Research on the risk of post partum haemorrhage (PPH) so far has concentrated on the actual mode of delivery, rather than the planned mode. These studies point to an increased risk with caesarean.

So Dr Charlotte Holm of Copenhagen University Hospital, Denmark, and her team looked at the outcomes of planned caesareans among 382,266 women giving birth between 2001 and 2008.

Compared to intended vaginal delivery, planned caesareans were associated with a reduced risk of severe PPH, based on red blood cell transfusions. Overall, two per cent of the women were estimated to have PPH.

For low risk first-time mothers the rate of PPH in the planned caesarean section group was significantly lower compared than the rate in the planned vaginal delivery group.

For women planning a caesarean for their second pregnancy, the rate was 60 per cent higher if they had a previous caesarean delivery compared to a previous vaginal delivery. But for women planning a vaginal delivery after a previous caesarean the risk was even higher, more than three-fold.

The study is published in BJOG: An International Journal of Obstetrics and Gynaecology. The authors believe that intended mode of delivery is more relevant to the decision-making process for obstetricians and women than actual mode of delivery on the day.

Dr Holm said: "The results of this study show that planned caesarean section can reduce the risk of severe post partum haemorrhage. These results may be useful in the counselling of pregnant women about the risks of bleeding in their first and second pregnancy."

Severe postpartum haemorrhage and mode of delivery: a retrospective cohort study. Holm, C. et al. BJOG: An International Journal of Obstetrics and Gynaecology February 8 2012 doi: 10.1111/j.1471-0528.2011.03267.x.

Serious infections cause about a third of global neonatal deaths (within 28 days of birth) each year, and up to half of neonatal deaths where death rates are high.

One "key entry point" for germs is the freshly-cut umbilical cord stump, say Professor Abdullah Baqui of Johns Hopkins Bloomberg School of Public Health, Baltimore, USA, and colleagues.

In the Lancet, they publish their study of two cord-cleansing methods based in Bangladesh. Both used the antiseptic chlorhexidine, either once at birth, or daily for a week. The study included 29,760 newborn babies.

The results were unclear, they say. Compared with standard care, death rates were 20 per cent lower in the single-cleansing group. Multiple-cleansing did not seem to reduce deaths - but this group did have significantly fewer severe cord infections.

The researchers say: "Chlorhexidine cleansing of a neonate's umbilical cord can save lives, but further studies are needed to establish the best frequency."

In a second study, Professor Zulfiqar Bhutta of the Aga Khan University in Pakistan, and colleagues looked at the effect of umbilical cord cleansing with chlorhexidine, with or without hand-washing with antiseptic soap.

A total of 9,741 newborn babies in Pakistan received either standard care, chlorhexidine application to the cord at birth and for up to two weeks plus educational messages promoting hand-washing. A further group had chlorhexidine only, and the fourth group had hand-washing only.

Overall, cord cleansing reduced the risk of infection by 42 per cent and mortality by 38 per cent. Hand-washing alone had no beneficial effect.

"The results of these trials done in community settings lend support to the policy of application of chlorhexidine on newborn umbilical cord," say the authors.

The effect of cord cleansing with chlorhexidine on neonatal mortality in rural Bangladesh: a community-based, cluster-randomised trial. Arifeen, S. E. et al. The Lancet, February 8 2012 doi:10.1016/S0140-6736(11)61848-5

Topical application of chlorhexidine to neonatal umbilical cords for prevention of omphalitis and neonatal mortality in a rural district of Pakistan: a community-based, cluster-randomised trial. Soofi, S. et al. The Lancet February 8 2012 doi:10.1016/S0140-6736(11)61877-1

Around 40 per cent of patients are 65 years or older at diagnosis. Dr Willemien van de Water of the Leiden University Medical Centre in the Netherlands, and colleagues, looked at whether age is a stand-alone risk factor.

They investigated the possible link among 9,766 postmenopausal patients with hormone receptor-positive breast cancer. Over about five years, 1,043 of the women died.

Compared with patients younger than 65 years risk of death due to the cancer increased with age, from 5.7 per cent in patients younger than 65, to 8.3 per cent in patients 75 or older. Risk of relapse also increased with age.

Writing in the Journal of the American Medical Association, the authors conclude that increasing age was associated with increased death rates from the disease.

They add that: "Because breast cancer incidence increases with increasing age, changing demographics and continuously increasing life expectancy will further enlarge the number of older women confronted with breast cancer."

However, the experts point out that the older women in the study may have been undertreated, missing out on vital chemotherapy or radiotherapy.

"In conclusion, regardless of a higher risk of other-cause mortality and independent of tumour and treatment characteristics, disease-specific mortality increases with age," they write.

They call for more age-specific breast cancer studies in order to improve outcomes in patients of all ages. Further studies may also uncover the reasons for this higher disease-specific mortality with increasing age, they add.

Association Between Age at Diagnosis and Disease-Specific Mortality Among Postmenopausal Women With Hormone Receptor-Positive Breast Cancer. van de Water, W. et al. The Journal of the American Medical Association February 8 2012 Volume 307 Number 6 pp. 590-97.

Weaning with solid finger food makes a child more likely to be happy to eat health food, according to a study in Nottingham, UK.

And it also means a child is less likely to be overweight.

The findings come from a survey of some 150 parents with young children, reported in BMJ Open. Psychologists asked them to recall how they weaned their child.

About 40 per cent used spoon-feeding with smooth purees and 60 per cent used solid finger food after the age of six months.

The researchers found that neither technique reduced the chances of a child being a "picky" eater - but that those which were spoon-fed were more likely to have a taste for sweet food.

Children who were given solid finger food were happier to eat carbohydrates, such as bread.

Researcher Dr Ellen Townsend, of Nottingham University, said: "Although numerous studies have focused on when to introduce solid foods into an infant's diet there is a dearth of evidence concerning the impact of different weaning methods on food preferences and health prospects.

"We believe our report is the first piece of research to examine whether weaning method can influence food preferences and the future health of the child."

Baby knows best - The impact of weaning style on food preferences and body mass index in early childhood in a case-controlled study NMJ Open February 7 2012; doi 10.1136/bmjopen-2011-000298

The latest study in the NUTRIMENTHE project, a 5.9 million Euro research programme funded by the European Commission’s 7th Framework Programme, found that children born to mothers who ate more fish during pregnancy score higher in verbal intelligence and fine motor skill tests.

They are also more likely to display increased levels of social behaviour, which suggests empathy and a desire to help others for no personal gain.

Professor Cristina Campoy Folgoso, of the University of Granada, Spain, who co-ordinated the study, analysed concentrations of long-chain fatty acids of the series omega-3 and omega-6 from blood samples from 2,000 women at 20 weeks’ pregnancy and from the umbilical cord of the infant at birth.

They examined the genotype of 18 polymorphisms in the fatty acid desaturase (FADS) gene cluster to try and assess the effects of maternal fish intake on foetal development, and to determine how the different genotypes affect long-chain fatty acid concentrations in the foetus.

Dr Pauline Emmett, from the University of Bristol, Dr Eva Lattka of Helmholtz Zentrum München, the German Research Centre for Environmental Health, with their colleagues found that fatty acid concentrations in umbilical cord blood depend on maternal and offspring genotypes.

Maternal genotypes are mainly related with omega-6 fatty acid precursors, and offspring genotypes are related with the more highly elongated fatty acids of the omega-6 series.

Researchers also found that concentrations of docosahexaenoic acid (DHA) of the Omega-3 series, which is the main component of brain cell membranes, depend on maternal and offspring genotypes.

“Foetal contribution of long-chain polyunsaturated fatty acids of the omega-6 series is more relevant than expected; foetal DHA concentrations depend on maternal and foetal metabolism,” says Dr Lattka.

The amount of DHA transmitted to the foetus through the placenta might be crucial for foetal development, but it is not yet known if maternal DHA concentrations are directly correlated with the offspring’s IQ.

The research has been submitted to the American Journal of Clinical Nutrition.

It may help patients to restart their usual daily activities, which may otherwise be hindered by fatigue. Their quality of life can also be boosted, says Dr Judy Ho of the University of Hong Kong, writing in the British Medical Journal.

Her team analysed the results of 34 trials of exercise - aerobic, resistance and strength training - in adult cancer patients. The trials included an average of 93 patients with either breast, prostate, gynaecologic, colorectal, gastric or lung cancer, who took part in exercise for about 13 weeks.

For breast cancer patients, the physical activity was linked to improvements in blood sugar control, body mass index and body weight, lower limb strength, fatigue, depression and quality of life.

Similar improvements were seen for patients treated for other types of cancer, including reduced body weight, improved physical function such as oxygen consumption and handgrip strength, depression, and quality of life.

The type and intensity of the exercise appeared to be significant, with breast cancer patients having a greater benefit from the combination of aerobic exercise and resistance training. This improved their physical fitness, "emotional fitness", overall well-being and concerns about breast cancer to a greater extent than aerobic activity alone.

The authors believe that, although more trials are needed, their results show that "quality of life was a clear significant benefit of physical activity and that clinically, there were important positive effects on physical functions and quality of life".

In an editorial, Dr Liam Bourke of Barts and the London School of Medicine and Dentistry, London, UK, and colleagues say that more information is needed on how to support long-term healthy lifestyle behaviours "in an economic climate of shrinking healthcare budgets".

Physical activity for cancer survivors: meta-analysis of randomised controlled trials. Fong, D. Y. T.et al. The British Medical Journal February 1 2012 doi:10.1136/bmj.e70

Being both overweight and a smoker increases the risk of these problems by two and a half times compared with that faced by a woman who smokes but is not overweight, researchers said.

The findings come from a study of nearly 800 babies born with heart abnormalities in the Netherlands over an 11 year period.

They were compared with another 300 babies born with chromosomal abnormalities - but not with heart defects.

Congenital heart defects affect about eight in every 1,000 babies.

The researchers also found a three times increased risk of blockages of the flow of blood from the heart when mothers who were overweight also smoked.

Writing in the journal Heart, the researchers say tobacco and weight combined may "disturb" the mothers' cholesterol levels. They suggest the two may interact with each other, aggravating the risk.

Researcher Dr Marian Bakker, of the University Medical Centre, Groningen, The Netherlands, says: "The findings add to the growing body of evidence for the links between smoking and overweight during pregnancy with, variously, miscarriage/stillbirth, stunted growth, and premature birth."

Heart January 31 2012 doi 10.1136/heartjnl-2011-300822

The island that student midwives in Nottingham use is a virtual one - found on the Second Life Network.

The virtual maternity unit has been created by midwife teacher Jenny Bailey at Nottingham University.

And now it has gained an award for innovation at the annual awards of the Royal College of Midwifery.

The virtual island carries all the facilities that might be expected in a modern birthing unit including a pool, a gym ball and inhalation pain-relief.

Students can use avatars to conduct role play on a range of scenarios - while the teacher takes the role of the pregnant woman.

Students are even able to practice clinical skills such as administering pain relief, checking contractions and taking pulse and blood pressure. A control panel provides the results of tests.

Student avatars are also expected to provide support and reassurance to the woman in labour.

Ms Bailey said yesterday: "I am absolutely thrilled to be a winner, especially considering the excellent calibre of the other candidates.

"Hopefully, the virtual maternity project will continue to go from strength to strength."

She explained: "Using avatars removes some of the embarrassment which can be experienced in real role play and is intended to enhance clinical practice rather than replace it.

"Part of a midwife's role is to be able to provide unbiased information to women so they can make informed choices for their journey through pregnancy and childbirth, and that means sometimes students need to alter or adapt their language depending on the situation to get the information across.

"Childbirth is a life-changing experience and some women can feel very vulnerable when they are in hospital so much so that it can affect their labour. Students need to learn very quickly how to put women at ease and gain their trust."

The study, published in the Journal of the American Medical Association today (January 25), looked at the impact of mutations in these "tumour suppressor" genes, which are the strongest known genetic risk factors for both breast and ovarian cancer.

About one in ten women with invasive epithelial ovarian cancer (the most common form) have one or more of these mutations. There have been suggestions that BRCA2-related disease is linked with an improved prognosis, but the effect of BRCA1 is unclear.

Dr Kelly Bolton of the National Cancer Institute, Bethesda, Maryland, USA, and colleagues analysed the findings of 26 studies on ovarian cancer survival. This included 1,213 women with the mutations and 2,666 without.

Five-year overall survival was 36 per cent for women without the mutations, 44 per cent for those with a BRCA1 mutation, and 52 per cent with a BRCA2 mutation.

"BRCA1 and BRCA2 mutation carriers showed a more favourable survival than non-carriers," say the researchers. They calculate that the risk of death was 22 per cent lower for BRCA1 and 39 per cent lower for BRCA2.

"Our study results have potentially important implications for the clinical management of patients with epithelial ovarian cancer," they write. "Most immediately, our findings can be used by health care professionals for patient counselling regarding expected survival."

Dr Paul Pharoah of Cancer Research UK added: "Women with BRCA faults respond better than we thought to current treatments, but it's important that researchers now look at what treatment approaches work best for women without those genetic faults."

Association Between BRCA1 and BRCA2 Mutations and Survival in Women With Invasive Epithelial Ovarian Cancer. Bolton, K. L. et al. The Journal of the American Medical Association January 25 2012 Volume 307 Number 4 pp. 382-90.

The Peninsula Medical School and Oxford University, UK, were among centres that helped to identify 13 genetic regions linked to the menopause.

Researchers say the findings should also provide clues about diseases linked to the onset of the menopause, such as breast cancer and heart disease.

The 13 regions bring the total number of genetic regions linked to age of menopause to 17.

The findings, reported in Nature Genetics, come from a world-wide study of more than 50,000 women.

Other researchers included Jenny Visser, of Erasmus Medical Centre, Rotterdam the Netherlands.

Researcher Dr Anna Murray, of Exeter University, UK, said: "Menopause is a process most women go through, yet we know very little about what governs the timing of this key event in a woman's life.

"By finding out which genes control the timing of menopause we hope to be able understand why this happens very early to some women, reducing their chances of having children naturally."

Nature Genetics January 22 2012