"Only God decides": young children's perceptions of divorce and the legal system.

OBJECTIVE: To describe research on perceptions of children aged 6 and younger from 21 families of their parents' divorce, of its impact on their families, and of legal officials. METHOD: Semistructured play interviews were conducted during home visits as parents were conjointly interviewed as part of a larger study on divorce in legal context. RESULTS: Children had much mis-information about divorce as an event and process. What they did know was often inappropriate, frightening, and confusing. They resented how the process "ruined their parents' being friends any more" and proposed reforms based on their wishes and observations. CONCLUSIONS: Greater awareness is needed of the child's desire to be heard during the process, to feel safe and less lonely, and to stay in touch with both parents and extended families. Age-appropriate explanations of psychological and legal aspects of the divorce process are likely to support children's positive adjustment and mental health.

Role of the father.

Fathers make definite contributions to infant development and are now spending more time with their children than in many past decades. This article reviews the most compelling research on the developmental importance of fathers, including father-infant attachment and interaction, and differences between maternal and paternal interaction styles. Results of a long-term study of primary caregiving fathers also are presented.

Fathers, divorce, and their children.

To minimize many of the negative consequences of divorce, it is beneficial to support a father's ongoing involvement in his child's life. Although the research literature isn't unequivocal on this point, it does strongly suggest that men who are "visitors" do not have as much impact on their children and that visits are a poor substitute for having a parental figure. The answer lies in creating meaningful roles for noncustodial fathers that elevate men's opportunities to contribute to their children's overall development. One of the most important messages parents can impart to children is that some commitments outlive change and that working together in the child's best interests is one of them.

Latency development in children of primary nurturing fathers. Eight-year follow-up.

This paper is an 8-year follow-up of 17 families in which fathers began as primary caretakers early in the lives of their children. The emphasis is on the developmental consequences for the children, now in the latency period, as well as their psychological experience of the father's increased significance.

The effects of magnesium sulfate therapy on Apgar scores.

When intravenous magnesium sulfate is infused in women with pregnancy-induced hypertension, the hypermagnesemia does not result in lower Apgar scores. The mean maternal serum and cord magnesium levels at delivery were 5.3 +/- 0.72 and 5.3 +/- 1.1 mEq/dl, respectively. The most common negative Apgar score was assigned for color, not for muscle tone.

Unknown uterine scar and trial of labor.

A review of 393 patients undergoing trial of labor after one or more previous cesarean sections was performed. Three hundred patients had an unknown uterine scar, 88 patients had a documented low cervical transverse incision, and five patients had a prior low vertical incision. The rate of vaginal delivery and maternal and fetal morbidity was no different in those patients with an unknown prior uterine incision compared with those having a known prior low cervical transverse incision. In 66 of the patients with a documented low cervical transverse incision, the original operative record was reviewed in regard to single-layer closure of the uterine incision versus double-layer closure or imbricating technique. No patient with a double-layer uterine closure had a subsequent dehiscence, whereas three patients with a prior single-layer closure exhibited scar separation. These data suggest that neither an unknown scar nor a single-layer uterine closure places the mother or fetus at greater risk.

Is vaginal birth after two or more cesarean sections safe?

Fifty-five patients with a history of two or more cesarean sections underwent a trial of labor. Forty-two had had previous uterine incisions of unknown type, 11 had had low cervical transverse incisions, and two had had low vertical incisions. Twenty-five women (45%) had successful vaginal deliveries, and 30 (55%) received oxytocin augmentation of labor. The incidence of vaginal delivery was significantly lower in patients who required oxytocin augmentation (30 versus 64%, P less than .01). Three of the 55 patients had scar separation detected at the time of delivery. Two patients underwent hysterectomy. There were no maternal or neonatal deaths. A history of multiple cesarean sections need not exclude the patient from the option of trial of labor.

Correlation of ultrasonography and bacteriology of the endocervix and posterior cul-de-sac of patients with severe pelvic inflammatory disease.

We evaluated 30 patients admitted with a diagnosis of pelvic inflammatory disease (PID) by culdocentesis and ultrasonography to determine the severity of disease in relation to endocervical and culdocentesis bacteriology. Specimens from the endocervix were cultured for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum. In addition, culdocentesis fluid was cultured for aerobes and anaerobes. Patients with N. gonorrhoeae or C. trachomatis had significantly milder disease (P less than 0.05) compared with patients whose specimens were negative for those organisms. Furthermore, those patients with ultrasound confirmation of a tubo-ovarian complex had significantly (P less than 0.0001) greater recovery of aerobes and anaerobes from culdocentesis fluid than did patients with milder disease.

Small-cell carcinoma of the ovary: an aggressive epithelial cancer occurring in young patients.

A case of small-cell carcinoma of the ovary occurring in a 33-year-old patient is described. At no time did the patient develop hypercalcemia. Despite aggressive cytoreductive surgery and multiagent chemotherapy, the patient expired after 13 months. These lesions must be differentiated from germ cell tumors or lymphoma. Review of the literature fails to reveal effective adjuvant therapy.

Father's influence in the development of infant's relationships.

Recent research on the father infant interaction has challenged the long held belief that the "most important thing a father can do for his children is to love their mother". Fathers have significant influences on the development of the infant's relationships both directly and indirectly. Certainly his greatest indirect influence is through supporting, protecting, and facilitating the maternal infant dyad when it is the primary nurturing relationship. New research from a variety of perspectives in Europe and the United States have begun to document the powerful impact that fathers have on their children directly, and not just mediated through the maternal infant dyad. The Nordic family study in Europe, and clinical research by Parke, Lamb, Yogman, and Pruett in the United States have all documented the impact on the infant of increased paternal involvement in the early years, thanks to a variety of influences. Evidence now suggests that infants are able to make direct use of the father's unique contribution to their growth and development. This contribution not only increases the repertoire of available to the infant, but appears to have its own unique meaning to the infant, who often seeks it out quite directly and aggressively. Stylistic differences between paternal and maternal nurturing, appear to be of great interest and use to the child. The close contact between father and infant does not appear to threaten maternal infant attachment. Data from an ongoing longitudinal study of primary care giving fathers in the intact families will be presented. The impact of such a rare but theoretically highly interesting phenomenon on the capacity of the infant to develop useful relationships will be highlighted with clinical materials. Finally, we shall conclude with a discussion of the question in reverse, i.e., how does the infant influence the development of the father's relationships?

Pyelonephritis associated with respiratory distress.

We present a case of pyelonephritis associated with respiratory distress and elevated liver enzymes in a pregnant patient.

Routine Serologic Testing for Syphilis in a Community Medical Practice.

A retrospective review of 8,100 serologic tests for syphilis ordered during a 42-month period yielded positive rapid plasma reagin test results in 127 patients (1.6 percent) and a positive fluorescent treponemal antibody absorption reaction in 91 patients (1.1 percent). Of the 36 cases of biologic false-positive reactions, most were in prenatal patients. Forty-six cases of syphilis were previously undiagnosed but antibiotic therapy was given in only 26 of the patients. Some 24 percent of syphilitic patients were not treated because the positive serologic findings were overlooked. Cerebrospinal fluid determinations were analyzed and cost-effectiveness of finding a single case of previously undiagnosed syphilis was calculated. We found that routine serologic tests and cerebrospinal fluid studies for syphilis in asymptomatic patients had low rates of positivity in our community hospital and outpatient practice.

Papular dermatitis of pregnancy.

Papular dermatitis of pregnancy is a condition characterized by widespread intensely pruritic papules that show no particular anatomic predilection. These lesions may occur at any time during the pregnancy and may be associated with increased fetal wastage. The response to corticosteroids is prompt and gratifying to the patient and the physician. Therapeutic doses of prednisone have not been associated with increased fetal loss. The etiology of the condition is unknown and it may recur with subsequent pregnancies.