Do consultant obstetricians and gynaecologists comply with motor traffic regulations when recalled to hospital to attend emergencies? A national audit.

Consultant obstetricians and gynaecologists are often recalled from home back into hospital to attend emergencies. We audited their driving practices and compliance to motor traffic regulations on recall to these emergencies with the aid of a questionnaire survey. A total of 218 of the 300 UK consultants surveyed responded. Some 65% of those who owned a green warning light beacon (GWL) admitted to speeding on some journeys and 46% ignored red lights; 84% of non-owners of a GWL would speed and 28% would ignore a red light. A total of 37 consultants had been stopped for traffic violations, nine with a GWL and 28 without. Five consultants had been involved in accidents returning to hospital to attend an emergency. Obstetricians and gynaecologists are disregarding motor traffic regulations in order to attend emergencies.

An audit of compliance with motor traffic regulations and use of green warning lights by consultants recalled to hospital to attend emergencies.

OBJECTIVES: To determine consultants' compliance with motor traffic regulations on recall to hospital to attend emergencies, and ownership and use of green warning lights (GWLs). To determine the views of senior police officers on consultants complying with traffic regulations on emergency recall with and without GWLs. METHOD: Questionnaire survey of all consultants in obstetrics and gynaecology, paediatrics and emergency medicine in the Yorkshire Deanery, UK, and members of the Association of Chief Police Officers (ACPO). RESULTS: 220 consultant questionnaires were distributed and 166 replies were received; 21% of respondents owned a GWL. Almost 50% of consultants would consider exceeding speed limits when returning to an emergency. Between 43% and 80% consultants would cross red traffic lights; driving habits varied with usage and ownership of a GWL. 12.7% (21) of respondents had been stopped for traffic violations attending emergencies, 2.4% (4) had been prosecuted and 4.8% (8) had been involved in accidents. The ACPO advised that consultants should observe all traffic regulations at all times. CONCLUSION: Consultants recalled to their hospitals for emergencies disregard speed restrictions and traffic light signals both with and without GWLs and risk both accident and prosecution for ignoring traffic legislation. They should consider using a GWL to ease their progress through traffic when attending an emergency and observe all traffic laws.

Inferior epigastric haemorrhage, an avoidable complication of laparoscopic clip sterilization.

Forty laparoscopists were questioned as to their preferred site for introducing a Samaritan clip applicator during sterilization procedures. The introduction sites were compared with the location recommended by Lieberman (1976) and with the surface anatomy of the inferior epigastric vessels. Of those gynaecologists questioned, only 12% used a site within 1 cm of that recommended by Lieberman; 25% used a site within 1 cm of the epigastric vessels as suggested by surface anatomy. It is proposed that a second puncture site in the midline or at the lateral border of the rectus muscle should be used to avoid the complication of inferior epigastric vessel trauma at laparoscopic sterilization procedures.

PIP: 40 clinicians who perform laparoscopies were questioned regarding their preferred site for introducing a Samaritan clip applicator during sterilization procedures. These sites were compared with the site originally recommended by Lieberman (1976), i.e., 3 cm below and 3 cm lateral to the umbilicus and with the surface anatomy of the inferior epigastric vessels (Rawlings 1929). There was conspicuous variation in the location chosen for the 2nd trocar site, with a distribution covering most of the lower abdomen. 5 clinicians (12%) used an introduction site for their Samaritan clip applicators within a 1 cm radius of that originally recommended and still used by Lieberman. 18 of those questioned (45%) used a site within 1 cm of the course of the inferior epigastric vessels, suggested by its surface anatomy. 4 had personal experience of inferior epigastric artery hemorrhage and all had had a laparotomy to control the bleeding. It is proposed that inferior epigastric vessel hemorrhage could be avoided if the surface anatomy of the vessel was more widely appreciated and a puncture site was used that was distant from the course of the vessels. It would appear from the survey that nearly half of those questioned risk damage to the artery by using a 2nd puncture site within 1 cm of the vessel's course. Even Lieberman's recommended site, which few appear to use, is relatively close to the course of the vessel.

How effective was the Health Education Authority's folic acid campaign?

The Health Education Authority's campaign, encouraging the use of periconceptional folic acid in the prevention of neural tube defects, started in February 1996 and is ongoing. Its effectiveness was assessed using a questionnaire, answered by patients not exposed to the campaign and by those that were. The study population was comprised of 337 women in approximately their 20th week of pregnancy, attending antenatal clinic for a routine fetal anatomy ultrasound scan. Data were collected on aspects of folate awareness, intake and sources of advice, before and after the campaign's start. Significant increases in preconceptional and total folate consumption, awareness of folate's benefits, and GP prescription were seen as the study went on. Unplanned pregnancy prevented compliance with periconceptional folate guidelines. We conclude that whilst the promotional campaign seemed to work in York, fortification of foodstuffs may need to be used to increase folate consumption in those with unplanned pregnancy.

Vaginal dilator therapy-an outpatient gynaecological option in the management of dyspareunia.

The management of 18 women complaining of superficial dyspareunia is reviewed. Primary treatment consisted of self-vaginal dilatation using graduated glass dilators on an outpatient basis. All patients were given verbal explanation and written instructions. Treatment was considered successful with dilator therapy in 14 (77.8%) women. Three (16.7%) women required additional therapy in the form of surgery or psychotherapy. We conclude that in selected cases, self-vaginal dilator usage on an outpatient basis is effective primary therapy for superficial dyspareunia.

Effective analgesia following perineal injury during childbirth: a placebo controlled trial of prophylactic rectal diclofenac.

OBJECTIVE: To determine if diclofenac suppositories administered prophylactically produce effective and lasting analgesia following perineal injury. DESIGN: A randomised double blind placebo controlled trial. SETTING: York District Hospital. POPULATION: One hundred women sustaining objective perineal injury (second degree tear or episiotomy) during spontaneous vaginal delivery at term. METHODS: Suppositories were administered at the time of repair and approximately 12 hours later. The suppositories were randomised prior to issue by the pharmacy department and contained either 100 mg diclofenac or placebo. MAIN OUTCOME MEASURES: Pain scores assessed at 12, 24, 48 and 72 hours after delivery using a six point numerical scoring system and the use of additional analgesia and local treatments to the perineum. RESULTS: The mean pain score was significantly reduced in the diclofenac group at 24, 48 and 72 hours after delivery (0.86, 0.7 and 0.59, respectively) compared with the control group (1.64, 1.31 and 1.5; P < 0.005). In addition there was less supplementary analgesia required (eight women only at 72 hours compared with 15 in the control group) and this was limited to paracetamol or topical treatments to the perineum. CONCLUSION: Prophylactic rectal diclofenac provides effective analgesia after perineal repair and its effect appears to be maintained into the second and third postpartum days.

Car seatbelts in pregnancy: the practice and knowledge of pregnant women remain causes for concern.

OBJECTIVE: To evaluate current knowledge and practice among pregnant women about the use of car restraint systems during pregnancy. DESIGN: A structured questionnaire. SETTING: District hospital antenatal clinic. PARTICIPANTS: Two hundred pregnant women attending for their routine mid-pregnancy anomaly scan. MAIN OUTCOME MEASURES: The women were asked about seatbelt and airbag usage, source of information about restraint systems and the legal requirements and recommendations regarding car safety systems. RESULTS: One hundred fifty-nine women (80%) completed the questionnaire. Ninety-eight percent wore seatbelts in the front, 68% wore seatbelts in the back of a car, 48% correctly identified where to place the seatbelt and 37% had received information on seatbelt use while pregnant. The latter were more likely to correctly position their restraints than those who had received no information (P = 0.03). Thirty-nine percent had an airbag system fitted and one woman had de-activated it. Fifty-eight percent were aware seatbelt use was a legal requirement for driver and passengers when fitted. CONCLUSIONS: Many pregnant women are ignorant of the correct usage of seatbelts, their positioning and legal requirements. This puts their own wellbeing, and that of the fetus, at risk. Women should receive written instructions and advice from well informed health professionals and be encouraged always to wear a correctly positioned seatbelt. Education increases compliance and correct usage.