784 c OR R E s P O N D E N c E some extent the appropriate term depends on the grammatical context in which it is used, but within this restraint many words would be syntactically correct. We therefore asked some current users of the maternity services for their views on how they would like to be addressed or referred to. The survey was carried out among 100 women (ages 15 to 40 years) attending the Antenatal Clinic at St James’s University Hospital in Leeds. Each woman was shown four separate sentences containing a blank space which could be filled in by any of the terms providedclient, consumer, matemant, mother to be, pregnant woman or patient. Within each context they were asked to indicate their strength of preference (0-10) on a linear analogue scale. The preferred term varied slightly according to context. For example, ‘mother to be’ achieved the highest mean rating (85%) in the context of an information brochure, while ‘pregnant women’ scored highest (82%) for an article in a medical journal. On the other hand, ‘consumer’ and ‘client’ scored respectively the lowest and next lowest mark in all cases. ‘Patient’ scored as intermediate in acceptability in all cases. The neologism ‘matemant’ scored fourth, irrespective of context. The unpopular terms, client, consumer and matemant, produced not only low mean scores, but also many extreme results. For example, over half of the respondents gave consumer a score of zero, irrespective of context. On the other hand, many women gave the more popular forms extremely good or bad scores. Mother to be and pregnant women each achieved mean scores exceeding 80% in the context of an information brochure or a medical article respectively. However, 2% of women gave these terms a score of zero in response to the same questions-it is impossible to please or not annoy everyone. People seem to like the slightly softer terms and dislike words reminiscent of the market--client and consumer. While prefening ‘pregnant women’ in the context of a medical article, ‘mother to be’ gets much the highest score for an information brochure. No single way of addressing or refemng to women during pregnancy wins all-round approval and the attempt to get round this with the new term, maternant, suggested to us by Mr Rupert Fawdry of Milton Keynes, found little favour.

N. Batra, Staff Grade Department of Obstetrics and Gynaecology St. James’ University Hospital Leeds LS9 7TF

British Journal of Obstetrics and Gynaecology September 1992, Vol. 99 Thomson A. (1986)Patienthood and Childbirth (Editorial). Midwifery 2, 163.

Intra-operative blood loss during elective lower segment caesarean section Dear Sir, The finding that the average blood loss at the time of the caesarean section was only 487 ml with only two cases where the loss was greater than 10oO ml (Duthie et ul. 1992) compares favourably with the mean loss of 1100 ml in previous studies. In view of this it is surprising that the authors strongly advocate that cross-matched blood should be available during an elective or emergency caesarean section. In our unit during October and November 1991,87 caesarean sections were performed, 2 1 elective and 66 emergency. Blood was crossmatched for 74 of these but in only one case was transfusion necessary, a case of placental abruption. The cost of cross-matching for caesarean section in a unit delivering 3200 mothers per year is about El 0 000. A large number of these requests are outside routine laboratory hours and can interfere with the ability to provide blood speedily for real emergencies. The fact that antenatal patients are screened late in pregnancy for atypical antibodies means that compatible blood can be provided within 1&15 minutes following an abbreviated cross-match and makes the policy of routine cross-matching hard to justify. In our unit the following recommendations have been adopted. Cross-matching for caesarean section is not routine but a serum sample should be taken from the patient to be stored in Transfusion for use if necessary. Two units of 0 Rh negative blood are kept in the Delivery Suite and would be available for dire emergencies. Blood is only cross-matched for caesarean section in selected circumstances such as suspected placental abruption, major degree of placenta praevia and for a patient with known atypical red cell antibodies. We feel that this is a cost effective policy which does not jeopardize patient care, and is in keeping with the guidelines prepared by British Committee for Standards in Haematology (Waters 1991). R. A. O’Connor Senior Registrar in Obstetrics & Gynaecology P. Skacel Consultant Huematologist

References References Bastian H. (1992) Confined, managed and delivered: the language of obstetrics. Br J Obstet Gynaecol99, 92-93. Rada R. T. ( 1986) The health care revolution: from patient to client to consumer. Psychosomatics 27,276-279.

Duthie S. J., Ghosh A,, Ng A. & Ho P. C. (1992) Intra-operative blood loss during elective lower segment caesarean section. Br J Obstet Gynuecol99,364-367. Waters A. H. (1991) Guidelines for implementation of a maximum surgical blood order schedule (letter). Clin Lab Haemat 13, 323-324.