References 1 Lockwood CJ, Senyei AE, Dische MR et al. Fetal fibronectin in cervical and vaginal secretions as a predictor of preterm delivery. N Engl J Med 1991; 325: 669414. 2 Momson JC, Allbert JR, McLaughlin BN et al. Oncofetal fibronectin inpatients with false labor as a predictor of preterm delivery. Am J Obstet Gynecoll993; 168: 538-542. 3 Nageotte MP, Casal D, Senyei AE. Fetal fibronectin inpatients at increased risk for premature birth. Am J Obstet Gynecol 1994; 170: 4 Anderson HF, Nugent CE, Wanly SD et al. Prediction of risk of preterm delivery by ultrasonographic measurement of cervical length. Am JObstet Gynecoll990; 163: 859-867. 20-25. An analysis of recent trends in vacuum extraction and forceps delivery in the United Kingdom Sir,We commend Dr Meniru for his illuminating analysis of the current trend of increasing use of the vacuum extractor over the traditional forceps for assisted vaginal delivery (Vol 103, February 1996)'. Whilst we approve of this trend, the finding that 67% of his respondents would apply the ventouse cup before full dilatation of the cervix is worrying. We note the 40% response rate of the survey, probably from vacuum extraction enthusiasts, hence nearly 7 in 10 of them would use the ventouse in an incompletely dilated cervix. This may not necessarily be representative of practice in the United Kingdom. It is also not clear if they simply acknowledged this procedure existed or routinely practised this technique.

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Background A 2006 Cochrane review demonstrated that although the use of CTG reduces the incidence of neonatal seizures, it makes no difference on the incidence of cerebral palsy or neonatal mortality. Fetal scalp electrodes are commonly used to accurately monitor fetal heart rate during labour in cases of poor CTG contact. Fetal blood sampling has also been used for over 60 years as a means of providing a more direct assessment of fetal well-being. Case We present the case of a neonate, born to a 21 year old primigravida by emergency caesarean section. During labour, a fetal blood sample was taken and a fetal scalp electrode applied for accurate monitoring. Five days following discharge, the baby presented with seizures and a scalp abscess around the site of the FBS/FSE. Following CT scan, the baby was transferred to a tertiary unit for surgical drainage. Simultaneously, his mother was re-admitted with intra-abdominal sepsis with pelvic abscess requiring laparotomy and washout twice. Mother and baby both made a full recovery. Discussion We review the literature and investigate the incidence of reported complications secondary to the process of fetal blood sampling and fetal scalp electrode application over the past 40 years. We discover that complications are rare, with the most frequent appearing to be haemorrhage, followed by infection, alongside some more isolated adverse events. We also revisit contraindications and precautions to prevent complications and conclude that, although uncommon, the clinician should be reminded that these are invasive techniques and are not without their risks.

Gestational diabetes (GDM) is the most common medical disorder in pregnancy.1 Pregnant women with this condition and their babies have increased risks in the antenatal, intrapartum and post-natal period and it also an impact on long term health.2 It is important to use a multi-disciplinary approach when caring for these patients to ensure the best outcomes.3

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