"Anomalous ovarian morphology in a patient with craniofrontonasal syndrome." Journal of Obstetrics and Gynaecology, 33(3), pp. 316–

In its 2007 guideline, the Royal College of Obstetricians and Gynaecologists (RCOG) recommends vaginal birth after caesarean (VBAC) as safer than repeat elective caesarean sections. However, this document does not give details of risk of emergency caesarean section for women accepting VBAC. An emergency caesarean is associated with increased maternal and neonatal morbidity, and women do consider the eventuality of emergency delivery when deciding mode of delivery. We sought to quantify this risk by designing a retrospective cohort study in a consultant-led unit. While higher than average rates of successful planned VBAC were achieved, the odds of emergency caesarean delivery were increased in women undergoing VBAC (OR 3.0, 95% CI 1.2–7.6, p = 0.03). Odds of requiring a Category 1 emergency caesarean were markedly raised. Our data adds to the VBAC literature by quantifying the risk of Category 1 or 2 emergency caesarean section for women entering labour who have delivered by caesarean section once previously, giving the odds of emergency caesarean section on entering labour compared with women without a scar. This gives further information to those counselling women about birth after caesarean section.

Ehler-Danlos syndrome (EDS) is a heterogeneous group of connective tissue disorders characterised by skin hyper-extensibility, joint hyper-mobility and a tendency to excessive bleeding. This haemor...

Solitary fibrous tumours are rare spindle cell neoplasms with diverse clinical and pathologic features. Non-islet cell tumour hypoglycaemia (NICTH) is a paraneoplastic syndrome occurring in patients harbouring large, slow growing tumours. Diagnosis is based on clinical suspicion of unexplained hypoglycaemia and serum biochemistry. IGF II is one of the insulin-like peptides commonly thought to be responsible for NICTH. Surgical removal of the IGF II secreting tumour is the reatment of choice, if possible.

A 25-year-old woman developed acute right loin pain and frank haematuria leading to urinary retention at 28 weeks’ gestation in her first pregnancy. Ultrasonography revealed an 8 cm solid mass in the upper pole of her right kidney, highly suggestive of renal tumour. Chest X-ray excluded obvious pulmonary metastases. An MRI, 1 week later, revealed the tumour had grown to 9.5 cm (Figure 1). Elective caesarean section at 32 weeks resulted in delivery of a healthy male child. Staging CT, then radical right nephrectomy, was performed 2 weeks later. Histology revealed Fuhrman grade 2 pT2 clear cell carcinoma, without invasion into perinephric fat or vasculature. Physical examinations, repeat CT at 1 year, subsequent annual chest X-rays and ultrasonography have all been negative for local or distant recurrence. Genetic tracing revealed a paternal uncle with renal carcinoma, aged 70 years. MRI-brain, ophthalmic review, 24-h urinary catecholamine screening investigations and genetic testing for von Hippel-Lindau disease (vHL) were all negative. Three years postoperatively, she remains well with normal renal function, and is considering a further pregnancy.

A 24-year-old primigravida was admitted to the labour ward at 39 weeks +5 days, with a 3-h history of spontaneous rupture of membranes and contractions. Her antenatal course had been uncomplicated ...

Overactive bladder (OAB) and glaucoma are prevalent and frequently co-exist, particularly in the elderly. Anti-cholinergic drugs are the cornerstone of medical management of OAB. There is a great deal of confusion about the safety of use of the anti-cholinergic medication regarding the risk of glaucoma. This review examines the pharmacological relationship of anti-cholinergic medications used to treat OAB and the various types of glaucoma.

A case of intravesical migration of a GyneFix® intrauterine device (IUD) is described, in which the patient presented with supra-pubic pain and urinary symptoms. The diagnosis was made 34 months after the insertion of the IUD, by ultrasound scan. The GyneFix was removed endoscopically. A description of the GyneFix device, the possible adverse effects and incidences of its complications, the importance of post-insertion follow-up, and the need for awareness of the possibility of intravesical migration are discussed.

Case report A 32-year-old woman in her ® fth pregnancy presented at 28 weeks’ gestation with a signi® cant, painless, antepartum haemorrhage (APH). She reported intermittent uterine tightenings and backache over the previous week. Routine ultrasound at 20 weeks’ gestation had shown the placenta to be clear of the cervical os and she had no antenatal problems of note. She was a non-smoker and had been consistently normotensive throughout pregnancy. Her ® rst pregnancy had ended in an emergency caesarean section for pre-eclampsia. This was followed by a normal vaginal delivery at term, a ® rst trimester miscarriage and a tubal ectopic pregnancy. She had been breastfeeding her 2-year-old child during the pregnancy. On admission, she was normotensive and described good fetal movements. Her abdomen was soft and non-tender and a cardiotocograph (CTG) was normal. Vaginal bleeding settled within 2 hours of admission and the patient remained in hospital for 3 days for observation and to complete a course of antenatal steroids to promote fetal lung maturity. Just before leaving the hospital she was directed to the hospital ultrasound department for an ultrasound assessment of fetal biometry to act as a baseline from which to assess subsequent growth. Whilst waiting for her scan, her sister arrived to transport her home and brought in the patient’ s 2-year-old child whom the patient promptly breastfed. Within 5 minutes, she developed back and lower abdominal pain and removed the child from the breast. Ultrasound, performed some 5 minutes later, showed normal growth for gestation, normal liquor volume but evidence of a large placental haemorrhage (Figure 1). During the ultrasound, the sonographer noted a period of fetal bradycardia of 90 beats per minute. The patient was immediately returned to the antenatal ward. CTG initially revealed a baseline of 140 with absent variability but soon a bradycardia developed. An emergency lower segment caesarean section was performed and a female child weighing 1280 g was delivered in extremely poor condition with no heart beat (cord arterial pH 6 66, venous pH 6 77). A huge retroplacental clot was removed and the patient required a 4 unit blood transfusion. The baby was resuscitated but developed Grade 3 hypoxic ischaemic encephalopathy. Over the next week she developed acute tubular necrosis, followed by multisystem failure and eventual death on day 14. Discussion To our knowledge this possible association between breastfeeding in pregnancy and placental abruption has not been reported before. Breastfeeding in pregnancy is generally acknowledged to be safe but many infants wean themselves at around 5 months’ gestation as the volume of milk produced decreases markedly and the taste changes. Breastfeeding, nipple and areolar stimulation cause a re ex release of oxytocin from the posterior pituitary which not only promotes milk ejection, but also causes uterine contractions. This is the basis for using nipple stimulation as a contraction stress test of fetal well-being (Figure 2). Plasma oxytocin concentrations increase markedly during nipple stimulation in the second and third trimesters of pregnancy, although the magnitude of such an increase is diminished in comparison with that obtained in non-pregnant women or postpartum breastfeeding women (Amico and Finley, 1986). This is likely to be due to an indirect inhibitory effect of high concentrations of oestrogen and progesterone during pregnancy. The response of the uterus to oxytocin in pregnant women who have been breastfeeding long term is less clear, but there is evidence

"Pancreatic pseudocyst: a rare cause of a pelvic mass." Journal of Obstetrics and Gynaecology, 17(5), p. 497

(1995). Delayed placental abruption after road traffic accident. Journal of Obstetrics and Gynaecology: Vol. 15, No. 3, pp. 186-187.