275 Letters 2008;10:275–278 10.1576/toag.10.4.275.27447 www.rcog.org.uk/togonline The Obstetrician & Gynaecologist © 2008 Royal College of Obstetricians and Gynaecologists ‘Accoucheur’—a misnomer? Dear Sir In the April edition of TOG, Professor James Drife correctly noted 1 that the word ‘accoucheur’— derived from the French—is used in Russian but he was incorrect when he further stated that there is a single word in Russian for both the professions of ‘midwife’and ‘obstetrician’. Sorry to be so pendantic but, as my Russian obstetrician wife informs me, in Russian, nouns are either male or female. Under the assumption that obstetricians are always men, the male version ‘accoucheur’ is used for all obstetricians (so far, virtually always ‘accoucheur-gynaecolog’), even if the obstetrician/gynaecologist is a woman; the female version,‘accoucherka’ is used for all midwives—again, regardless of their gender. Rupert DS Fawdry LMCC FRCS(ED) FRCOG Consultant Specialist in Maternity Care, Gynaecology and Medical IT Website: www.fawdry.info Email: rupert@fawdry.demon.co.uk References 1 Drife J. Author’s reply. [Letter.] The Obstetrician & Gynaecologist 2008; 10:125. doi:10.1576/toag.10.2.125.27403 Author’s reply Dear Sir I am grateful to Mr Fawdry for clarifying the difference between ‘accoucheur’ and ‘accoucherka’—a nuance that escaped the various interpreters on my visits to Eastern Europe and the former Soviet Union over the last few years. On those visits, almost all the obstetricians I met were female, so no wonder we were confused. James Drife MD FRCOG FRCPED FRCSED HonFCOGSA Department of Paediatrics, Obstetrics and Gynaecology, Leeds General Infirmary, Leeds, UK Email: j.o.drife@leeds.ac.uk Postpartum voiding dysfunction Dear Sir I read the article on postpartum voiding dysfunction with great interest. 1 It was a very useful work on a common problem encountered in the labour ward. I felt another important issue worth stressing in the management of voiding dysfunction is identifying occult haematoma that is causing retention without any obvious symptoms other than retention. While most perineal haematomas present with pain and swelling, supralevator haematomas may not present with swelling. A vaginal examination is important in all cases of retention to identify paravaginal haematomas but supralevator haematomas could still be missed (also, we shouldn’t forget anecdotal references of retained swabs causing retention). Another benefit of ultrasound examination, in addition to measuring residual urine, is identifying pelvic haematomas. 2 The other issue I felt worth mentioning is the risk of sudden decompression of an overdistended bladder (up to 1500 ml). Even though the risks of sudden decompression, such as haematuria, are common with chronic retention, problems have been reported with acute retention. I believe an interrupted slow release would be safer in these cases. 3 Sivarajasingam Navaneethan MS MRCOG Consultant Obstetrician and Gynaecologist Griffith Base Hospital, Griffith, New South Wales, Australia Email: snava5@hotmail.com References 1 Kearney R, Cutner A. Postpartum voiding dysfunction. The Obstetrician & Gynaecologist 2008;10:71–4. doi:10.1576/toag.10.2.071.27393 2 Melody GF. Paravaginal hematomas; theirrecognition and management postpartum. Calif Med 1955;82:16–8. 3 Haydar AA, Hujairi NM, Quateen A, Hatoum T, Goldsmith DJ. Massive bilateral perirenal hematoma following urinary catheterization for urinary obstruction. Int J Urol 2004;11;663–5. doi:10.1111/j.1442-2042.2004.00856.x Authors’ reply Dear Sir We would like to thank Dr Navaneethan for his comments regarding the possibility of a supralevator haematoma contributing to the development of postpartum urinary retention. This may indeed be a contributing factor and is easily identified on ultrasound. With regard to ‘interrupted slow release’versus immediate drainage of urinary retention, we are unaware of any evidence to support slow interrupted drainage in the postpartum woman. Although haematuria and hypotension have been reported, these are rarely of clinical significance. 1 Rohna Kearney MD MRCOG MRCPI Consultant Gynaecologist and Subspecialist in Urogynaecology Department of Urogynaecology and Pelvic Floor Reconstructive Surgery,Addenbrooke’s Hospital, Cambridge, UK Email: rkearney@doctors.org.uk Letters and emails Please note that letters and emails to the Editor should be no more than 500 words with a maximum of five references