Joubert's syndrome is a well-documented but rare disorder characterized by a variable combination of central nervous system, respiratory, renal and eye anomalies. The most significant and constant neuropathological finding is partial or complete agenesis of the cerebellar vermis. The syndrome was first described by Joubert and colleagues as a familial agenesis of the cerebellar vermis and appears to be inherited as an autosomal recessive trait. A case of Joubert's syndrome is described in which second-trimester ultrasonography demonstrated abnormal findings in the fetal posterior fossa with associated renal abnormalities. However, postnatal sonography of the posterior fossa could not confirm the prenatal findings, and the diagnosis of Joubert's syndrome was only later established by computed tomography of the neonatal brain in the knowledge of the characteristic clinical picture.

Objective - To determine whether nulliparae whose second stage of labour is conducted in an obstetric birth chair have a lower incidence of instrumental delivery than those using a conventional delivery bed.Design - Randomized controlled trial using sealed, opaque envelopes for allocation.Setting - Delivery ward in a busy teaching hospital.Patients - 1250 nulliparae with a singleton live fetus with cephalic presentation, without epidural anaesthesia, who had achieved full dilatation.Intervention - Intention to conduct second and third stages of labour in either the Birth-EZ chair or the conventional delivery bed, as randomly allocated.Main outcome measures - Primary measure: vaginal operative delivery; principal secondary measures: duration of second stage, perineal trauma, blood loss, women's views, and neonatal status.Results - Delivery in the birth chair did not result in a reduction in operative delivery, overall. However, there was a reduction in vaginal operative delivery for fetal heart rate abnormality. There was no beneficial effect on perineal trauma or puerperal perineal pain. Post-partum haemorrhage was more frequent in the birth chair group.Conclusions - Delivery in the birth chair does not offer any obvious advantage to women over delivery on a bed.

OBJECTIVE:To determine whether intrauterine growth retardation associated with normal umbilical artery blood flow is a benign condition.DESIGN:A prospective comparative study of growth retarded fetuses with normal and abnormal umbilical artery blood flow.SETTING:The fetal assessment clinic of a large maternity hospital in Ireland.PATIENTS:179 Women with singleton pregnancies in which the fetal abdominal circumference, measured by ultrasonography, was below the fifth centile for gestation.MAIN OUTCOME MEASURES:Perinatal deaths, fetal distress requiring caesarean section, preterm delivery, cerebral irritation.RESULTS:Of 124 fetuses with normal flow, all physically normal fetuses survived but one baby had cerebral irritation; there were six preterm deliveries and four caesarean sections for fetal distress. Among 55 women with abnormal flow there were two midtrimester abortions, three perinatal deaths, and one case of cerebral irritation in physically normal fetuses.CONCLUSIONS:Intrauterine growth retardation associated with normal umbilical blood flow is a different entity from that associated with abnormal flow, normal flow being largely benign and abnormal flow carrying a serious risk of adverse outcome.

Asphyxial seizures occurred in 89 of 101,829 infants born alive at term (0.87/1000) in three large maternity hospitals from January 1980 to December 1984. These seizures were significantly associated with antenatal complications, primiparity, and prolonged pregnancy. Meconium staining of the amniotic fluid was also associated with asphyxial seizures, but there were high false positive (11%) and false negative (50%) rates. Fifteen of the infants who had seizures died (18%) and 21 (25%) were handicapped at 1 year. Outcome was most successfully predicted by the way the infant was feeding at 1-2 weeks. All infants taking more than half their estimated requirements by mouth at 1 week were normal, and those still being fed by tube at 2 weeks were handicapped.

SummaryThe incidence of puerperal infection was determined in a control series of 1750 consecutive mothers, while face masks were worn routinely in the delivery room. Face masks were then totally abandoned in the delivery room and the incidence of puerperal infection was again determined in a further series of 1750 consecutive mothers. There was no difference in the incidence of puerperal infection between the masked and unmasked groups, suggesting that face masks do not contribute to the prevention of puerperal infection.