The CuFix (GyneFix), conceived in 1985, was developed to minimize three major problems frequently associated with discontinuation of IUD use: expulsion, bleeding and pain. Since the initial clinical investigations, over 10,000 woman years of experience and up to 8 years of follow-up in international multicenter, non-comparative and comparative clinical trials, including a large proportion of nulligravid/nulliparous women, have been collected. Based on new clinical information about the GyneFix from a long-term multicenter clinical trial, conducted in young nulligravid/nulliparous and parous women, the importance of this new contraceptive is discussed. The following conclusions were reached: The unique design characteristics of the GyneFix (frameless, flexible and fixed to the fundus of the uterus) have resulted in optimal tolerance and almost complete absence of expulsion. The result is enhanced effectiveness (comparable to OCs and male/female sterilization) and a high rate of continued use. The GyneFix reduces the IUD failure rate to a minimum and is, therefore, a welcome reversible alternative to OCs and female surgical contraception. Framelessness and flexibility explain the absence of side-effects and adverse events caused by dimensional incompatibility between the frame of conventional IUDs and the uterine cavity and may also explain the absence of PID and ectopic pregnancies in any of the clinical studies. The GyneFix is a promising new, highly effective and safe, contraceptive option for parous women and an equally effective and well-accepted method for nulliparous women.

SUMMARY Two neonates who went. into acute hypovolaemic shock due to a tight nuchal cord were successfully resuscitated. The occurrence of this life threatening complication in two low risk pregnancies emphasises the importance of having staff trained in resuscitation immediately available in the delivery unit. The infant was extremely hypotonic and pale, with a tachycardia. The peripheral pulses were weak, and there were signs of poor capillary perfusion. There was no oedema or splenohepatomegaly. Five minutes after birth the pH of the infant's blood was 7 05. He was immediately intubated and 50 ml of plasma given through a venous umbilical catheter in the delivery room. Shortly afterwards 75 ml of whole blood was transfused because of the suspicion of acute fetal blood loss. Venous haematocrit before the blood transfusion was 33%. Examination of a peripheral blood smear showed a normochromic normocytic anaemia (haemoglobin concentration 90 g/l) without normoblastosis. A few hours after the blood transfusion the child was extubated and 48 hours later he was transferred to the postnatal ward, from which he was discharged in good health when 6 days old.In this case there was no fetomaternal blood group incompatibility and the direct Coombs' test was negative. The placenta (700 g) and the umbilical cord (length 42 cm) were normaL Cord insertion was paramarginal without aberrant vessels. Fetal membranes were complete and there were no blood. clots on the maternal surface of the placenta. Fetomaternal transfusion was excluded because the Kleihauer test performed six hours after delivery was negative. The infant had no signs of external or internal haemorrhage. Ultrasound and computed tomography scans of the brain and abdominal ultrasound examination yielded normal results. CASE 2 A baby boy weighing 3010 g was born at a gestational age of 38 weeks. The mother was 29 years old, healthy, normotensive and multiparous. The cervix was softened by extra-amniotic instillation of prostaglandin E2 gel, and low amniotomy was performed two hours before delivery. The liquor was clear. Epidural anaesthesia (12 ml 0-25% bupivacaine for one hour) was started during labour and blood pressure remained normal. The second stage was augmented with oxytocin (6 mU/minute). Internal monitoring showed early (type I) and late (type II) decelerations. Five minutes before birth the pH of the scalp blood was 7-31. The infant's head was delivered easily by ventouse but the neck was tightly entangled by two loops of cord. Because the nuchal cord could not be reduced early clamping and cutting were necessary for full delivery. Apgar scores were 4 and 6 after one and five minutes, respectively. The umbilical arterial pH was 7 05.

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