The problem with teenage pregnancy
Britain has the highest teenage pregnancy rate in the European Union. While the social burden of this is considerable, it may be that pregnancy itself poses little health risk to teenagers or their babies. Now, from Sweden, comes evidence that teenage mothers face a higher risk of premature death in later life (Olausson et al., pages 793–799). These women's lifestyles and their continued exposure to a hostile social environment contribute to their early demise. In an accompanying commentary, Drife (pages 763–764) suggests a dual approach of preventing unwanted teenage pregnancies whilst supporting those who wish to have their babies.
Fetal imaging using ultrasound and MRI
Ultrasound has been the cornerstone for fetal imaging for a number of years but in-utero Magnetic Resonance Imaging (MRI) may be better at visualising some aspects of fetal anatomy. On pages 784–792, Whitby et al. compare ultrasound and MRI imaging in pregnancies with suspected fetal brain abnormalities and suggest that where ultrasound is equivocal, MRI provides information which can potentially change clinical management. The authors do not report a direct comparison of MRI versus ultrasound so while MRI may have a role in clarifying ultrasound suspected abnormalities it should not become the screening method of choice in all pregnancies.
Pelvic floor surgery
As women live longer, the limitations of traditional methods of prolapse surgery become more apparent. Dwyer and O' Reilly, from Australia (pages 831–836) describe a promising new approach to the use of synthetic mesh in vaginal surgery. Meanwhile, the debate about the place of tension free vaginal tape (TVT) in the treatment of urinary incontinence continues. Trial evidence supports TVT as an effective and less morbid alternative to Burch colposuspension but a group from St George's Hospital (Karantanis et al., pages 837–841) report that in women over sixty five it is associated with lower satisfaction rates. Developing new surgical techniques should not distract us from subjecting routine aspects of postoperative care to rigorous evaluation. Results of a randomised comparison of short and long term post-operative bladder catheterisation following vaginal surgery for prolapse are reported on pages 828–830. Women in the long-term catheterisation group were less likely to undergo repeat catheterisation, but experienced a higher incidence of urinary tract infection and a longer hospital stay. The authors conclude that the disadvantages of short-term catheterisation outweigh the advantages, but crucially omit to present any data on women's perceptions of the quality of their care.
The last few years have seen the publication of many clinical guidelines. On pages 874–876, Zaki and colleagues deplore the wide variation in standards of intra-partum and post-partum bladder care across England and Wales and blame a lack of guidelines. However Foy and colleagues, (pages 765–770) suggest that guidelines may not always be the answer. They examined the impact of a Scottish national guideline on the management of mild non-proteinuric hypertension. Despite steps to ensure guideline implementation by a national clinical effectiveness programme, pregnant women continued to receive inconsistent clinical care. Guidelines aim to improve standards of practice but even clear consistent guidelines, supported by a national implementation programme, do not guarantee success.
SARS and pregnancy
The global impact of the Severe Acute Respiratory Syndrome (SARS) epidemic last year cannot be overstated. Despite the plethora of publications on this topic, few papers have directly addressed the issue of SARS in pregnancy. A paper from Hong Kong (Lam et al., pages 771–774) shows that pregnant women face a higher rate of complications and require more aggressive management than non-pregnant controls. The authors provide a much needed insight into the obstetric aspects of this life threatening infection and highlight the uncertainty surrounding its treatment in pregnant women.