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Toxoplasmosis

  1. Top of page
  2. Toxoplasmosis
  3. Perception of smells in pregnancy
  4. Twin-to-twin transfusion syndrome
  5. New tocolytics
  6. Prostaglandins and uterine scar rupture
  7. Down's screening debate

Over the last decade or so the European Multi-centre Study on Congenital Toxoplasmosis (EMSCOT), led by Ruth Gilbert, has done much to clarify the fetal risks of maternal infection. They have previously suggested that the risks of fetal damage may be lower than previously thought. In this issue (pp. 31–37) they examine the risks of prematurity and growth restriction in a series of pregnancies, most of which had been treated with spiramycin. The gestation at delivery was reduced, albeit by only five days on average, but there was no association with impaired fetal growth.

Perception of smells in pregnancy

  1. Top of page
  2. Toxoplasmosis
  3. Perception of smells in pregnancy
  4. Twin-to-twin transfusion syndrome
  5. New tocolytics
  6. Prostaglandins and uterine scar rupture
  7. Down's screening debate

Some people have suggested that nausea and vomiting in pregnancy may be an adaptive response to help women avoid damaging their fetus by ingesting toxic foodstuffs, but their theory gets no support from the paper by Daskalakis and his colleagues from Hull on pp. 57–62. Pregnant women disliked potentially harmful odours more than they did safe ones, but so also did men and non-pregnant women.

Twin-to-twin transfusion syndrome

  1. Top of page
  2. Toxoplasmosis
  3. Perception of smells in pregnancy
  4. Twin-to-twin transfusion syndrome
  5. New tocolytics
  6. Prostaglandins and uterine scar rupture
  7. Down's screening debate

Although the short term outcome for twin-to-twin transfusion syndrome has been transformed in recent years by serial amnio-reduction, laser ablation of communicating vessels and improved neonatal care, the long-term outcome is less clear. The report from Western Australia on pp. 63–69 is moderately reassuring. Almost all surviving cases in the region were identified and examined at some age beyond 18 months. Three out of 52 children had cerebral palsy, which was more than the general population but not significantly different from the rate among gestation-matched singletons or unaffected twins.

New tocolytics

  1. Top of page
  2. Toxoplasmosis
  3. Perception of smells in pregnancy
  4. Twin-to-twin transfusion syndrome
  5. New tocolytics
  6. Prostaglandins and uterine scar rupture
  7. Down's screening debate

The failure of current trials of tocolytic drugs to demonstrate any significant reduction in serious fetal morbidity is one reason that basic scientists are still searching for better agents. On pp. 69–74 Murata and colleagues from Japan evaluate a new beta 2-adrenoreceptor antagonist (KUR-1246) in pregnant sheep. It looks promising.

Prostaglandins and uterine scar rupture

  1. Top of page
  2. Toxoplasmosis
  3. Perception of smells in pregnancy
  4. Twin-to-twin transfusion syndrome
  5. New tocolytics
  6. Prostaglandins and uterine scar rupture
  7. Down's screening debate

Some years ago a patient of mine, undergoing a prostaglandin termination for Down's, ended up with a hysterectomy for scar rupture, went on to commission a surrogate mother, and when the surrogate baby was safely delivered went on the radio to describe her experience! I would love to avoid another such case and am interested in the two papers in this issue which consider the problem of scar rupture after prostaglandin. Buhimschi and her colleagues from Yale (pp. 38–42) reviewed a series of women who had had a scar rupture in a pregnancy following a Caesarean delivery. She compared the location of the rupture in the 10 women given prostaglandin at any stage of labour with the 16 who had not been so treated. The prostaglandin group were more likely to rupture at the site of the previous scar. She argues that this suggests that prostaglandin has a local scar-weakening effect. In contrast Daskalakis and his colleagues from Athens (pp. 97–99) compared 108 women undergoing termination with prostaglandin who also had a uterine scar, with 216 similar women without a scar. The only recorded uterine rupture occurred in the ‘no scar’ group.

Down's screening debate

  1. Top of page
  2. Toxoplasmosis
  3. Perception of smells in pregnancy
  4. Twin-to-twin transfusion syndrome
  5. New tocolytics
  6. Prostaglandins and uterine scar rupture
  7. Down's screening debate

I cannot resist drawing readers attention to the correspondence about Down's screening on pp. 80–83. My co-editor Zarko Alfirevic takes Nick Wald and the SURUSS (Serum Urine and Ultrasound Screening Study) investigators to task for advocating a single Down's screening package to all women in their June paper in the journal. He argues that women differ in their risk aversion to Down's and miscarriage, and should be allowed to choose between a wider range of test options, including the option of going directly to invasive testing. The SURUSS authors retort that their integrated testing package offers the best ratio of Down's detected to miscarriage caused, and that women can always opt for invasive testing after a low-risk integrated test if they wish. They also imply, correctly in my view, that offering invasive testing directly would lead some women to choose it against their own best interests. Nevertheless sceptical readers may still wonder why they do not feel the same about the offer of integrated testing itself.