Clinical Pearls: Obstetrics.

Meyer's Law, a corollary to Murphy's Law, states that "it is a simple task to make things complex but a complex task to make them simple." Murphy's Law and its corollaries are meant to be humorous, but they often describe remarkably useful concepts. The best clinical pearls follow Meyer's Law--not Murphy's. Thanks to all the readers who take the time and effort to share your precious pearls of wisdom.

* 'Half the dose, twice as often.'

For reasons that are not entirely clear, the national shortage of betamethasone (Celestone) continues. The FDA Web site that discusses drug shortages (www.fda.gov/cder/drug/shortages/#current) lists "manufacturing issues" as the problem. In any case, the next time you order betamethasone for a patient in premature labor, you may get a call from the pharmacist explaining that your hospital is out. If you get the call at 3 a.m., you may be awake enough to remember that dexamethasone is an alternative but not alert enough to recall the dosage.

Dr. Mark Bernhardt, one of my clever colleagues, has a simple solution: Just give "half the dose, twice as often." Since the usual betamethasone dose is 12 mg q 24 hours IM for two doses, the dexamethasone dose is 6 mg q 12 hour IM for four doses.

* A tip for twins (and other multiples).

Twins and higher order multiples can be wonderful, but pregnancy complications are common and the problems don't necessarily end when the babies are born.

Ob.Gyn. News editor Kathy Scarbeck speaks from personal experience when she recommends that you direct patients with multiple gestation to a multiples support group. These groups are invaluable for connecting parents with similar ...