Editor's Choice

Abstract

The observation that babies with Down's syndrome have flatter noses than their normal siblings led a few years ago to attempts to use nasal bone visualisation in early pregnancy to screen for Down's pregnancy. Not surprisingly it was soon suggested that, since nasal prominence also varies by race, the likelihood ratio of nasal bone absence might need to be adjusted for the parents' ethnic origin. On page 109–112 Basky Thilanagathan and his colleagues at St George's hospital in London demonstrate that this supposition is correct. It may not be long before Down's screeners go the next step and adjust the risk for the individual parent's nose size. BJOG occasionally publishes trials which have failed to meet their recruitment targets, and we have one this month (p. 148–153). David Grimes and his colleagues from Chapel Hill, North Carolina wanted to compare medical and surgical methods for mid-trimester pregnancy termination. Their first step was to enrol 60 women in a pilot study, in order to estimate recruitment to a definitive trial. However, after one year they had recruited only 18 women, and decided to stop. Even this number is still worth reporting. It has taught us that most women who declined to participate preferred a surgical procedure. This should give UK doctors pause for thought since dilatation and evacuation is often unavailable here. There was also a slight trend to more pain and minor complications in those allocated to the medical procedure. Not surprisingly most women were satisfied with either method and, as so often in trials, whatever method they were allocated most would choose the same one in future. These data will inform other trial protocols, and may be included in future systematic reviews. BJOG publishes relatively little basic science for the simple reason that we are primarily a clinical journal and most of our readers are clinicians. However, we are always interested in developments that are still some way from clinical application. Åkerlund and colleagues' demonstration (p. 120–124) that a newly synthesised compound, ONO-8815Ly, inhibits uterine contractions in vivo in non-pregnant volunteers may not immediately grab all our readers attention. However, the compound was synthesised specifically to act as an endoperoxidase-2 (EP-2) receptor agonist, since these are believed to cause uterine relaxation. It is plausible that after further testing it may have a role in treatment of preterm labour or dysmenorrhoea. Last September we published two papers from Helena Strevens and her colleagues from Lund in Sweden in which the researchers had performed renal biopsies on women with pre-eclampsia, as well as on some normal pregnant women. This has provoked a lively correspondence from experts who believe both that the original trial was unethical and that BJOG should have refused to publish the results, and a vigorous defence from the original researchers (p 193–195). We have probably not heard the last of the topic. Most experts accept that variations in maternal mortality ratios between more and less developed countries are related to the quality of maternal care. It is less clear whether variation within developed countries can be attributed to the same cause. This matters because there is a nearly twofold difference in maternal mortality ratio across the countries of Europe, and it would be important to know whether this can be altered by improvements in maternity care. The paper by the late Katherine Wildman and her colleagues in the MOMS group (p 164–169) suggests that even at the low mortality ratios seen in Europe the quality of care is important. This will help people prevent women dying and encourage us all to evaluate different health care delivery systems. Tragically, Katherine Wildman died suddenly in November 2003. She suffered anaphylactic shock after eating snails. Katherine was aged only 35 and was one of the most promising young public health physicians working on Maternal and Child health. She had experience in Tanzania and had worked at INSERM in Paris since 2001. This important paper is a fitting memorial.