Editors’ highlightsDeath rates of mothers and fetuses during pregnancy, labor and the puerperium have always been strong indicators of the functioning of a health care system. Maternal death, once the most important indicator, is no longer the focus of attention as antepartum and intrapartum fetal death and neonatal death play an increasing role. Perinatal mortality (PNM) has fallen strikingly during the last decades, reaching 0.5–1.0% today in European countries, due to reorganization of hospital care by establishing neonatal intensive care units and improvement of obstetrical services.
Editors’ highlightsThe stillbirth rate attracts less attention in European countries than the perinatal mortality rate (PMR), which also includes neonatal deaths. Nevertheless the stillbirth rate may be the better guide to the quality of maternity care. We focus on the PMR because adverse events in pregnancy may lead to death after delivery as well as to stillbirth but the PMR may give us false reassurance about how well we are doing. In the UK in recent years there has been a slow but steady fall in the PMR which has been due entirely to a reduction in neonatal deaths, largely as a result of improving paediatric care of preterm babies.
Editors’ highlightsSix months ago, in the Editors’ Highlights of our October 2008 issue, we described the “Maternal and neonatal health – obstetric fistula” project in Northern Nigeria. It is supported by The Rotary Foundation, the Aventis Foundation, the Bundesministerium für Zusammenarbeit und Entwicklung and Rotary Clubs from Nigeria, Germany and Austria. We pointed out that this project, which uses a benchmarking model in 10 hospitals in Kaduna and Kano, is designed to reduce the high maternal and fetal mortality in that area.
Editors’ highlightsWe are writing this “Editors’ highlights” column on what is an historic day – a global “highlight” indeed. By the time we finish writing, Barack Obama will have been inaugurated as the 44th President of the USA and the first president of African-American descent. There are people in America whose great-grandparents were bought and sold as slaves, and for them the impact of this event must be overwhelming, but the rest of us across the world can share the feeling of inspiration. Sadly, it was Europeans who introduced slavery into the Americas, and during the period of British colonisation, cities such as Glasgow, Liverpool and Bristol prospered greatly due in large part to the transatlantic slave trade.
Editors’ highlightsThe European Perinatal Health Report from the EURO PERISTAT project was released in December 2008, showing for the first time comparable data on maternal and infant health across Europe. It is the most comprehensive report on the subject to date and takes a new approach to health reporting. Instead of comparing single indicators like infant mortality in European countries, it paints a fuller picture by presenting data about mortality, low-birth-weight and preterm birth alongside data about health care and other factors that affect the outcome of pregnancy.
Editors’ highlightsAt the start of a new year we all like to look forward and already some forthcoming events in our specialty are creating a sense of anticipation. The nineteenth FIGO World Congress of Gynecology and Obstetrics will be held in Cape Town in October ( www.figo.org/meetings_congress_world.asp ). This city, at the meeting-point of two oceans and overlooked by its famous mountain, is a beautiful setting, and South Africa, ever since its first democratic elections in 1994, has been an inspiring country for the rest of the world.
Editors’ highlightsPoliticians are responding more and more to the fact that Millennium Development Goal (MDG) 4 (reduction of infant mortality) and MDG 5 (improvement of maternal health) are still a long way from being achieved in 2015. The development of a Global Business Plan (GBP) during 2007 represented a new-found determination among development agencies and international stakeholders to reach these goals. The GBP reflected the frustration that after 20 years of the “Safe Motherhood” initiative, little progress has been made.
Editors’ highlightsLike most journals in our specialty, EJOGRB appears every month. Our “Editors’ Highlights” is therefore prepared a few weeks ahead, and today as we write there is a flurry of concern in the media that taking antibiotics during pregnancy may increase the risk of cerebral palsy. This was the result of a press conference in London prior to on-line publication in The Lancet of a paper reporting 7-year follow up of the ORACLE study, a randomised trial of antibiotics to treat premature labour. Among the women who had had intact membranes, the incidence of subsequent reported cerebral palsy in the children was 1.7% in the control (no antibiotics) group but 3.3% in the group which had received erythromycin.
Editors’ highlightsOn a recent visit to Nigeria, in particular to the Northern States Kano and Kaduna, I [WK] became aware of the needs of the obstetrical services, especially in rural areas. Plenty of information is already available about the high maternal and infant mortality in such states. Despite a huge supply of drugs and other necessities by many non-governmental organisations the tragedy of maternal mortality and obstetric fistula continues and could not be changed over the past 20 years. This was stated again at the “Women deliver” conference last November in London.
Editors’ HighlightsAlthough Editors’ Highlights usually focuses on the needs of European readers we are very pleased that, through the Internet, this Journal has a worldwide readership with a high proportion of electronic readers in North America. Transatlantic professional links are rather haphazard, however, and it is good to see that this month they are being strengthened by a gathering of obstetricians and gynaecologists from the UK, Canada and the USA. The seventh international scientific meeting of the Royal College of Obstetricians and Gynaecologists has been organised in conjunction with the Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynaecologists.
Editor's highlightsWhat is new?Review: Ovarian carcinoma is generally revealed too late, at a time when management is restricted to reducing the size of the tumour by operative treatment followed by chemotherapy. Only a small number of patients are diagnosed during the very early development of the tumour, usually during an abdominal or vaginal ultrasound examination within the framework of a routine check. Thus about 20% of ovarian cancer patients are diagnosed while the disease is limited to one or both ovaries.
Editors’ highlightsJuly is the month when most people look forward to holidays but it is a stressful time for medical students facing important examinations. Assessing clinical skills has never been easy and methods of doing so have changed. In the past students were watched examining real patients and the result might depend on whether the case was simple or difficult. Today many schools are trying to make assessment objective by using rubber models of the abdomen and pelvis, but these are expensive and the techniques of examining them are different from those required in practice.
Editors’ highlightsIn the February issue we made you aware of the Congress of the European Board and College of Obstetrics and Gynaecology at the beginning of March in Lisbon. Those of you who attended can confirm the high attendance of about 1700 colleagues from all over Europe and the excellent atmosphere. The meeting had a real European flavour and there were outstanding presentations and lectures. At the opening ceremony Dr. Eberhard Müller-Heubach of Winston-Salem, USA, a past president of the American Gynecological and Obstetrical Society, gave an impressive insight into research in our specialty and experience in the USA.
Editors’ HighlightsMay 9th is “Europe Day”. On that date in 1950 the French foreign minister, Robert Schuman, called for the creation of a supranational institution to manage the combined coal and steel industries of France and Germany. His purpose, in the aftermath of World War II, was to make another war “not merely unthinkable but materially impossible” and he crystallised this into a practical proposal. Thirty-five years later European leaders recognised the Schuman declaration as the beginning of the European Union (EU) and decided to mark the date, though admittedly this celebration has not yet captured public imagination across the continent.
Editors’ highlightsGermany is presently fighting for a change in the law on stem cell research. On Thursday February 14, the discussion in the Bundestag, the German parliament, addressed one of science's most sensitive issues. Pressure is growing for an easing of restrictions that local scientists complain prevent them from keeping up with global advances. The Bundestag sees the stem cell question as one which carries historic overtones of the Nazis’ genetic experiments linked to the creation of a “master race”. Six years ago a law was passed banning the production of embryonic cells from pre-existing stem cell lines.
Editors’ highlightsFor doctors, the ability to move between countries is one of the attractions of a career in medicine. Patients too are now becoming more mobile. Intercontinental air travel means that obstetricians may see women who have had their early antenatal care thousands of miles away. Humanitarian crises, particularly in Africa, are bringing asylum-seekers to Europe and presenting the medical services with new challenges. Within Europe, economic migration from East to West has increased markedly in recent years and clinicians face increasing problems in communicating with patients.
Editors’ HighlightsThe February Editors’ Highlights is an excellent opportunity to make you aware of the 20th European Congress of Obstetrics and Gynaecology that will take place on 4–8 March 2008 in Lisbon, Portugal. It is the former EAGO congress now organized by the European Board and College of Obstetrics and Gynaecology (EBCOG). Professor Dunlop, the congress president and President of EBCOG and of the Union Européenne des Médecins Spécialistes (UEMS) Section of O & G, says: “The Congress will bring you up to date information about all aspects of obstetrics and gynaecology.
Editors’ highlightsAssisted reproduction techniques (ART) are available in 28 European countries and are being used to treat increasing numbers of patients. In 2003, the most recent year for which pan-European figures are available, there were 365,103 treatment cycles with ART, 132,932 of which involved IVF and 162,149 involved ICSI. Over 46% of women undergoing IVF were aged over 34 and 12% were over 40. The risks of pregnancy are increased by ART. Risk to the baby has been reduced in some countries by limiting the number of embryos replaced but in eastern Europe more than 10% of ART cycles involved replacement of four or more embryos and in Greece the figure was 30%.
Editors’ highlightsThe 4th and 5th Millennium Development Goals (MDG), proclaimed in 2000 by the United Nations, aim at reducing child mortality by two thirds and eliminating two thirds of maternal mortality by the target date of 2015. At a global conference, “Women deliver”, held from 18th to 20th October 2007 in London, however, health politicians, international non-governmental organisations (NGOs) and professional bodies had to confess that these goals are still far away from being reality.
Editors’ highlightsEurope's boundaries are hard to define. Greenland, to the west, has left the European Union but is still part of the kingdom of Denmark. On the southern Mediterranean coast, African and European cultures mingle. Eastwards, Turkey is working towards membership of the European Union. To the north-east, Russia has been a European power since the time of Peter the Great and today the World Health Organisation's Europe office is responsible for all the former Soviet republics up to the Chinese border.
Editors’ highlightsIn 1826 a group of German professors with advanced ideas founded the “Common German Journal of Obstetrics” (Gemeinsame deutsche Zeitschrift für Geburtskunde) under the editorship of W.H. Busch of Marburg, L. Mende of Göttingen and F.A. Ritgen of Giessen. The editors wanted the content of the new journal to comprise obstetrics in the broadest sense. Similar activities also started in other European countries. At this time maternal mortality was elevated and infant mortality was incredibly high. Information and discussion about normal and pathologic situations during delivery were the first steps in improving the quality of obstetrical services.
Editors’ highlightsSeptember is always busy with conferences—too busy, perhaps. This month an international infertility meeting in Barcelona overlaps with the World Congress on IVF in Montreal, and the Asian and Oceanic Congress of Obstetrics and Gynaecology in Tokyo is followed immediately by the German Congress of Endometriosis in Berlin. Next month the World Congress on Ultrasound in Obstetrics and Gynaecology in Florence will overlap with the Congress of the European Society of Gynecology in Paris. Choice is enjoyable but environmentalists may worry about our specialty's carbon footprint.
Editors’ highlightsThe meetings of the Heads of States in Heiligendamm and in Brussels in June 2007 have undoubtedly demonstrated that the European Community should speak with one voice. To strengthen Europe for the future, finance and manpower on research have to be focussed on selected projects if it is to compete in the global market with the steadily growing regions of Asia and Africa. This is true not only for global business but also for science in many fields including health issues. The creation of Euroscience is a promising step in the right direction.
Editor's highlightsThis year the European Community's “Erasmus” programme is 20 years old. It is named after Desiderius Erasmus, an illegitimate boy from Rotterdam who studied in Paris, Louvain, Cambridge, Venice and Basel and became Europe's leading scholar of the 16th century. Five hundred years later, European academics are much less mobile, partly because we no longer speak to one another in Latin. Nevertheless, despite language barriers, it is possible for students – even medical students – to undertake parts of their courses in different countries.
Editors’ highlightsHave you heard yet about European Research Area (ERA)-Link, the flourishing networking tool for European researchers, scientists and scholars in the US? It focuses on three types of activity: networking of researchers, information dissemination and helping expatriate researchers to collaborate with colleagues in Europe or to return to rewarding careers in Europe. ERA-Link has now grown to over 3000 members from 24 of the 25 member states in Europe as well as people from many other countries. The largest numbers of members work at universities in the area of biology (26%), with an additional 12% in medicine or veterinary medicine.