Obesity is associated with increased risk of first trimester and recurrent miscarriage.

Caesarean section has gradually become the preferred mode of delivery for the term breech presentation, despite prior lack of clinical evidence This change in trend may be influenced by maternal wishes. Reduced experience in the conduct of vaginal breech deliveries will have important implications for future obstetric specialists. A trial of vaginal delivery should be allowed in suitably selected cases before obstetricians lose the skills and confidence in performing an assisted vaginal breech delivery.

Background. The recent evidence from a randomised controlled study on the management of breech delivery has settled the argument, however, this has not been to everybody's satisfaction. Elective delivery of all full term breech babies has implications. However, the trend seems to have been set long before the recent evidence, which is bound to accelerate the changes. Materials and methods. This is a retrospective observational study in a district general hospital. All planned term singleton (Ն 37 weeks gestation) breech deliveries between 1988 and 1997 were reviewed to assess changes in the management of the term breech delivery over a 10-year period. The main outcome measure was the trend of the intended mode of delivery correlated with the time period of the study and its effect on the neonatal and maternal outcome.Results. There was a significant almost linear increase in the planned elective caesarean birth rate over the study period (OR Ω 1.25, 95% CI Ω 1.18-1.32). This was associated with a significant decline in neonatal intubation but no other effect on maternal or neonatal morbidity. There was no effect on perinatal mortality. Conclusions. Caesarean section has gradually become the preferred mode of delivery for the term breech presentation, despite prior lack of clinical evidence This change in trend may be influenced by maternal wishes. Reduced experience in the conduct of vaginal breech deliveries will have important implications for future obstetric specialists. A trial of vaginal delivery should be allowed in suitably selected cases before obstetricians lose the skills and confidence in performing an assisted vaginal breech delivery.

Objective To identify prognostic factors for the long-term success of transcervical resection of endometrium (TCRE). Design A retrospective analysis. Subjects 301 patients, who chose endometrial resection rather than hysterectomy and who underwent their first TCRE between 17 October 1989 and 31 December 1994.Interventions Endometrial resection carried out by one surgeon (D.W.S.). Main outcome measures Patient satisfaction, degree of bleeding and degree of pain, 1-6 years following TCRE. The procedure was considered to have failed if hysterectomy was necessary later. Results 301 patients underwent a total of 329 procedures (TCRE) and were followed up for 1-6 years (mean 2.8). Complications were few and there was no death or major morbidity. About 80% of patients were satisfied with the procedure and had either amenorrhoea (34%), scanty periods (33%) or moderate/acceptable periods (14%). The incidence of hysterectomy because of the failure of this procedure was 15%. The success rate was significantly higher in the older age group (>40 years); in those without previous moderate or severe dysmenorrhoea; where histological examination of the endometrial chippings did not show any abnormality; where further surgery such as diagnostic hysteroscopy, laparoscopy or repeat resection (repeat TCRE) was not required, and with increasing operator experience. Conclusion TCRE should remain a useful option in the management of women with menorrhagia. Greater awareness of the prognostic factors identified in this study will improve preoperative counselling and the appropriate selection of patients for TCRE.