BACKGROUND: The commonest reason for undertaking termination of pregnancy (TOP) in the UK is as defined by Clause 2 of the Abortion Act. There are no agreed criteria for defining 'recurrent abortion seekers'. We aimed to review the characteristics of women requesting termination of at least two consecutive pregnancies within 24 months of the first and to identify any factors for seeking repeat TOP. METHODS: The database of patients that attended our Fertility Control Services from 2001 to 2006 was evaluated. Demographic data, contraceptive use in the cycle of conception and reasons for request were assessed for possible associations with repeat TOP. RESULTS: The incidence was 2.3% as defined by our criteria. Financial circumstances was the commonest reason for seeking TOP (75%). The combined oral contraceptive pill and condom were the commonest forms of contraception in these patients before the first TOP (35% and 38%, respectively). Long-acting reversible contraception (LARC) was used by only 8% of women before their TOP. Although 58% accepted LARC following TOP, only 2% continued its use thereafter and 50% of women were not using any contraception at the time of the repeat TOP. CONCLUSION: This study suggests that social workers and perhaps psychologists should be part of the peri-abortion counselling team. Contraceptive counselling should emphasise the side effects of LARC to improve compliance. Follow-up to ensure compliance and involvement of partners in decision-making could help to reduce the incidence of repeat TOP.

This retrospective observational study was designed to study the impact of a dedicated antenatal clinic service on obstetric and neonatal outcomes among teenage mothers in the maternity unit of a district general hospital in the UK. Outcomes were measured to investigate improvement in obstetric and neonatal outcomes before, and 12 months after the establishment of dedicated clinic for teenage pregnant women. Significant improvement in the birth weight was observed p = 0.01. A modest decrease in neonatal admission to special care unit by 6% was observed. Rate of spontaneous vaginal deliveries increased p = 0.0009. There was significant uptake of contraception and continuation of breast-feeding in this group of young women (p < 0.0001).

The teenage pregnancy unit's strategy for dealing with the increasing problem of unwanted pregnancy is rather prescriptive and simplistic for such a complex problem. It is not surprising that despite its recent recommendations, the problem has worsened. It is ludicrous to promote efficient ways to provide oral contraceptive pills to teenagers when good evidence of its inconsistent use among this age group is common knowledge. In addition, increasing access to emergency contraception could undermine teenagers' perception of the importance of commitment in relationships and thus send them a wrong message. This paper reviews the available evidence on the subject and highlights some good practices from other parts of the western world, which have not been incorporated into the UK strategy. It challenges the various stakeholders to show better commitment by providing a more rigorous and effective strategy.

This article presents a case study of the 'oestrogen sparing effect' of etonorgestrel especially high lighting its use in a patient with hypoestrogenism following long-term use of depomedroxyprogesterone acetate (DMPA); still wishing a long-term reversible method of contraception. There are studies demonstrating the effects of both DMPA and etonogestrel on estrogen status, but evidence is sparse, exploring the possibilities of usage of etonorgestrel following demonstration of hypo-oestrogenism with DMPA usage.

A prospective follow-up study of 196 women who underwent a colposuspension operation for genuine stress incontinence (GSI) at the Leicester General Hospital between June 1991 and May 1996 (inclusive) was carried out to review the outcome of surgery. The outcome was based on clinical symptomatology, demonstration of stress incontinence in the clinic and limited postoperative urodynamic studies. The clinical cure rate was 91.33%. Continence rate was reduced by age above 70 years and post-operative urinary tract infections, and not affected by previous colposuspension, or anterior colporrhaphy. On the other hand, previous colposuspension, previous pelvic floor operations and urinary tract infections caused a significantly higher incidence of voiding problems. Older women and those who have had previous bladder neck surgery need special attention in assessment, counselling and in choice of surgery. Reducing postoperative urinary tract infections might help improve the overall outcome of the operation.

We aimed to calculate the stillbirth rate at each gestation and also determine antenatal factors, which may be associated with unexplained stillbirth in a large UK teaching hospital. This was a retrospective study of all the stillbirths between January 1995 and October 1998. There were 27 170 births at > or =24 weeks, gestation during the study period. Of these 161 were stillbirths giving a stillbirth rate of 5.9/1000; 149 (92.5%) were antepartum. Eighty-two (50.9%) were unexplained. The "risk" of unexplained stillbirth per 1000 ongoing pregnancies was 0.3 at 24-25 weeks, fell steadily to 0.07 at 30-31 weeks and then rose to a peak of 1.16 at 40-41 weeks. About half (49.2%) of the pregnancies that ended in unexplained stillbirths had a normal antenatal course with no associated factors. Associated factors in the unexplained stillbirth group were identified in 50.8% of cases. The most common was intrauterine growth restriction, identified in 41.5% of cases. The "risk" of stillbirth increases at term. No significant antenatal associated factor, detection of which would aid prevention, could be identified in the majority of cases.

Incidental ingestion of foreign bodies in the pediatric age group is a recognized problem worldwide, however, it is unusual to have a neonate who presents with impacted esophageal foreign body. As such, this case is rare and considered a new form of child neglect.

The pattern of pneumatisation and normal width of the maxillary sinus in 191 Nigerian infants and children whose age range was 6 months to 14 years was determined. Fifty-four percent of children with no respiratory tract or sinus infection had an opaque maxillary sinus. A figure of 44.5% was obtained amongst children with suspected bronchopneumonia. Only 41.5% of suspected cases of sinusitis, acute and chronic middle ear disease had opaque sinuses. The highest rate of sinus opacity was seen in children under 2 years who were asymptomatic. The mean maximal width of the normally aerated sinus was 8.74 mm for children under 2 years, 16.5 mm for 3-6 years, 21.5 mm for 7-11 years and 25 mm for children 12 years and above. We conclude that maxillary sinus opacity in our experience is an unreliable index for the diagnosis of sinusitis in children.