Objective To examine women's role in the decision to perform caesarean section (CS). Design Cross‐sectional survey. Written questionnaires were completed seven weeks after giving birth by CS. Setting An obstetric tertiary referral hospital (Women's and Children's Hospital, Adelaide, South Australia), July to December 1996. Participants A consecutive sample of women who underwent CS over a six‐month period. To be eligible, women had to be at least 18 years old, able to complete a questionnaire in English and well enough to consent to study participation. Main outcome measures Women's involvement in decision making, stated preference for CS, and satisfaction with obstetric care. Results 278 women (76.4%) returned questionnaires: Conclusions It is of concern that over a third of women felt they had not been involved in the decision to have a CS; others were very positive about CS, but an appreciable proportion may not have received sufficient information. A broad‐based strategy of providing more information to women and their partners could be one way of ensuring appropriate CS rates and should be tested in a randomised controlled trial.

There is increasing evidence demonstrating a relationship between intrauterine infection and the development of neonatal intraventricular haemorrhage and periventricular leukomalacia with the subsequent occurrence of cerebral palsy, which is thought to be mediated through the generation of pro-inflammatory cytokines by the fetus. In the light of this relationship, a review of the current management of intrapartum infection and the associated complications of intrauterine infection such as preterm labour and preterm premature rupture of the membranes would seem timely along with the development of potential strategies which might prevent or ameliorate the effects of the fetal inflammatory response syndrome. The suggested changes in the understanding and management of the fetal inflammatory response syndrome provide a challenge and pose a dilemma for the practising obstetrician.

A retrospective study of 75 pregnant epileptic women compared with a parity, age and socioeconomic matched control group of women is presented. Deterioration of control of epilepsy during pregnancy occurred in 24% of women. Statistically significant obstetric complications noted were anaemia, premature labour, premature rupture of the membranes and postpartum haemorrhage. There was 2.5-fold increase in the incidence of congenital anomalies in the neonates, an increase in feeding difficulties and a reduced incidence of jaundice. There was no maternal or perinatal death. Refinements in management may further reduce the maternal and fetal morbidity in epileptic women who choose to become pregnant.

A woman with paroxysmal nocturnal haemoglobinuria (PNH) who was successfully delivered of 3 healthy infants after 4 pregnancies is reported. The obstetric literature of women with PNH is reviewed and the consequent view presented that judicious advice should not preclude pregnancy in such women.