This study was performed to improve our knowledge and understanding of the needs of women affected by female genital mutilation. We looked at the types of complications of these practices which present to a large metropolitan women's hospital in order to determine how we can appropriately treat and support affected women. This was an observational study of women from countries with a high prevalence of female genital mutilation who presented to the Royal Women's Hospital between October, 1995 and January, 1997. Fifty-one patients with a past history of female genital mutilation who were attending the hospital for antenatal or gynaecological care consented to participate in the study. We found that 77.6% of women identified as having had female genital mutilation had undergone infibulation. More than 85% of the women in our study reported a complication of the procedure. The major complications were dyspareunia, apareunia and urinary tract infections; 29.4% of these women required surgery to facilitate intercourse. In our study group there was no difference in Caesarean section rates between the women who had previously delivered in Australia compared with those who had delivered in Africa. Women who have had a female genital mutilation procedure have specific needs for their care which present challenges to both their general practitioners and obstetrician/gynaecologists. These women have significant complications related to their procedure including social and psychosexual problems which require sympathetic management.

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The risk of preterm delivery in multiple pregnancy is high with an incidence of up to 50%. In less than 1% of twins labour results in delivery at a previable gestation. Delayed delivery of twins or higher order multiple gestation with survival of the remaining twin to a viable gestation is rare, although reported. We report a case of in vitro fertilization twins where previable delivery of the first twin was foilowed by prolongation of pregnancy for 46 days allowing delayed delivery of the second twin resulting in an excellent outcome for both mother and baby. The patient was monitored as an outpatient using OUT hospital's pregnancy day care facilities. CASE REPORTcongenital rubella deafness and an in vitro fertilization twin pregnancy presented to the Royal Women's Hospital in 1996 for management of her third pregnancy. The patient had a past history of a term delivery in 1990. She subsequently had an ectopic pregnancy treated by salpingectomy. Following the salpingectomy she had 3 years of unexplained secondary infertility. After patency of the left tube was demonstrated at laparoscopy, she was referred for in vitro fertilization. She conceived in her second cycle after a dual embryo transfer. An early ultrasound at 7 weeks' confirmed a viable intrauterine twin pregnancy.Her antenatal course was uneventful until 18 weeks' gestation when a routine ultrasound was performed and the patient was found to have a cervix which was 2 to 3 cm dilated with bulging membranes. Cervical swabs were taken and the patient was admitted to hospital for bed rest. After arrival in the ward, 5 hours after the ultrasound examination spontaneous rupture of membranes occurred and repeat ultrasound confirmed premature rupture of membranes around twin I with normal liquor volume around twin 2. The patient was confined to strict bed rest and commenced on oral amoxycillin. Four days later the patient went into premature labour and A 33-year-old woman with I 2 Addre\\ for corre\pnndencc [k Rachael Knight. Royal Wornen'\ ttospndl I32 Grattan Street. Carlton. Victoria 3 0 5 1 Registrar in Obctetric\ and GyndeLolog) Condtant Ohztetncian and G) nrccolop\l spontaneousiy delivered twin 1, birth-weight 2653. This twin did not survive.Following the delivery of twin I , the contractions settled, there was no clinical evidence of intrauterine infection or bleeding and the placenta remained in situ. Considering the patients poor past obstetric history and prolonged infertility it was decided to attempt conservative management. Speculum examination revealed a reformed cervix and repeat cervical swabs were taken. Ultrasound examination revealed that the remaining fetus was active in transverse he.had no evidence of placental abruption, normal growth parameters, intact membranes and a normal liquor volume. The patient was transferred to the operating theatre where a high ligation of the umbilical cord from twin 1 was performed under general anaesthesia with chromic catgut suture material and the cord stump was pushed back through the cervix. At the time ...

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