The Sara quads.

In August 1950, Mrs Betty Sara, aged 29 years, was confined of quadruplets in the town of Bellingen, New South Wales, which is 500 km north of Sydney. All four babies were delivered vaginally, after a confinement lasting over two and a half days.

Maternal deaths in Australia from ruptured splenic artery aneurysms.

The rupture of a splenic artery aneurysm (SAA) in pregnancy is a highly lethal condition, but so rare that most obstetricians would not encounter it during their career. In the seven official 'Maternal Deaths in Australia' reports, that covered 21 years from 1997 to 2017, among a total of 449 direct and indirect deaths, there were nine deaths (2%) from a ruptured SAA. These cases, and other cases from the literature and the Cochrane Library, are reviewed. The aim of the review is to raise awareness among clinicians of this potentially fatal condition.

Naegele's rule and the length of pregnancy - A review.

BACKGROUND: The proposition that a pregnancy is 40 weeks or 280 days in duration is attributed to the German obstetrician Franz Naegele (1778-1851). His rule adds nine months and seven days to the first day of the last menstrual period. The expected date of confinement from this formula is approximately right in the majority of cases. However, the idea that this rule can apply to every pregnant female - young or old, nulliparous or multigravida, Caucasian, Asian, African, or Indigenous - stretches credulity. In addition, many women regard the 40-week date as a deadline, which if crossed, may then place the baby under stress. Forty weeks is such a simple, round, convenient figure that it has proved difficult to challenge, despite criticism. Nonetheless, what might have been an appropriate formula in Germany in the 19th century deserves to be revisited in the 21st. AIMS: To review the length of pregnancy, in the light of current technology, in particular ultrasound scanning, and assisted reproductive techniques. MATERIAL AND METHODS: A Medline search was performed for variables on the length of pregnancy, the expected date of confinement, and prolonged pregnancy. RESULTS: A number of factors were found to significantly influence the length of a pregnancy, including ethnicity, height, variations in the menstrual cycle, the timing of ovulation, parity and maternal weight. CONCLUSIONS: Naegele's rule should be considered as a guideline for the expected date of confinement, and not a definite date.

Gynaecological laparoscopy deaths in Australia.

AIM: To determine the incidence and clinical features of laparoscopic gynaecological deaths in Australia. MATERIALS AND METHODS: Gynaecological laparoscopic mortality data were obtained from the National Coronial Information Systems (NCIS) and Australian State Coroners Courts, for the period July 1 2000 to December 31 2012. RESULTS: Eighteen deaths were identified, providing a mortality rate of approximately 1 per 70,000 laparoscopic procedures. The commonest cause of death was from bowel perforation, most of which were unrecognised during the operation. CONCLUSION: Gynaecologists should be trained to recognise and manage the rare event of laparoscopic perforation of a viscus or a blood vessel.

Delayed fatherhood.

Birth data from developed countries indicates that the average paternal age is increasing. As the trend to older fatherhood has become established, concerns have been raised that this may be linked to adverse outcomes, such as pregnancy complications, congenital anomalies, and long-term health implications for the child. Since the sperm of older fathers may be impaired due to the general effects of ageing, their offspring may be at risk due to defects in sperm quality at conception. A literature search was performed to identify pregnancy complications, fetal anomalies and health issues for the child when the father is in an older age bracket. Evidence for impairment in the sperm and genetic material of older fathers was reviewed. With an older father, there is evidence of an increase in stillbirths and a slightly increased risk of autism, bipolar disorder and schizophrenia in the offspring later in life. The increased risk of achondroplasia has long been recognised. For the mother, there is an increased rate of Caesarean section. Investigations of other possible adverse outcomes have produced mixed findings. Further robust and longitudinal studies are needed to clarify these issues.

Reflections on the maternal mortality millennium goal.

BACKGROUND: Nearly every 2 minutes, somewhere in the world, a woman dies because of complications of pregnancy and childbirth. Every such death is an overwhelming catastrophe for everyone confronted with it. Most deaths occur in developing countries, especially in Africa and southern Asia, but a significant number also occur in the developed world. METHODS: We examined the available data on the progress and the challenges to the United Nations' fifth Millennium Development Goal of achieving a 75 percent worldwide reduction in the maternal mortality by 2015 from what it was in 1990. RESULTS: Some countries, such as Belarus, Egypt, Estonia, Honduras, Iran, Lithuania, Malaysia, Romania, Sri Lanka and Thailand, are likely to meet the target by 2015. Many poor countries with weak health infrastructures and high fertility rates are unlikely to meet the goal. Some, such as Botswana, Cameroon, Chad, Congo, Guyana, Lesotho, Namibia, Somalia, South Africa, Swaziland and Zimbabwe, had worse maternal mortality ratios in 2010 than in 1990, partially because of wars and civil strife. Worldwide, the leading causes of maternal death are still hemorrhage, hypertension, sepsis, obstructed labor, and unsafe abortions, while indirect causes are gaining in importance in developed countries. CONCLUSIONS: Maternal death is especially distressing if it was potentially preventable. However, as there is no single cause, there is no silver bullet to correct the problem. Many countries also face new challenges as their childbearing population is growing in age and in weight. Much remains to be done to make safe motherhood a reality.

The term breech trial ten years on: primum non nocere?

In 2000, the Term Breech Trial was published, and its authors recommended cesarean section as the safest mode of delivery for breech-presenting babies. Criticisms of the trial were raised at the time, which the authors dismissed. Since then, maternal deaths have been recorded among women undergoing cesarean sections for breech presentations. Accordingly, those initial criticisms deserve to be revisited.

Report of a breech cesarean section maternal death.

In Australia in 2007, a woman with two previous normal vaginal deliveries underwent an emergency cesarean section at full dilatation of the cervix with a breech presentation. The woman died after a severe hemorrhage. The official Coroner's Report attributed the cause of death to postpartum hemorrhage, whereas the breech presentation was barely mentioned, suggesting that complications with breech cesarean deliveries are under-appreciated and under-reported.

Blindness after confinement.

Four days after an elective caesarean section, a patient went blind within a few hours, associated with a sudden rise in blood pressure. The blindness, initially thought to be caused by a cerebral infarct, was ultimately diagnosed as a result of posterior reversible leuco-encephalopathy syndrome. This rare syndrome is reviewed.