Both teaching and examining of sexual history taking skills are possible and are likely to occur increasingly in UK medical schools.

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There has been an increasing worldwide incidence of invasive group A streptococcal (GAS) disease in pregnancy and in the puerperal period over the past 30 years. Postpartum Group A streptococci infection, and in particular streptococcal toxic shock syndrome (TSS) and necrotizing fasciitis, can be life threatening and difficult to treat. Despite antibiotics and supportive therapy, and in some cases advanced extensive surgery, mortality associated with invasive group A streptococcal postpartum endometritis, necrotizing fasciitis, and toxic shock syndrome remains high, up to 40% of postpartum septic deaths. It now accounts for more than 75,000 deaths worldwide every year. Postpartum women have a 20-fold increased incidence of GAS disease compared to non-pregnant women. Despite the high incidence, many invasive GAS infections are not diagnosed in a timely manner, resulting in potentially preventable maternal and neonatal deaths. In this paper the specific characteristics of GAS infection in the field of Ob/Gyn are brought to our attention, resulting in guidelines to improve our awareness, early recognition and timely treatment of the disease. New European prevalence data of vaginal GAS colonization are presented, alongside two original case histories. Additionally, aerobic vaginitis is proposed as a supplementary risk factor for invasive GAS diseases.

Maternal nutrition in early pregnancy may affect placental ratio ED1ToR,-In their editorial discussing the early origins of coronary heart disease Nigel Paneth and Mervyn Susser emphasise the importance of further investigation of the influences on the ratio of placental to fetal weight.' Godfrey et al have proposed that iron deficiency has a role since low maternal haemoglobin concentrations and a decrease in mean red cell volume during pregnancy are associated with an increase in the ratio.2 In contrast, Perry et al found no relation between maternal haemoglobin concentrations in early pregnancy and placental ratio at delivery' but confirmed the positive association between the ratio and maternal body mass index. ' Timing is another important consideration when the influence of the maternal environment on the developing fetus and placenta is studied. Many women start pregnancy with low iron stores, and we hypothesised that placental size would be increased by mid-pregnancy in those with low ferritin and haemoglobin concentrations. To investigate this we developed a method of measuring placental volume during the routine scan at around 18 weeks of pregnancy. In a study of 568 white women we found that low haemoglobin and ferritin concentrations at 14 weeks' gestation were associated with increased placental volume.4 Placental volume was also greater in taller women, in multiparous women, and in those who smoked heavily at the time of their last period. We found no relation between maternal weight or body mass index and placental volume.We have since examined the factors affecting the ratio of placental to fetal size in mid-pregnancy by estimating fetal weight using Shepard et als algorithm.' The relations between maternal characteristics and the ratio of placental volume to estimated fetal weight were examined by multiple regression analysis (table)

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Placental bed biopsies were obtained at caesarean section from 34 women. Their plasma urate was directly related to maximum mean arterial pressure and inversely t o adjusted birthweight; but it was related most closely t o the histological appearances of the spiral arteries in the placental bed. Nine women had physiological changes in the spiral arteries: their mean urate (233, SD 28.9 pmol/l) was significantly (P

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