Intrauterine growth restriction--diagnosis and management.

BACKGROUND: Fetal growth disorders are an important cause of perinatal morbidity and mortality with long term health implications for the survivors of intrauterine growth restriction (IUGR). The accurate assessment of fetal growth during pregnancy is difficult, but recent advances have improved this important aspect of obstetric care with positive implications for antenatal patients and their babies. OBJECTIVE: This article provides an overview of the detection of fetal growth problems in pregnancy, the determination of the likely cause, and the antenatal and intrapartum care of women with pregnancies identified as being affected by IUGR. The role of customised fetal growth assessment in the detection of IUGR is considered and followed by an outline of the appropriate monitoring and management of these pregnancies based on the underlying pathophysiology. DISCUSSION: Accurate assessment of fetal growth is improved by early clarification of gestational age and the use of customised fetal growth charts. Once infections and anomalies have been excluded, it is imperative to distinguish the healthy small fetus from the growth restricted fetus. While treatment options are limited, the optimal management of the IUGR affected fetus aims to achieve the delivery of the newborn in the best possible condition, balancing the risks of prematurity against those of continued intrauterine existence.

Developing a conceptual understanding of rural health practice.

OBJECTIVE: This study presents a set of concepts underpinning rural practice that could assist teaching health and medical students. OUTCOME: Five concepts, important in distinguishing rural health practice, are presented and discussed. These are rural-urban health differentials, access, confidentiality, cultural safety and team practice. Together these concepts impact the ways in which rural health professionals provide care, due to fewer services, greater distances, smaller populations, less choice of services and smaller workforce. CONCLUSION: These concepts introduce students to some of the positive and negative aspects of rural practice, as well as opportunities for rural practitioners to have a diverse practice, to become involved in all aspects of health and to initiate change. They provide an understanding of rurality from which health students can learn from their practical experiences during rural placements.

Development of a clockwork light source to enable cervical inspection by village health workers.

BACKGROUND: Cervical cancer can often be prevented by screening and may be curable if identified and treated in its early stages. However, 80% of new cases occur in less-developed countries where cervical cancer screening programmes are small-scale or non-existent. This is a human tragedy of great proportion, with many of those affected being young mothers. There is some evidence that cancerous or precancerous lesions may be detected by visual inspection with acetic acid (VIA) and field studies indicate that this technique is effective, safe and acceptable to women. However, the provision of a light source for inspection of the cervix presents a major problem in less-developed countries, where candles and torches often provide the only means of illumination. Our objective was to develop a light source based on clockwork technology, that required no batteries or external power source. METHODS: We adapted the design of a commercially available clockwork torch to provide a light source for cervical inspection. The light source was then tested under laboratory conditions in a comparison with other illumination methods typically used in this application. RESULTS: The light source gave illuminance levels greater than those produced by any other method tested, and also had considerable advantages in terms of ease of use and safety. CONCLUSION: This design is small, compact, effective and safe to use and promises a better and more affordable means of visualising the cervix. Further field trials of VIA are now required which incorporate this light source.