This week in the BMJ
Volume 328, Number 7435, Issue of 7 Feb 2004Instrumental delivery makes future vaginal delivery more likely
Instrumental delivery makes future vaginal delivery more likely
Instrumental vaginal delivery is better than caesarean section for future delivery outcomes. Three years after the delivery, Bahl and colleagues (p 311) surveyed 283 women who had had instrumental delivery or caesarean section. They found that subsequent spontaneous vaginal delivery was more likely after an instrumental delivery than after a caesarean section, that fear of childbirth was common after all types of operative delivery, and that difficulty conceiving was more likely after caesarean section. Operative delivery in the second stage of labour has important implications for future delivery outcomes, the authors say, and its psychological impact needs urgent attention.
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Water delivery helps labour progress
Labouring in water may reduce the need for augmentation and other forms of obstetric intervention in women with dystocia, and be an option when progress in the first phase of labour is slower than expected. Cluett and colleagues (p 314) randomised 99 nulliparous women with dystocia to immersion in water in a birth pool or to standard augmentation (amniotomy and intravenous oxytocin). Women labouring in water had a lower rate of epidural analgesia, and fewer required augmentation. There was no difference in the rate of operative delivery, but more neonates in the water group were admitted to a neonatal unit for reasons apparently unrelated to water labouring. The authors believe that this strategy may increase satisfaction, reduce pain, and optimise use of resources.
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Do in-hospital opportunistic interventions help problem drinking?
The evidence of the effectiveness of opportunistic brief interventions in general hospitals for problem drinkers remains inconclusive. In their systematic review of 481 studies investigating opportunistic brief interventions for problem drinking delivered by nurses, psychologists, physicians, or an intervention team specialised in substance misuse, Emmen and colleagues (p 318) found that study designs and outcomes were too heterogeneous to allow pooling of data. Most studies had methodological weakness, and only one showed a significant reduction in alcohol consumption in the intervention group.
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Risk of stroke after TIA or minor stroke is unexpectedly high
The early risk of stroke after transient ischaemic attack (TIA) or minor stroke is much higher than commonly quoted. A prospective cohort study carried out by Coull and colleagues (p 326) included 87 patients who had had a TIA and 87 who had had a minor stroke. The estimated risk of stroke in these patients was 8-12% at seven days, 11-15% at one month, and 17-18.5% at three months. If the maximum recommended time for clinic appointment—two weeks—recommended by the British guidelines is followed, say the authors, a considerable number of patients will have a stroke; patients should be seen within the first few hours or days.
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Indian students use tobacco dentifrice
Although tobacco products are prohibited in India for use as a dentrifice, 6-68% of students aged 13-15 still use them. Sinha and colleagues (p 323) surveyed the use of tobacco products as dentifrice in 14 states of India. Tobacco toothpaste and tooth powder were commonly reported in all states, but usage varied widely: 6% of students in Goa—and 68% in Bihar—used these products, probably because of the misconception that tobacco is good for the teeth. Differences between the sexes were minimal and similar to those reported globally.
Occult coeliac disease can be detected in childhood
At age 7 years, 1% of children may have subclinical coeliac disease, but few have a gluten-free diet. In two-stage screening of 5470 children participating in the Avon longitudinal study of parents and children, Bingley and colleagues (p 322) tested for antibodies to tissue transglutaminase and then IgA antiendomysial. The 54 children who tested positive for the second enzyme were shorter and weighed less than age and geographically matched controls who had tested negative in the first stage; half had diarrhoea, and more were girls. Less than 10% of children with suspected coeliac disease were receiving a gluten-free diet. The benefit of early diagnosis of subclinical coeliac disease remains unproved, but the disease can be diagnosed in childhood.
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