ObjectiveDesign A structured questionnaire. Setting District hospital antenatal clinic.Participants Two hundred pregnant women attending for their routine mid-pregnancy anomaly scan. Main outcome measuresTo evaluate current knowledge and practice among pregnant women about the use of car restraint systems during pregnancy.The women were asked about seatbelt and airbag usage, source of information about restraint systems and the legal requirements and recommendations regarding car safety systems.One hundred fifty-nine women (80%) completed the questionnaire. Ninety-eight percent wore seatbelts in the front, 68% wore seatbelts in the back of a car, 48% correctly identified where to place the seatbelt and 37% had received information on seatbelt use while pregnant. The latter were more likely to correctly position their restraints than those who had received no information ( P = 0.03). Thirty-nine percent had an airbag system fitted and one woman had de-activated it. Fifty-eight percent were aware seatbelt use was a legal requirement for driver and passengers when fitted.Many pregnant women are ignorant of the correct usage of seatbelts, their positioning and legal requirements. This puts their own wellbeing, and that of the fetus, at risk. Women should receive written instructions and advice from well informed health professionals and be encouraged always to wear a correctly positioned seatbelt. Education increases compliance and correct usage. Results Conclusions INTRODUCTIONLavenne developed the seatbelt in France in 1903 for use in aeroplanes and it was adopted for use in motor racing. From this approach evolved the standard threepoint restraint fitted in automobiles today'. Accident investigation in a research work published by De Haven entitled 'Injuries and death by car collision' in the 1950s identified that in 25% of serious accidents, death was caused by ejection from the car'. Adoption of the threepoint seatbelt has decreased deaths from road traffic accidents by 45% and moderate to critical injuries by 50%2. It became a statutory requirement to use seatbelts in the UK in 1983 in the front seats, and rear seats in 1991. The Department of Transport estimated that 200 lives and 7000 serious injuries a year are avoided by the compulsory use of seatbelts in front seats and that 100 deaths a year and 1000 major injuries are prevented when rear seatbelts are used in conjunction with front seat belts3. 644Trauma from motor accidents occurs in 2%-3% of pregnancies, 90% of which are of a minor nature. Fetal loss is reported as occurring in 1 %-3%46 and pregnancy outcome appears related to seatbelt use in a car accident7-12. In 1971, Crosby et al. reported that the major cause of fetal death in an accident was maternal death and this was significantly reduced by wearing a seatbelt. Fetal survival was improved if a three-point seatbelt rather than a lapbelt alone was ~o r n~, '~, '~.The American College of Obstetricians and Gynecologists issued guidelines on seatbelt usage for pregnant women in 199115. Subsequent ...

Measurements of maternal height, shoe size and weight at the last clinic visit are not useful for the identification of women with inadequate pelvis.

PurposeThe purpose of this paper is to determine if recommendations from the General Medical Council (GMC), Royal College of Obstetricians and Gynaecologists (RCOG) and Ayling Inquiry with regard to chaperoning are observed in the hospital setting by consultants performing intimate physical examinations, and to ascertain consultants' views on the availability, nature and role of chaperones.Design/methodology/approachA quantitative postal questionnaire was carried out based on the GMC and RCOG recommendations, and point 2.58 of the Ayling Inquiry. Participants were all consultants specialising in obstetrics and gynaecology, colorectal surgery, breast surgery, urology, genito‐urinary medicine, and paediatrics in York and West Yorkshire Hospitals. The questionnaire covered consultant practice and views on the role of chaperones for intimate physical examinations.FindingsA response rate of 70 per cent was achieved. All gynaecologists, paediatricians, urologists, colorectal surgeons and genito‐urinary physicians request a chaperone when performing female intimate examinations. A total 90 per cent of genito‐urinary physicians request a chaperone compared to only 39 per cent of colorectal surgeons and 28 per cent of urologists for male intimate examinations. Of the consultants 97 per cent reported that a chaperone was “always” or “usually” available. A total 94 per cent considered health‐care professionals to be appropriate chaperones. Cited roles of a chaperone include doctor protection (93 per cent), patient protection (84 per cent), patient comfort (73 per cent), and medico‐legality (72 per cent). Only 20 per cent of consultants stated they document the presence of a chaperone.Originality/valueThe paper reveals that consultants use a chaperone for all female genital examinations, but inter‐speciality differences exist for male intimate examinations in spite of national recommendations. A minority of consultants document the presence of a chaperone for intimate examinations. Consultants consider health‐care professionals to be the most appropriate chaperones, and believe chaperones add to patient comfort and protect both doctor and patient.

The Health Education Authority's campaign, encouraging the use of periconceptional folic acid in the prevention of neural tube defects, started in February 1996 and is ongoing. Its effectiveness was assessed using a questionnaire, answered by patients not exposed to the campaign and by those that were. The study population was comprised of 337 women in approximately their 20th week of pregnancy, attending antenatal clinic for a routine fetal anatomy ultrasound scan. Data were collected on aspects of folate awareness, intake and sources of advice, before and after the campaign's start. Significant increases in preconceptional and total folate consumption, awareness of folate's benefits, and GP prescription were seen as the study went on. Unplanned pregnancy prevented compliance with periconceptional folate guidelines. We conclude that whilst the promotional campaign seemed to work in York, fortification of foodstuffs may need to be used to increase folate consumption in those with unplanned pregnancy.

Objective To determine if diclofenac suppositories administered prophylactically produce effective Design A randomised double blind placebo controlled trial. Setting York District Hospital.Population One hundred women sustaining objective perineal injury (second degree tear or episiotomy) during spontaneous vaginal delivery at term.Methods Suppositories were administered at the time of repair and approximately 12 hours later. The suppositories were randomised prior to issue by the pharmacy department and contained either 100 mg diclofenac or placebo.Main outcome measures Pain scores assessed at 12, 24, 48 and 72 hours after delivery using a six point numerical scoring system and the use of additional analgesia and local treatments to the perineum. ResultsThe mean pain score was significantly reduced in the diclofenac group at 24, 48 and 72 hours after delivery (0.86, 0.7 and 0-59, respectively) compared with the control group (1.64, 1.31 and 1.5; P < 0.005). In addition there was less supplementary analgesia required (eight women only at 72 hours compared with 15 in the control group) and this was limited to paracetamol or topical treatments to the perineum. ConclusionProphylactic rectal diclofenac provides effective analgesia after perineal repair and its effect appears to be maintained into the second and third postpartum days.and lasting analgesia following perineal injury.