Although increased nuchal translucency (NT) has been linked to a wide range of fetal chromosomal abnormalities and genetic syndromes, very few studies have looked at the outcomes of chromosomally normal pregnancies in unselected obstetric populations. This study aims to evaluate the outcomes of pregnancies with nuchal translucency measurements greater than or equal to 4 mm in a low risk obstetric population attending for routine first trimester screening. Women attending for booking scans were routinely offered nuchal translucency measurement as a screening test for Down's syndrome between 10 and 14 weeks gestation. The prevalence of increased nuchal translucency was 0.8% (n = 53). There were 15 (28.3%) chromosomal abnormalities, the commonest of which was Down's syndrome. Of the 38 chromosomally normal pregnancies, seven resulted in intrauterine death, early neonatal death or termination of pregnancy. The remaining 31 cases resulted in livebirths, of which two infants now exhibit developmental delay of unknown aetiology and one has been diagnosed as having Noonan's syndrome. 10 (19%) pregnancies were diagnosed as having major anatomical malformations resulting in fetal or neonatal demise or requiring postnatal surgery. In a routine obstetric population, the finding of an NT measurement greater than or equal to 4 mm is associated with a poor pregnancy outcome in the majority of cases, mainly owing to chromosomal abnormality. This study establishes the need for focused fetal assessment in cases with such first trimester findings.

Background Hallux valgus deformity is a common sequel of spastic cerebral palsy. Methods Twenty ambulatory patients (24 feet) suffering hallux valgus deformity, with painful forefoot and restricted footwear, secondary to spastic cerebral palsy acquired perinatally, were treated with great toe metatarsophalangeal (MTP) arthrodesis using percutaneous K-wires for fixation. The mean age at the time of surgery was 16.2 years (range 14-18 years). They were retrospectively evaluated for the results after arthrodesis at a mean interval of 3 years and 4 months (range 3-4 years) by physical examination and radiographs. Results All patients had a stable painless aligned great toe, with \10°valgus, \20°dorsiflexion and neutral rotation after arthrodesis, evidenced by improvement in pain, cosmesis, functional activity, footwear, callosities and hygiene, as well as by significant improvement in the measures of the MTP and the intermetatarsal angles (IMA) by postoperative radiographs. Neither non-union (pseudoarthrosis) nor recurrence of the deformity developed. Complications included superficial wound slough in a single case. Using the modified American Orthopaedic Foot Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale, 18 feet (75%) were classified as excellent and six feet (25%) as good. Neither fair nor poor cases were recorded. Conclusion Hallux valgus deformity in adolescents with spastic cerebral palsy is best treated by great toe MTP arthrodesis to improve segmental foot malalignment and dynamic foot deviation.

Miscarriage is the most common complication of pregnancy, which creates a significant workload for health-care professionals. For decades, surgical evacuation of the uterus has remained the conventional treatment of first-trimester miscarriage. Recently, non surgical treatments have been introduced with increasing popularity. This review explores the evidence in support of expectant management of first-trimester miscarriage. It is safe, effective and well-tolerated by women. It enhances women's choice and control. It generates significant cost savings compared with the traditional surgical management. Accurate diagnosis, counselling, 24/7 telephone advice and follow-up are among the important aspects of expectant management. More studies are needed to develop methods for identifying miscarriages suitable for expectant management.