bmj.com -- Press Releases

Releases Saturday 14 April 2001
No 7291 Volume 322

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(1) OBSTETRIC COMPLICATIONS AMONG OLDER
WOMEN CANNOT EXPLAIN THEIR HIGH CAESAREAN
RATES

(2) TAKE AWAY OPIATE ANTIDOTE SAVES LIVES

(3) COPING WITH PATIENT DEATH: THE SURGEON'S
PERSPECTIVE

(1) OBSTETRIC COMPLICATIONS AMONG OLDER
WOMEN CANNOT EXPLAIN THEIR HIGH CAESAREAN
RATES

(Do obstetric complications explain high caesarean section rates
among women over 30? A retrospective analysis)
http://bmj.com/cgi/content/full/322/7291/894

Delivery by caesarean section is associated with advancing age,
yet a study in this week's BMJ finds that this relation cannot be
entirely explained by obstetric complications among older
women. This raises the question of why rates for caesarean
section are high amongst older mothers.

The research team analysed over 23,000 deliveries to Aberdeen
residents aged at least 20 years during 1988-97. Details of
obstetric complications and interventions associated with a higher
probability of caesarean section were used to investigate the
association with age.

Among women who had not previously had a caesarean section
and whose babies presented normally at delivery, there was a
strong and consistent relation between maternal age and delivery
by caesarean section that remained after controlling for relevant
obstetric complications and other confounding factors. In
contrast, the association between maternal age and both elective
and emergency sections was either small or completely absent
among women who had previously had a caesarean section or
whose babies presented abnormally at delivery.

These results suggest that the relation between maternal age and
caesarean section cannot be entirely explained by the obstetric
complications considered in this study.

Physician and maternal preference may explain the higher section
rates among older women, say the authors. However, further
investigation is needed into women's views about increased
intervention, the variation in rates for caesarean section among
obstetricians, and how maternal age influences both of these
factors, they conclude.

Contact:

Angela Begg, Public Relations Office, University of Aberdeen,
King's College Aberdeen, Scotland.
Email: a.begg{at}abdn.ac.uk

(2) TAKE AWAY OPIATE ANTIDOTE SAVES LIVES

(Take home naloxone and the prevention of deaths from opiate
overdose: two pilot schemes)
http://bmj.com/cgi/content/full/322/7291/895

Distributing naloxone (the antidote for opiate overdose) to opiate
addicts saves lives, according to the first ever results of two pilot
schemes published in this week's BMJ

Opiate users in two centres (Berlin and Jersey) were offered
training in emergency resuscitation after overdose and were given
supplies of naloxone to take home. They were asked to report
on any use of the drug. After 16 months, 34 instances of
resuscitation using naloxone were reported. All fully recovered.
At least 10% of distributed naloxone had saved lives.

The drug was generally used appropriately. In only one case was
its use inappropriate, with two of doubtful benefit. No adverse
consequences, other than withdrawal symptoms, were reported.

These early reports are encouraging, say the authors, and in
future, family members may be trained to give emergency
naloxone. A study of the wider distribution of take home
naloxone is now required, they conclude.

Contact:

John Strang, National Addiction Centre, Institute of Psychiatry
and the Maudsley Hospital, London, UK
Email: j.strang{at}iop.kcl.ac.uk

(3) COPING WITH PATIENT DEATH: THE SURGEON'S
PERSPECTIVE

(Surgeons' attitudes to intraoperative death: questionnaire
survey)
http://bmj.com/cgi/content/full/322/7291/896

A study in this week's BMJ finds that many surgeons continue to
operate on the same day that a patient dies during surgery,
despite suggestions that a surgeon should not operate for a
period of 24 hours after such an event, for psychological
reasons.

These findings are not surprising as it has been suggested that
surgeons are able to cope with situations that might be thought of
as stressful to others, report the authors.

Forty-four orthopaedic surgeons were surveyed about their
experiences of losing patients during surgery (intraoperative
death), based on concerns raised by a recent inquiry and related
issues. Of 31 questionnaires returned, 16 surgeons experienced
the death of a patient during surgery, and 13 performed further
operations that day. All those who continued to operate felt their
competence had not deteriorated.

Eight of the surgeons who experienced the death of a patient
during surgery felt that some time without operating would have
been advisable. Most surgeons thought counselling should be
offered, although the majority of these felt they would not have
taken up this offer.

"We were not surprised to find that all but one of the surgeons
continued to operate and that the prevailing attitude was one of
'it's part of the job,'" say the authors. Clearly, there is no general
consensus among the orthopaedic surgeons about how to cope
with intraoperative death, they conclude.

Contacts:

Ian Smith, Orthopaedic Specialist Registrar or M W Jones,
Consultant Orthopaedic Surgeon Department of Orthopaedics,
Ysbyty Gwynedd, Bangor, Gwynedd, Wales.
Email: lasoksmith{at}aol.com

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