bmj.com -- Press Releases

Press Releases Saturday 15 August 1998
No 7156 Volume 317

Please remember to credit the BMJ as source when publicising an
article and to tell your readers that they can read its full text on the
journal's web site (http://www.bmj.com).

If your story is posted on a website please include a link back to
the source BMJ article (URLs are given under titles).

(1) SHOULD DOCTORS PERFORM AN ELECTIVE CAESAREAN SECTION ON REQUEST?

(2) CREDIT CARDS COULD DOUBLE AS DONOR CARDS

(3) THE MISSING CONTACT LENS THAT TURNED UP SIX YEARS LATER... IN THE PATIENT�S EYE!

(4) NEED FOR ARTERY OPERATION EXCEEDS TREATMENT RATE

(1) SHOULD DOCTORS PERFORM AN ELECTIVE CAESAREAN
SECTION ON REQUEST?

(Yes, as long as the woman is fully informed)
http://www.bmj.com/cgi/content/full/317/7156/462#resp1

(Maternal choice alone should not determine method delivery)
http://www.bmj.com/cgi/content/full/317/7156/462#resp2

Rates of Caesarean section are rising and mothers� requests for elective
Caesarean section in an uncomplicated pregnancy are common - the
reasons for which are unclear. Performing a Caesarean section when
it is not clinically indicated has traditionally been considered inappropriate
but views may be changing, as reported by Sara Paterson-Brown from
Queen Charlotte�s and Chelsea Hospital in London and Olubusola Amu
and colleagues from Leicester General Hospital in this week�s BMJ.

Evidence as to the pros and cons of Caesarean or vaginal birth is
incomplete; but for a Caesarean section the prevalence of hysterectomy
due to haemorrhage is ten times that of a vaginal delivery and the risk of
maternal death (including non-elective Caesarean sections) is up to 16
times greater. In those women who wanted a vaginal birth there may
also be feelings of "inadequacy, guilt and failure in not completing a
natural process [and a Caesarean] may affect bonding between mother
and infant, particularly if the operation was conducted under general
anaesthetic". The risks of vaginal birth include damage to the pelvic
floor, trauma to the urethral and anal sphincters, long term predisposition
to genital prolapse and urinary and anal incontinence. Also a significant
risk of labour is that of fetal death (one in 1500 babies weighing more
than 1500g).

Armed with this information Sara Paterson-Brown says women and
obstetricians are increasingly sympathetic to the concept of
Caesarean section as a means of avoiding problems. This is
supported by the fact that 31 per cent of London female obstetricians
with an uncomplicated singleton pregnancy at term would choose an
elective Caesarean section for themselves and half of those women
who have already had a Caesarean section would choose to have
another. She argues that, having encouraged professionals to
respect womens� choices, we should not be critical of them just
becausethey are not what was expected, and concludes that prophylactic
Caesarean section can no longer be considered clinically unjustifiable
- it now forms part of accepted medical practice.

Olubusola Amu and colleagues argue that women�s requests for a
particular mode of delivery, for fear of the consequences of the other
method, are not necessarily rational. They stress that choice is a
human right and the crucial element is that it is informed. The authors
say: "Conflicts between maternal and fetal interests are potentially
complex, ethically and emotionally, and difficult to resolve." Amu
et al conclude that doctors, midwives and childbirth educators
must give full and honest advice and encourage the active
participation of patients in order that a safe and logical informed
decision can be reached about the method of delivery.

Contact:

Sara Paterson-Brown, Consultant in Obstetrics and Gynaecology,
Queen Charlotte�s and Chelsea Hospital, London
email: s.paterson-brown@rpms.ac.uk

Dr Ibrahim Bolaji, Consultant Obstetrician and Gynaecologist,
Department of Obstetrics and Gynaecology, Grimsby Hospital,
Grimsby
email: general@grimhosp.demon.co.uk

(2) CREDIT CARDS COULD DOUBLE AS DONOR CARDS

(Credit cards could be used to indicate availability of cadaver
organs for transplantation)
http://www.bmj.com/cgi/content/full/317/7156/478/a

In a letter in this week�s BMJ Dr Neil Davidson from the Armed
Forces Hospital in Kuwait suggests that credit cards could be used
as donor cards, indicating that on the death of a patient they
consent to donate their organs for transplantation.

"There is a willingness in life to donate organs for transplantation
after death, but it is the tiny hindrances to translating that willingness
into a consent that is legally binding, rather than the availability of
cadavers, that has led to severe shortages of organs," says the
author. He recognises that until "smart cards" (which could
incorporate medical information) become available, a format
for making consent apparent needs to be devised and that the
phraseology and mechanism for non-consents needs to be
developed. He concludes that credit cards could radically
improve the supply of donor organs for transplantation.

Contact:

Dr Neil Davidson, Consultant Physician, Department of
Medicine, Armed Forces Hospital, PO Box 5190,
Salmiya 22062, Kuwait

(3) THE MISSING CONTACT LENS THAT TURNED UP
SIX YEARS LATER... IN THE PATIENT�S EYE!

http://www.bmj.com/cgi/content/full/317/7156/482

This week�s BMJ reports the case of a woman who complained,
on and off for six years, that she felt that she had something in her
left eye. She was referred to an ophthalmologist with a suspected
cyst. By coincidence she had "lost" a rigid gas permeable contact
lens six years before and since then had started wearing a new pair
of soft lenses instead. The "lost" lens turned out to be lodged in the
left eyelid and once it was removed the patient made a complete
recovery!

Contact:

Dr S Elsherbiny, Senior House Officer, Department of
Ophthalmology, Bradford General Hospital, Bradford

(4) NEED FOR ARTERY OPERATION EXCEEDS TREATMENT RATE

(An epidemiological needs assessment of carotid endarterectomy
in an English health region. Is the need being met?)
http://www.bmj.com/cgi/content/full/317/7156/447

Strong evidence exists that carotid endarterectomy (an operation
on the carotid artery) is an effective intervention for the prevention
of stroke in patients with symptoms of obstruction in the carotid
area. A paper in this week�s BMJ shows that in one English region
only half the people in need of the treatment actually get it.

Stroke is the third commonest cause of death in the UK and the
commonest cause of physical disability. Ferris et al looked at all
patients in the former Wessex Regional Health Authority who
had had the carotid artery reconstruction and compared this
with the estimated level of need in patients with relevant symptoms
after transient ischaemic attack or minor stroke. They noted that
while the operation rate more than doubled in the early 1990s
after national guidelines were produced, there was still a large
unmet need. By 1995-6 the operation rate was 89 per million,
but the need was estimated at 153 per million of the population
who had symptoms.

Contact:

Dr Paul Roderick, Senior Lecturer,
Wessex Institute for Health Research and Development,
University of Southampton, Southampton General Hospital

FOR ACCREDITED JOURNALISTS

Embargoed press releases and articles are available from:

Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact Jill Shepherd;jshepher{at}bma.org.uk)

and from:

the EurekAlert website, run by the American Association for the
Advancement of Science
(http://www.eurekalert.org)