HRT products in Canada to their availability in other countries., Methods: A systematic review was conducted of the availability of products indicated for treatment of menopausal symptoms in Canada, the United States (US), the United Kingdom (UK), Sweden, and Australia. Products indicated for the treatment of menopausal symptoms were determined for each country by using on-line drug product databases. Products administered by injection and androgen products, unless combined with estrogens, were excluded from the analysis., Results: There were 111 different brands identified in the 5 countries examined, with Canada having the lowest number of brands and active ingredients (28 and 22, respectively) compared to the other countries (Sweden and UK at 67 and 47 brands and 39 and 40 active ingredients, respectively). Not available in Canada are 34 active ingredients (either alone or in combination products) and 5 different types of formulations of HRT. There was a significant difference between the number of combination brand products available in Canada and in the UK (5 versus 29, P <.001, respectively)., Conclusions: Canadian women have comparatively few options available to them for the management of menopausal symptoms. The wide range of HRT products available in other developed countries provides alternatives for managing side

In 1998, the ob/gyn associations of Uganda and Canada launched, under the umbrella of the FIGO Save the Mothers Initiative, a district-wide intervention which aimed to increase the availability and utilization of emergency obstetric care (EmOC) services in a rural district of Uganda. The article describes the experience of two professional ob/gyn associations in the development, implementation, monitoring and evaluation of the project. Preliminary results after 24 months of intervention indicate important gains in the capacity of health professionals to deliver EmOC, the availability of emergency transportation services and met need for EmOC.

In November 2002, the Royal Commission on the Future of Health Care in Canada, headed by Mr. Roy J. Romanow, will deliver its final report to the Governor-in-Council of Canada. In October 2001 the Society of Obstetricians and Gynaecologists (SOGC) submitted to Mr. Romanow concrete ideas and proposed actions to improve the health of Canadian women and their families, and to sustain and strengthen Canada's publicly funded health care system, in its report Ensuring Women's Health: Options for the Future of Canada's Health Care System. This Commentary brings to you the thoughts that the SOGC will continue to forward after the Romanow Commission's report is delivered next month.

The recent Women's Health Initiative study report evaluated the long-term benefits and risks of hormone replacement therapy among healthy postmenopausal women. The report showed that the risk-benefit profile of continuous combined hormone replacement therapy was not consistent with the primary prevention of coronary heart disease. The Women's Health Initiative study of continuous combined hormone replacement therapy is a landmark study and the results provide valuable information for patients and clinicians. However, the most common indication for hormone replacement therapy is menopausal symptoms, for which it is effective, not prevention of disease, and the most common use is for less than three years. Nevertheless, even short-term use has small effects on some outcomes. This statement discusses how the findings of the Women's Health Initiative study can be applied to reach appropriate clinical decisions.

Fetal ventriculomegaly usually involves both lateral ventricles. If dilatation of the dependent lateral ventricle is seen, it might be assumed that the condition is bilateral and symmetric and that reverberation artifact is obscuring the ventricle nearer to the transducer. However, unilateral hydrocephalus can occur, though rarely and usually as a result of unilateral obstruction of the foramen of Monro. Careful attention to visualization of the obscured hemisphere is emphasized. In the patient described here the condition was associated with frontoethmoidal encephalocele.

By minilaparotomy or through the laparpscope, Falope Ring sterilization is accomplished by applying silicone rubber bands to the Fallopian tubes. The applicator and its use are described and 383 cases without any major complication are reported. The major advantage is elimination of thermocoagulation. The occlusion is complete in a short segment and offers theoretical possibilities of tubal reconstruction.

Of 106 consecutive women referred for secondary amenorrhea of more than 1 year's duration, 65 were diagnosed as having functional amenorrhea. Of these 65, 29 had amenorrhea directly following discontinuation of oral contraceptives (OC group) and 36 had never used oral contraceptives (NOC group). There was no difference in the incidence of prior menstrual irregularity in either group. Similarly, there was no difference in the resting serum estrone, estradiol, luteinizing hormone, follicle-stimulating hormone, and prolactin levels between the OC and NOC groups. Nor was there a difference between the OC and NOC groups in response to medroxyprogesterone acetate, clomiphene citrate, or luteinizing hormone-releasing factor. Of 106 patients, 17 were proven to have prolactinomas. Eight patients had a prior history of OC use, whereas nine did not. With the exception of elevated serum prolactin levels, there were no significant differences in biochemical tests or history of oral contraceptive use between the prolactinoma group and patients with prolonged "functional" amenorrhea (OC plus NOC groups). The lack of historical or biochemical difference between the OC and NOC subjects indicates homogeneity between groups, and does not support the existence of a "postpill" syndrome.

Sterilization with the Falope Ring may be performed by means of laparoscopy of the minilaparotomy. This technique avoids the potential hazards of electrocoagulation, such as intestinal burns. Among the 825 cases reported in this paper there was only one serious complication, an ectopic pregnancy. One other patient had an undetected early pregnancy at the time of sterilization. Two patients became pregnant 4 and 42 month after the procedure. In most cases a diagnostic dilatation and curettage was done before hand. Pathological study of the fallopian tubes of one patient 28 days after the ring was applied revealed complete occlusion of the buckled segment of each tube. Falope Ring sterilization is simple, effective and safe, and the rate of subsequent pregnancy is lower than with conventional burning or clipping techniques.