A reduction in neonatal respiratory morbidity can be achieved by delaying elective caesarean section until 39 weeks gestation.

Background “Natural” caesarean section (NCS) is a technique in which the obstetrician replicates the mechanisms of normal parturition at the time of caesarean delivery.1 NCS has the potential to improve the birth experience for the mother and might also reduce the incidence of neonatal respiratory morbidity associated with caesarean delivery. There is no published quantitative data on the safety of NCS to validate the technique, only anecdotal evidence from current advocates. Aims To compare outcomes for women delivered by NCS to traditional techniques of caesarean delivery. Methods A case-control study of women delivered by planned caesarean section in Ninewells Hospital Dundee. Women were matched for age, parity, body mass index and gestational age at delivery. The obstetric case notes and local maternity database (Torex Protos Evolution) were used to determine obstetric and neonatal outcomes. Results 22 women had NCS and were matched to 44 controls. There were no differences in operative haemorrhage (Mean-Mean difference NCS-Control=-72ml, p=NS), or the rates of maternal sepsis (NCS=0/22, Control=0/44, p=NS). There were no differences in the rates of neonatal admissions to special care baby unit (NCS=3/22(14%), Control=7/44(16%), p=NS) and no differences in the rates of neonatal respiratory morbidity. There were also no differences in mean APGAR Scores (Mean-Mean difference NCS-Control=0.181, p=NS) and mean Umbilical Arterial Cord pH (Mean-Mean difference NCS-Control=0.02, p=NS). Conclusions NCS is not associated with increased risk of adverse maternal or neonatal outcomes and appears to be as safe as traditional caesarean delivery. Larger studies are required to confirm these findings.

Between 13 and 19 May, 29 cases of vomiting, diarrhoea, and fever affected British military staff in Bagram, Afghanistan, as reported in this week’s Communicable Disease Report (1). The illness had a short incubation period and mainly affected staff in the field hospital. Three patients were classified as seriously ill, with circulatory collapse (Glasgow coma score 4). Due to the difficult conditions in Bagram, 10 of them were brought back to the United Kingdom (UK) for medical care in National Health Service (NHS) hospitals.

SUMMARY A survey of preschool children in three inner city day nurseries serving deprived areas found 13 children with pink oedematous hands and feet-'deprivation hands and feet'. The children and their families were compared with similar children in the nurseries. Growth and development were poor compared with accepted norms, but not notably different from controls. The families of the affected children were exceptional in being at a considerable social disadvantage. Other children in the families of these children also showed the sign.In both hospital and community work we have noticed that some children from deprived families have persistently pink hands and feet. Typically, the extremities are deep pink (sometimes with a bluish tinge) and mildly oedematous. The skin is often shiny, and feels cold to the touch, though in a warm room they can become excessively warm as the skin blood vessels dilate. In extreme cases the condition may extend to the knees and face, and the skin desquamates. The children often have other signs of deprivation. The sign is commoner and more severe in cold weather, but persists even in a warm room in the worst cases. The sign seems most common in children between 18 months and 5 years and resolves as they get older. For convenience we have labelled this 'deprivation hands and feet'. In the published reports on childhood deprivation, the sign is only occasionally mentioned, and then only in passing.1 2 We have most commonly encountered this sign in inner city social services day nurseries. Therefore the study was based in Nottingham city nurseries which serve areas of considerable social deprivation. Children often receive places in these nurseries because of their poor social circumstances, and frequently show inadequate growth and development.3 MethodsTwo of the authors (AN and CP) visited three day nurseries which they were not familiar with during the spring and summer of 1983, and inspected all of the Caucasian children for the sign (it is hard to distinguish the sign in black and Asian children). Physically handicapped children were also excluded. Sixty seven children were inspected, and 13 were found to show the sign to varying degrees. Thirteen controls matched for age and race were chosen from other day nursery children. A number of social details of the children's families were obtained from their health visitors, who were unaware whether they were cases or controls. Details were: family composition, parental employment, whether the child or a sibling had ever been in care, if the child had ever been on the non-accidental injury register, whether a social worker or probation officer was actively involved with the family, and the number of changes of address since the birth of the child. The health visitors rated the families on a scale of 0 (poor) to 6 (good) for physical home conditions and maternal emotional warmth towards the child. Details were obtained of the children's birthweights, completion of first year's immunisations, and any hospital admissions. The health visi...

As of 2 April 2003, 2223 cases of Severe Acute Respiratory Syndrome (SARS) and 78 deaths have been reported to the World Health Organization (WHO), a case fatality rate of 3.5% (http://www.who.int/csr/sarscountry/2003_04_02/en/). This is an increase of four to fivefold in the global totals in the last seven days (http://www.who.int/csr/sarscountry/2003_03_25/en/) with the greatest proportionate and absolute increases being in China (Hong Kong and Guangdong Province), and to a much lesser extent in Canada. There has been little absolute rise in other country totals. Eighteen countries have now reported cases but in most of these no transmission seems to have occurred. Local transmission has occurred in Hanoi (Vietnam), Singapore, Toronto (Canada), Taiwan, and the following parts of China: Guangdong Province; Beijing; Shanxi; and the special administrative region of Hong Kong. In the United Kingdom three probable SARS cases have been reported; all have now recovered. Indeed, the only areas where WHO feels there is evidence consistent with current transmission are Hong Kong and Guangdong (http://www.who.int/csr/sarsarchive/2003_02_02b/en/), and the WHO has issued advice to international travellers not to travel to or through either area.