Graeme J. Ratten

Cervical pregnancy treated by ligation of the descending branch of the uterine arteries. Case report

The reported incidence of cervical pregnancy varies from one in 18 OOO (Dees 1966) to one in 1000 (Shinagawa & Nagayama 1969) pregnancies. Breen (1970) reviewed 654 ectopic pregnancies encountered in 56 700 deliveries over a 20-year period and found only one cervical pregnancy (0.15%). Although uncommon, cervical pregnancy is important as it is frequently associated with lifethreatening haemorrhage necessitating muitiple blood transfusion and total hysterectomy. Moreover, the correct diagnosis is usually not suspected pre-operatively resulting in the surgeon, often inexperienced, being confronted with catastrophic haemorrhage when attempting to evacuate the uterus of a supposed incomplete abortion. It is possible that with the greater use of ultrasound in the investigation of abnormal bleeding in early pregnancy this clinical emergency may become less common. The following case is reported because it illustrates the problem involved in making a preoperative diagnosis and because the simple manoeuvre of ligation of the descending branch of the uterine arteries instantly controlled massive haemorrhage.

Organization and Early Results of a Shared Antenatal Care Programme

EDITORIAL COMMENT: For the purposes of comparison of perinatal mortality rates with other papers discussing shared care/birth centre care, it should be noted that 2 of the 5 perinatal deaths in the 780 women who completed shared care (tables 4 and 5), and 2 of the deaths in the 185 women who were removed from the shared care programme (tables 6 and 7) were associated with birth‐weight less than 500 g, the criterion for inclusion of perinatal deaths for statistical purposes in the State of Victoria. With these cases excluded the perinatal mortality rate for the entire series of 962 women was 7.2 per 1,000 births; the rate was 3.9 per 1,000 in the 778 women who remained in the shared care programme, and 20.6 per 1,000 births in the 184 women who were removed from the programme.

Spontaneous Haematoma of the Umbilical Cord

A case of haematoma of the umbilical cord is described. Fetal bradycardia occur‐ red during labour and was associated with acidosis (pH 7.13). Caesarean section was performed and a depressed but live infant obtained.

MEDICOLEGAL MATTERS INVOLVING A MAJOR OBSTETRIC AND GYNAECOLOGICAL TEACHING HOSPITAL

Summary: Review of medicolegal files held by the Royal Womens Hospital. Melbourne confirms that during the last 25 years there has been a marked increase in the number of claims for compensation brought by patients who believe that the care they received was inadequate; thus 4 claims for compensation were received during the first 5 years of the study period and 29 claims in the last 5 years. Complaints about service provision resulted in a claim for compensation in 29.7% of cases in which the dissatisfied client was represented by a legal firm and in 6.25% of cases where the initial approach was made through the Health Services Commission. One half of all claims for compensation were received in response to perceived complications of birth, surgery or treatment of a premature baby.

Changes in Obstetric Practice in Our Time

Summary: In the years since 1939 there has been a marked change in the nature and results of obstetric practice at the Royal Womens Hospital, Melbourne.

Cardiorespiratory Collapse and Pulmonary Oedema Due to I niravascular Absorption of Prostaglandin F2aL Administered Extraamniotically for Midtrimester Termination of Pregnancy

Summary: A case of severe reaction to extraamniotically administered prostaglandin F2aL, with cardiorespiratory collapse and pulmonary oedema necessitating transfer to an intensive care unit, is presented. Attention is drawn to the profound haemodynamic effects of systemically administered prostaglandin, and the need for caution and ready availability of facilities for resuscitation when this potent substance is administered. Treatment for the effects of intravascular absorption of prostaglandin F2aL is discussed.

The Management of Missed Abortion

A review has been made of 83 patients with missed abortion. Conservative management would appear to be the treatment of choice of this condition about which the risks of haemorrhage at the time of curettage and hypofibrinoganaemia are discussed.

Analysis of Results of Answers to Journal Questionnaire of Readers' Preferences

The response rate to the questionnaire circulated in the August, 1993 issue of the Journal was 13.3% with completed questionnaires being received from 527 subscribers. This compared favourably with the response rate to the previous questionnaire of slightly less than 10% (1).