Confidential enquiries into maternal deaths

Correspondence

References

specific MMR of 2.6 per 100 000 live births in 2004– 2006 (including ectopic pregnancy and genital tract trauma). This particular profile has motivated specific research programmes and recent national clinical recommendations focussed on the issue of postpartum haemorrhage. j

1 Saucedo M, Deneux-Tharaux C, Bouvier-Colle MH. Confidential enquiries into maternal deaths. BJOG 2010;117:894–5. 2 Schutte JM, Steegers EA, Schuitemaker NW, Santema JG, de Boer K, Pel M, et al. Rise in maternal mortality in the Netherlands. BJOG 2010;117:397–406.

References

JM Schutte, EAP Steegers, NWE Schuitemaker, J Santema, K de Boer, M Pel, G Vermeulen, W Visser & J van Roosmalen

1 Schutte JM, Steegers EA, Schuitemaker NW, Santema JG, de Boer K, Pel M, et al. Rise in maternal mortality in the Netherlands. BJOG 2010;117:397–406. 2 Deneux-Tharaux C, Carmona E, Bouvier-Colle MH, Breart G. Postpartum maternal mortality and cesarean delivery. Obstet Gynecol 2006;108:541–8. 3 Philibert M, Deneux-Tharaux C, Bouvier-Colle MH. Can excess maternal mortality among women of foreign nationality be explained by suboptimal obstetric care? BJOG 2008;115:1411–8. 4 EURO-PERISTAT. EURO-PERISTAT project, with SCPE EUROCAT, EURONEOSTAT. European perinatal health report. 2008 [www.euro peristat.com]. Accessed 11 January 2010.

M Saucedo, C Deneux-Tharaux and MH Bouvier-Colle* INSERM U 953, Epidemiological Research Unit on Perinatal Health and Women’s and Children’s Health, Paris, France Accepted 20 January 2010. DOI: 10.1111/j.1471-0528.2010.02541.x

Confidential enquiries into maternal deaths

Authors’ Reply Sir, We thank M. Saucedo, C. Deneux-Tharaux and MH Bouvier-Colle1 for their interest in our article.2 We read your confidential enquiry on the period 2001– 2006 in France with great interest (www.invs.sante.fr/ publications). As it was published after our manuscript went to press, we were unable to discuss and refer to it in our article. We were aware of surveys performed in France, but had not realised that these surveys were part of a nationwide ongoing confidential enquiry. We apologise for this. We fully agree that comparison between national enquiries – including analyses of differences between France and the Netherlands – is very useful. In order to make such comparisons the different methodologies used for categorising maternal deaths should indeed be studied, because data from vital statistics often suffer from under-reporting. We hope that this becomes part of the EURO-PERISTAT initiative. j *Director of the French National Confidential Enquiry into Maternal Deaths (ENCMM).

The Netherlands Maternal Mortality Committee Accepted 10 February 2010. DOI: 10.1111/j.1471-0528.2010.02543.x

Labial surgery for well women

Sir, We read the review paper by Liao et al.1 with interest. The demand for labial reductive surgery is a growing issue for gynaecologists in the UK. One of the contributory reasons for this increase in demand, felt at the secondary-care level, is the ready willingness of some general practitioners to refer these women to gynaecologists. The mere act of making a referral implies to a woman that her doctor considers it as a surgical problem. In an audit on this subject held locally we could show that a significant proportion of women are not satisfied with the appearance of their genitalia after this surgery and a majority of women experience minor complications (Gupta et al.)2. In our view, surgery should not be the first-line treatment for women concerned about the aesthetic appearance of their labia. In many cases, perceived abnormal appearance of the labia is primarily related to abnormal perceptions of the body image, which should be managed by educational, emotional and psychological support. Only in a minority of cases with genuine physical or psychological issues that have been fully evaluated by the appropriate professionals, should surgery be performed. The important questions are where the resources to provide educational and psychological support are and who should be paying for them, and what guidelines should gynaecologists work to when faced with young women unhappy with the appearance of their labia? The current psychiatric and psychological support services in our area are already stretched to the limit and cannot cope with any extra referrals. We accept the authors’ conclusions that there is not a sound evidence base for correct clinical management but while we are waiting for such evidence to become available, general practitioners and gynaecologists in the UK need some guidance for the correct management of this growing problem and in our view this ought to come from the RCOG after consultation with all interested stakeholders. j

ª 2010 The Authors Journal compilation ª RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology

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