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  1. Richard Lehmann, MRCGP, MA
  1. Department of Primary Care, University of Oxford
 Oxford, UK

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    Pregnancy has become highly medicalised over the last century, and is much safer as a result, but we are still learning how best to manage it. Until recently, most early pregnancy failure was treated surgically by curettage, but increasingly medical management has been recognised as a safe option. This is confirmed in a recent American trial (

    ) which found that women given intravaginal misoprostol rarely needed further intervention although they experienced more bleeding. Their curettage rate of 3% contrasts with 30–40% of medically managed miscarriages in a large British trial (MIST:
    ) . Large changes in prenatal diagnosis are also afoot, now that techniques have been developed to isolate fetal DNA from cells circulating in maternal blood. Soon it may be possible to base rhesus factor prophylaxis on non-invasive RhDgenotyping, but a meta-analysis of current studies (
    ) shows that diagnostic accuracy is still often less than 100%. Preterm labour remains the greatest threat to neonatal wellbeing, and the finding …

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