The patient with recurrent pregnancy loss is often frustrated and on the verge of despair. Evaluation can sometimes take several visits, allowing the physician the time and opportunity to provide emotional support to the couple. With proper evaluation and therapy, the majority of patients will become pregnant. For those who have exhausted diagnostic and treatment options, the physician should encourage consideration of assisted reproductive technologies or adoption.
The treatment of displaced intraarticular fractures of the calcaneus continues to challenge the orthopaedic community. The recent development of prognostic classification systems based on computerized tomography has clarified the roles of non-operative and operative treatment. It has also opened the door for further prospective study of the appropriate treatment of this injury and comparison of operative methods. Based on current literature and our experience, we recommend CT evaluation of all intraarticular fractures of the os calcis in patients who are operative candidates with treatment guided by fracture classification.
The risk of prematurity, stillbirth, small for gestational age, and central nervous system damage are clearly a consequence of maternal cocaine use during pregnancy. There is also the risk of concommitent use of alcohol which may cause long term developmental problems. Therefore cocaine should be avoided in pregnancy, but the good news is that if the child survives, the longterm outcome may be very favorable. The cocaine exposed child given proper parenting and educational support may well develop normally with a bright future. It is important not to be too pessimistic about the term infant exposed to cocaine since it may lead to a "self-fulfilling prophecy". Supporting the cocaine exposed child and their family is an important task for all health professionals who deal with children.
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