BRITISH MEDICAL JOURNAL 23 FEBRUARY 1980 561

However, it seems relevant to refer now to thewomen who book early at the antenatal clinic portion may not have changed, perhaps the
incidence of vomiting in paracetamol poison- and receive regular and skilled antenatal care. diagnosis of relative cephalopelvic dis-
ing. They suffer from complications such as proportion has. The use of partograms
In total, we have records of 392 patients premature rupture of membranes, spontaneous highlights slow progress during labour,' while
who ingested analgesic overdoses which premature onset of labour, hypertensive it has been reported that slow progress after
included paracetamol; 120 took paracetamol disease of pregnancy, antepartum bleeding, dilatation of 7 cm may be associated with a
alone, 44 took Distalgesic (dextropropoxy- and fetal growth retardation. We know very difficult forceps delivery.2 The clinician may
phene and paracetamol) alone, 157 took little about the causes of these conditions and now be more likely to anticipate such a delivery
paracetamol combined with other drugs, and we know even less about their treatment. and, either in the best interests of the baby or
71 took Distalgesic combined with other drugs.Regular antenatal supervision might lead to for medicolegal reasons (17 March 1979, p 763),
Among these patients only 46 (11-7 %) had their prompt diagnosis-but then what? That opt for caesarean section earlier than he would
vomited or were vomiting at the time of there is still an ill or high-risk neonate to be have done some years ago.
admission; and of the 63 who were treated cared for is a measure of the success of the GERALD J JARVIS
with oral methionine, vomiting occurred in obstetrician in preventing the death of the Jessop Hospital for Women,
only 13. Further examination of these cases unborn baby. In many respects there is a Sheffield S3 7RE
shows that all vomited before the treatment positive correlation between the quantity and I
Med_J
Philpott RH, Br 1972;iv:163-5.
2 Davidson AC, Weaver JB, Davies P, Pearson JF.
began but that this symptom did not persist quality of antenatal care and the paediatric BrJ Obstet Gynaecol 1976;83:279-83.
during treatment. resources needed. The problem is that in
Obviously further analysis of these data ismany of our maternity hospitals technological
required, but it is already appaient that the advances in monitoring the health of the Herpes zoster in pregnancy
difference in the incidence of vomiting with fetus have outstripped the availability of
this type of poisoning as reported from resources required to care for the resultant SIR,-The letters by Drs Veronique Moens
Edinburgh (77 %)1 and London (16 %)2 high-risk baby after birth. and K M Huntington (6 October, p 870) which
cannot be explained simply by the fact that Firstly, we must stop laying the blame for followed Professor A P Waterson's interesting
many of the latter data are collected indirectly
things we do not understand at the feet of our review of virus infections during pregnancy
through the Poisons Information Service patients. Failure to do so merely magnifies the (8 September, p 566) suggest that zoster may
inquiries. guilt that women are already burdened with be commoner than the 13 cases found by
ROSEMARY H M ADAMS when their baby dies so soon after birth. Brazin et al in their review of the literature.'
Norfolk and Norwich Hospital, Secondly, if we want women to book early and However, in 33 years of detailed surveillance
Noiwich, Norfolk attend the antenatal clinic so that they and of zoster cases in a practice of 3800 patients,
V DALLOS their unborn babies may benefit from Dr R E Hope-Simpson (personal communica-
Whipps Cross Hospital, obstetric services, we must also ensure that tion) has not seen a case in pregnancy, and
London E1i delivery units and special care baby units
R G DANIELS have the proper staff and facilities to look
none occurred in 87 cases of zoster reported
after those same babies after birth. The from a Glasgow general practice.2
Northampton General Hospital, I wish to report three more cases of zoster
Northampton message is simple-regular antenatal care
P J HELPS won't make ill babies go away. in pregnancy. They have occurred within
Royal Sussex County Hospital, four months, during an epidemic of varicella,
Brighton, Sussex BN2 5BE in a practice of 7800
N C ROGERS MALCOLM L CHISWICK deliveries a year. Nonewith approximately 100
of the patients give a
Neonatal Medical Unit,
Guy's Hospital, St Mary's Hospital, history of recent contact with varicella zoster
London SEI 9RT Manchester M13 OJH virus, nor did they meet at antenatal clinics.
K P GUEST Case I-A 25-year-old woman, gravida 2. Ex-
D ROSE pected date of delivery assessed as 19 August
H M WISEMAN Quality not quantity in babies 1979 by ultrasound scan, which gave a maturity
GLYN N VOLANS of 19 weeks on 29 month. Rubella immune. Zoster
Poisons Unit, rash appeared on 9 August (38 weeks' gestation),
Guy's Hospital, SIR,-In your leading article (9 February, left T8 dermatome. She had a normal delivery on
London SE14 5ER p 347) you discuss an "amniocentesis pro- 25 August at the general practitioner maternity
gramme to detect fetuses with lethal central home, and returned to her own home four hours
Prescott LF, Illingworth RN, Critchley JAJH,
Proudfoot AT. Br MedJ3 1980;280:46-7. nervous system abnormalities." I think I am later. The baby appeared normal and healthy and
2Vale JA, Meredith TM, Crome P, et al. Br Med J right in saying that amniocentesis will detect has remained so. Complement-fixation test: 1/160
1979 ;ii :1435. open central nervous system lesions, but against varicella zoster virus on cord blood. The
cannot distinguish between those of varying Epidemiology Research Laboratory, Colindale, was
severity, let alone indicate which are lethal. consulted antenatally and advised that zoster
Antenatal care and high-risk babies There is a similar widespread but mistaken immune globulin was unnecessary. The patient
belief that open myelomeningocele in the had had a severe attack of varicella in childhood at
an unknown age.
SIR,-Regular antenatal assessment is neonate is lethal unless operation is done. This Case 2-A 31-year-old woman, gravida 3.
important in the interests of fetal and maternal is, of course, untrue-unless steps are taken to Rubella immune. Last menstrual period 29 August
health. However, as your leading article ensure that they all die-for example, by 1979. Expected date of delivery 5 June. Zoster rash
"Quality not quantity in babies" (9 February, heavy sedation and inadequa:e feeding. appeared 26 November (12 weeks' gestation) with
p 347) points out, the fall in British perinatal right L 1 distribution. Complement-fixation test:
mortality has occurred before there has been a R B ZACHARY 1j> 320 for varicella zoster virus. Severe varicella
chance to introduce incentives for mothers to Sheffield S10 5BS at age 2 years 9 months. Pregnancy appears normal.
attend antenatal clinics. But the idea is being Case 3-A 25-year-old woman, primigravida.
Rubella non-immune. Last menstrual period 7
spread through the media-presumably be- October 1979. Expected date of delivery 14 July.
cause of the misinformed opinion of certain Cephalopelvic disproportion and Zoster rash on 26 November (seven week's gesta-
professional health workers-that failure of caesarean section tion), left T10 dermatome. Complement-fixation
pregnant women to avail themselves of test 1/> 320. The patient had severe varicella
antenatal check-ups is a leading cause of SIR,-Barbara Culliton and Mr Wallace aged 5 years. The patient is booked for confine-
death, illness, and subsequent handicap in Waterfall (8 December, p 1488) comment that ment in the specialist unit as she is a primigravida
newborn babies. The implication is that the the caesarean section rate in the United States and 150 cm (4 ft 11 in) tall.
mother is at fault. has doubled over the last decade and I believe Zoster is less common in women aged
About 700 of deaths in the first week occur that many obstetricians are worried lest a under 30 years than in older people (6 4% and
in low-birthweight babies, and many- similar trend occurs in this country. Dr Marion 9 60, of two series2 3) but may be under-
perhaps most-weigh less than 1-5 kg. In the Hall (2 February, p 333) incriminates intra- reported in pregnancy as it seems probable
light of present knowledge it is difficult to see partum fetal monitoring and refutes the that the fetus is rarely infected.
how regular antenatal assessment might explanation, given by these authors, that the The two normal cases reported to your
prevent this happening. Certainly most of the rise is due to an increase in cephalopelvic journal by Drs Moens and Huntington, the
ill low-birthweight babies cared for in our own disproportion. 13 cases reviewed by Brazin et a1,' and my
newborn intensive care unit are born to While the incidence of absolute dispro- first case total 16. Eleven babies were reported