[Christmas article: Coitus is not recommended - a systematic review].

The overall positive effects of coitus have not been estimated before. A systematic review and meta-analysis was conducted for coitus versus everything. A search was made in MEDLINE resulting in 1,121 hits. The authors screened studies and conducted a meta-analysis. Thirty publications randomising to coitus or something else were included. Pooled results showed a relative risk of 0.91 (95% CI: 0.86-0.96) favouring "everything else" over coitus. Subjective pleasure is not a primary outcome in any of the included studies, and trialists must have regarded this outcome as less important. In conclusion, coitus cannot be recommended based on the published randomised studies. Evaluation by evidence-based methodology makes it clear, that better alternatives exist.

Cervical dilation at the time of cesarean section for dystocia -- effect on subsequent trial of labor.

OBJECTIVE: To investigate the effect of cervical dilation at the time of cesarean section due to dystocia and success in a subsequent pregnancy of attempted vaginal delivery. DESIGN: Retrospective study. SETTING: University hospital in Copenhagen capital area. POPULATION: All women with a prior cesarean section due to dystocia who had undergone a subsequent pregnancy with a singleton delivery during 2006-2010. METHODS: Medical records were reviewed for prior vaginal birth, cervical dilation reached before cesarean section and induction of labor, gestational age, use of oxytocin, epidural anesthesia and mode of birth was collected. RESULTS: A total of 889 women were included; 373 had had a trial of labor. The success rate for vaginal birth among women with prior cesarean section for dystocia at 4-8 cm dilation was 39%, but 59% for women in whom prior cesarean section had been done at a fully or almost fully dilated cervix (9-10 cm) (p < 0.001). Among the women with a previous vaginal delivery prior to their cesarean section, the success rate for vaginal birth was 76.2%, in contrast to 48.9% in the group without a previous vaginal delivery (p < 0.01). CONCLUSION: Women who had a trial of labor after a prior cesarean section for dystocia done late in labor and women with a vaginal delivery prior to their cesarean section had a greater chance of a successful vaginal birth during a subsequent delivery.

Attitudes towards abortion among trainees in obstetrics/gynecology and clinical genetics.

This study aimed to provide knowledge about attitudes towards abortion among Danish physicians in training in the specialties of obstetrics/gynecology and clinical genetics. The study was a questionnaire survey among trainees in these specialties. Ninety-six responded. Trainees in clinical genetics were more pro-abortion than those in obstetrics/gynecology (p=0.04). Of the respondents, 30 versus 48% found working with early and late abortions unpleasant. Nearly half agreed that they had chosen their specialty despite having to counsel and treat women having abortions. Twenty-one percent agreed that working with late abortion affected their job satisfaction negatively. Those agreeing with the above statements had a tendency towards lower pro-abortion scores than those who were indifferent or who disagreed but the differences were not significant. A substantial fraction of physicians in training have negative feelings associated with abortion-related work and require support in handling and coping with these challenges.