Severe complications of a "Brazilian" bikini wax.

A 20-year-old Australian woman with poorly controlled type 1 diabetes presented with life-threatening Streptococcus pyogenes and Herpes simplex infection of her external genitalia following a routine perineal "Brazilian" bikini wax. Extensive pubic hair removal is now common among young adults in Australia and elsewhere. However, the infectious risks of these practices, particularly among immunosuppressed individuals, are often underappreciated.

Serum concentrations of macrophage inhibitory cytokine 1 (MIC 1) as a predictor of miscarriage.

Macrophage inhibitory cytokine 1 (MIC 1) is thought to have immunomodulatory actions favouring fetal viability. We measured serum concentrations of MIC 1 in asymptomatic women at 6-13 weeks' gestation who subsequently miscarried or who had already miscarried. MIC 1 concentrations in the miscarriage cohort (n=100), were a third of those who had ongoing pregnancies (n=197). Multiples of the median for miscarriage was 0.32 (95% CI 0.23-0.32) versus 1.00 (0.93-1.06) for ongoing pregnancies; p<0.0001. Concentrations were just as low 3 weeks before diagnosis as on the day of diagnosis. That MIC 1 serum concentrations seem to be low weeks before miscarriage suggests possible predictive and causative roles, as well as therapeutic potential.

Low levels of pregnancy-associated plasma protein-A in asymptomatic women destined for miscarriage.

In an asymptomatic cohort, serum pregnancy-associated protein-A (PAPP-A) levels among women destined to miscarry were 14% of those seen with ongoing pregnancies. Levels were as low 3 weeks before diagnosis as on the day of diagnosis, suggesting that PAPP-A levels might predict future miscarriage.

Women's preferences for reporting of Down syndrome screening results.

OBJECTIVE: The aim of this study was to determine whether women prefer the results of screening for Down syndrome tests to be reported as the risk of Down syndrome in early pregnancy at the time of the screening test or the risk at delivery (which takes into account the number of Down syndrome pregnancies that will be spontaneously lost before birth). DESIGN: A structured questionnaire. SETTING: A tertiary hospital antenatal clinic. SAMPLE: One hundred and fifteen English-speaking women who expressed an interest in having screening tests for Down syndrome performed. METHODS: A structured questionnaire exploring women's preferences for risk reporting was self administered by women attending for their first antenatal visit. MAIN OUTCOME MEASURES: Women's preference for reporting of screening test results as risk at time of test, risk at birth or both, and the reasons for this preference. RESULTS: The majority (n = 82) of women preferred to have both the risk of Down syndrome at the time of screening and at the time of birth reported. The most common reason (n = 60) given for this preference was a desire to have as much information available as possible so that an informed decision regarding further investigations could be made. CONCLUSIONS: The majority of women prefer to receive Down syndrome screening results as both the risk at the time of the test and the risk at birth.

The effect of image size on nuchal translucency measurement.

OBJECTIVES: To assess the effect of altering image size on the absolute nuchal translucency (NT) measurement. METHODS: NT was measured at three image magnifications (60%, 100% and 200%) in 120 singleton pregnancies. RESULTS: The mean +/- SD NT measurements were 1.52 +/- 0.57 mm, 1.35 +/- 0.53 mm and 1.18 +/- 0.48 mm at 60%, 100% and 200% magnification, respectively (p = 0.00001). CONCLUSIONS: The measurement of NT decreases significantly with increasing image size. Optimisation of NT as a method of screening will require agreed standardisation of image magnification.

Do women prefer to have screening tests for Down syndrome that have the lowest screen-positive rate or the highest detection rate?

OBJECTIVE: To assess whether women have a preference for Down syndrome screening test performance. METHODS: A structured questionnaire exploring women's preferences for screening test performance was administered to women attending their first prenatal visit who wished to have Down syndrome screening performed. RESULTS: One hundred and twenty women were interviewed. The majority of women (n=80) chose a screening test with a low screen-positive rate rather than the highest detection rate. The reasons given for this preference were a desire to minimise the risk of miscarriage of a normal baby and a belief that a detection rate of 80 to 90% was acceptable. However, older women (>37 years) chose a test with the highest detection rate possible, regardless of the higher screen-positive rate, preferring to miscarry a normal baby as a result of a diagnostic test rather than miss the detection of a baby with Down syndrome. Preferences were not influenced by previous screening experience. CONCLUSIONS: Women express different preferences for screening test performance. Maternal age rather than previous screening experiences appears to be the major influence in these choices.

Optimising the timing for nuchal translucency measurement.

It appears from current evidence that the most effective screening strategy for Down syndrome will involve a combination of first trimester nuchal translucency and serum biochemistry, whether performed in the first or second trimester. The aim of this study was to determine the optimum gestation based upon menstrual dates at which to schedule nuchal translucency (NT) measurement for the evaluation of fetal Down syndrome risk. Five thousand eight hundred and thirty-five pregnancies had an ultrasound scan scheduled between 11 and 14 completed weeks of gestation based upon either the last menstrual period (n = 3199) or a prior ultrasound scan (n = 2636). For last menstrual period-based ultrasound scans, with advancing gestation the frequency of missed miscarriage significantly decreased (p = 0.009, chi squared test), as did the need to reschedule a further scan because the gestation of the scheduled scan was too early to measure NT (p < 0.0001, Chi-squared test). In contrast, with advancing gestation the rate of unsuccessful NT measurement because the crown-rump length (CRL) was greater than 84 mm significantly increased (p < 0.0001, Chi-squared test). Of the women who had had an earlier ultrasound, 42 (1.6%) had a missed miscarriage and 9 (0.3%) were over gestation at the time of the NT scan. These data suggest that when only the last menstrual period is known the optimum time to schedule a nuchal translucency measurement is at 12 to 13 weeks' gestation.