We examined for a regional sample of the New Zealand population, the relationship between maternal height and an increased risk of emergency Caesarean section due to arrested labour, to identify a height below which the risk of Caesarean section increases markedly and to quantify the risk of a Caesarean section for a range of maternal heights. The data of nulliparous singleton pregnancies over the period 1994-1998 was sorted into 2 study groups, one resulting in emergency Caesarean section for arrested labour and the other a group of women who had normal vaginal delivery requiring no intervention. The means and standard deviations of these 2 groups were found and 99% confidence intervals calculated. They were analysed for statistical difference and then a logistical regression calculation tried to identify a height at which the risk of a Caesarean section increased suddenly. There were 81 women in the Caesarean section group and 997 in the normal vaginal delivery group. Mean heights and confidence intervals were 161.0 cm (158.9-163.1) and 164.6 cm (164.0-165.2) respectively. There was a statistically significant difference between these means (p<0.001) but logistic regression analysis showed that risk of Caesarean section increased gradually with decreasing height, and even then did not reach more than 30% risk until a height of less than 140 cm. Low maternal height was associated with increased risk of Caesarean section due to labour arrest. Because the likelihood of having a normal vaginal delivery was still very good (>80 %) at modest degrees of short stature, this risk factor alone is unlikely to affect management. However the combination of other risk factors with maternal height may be of clinical use.

EDITORIAL COMMENT We accepted this paper for publication because we have not reported previously on pseudocyesis, which is a rare condition, especially if 'jirst trimester cases ' are excluded where there has been confusion with interpretation of intervals of amenorrhoea. These cases can occur at the climacteric when elevated levels of LH can give a false positive HCG test result with older methods of assay and add further to the temporary clinical confusion. The classical clinical picture, unlike the 3 cases reported in this papel; is said to be the nullipara approaching the time of the climacteric who is anxious to conceive. Queen Mary's case must be the most famous on record and also the best documented by means of the serial bulletins issued for her loyal subjects concerning the progress of her royal pregnancy (A). The editor can remember only I case of 'late pregnancy' pseudocyesis in 40 years of obstetric practice. This woman was finally convinced of her nonpregnant status by failure of a fetal skeleton to show on an abdominal X-ray. This was many years ago. This test was claimed to be definitive. One wonders how these women coped thereafter: We agree with the authors that follow-up, not necessarily by a psychiatrist, is important. In the editor's experience pseudocyesis of late pregnancy is less common than advanced true normal pregnancy in a nullipara aged more than 40 years, married for many years, who presents with abdominal pain and finds out to her delighted surprise that she is in labour at term and shortly thereafter produces a surviving normal infant. The reviewers of this paper did not agree with the suggestion that curettage would be an appropriate procedure to convince a woman with pseudocyesis that she was not pregnant. Uowevel; the authors, having read this editorial comment, stated that curettage is mentioned in the pseudocyesis literature (4).

EDITORIAL COMMENT We accepted this case for publication, not so that readers well wince with embarrassment when reading it, but to remind them that patients with chronic andlor multiple ailments that cause long-term misery, need periodic review and fresh diagnostic appraisal. Most practitioners will have seen many patients with numerous or persistent symptoms, taking many tablets, prescribed by a procession of doctors, but their clinical histories have never previously been recorded and offered to our editorial committee for publication. In this woman, electroconvulsive therapy was followed by almost full recovery, in the short term. Howevel; the final episode in this saga of her illness may be yet to be recorded. The editor was gynaecologist at the Repatriation General Hospital, Melbourne, for 20 years and learned there that elderly widows, mostly war widows, who attended the gynaecology clinic, were a special group of women, In previous years urinary incontinence (the nonstress, nonurge, persistent variety) with associated vulva1 excoriation, 2 obesity, diabetes and physical frailty was the challenge that dominated every outpatient session. Times have changed. Incontinence clinic staff (nurse educatol; urogynaecologist, dietician, physician, social worker) have achieved wonders with these women providing dietary advice, pelvic jloor exercises, local oestrogen therapy, appropriate medications and genital dryness with sanitary pads and continence devices. Howevel; the mental picture remains of the old warriol; as in the case presented here, with her shopping list of prescriptions to be renewed by the gynaecologist, unversed in many cases with the multitude of drugs thus listed. It is common for elderly women, perhaps more so when widowed and lonely, to continue taking all medications prescribed, with each new doctor adding to rather than reducing the therapeutic burden. The moral of this story is to advocate that each major hospital should develop a day-care centre for reappraisal of medical management of women with a long history of multiple drug therapy. EPILOGUE:The authors provided the following further details of this woman s history when given the Editorial Comment, which they approved. The patientS medical, psychiatric and social management was discussed at a psychiatric postgraduate conference and it was suggested that her widowhood, loneliness and lack of social network might be significant aetiological factors. She was therefore advised to consider the option of returning to the rest home. Members of her family who were also present at the conference supported this idea.