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SPONTANEOUS EVOLUTION OF A SHOULDER PRESENTATION
825 She might work herself up into a state in which she believed, quite wrongly, that an unplanned baby would break up her marriage, and get an abortion at a clinic where she was not known with a story that the child was illegitimate, and she was thinking of suicide. When she comes to herself she is horrified at what has been done and, fearing not unnaturally that her husband may be annoyed, seeks to transfer the blame to the gynxcologist who destroyed their child. The Medical Defence Union is probably quite right to say in its memorandum that if a pregnancy is terminated in good faith in spite of a husband’s refusal the courts are unlikely " to uphold a claim by the husband based on loss of parenthood of his child." But what if he never was consulted, and argues with the full support of his now repentant wife that he ought to have been, and that the gynecologist was at fault in accepting the story of an obviously unstable patient without making proper
Parliament
nancy.
inquiries of his own ? Gonville and Caius College,
Cambridge.
C. B. GOODHART.
SPONTANEOUS EVOLUTION OF A SHOULDER PRESENTATION .
SIR,-We describe here the spontaneous evolution of a shoulder presentation in a second twin. The mother was a 34-year-old Afro-Asian woman with a previously normal obstetric history (para 4). A twin pregnancy was diagnosed at 36 weeks, with the foetuses in vertex and breech positions. Although she did not know her last menstrual period she went into labour on July 11, 1967, at about the expected time. After a normal delivery of the lst twin, contractions were still present, and palpation revealed a normal breech lie of the 2nd twin, and after excluding a cord presentation its membranes were ruptured. Vaginal examination showed an arm in the vagina alongside the breech which was now ascending in the pelvis, and the shoulder and the nape of the neck were palpable in the uterine cavity. The arm was replaced, but it was found impossible to move the baby into either full vertex or breech positions. The mother was now having very strong contractions and once more the arm prolapsed. A further attempt to rotate the baby was unsuccessful ; examination of its carotid pulse, which could be reached, and of the faetal heart, suggested that the child was dead. By now uterine contractions were very strong, and imminent uterine rupture seemed a real danger. An anxsthetist had already been summoned, but he had to come from another hospital 2 miles away. Preparations were made for a destructive operation. Any further attempts at altering the position of the child had to be abandoned owing to the shock produced in the mother. Then followed a tremendous effort by both mother and uterus which resulted in delivery in order of the right arm, right shoulder, back, right buttock, left buttock, left shoulder, and left arm. This procedure was too rapid for the doctor to do more than hold the parts as they emerged. The baby was then in the hanging position for a breech. A very faint heart beat was now felt. Breech extraction by the MauriceauSmellie-Veit manoeuvre was carried out, mouth-to-mouth resuscitation instituted, and lethidrone, 10 mg., given Weak respiration was established within roughly 8 minutes, and the baby was transferred to an incubator, at 90°F (32°C), which controlled only temperature. 1 ml. of hydrocortisone was injected intramuscularly, and 1 ml. of procaine penicillin was given and continued daily for 5 days. Intermittent oxygen was fed into the incubator for the next few hours. The baby’s condition improved slowly over the next few days, and he was taken from the incubator on July 14, when he was found to be 3 lb. 6 oz. (1530 g.). He was discharged on Aug. 3 weighing 5 lb. (2270 g.), showing no abnormality. The mother’s 3rd stage and puerperium were normal. Both twins are developing norm"l1v
Camp Hospital,
1. Except in emergencies, a certificate of opinion shall first be given by two registered medical practitioners before the commencement of the treatment for termination of pregnancy. While the operating doctor will usually be one of the signatories, the Act does not require this. It is in the operating doctor’s own interest that he be in possession of the certificate before he carries out the operation, in case his action should subsequently be challenged. He is required to preserve the certificate for 3 years after the termination. emergency, the operating doctor shall complete the emergency certificate before commencing the treatment or, if that is not possible, within 24 hours of carrying it out. The doctor is required to preserve the certificate for 3 years after the termination.
2. In
an
prescribed
3. Whenever treatment for the termination of pregnancy is carried out, the prescribed notification form must be submitted by the operating doctor, within 7 days of the abortion, in a sealed envelope to the chief medical officer of the Ministry of Health.
The form of notification contains questions designed provide statistical information on the epidemiology of abortion, and arrangements have been made to process these data in conditions of strict confidentiality. The Regulations provide that disclosure of a notification or information furnished to the chief medical officer may only be made: (a) To an officer of the Ministry of Health authorised by the chief medical officer or to the Registrar General or a member of to
his staff authorised by him; (b) To the Director of Public Prosecutions or a member of his staff authorised by him; (c) To a police officer not below the rank of superintendent or a person authorised by him; (d) For the purposes of criminal proceedings which have
begun; (e) For the
purposes of scientific research; To the doctor who terminated the pregnancy; (g) To a doctor with the consent in writing of the whose pregnancy was terminated.
(f)
intravenously.
P.O. Zomba, Malawi.
Abortion Regulations ON April 1 the Minister of Health laid before Parliament Regulations governing the giving by doctors of certificates of opinion as to need for termination of a pregnancy and notices of terminations carried out. The Minister proposes shortly to write to hospital authorities and executive councils with advice on the provisions of the Act and Regulations so that doctors may be informed of their obligations before the Act comes into operation on April 27. Copies of this guidance will be sent also to local health authorities and to the proprietors of establishments outside the National Health Service which the Minister has approved for the purposes of the Act. The Regulations require that:
K. B. HUGHES J. ROBBINS.
woman
The Act
provides that any person who wilfully conto comply with the Regulations shall be penalty, on summary conviction, of a fine not
travenes or
liable
to a
exceeding
fails
E100. Three New Clauses
On April 1, the Health Services and Public Health Bill, as amended in the Standing Committee, was considered. Mr. KENNETH ROBINSON, the Minister of Health, moved a new clause to disqualify doctors from practising in England and Wales and Scotland if they had been disqualified by the tribunal
Parliament
nancy.
inquiries of his own ? Gonville and Caius College,
Cambridge.
C. B. GOODHART.
SPONTANEOUS EVOLUTION OF A SHOULDER PRESENTATION .
SIR,-We describe here the spontaneous evolution of a shoulder presentation in a second twin. The mother was a 34-year-old Afro-Asian woman with a previously normal obstetric history (para 4). A twin pregnancy was diagnosed at 36 weeks, with the foetuses in vertex and breech positions. Although she did not know her last menstrual period she went into labour on July 11, 1967, at about the expected time. After a normal delivery of the lst twin, contractions were still present, and palpation revealed a normal breech lie of the 2nd twin, and after excluding a cord presentation its membranes were ruptured. Vaginal examination showed an arm in the vagina alongside the breech which was now ascending in the pelvis, and the shoulder and the nape of the neck were palpable in the uterine cavity. The arm was replaced, but it was found impossible to move the baby into either full vertex or breech positions. The mother was now having very strong contractions and once more the arm prolapsed. A further attempt to rotate the baby was unsuccessful ; examination of its carotid pulse, which could be reached, and of the faetal heart, suggested that the child was dead. By now uterine contractions were very strong, and imminent uterine rupture seemed a real danger. An anxsthetist had already been summoned, but he had to come from another hospital 2 miles away. Preparations were made for a destructive operation. Any further attempts at altering the position of the child had to be abandoned owing to the shock produced in the mother. Then followed a tremendous effort by both mother and uterus which resulted in delivery in order of the right arm, right shoulder, back, right buttock, left buttock, left shoulder, and left arm. This procedure was too rapid for the doctor to do more than hold the parts as they emerged. The baby was then in the hanging position for a breech. A very faint heart beat was now felt. Breech extraction by the MauriceauSmellie-Veit manoeuvre was carried out, mouth-to-mouth resuscitation instituted, and lethidrone, 10 mg., given Weak respiration was established within roughly 8 minutes, and the baby was transferred to an incubator, at 90°F (32°C), which controlled only temperature. 1 ml. of hydrocortisone was injected intramuscularly, and 1 ml. of procaine penicillin was given and continued daily for 5 days. Intermittent oxygen was fed into the incubator for the next few hours. The baby’s condition improved slowly over the next few days, and he was taken from the incubator on July 14, when he was found to be 3 lb. 6 oz. (1530 g.). He was discharged on Aug. 3 weighing 5 lb. (2270 g.), showing no abnormality. The mother’s 3rd stage and puerperium were normal. Both twins are developing norm"l1v
Camp Hospital,
1. Except in emergencies, a certificate of opinion shall first be given by two registered medical practitioners before the commencement of the treatment for termination of pregnancy. While the operating doctor will usually be one of the signatories, the Act does not require this. It is in the operating doctor’s own interest that he be in possession of the certificate before he carries out the operation, in case his action should subsequently be challenged. He is required to preserve the certificate for 3 years after the termination. emergency, the operating doctor shall complete the emergency certificate before commencing the treatment or, if that is not possible, within 24 hours of carrying it out. The doctor is required to preserve the certificate for 3 years after the termination.
2. In
an
prescribed
3. Whenever treatment for the termination of pregnancy is carried out, the prescribed notification form must be submitted by the operating doctor, within 7 days of the abortion, in a sealed envelope to the chief medical officer of the Ministry of Health.
The form of notification contains questions designed provide statistical information on the epidemiology of abortion, and arrangements have been made to process these data in conditions of strict confidentiality. The Regulations provide that disclosure of a notification or information furnished to the chief medical officer may only be made: (a) To an officer of the Ministry of Health authorised by the chief medical officer or to the Registrar General or a member of to
his staff authorised by him; (b) To the Director of Public Prosecutions or a member of his staff authorised by him; (c) To a police officer not below the rank of superintendent or a person authorised by him; (d) For the purposes of criminal proceedings which have
begun; (e) For the
purposes of scientific research; To the doctor who terminated the pregnancy; (g) To a doctor with the consent in writing of the whose pregnancy was terminated.
(f)
intravenously.
P.O. Zomba, Malawi.
Abortion Regulations ON April 1 the Minister of Health laid before Parliament Regulations governing the giving by doctors of certificates of opinion as to need for termination of a pregnancy and notices of terminations carried out. The Minister proposes shortly to write to hospital authorities and executive councils with advice on the provisions of the Act and Regulations so that doctors may be informed of their obligations before the Act comes into operation on April 27. Copies of this guidance will be sent also to local health authorities and to the proprietors of establishments outside the National Health Service which the Minister has approved for the purposes of the Act. The Regulations require that:
K. B. HUGHES J. ROBBINS.
woman
The Act
provides that any person who wilfully conto comply with the Regulations shall be penalty, on summary conviction, of a fine not
travenes or
liable
to a
exceeding
fails
E100. Three New Clauses
On April 1, the Health Services and Public Health Bill, as amended in the Standing Committee, was considered. Mr. KENNETH ROBINSON, the Minister of Health, moved a new clause to disqualify doctors from practising in England and Wales and Scotland if they had been disqualified by the tribunal