Massive feto-maternal haemorrhage with good perinatal outcome following failed external cephalic version.

OBJECTIVE: To reinforce the risk of feto-maternal haemorrhage associated with external cephalic version for breech presentation. METHOD: A single case report with a literature review. RESULTS: Our case report was associated with the largest feto-maternal haemorrhage following external cephalic version reported so far. The perinatal outcome in this case was favourable despite a significant amount of fetal haemorrhage. The literature review did include cases with unfavourable outcomes. No reliable method of monitoring fetuses with feto-maternal haemorrhage has been reported, although middle cerebral artery Doppler studies appear to show promise. CONCLUSION: External cephalic version is useful in the management of breech presentations at term, but it is not without risks and clinicians need to be aware of this.

Local anaesthetic on Filshie clips for pain relief after tubal sterilisation: a randomised double-blind controlled trial.

Pain during tubal sterilisation is thought to be due to either ischaemia or pressure at the site of impact of sterilising devices on the fallopian tubes. We have evaluated the effectiveness of an application of 2% lignocaine gel to Filshie clips to relieve postoperative pain. In a randomised double-blind placebo-controlled study, 80 healthy women undergoing tubal sterilisation under general anaesthesia at the County Hospital, Lincoln, UK, were allocated to be sterilised by Flishie clips covered with 2% lignocaine gel or K-Y gel as placebo. Pelvic pain was assessed, with a 100 mm visual analogue scale, at 1 hour, at hospital discharge, and time of first analgesia or any other time analgesia was demanded. The lignocaine-treated group had significantly longer time to first analgesia, less pain at 1 hour, less nausea and vomiting, and shorter recovery time. Fewer lignocaine-treated patients needed additional analgesia and they required fewer opioids. There was no case of failed sterilisation or adverse reaction to lignocaine. The application of local anaesthetic gel to Filshie clips is a safe, non-invasive, and effective method of relieving postoperative pain during laparoscopic tubal sterilisation.

Patient-recorded domiciliary fetal monitoring.

Domiciliary fetal monitoring via a telephone link has been in clinical use at the Royal Free Hospital for 2 years, during which time 858 traces of 134 patients who were moderately at risk have been transmitted to the hospital. All recognized abnormal heart rate patterns were detected during the study period. In seven patients obstetric intervention took place on the basis of the domiciliary fetal monitoring recording and subsequent hospital monitoring. There were no intrauterine or neonatal deaths, and there was no overall increase in obstetric operative intervention. There appeared to be a significant reduction in the inconvenience suffered by the patient and her family, compared with conventional monitoring. Fetal heart recordings performed solely by the patient were of a high quality and reduced the demand on midwifery resources. To allow this only 3 hours of midwifery time daily was required and no additional demands on obstetric staff were made. It is anticipated that domiciliary fetal monitoring, performed by patients, will become an essential and established service throughout the United Kingdom (and probably Europe) as the principal means of monitoring fetal well-being.

Nausea and vomiting in early pregnancy.

To study the problem of nausea and vomiting in early pregnancy an epidemiological survey was undertaken, obtaining information from 500 consecutive antenatal patients. Seventy-six percent of women complained of symptoms during the first trimester, and in only 27% had the symptoms resolved by the twelfth week. Job efficiency was markedly impaired. Women who suffered nausea premenstrually, or on the oral contraceptive pill, were much more likely to develop symptoms, lending credence to a hormonal etiology for the condition.

Effect of spironolactone on premenstrual syndrome symptoms.

The premenstrual syndrome (PMS) has long been considered one in which fluid retention plays an important role. Detailed studies, however, have failed to reveal good evidence for this assumption, and investigations of weight change and of sodium and water balance have yielded contradictory results. Even so, a number of the etiologic theories and treatment regimens are based on this premise. Many of the endocrine theories depend on the endocrine effect on water balance to explain the mechanism, and the treatment often proposed involves salt and water restriction and the liberal use of diuretics. There is no justification for this advice except for a few well-conducted studies that showed the benefits of diuretic therapy. The evidence from these studies suggests that diuretics, especially spironolactone, have a particular role in the management of the PMS symptoms of bloatedness and abdominal distension despite the fact that the underlying water retention theory remains in doubt. An improvement in the various psychologic symptoms of PMS has also been reported.

A double-blind, placebo-controlled evaluation of spironolactone in the premenstrual syndrome.

The effect of spironolactone in the alleviation of the symptoms of the premenstrual syndrome was compared with placebo in a double-blind, parallel group controlled study. One tablet daily of 100 mg spironolactone or placebo was given to 63 women from Day 12 of the menstrual cycle until the first day of the next menstrual bleed. This regimen was repeated for two consecutive cycles. Spironolactone was statistically significantly superior in providing relief from bloatedness (p less than 0.001). No statistically significant changes were observed in blood biochemistry of plasma hormone levels of oestradiol, progesterone or prolactin, though an increase in serum aldosterone levels was seen in the spironolactone-treated group. No differences were detected in weight, blood pressure or the incidence and severity of complaints following treatment.