{'fraction_non_alphanumeric': 0.012507817385866166, 'fraction_numerical': 0.0300187617260788, 'mean_word_length': 4.904059040590406, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Comment: Anatomy of complications workshop: An educational strategy to improve performance in obstetricians and gynaecologists 
 1

I was pleased to see Grace and Vurobaravu’s manuscript of the largest published series of labour floor data collected from any Pacific island nation. I was disappointed, however, to see that they erroneously attributed the dramatic rise in Caesarean section rates in 1994 to the introduction of ultrasound. It is incorrect to state that ‘obstetric ultrasound first became available at VCH in 1994’. I was the resident specialist obstetrician in Vanuatu during 1992 and 1993 and during this time I was performing obstetric ultrasound scans on a regular basis whenever I thought it was necessary. Thus it is difficult to explain how ultrasound could have led to an appreciable increase in the Caesarean section rate in 1994. The only major change in obstetric services in 1994 was that following my departure at the end of 1993, the position of the only specialist obstetrician for Vanuatu remained unfilled for more than 1 year. I think that this provides a more plausible explanation for the rise in Caesarean sections and strongly disagree with their statement that ‘the absence of a specialist obstetrician made no difference to the rate of Caesarean sections’. I suggest that their data support the opposite view. I know that at the same time the perinatal mortality rate increased from 29 to 30 per thousand in 1992–1993 to 35 per thousand in 1994 and it would be very interesting to know whether there was any concomitant increase in the maternal mortality rate.