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BMJ 1997; 315 doi: (Published 13 December 1997) Cite this as: BMJ 1997;315:1632

Women with the factor V Leiden mutation (which increases the risk of thromboembolic disease) are best identified by the careful taking of a family history rather than by population screening, says a review in Annals of Internal Medicine (1997;127:895-902). Those women in whom the mutation is confirmed should not use combined oral contraceptives and may require anticoagulation during pregnancy and the puerperium.

Further data on the continuing controversy about the safety of vaginal delivery in breech presentation have come from Sweden. A study looked at intrapartum and early neonatal mortality in 6542 singleton fetuses presenting by the breech (British Journal of Obstetrics and Gynaecology 1997;104: 1288-91). There were two deaths among the 2248 babies delivered vaginally and two deaths also among the 4029 delivered by caesarean section (not a significant difference), but more of the babies delivered vaginally had low Apgar scores at five minutes. The mortality in both groups was substantially lower than that in many other series.

Genetic tests on 86 women who either had developed breast cancer before the age of 40 or had a family history of breast cancer or ovarian cancer before the age of 50 found that only nine had either of the two mutations known to be linked with breast cancer, BRCA 1 or …

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