Panel seeks accountability after Benghazi attacks


WASHINGTON (Reuters) - After a car bomb struck the U.S. ambassador's residence in Lima in 1992, the State Department convened a special panel to answer the same questions now hovering over a review of the September attacks in Benghazi, Libya: How much security is enough? What is the right role for U.S. diplomats?


The Lima panel, known as an Accountability Review Board, issued a final report "that didn't find anybody had been delinquent," former U.S. Ambassador to Peru Anthony Quainton said. That report was never made public.


Whether the report by the Benghazi Accountability Review Board, expected to be completed in mid-December, comes to the same conclusion could affect the arc of a controversy that has seen the Obama White House subjected to withering criticism over security arrangements in Libya and the administration's shifting explanations of the violence.


The attacks on the diplomatic mission and a nearby CIA annex in Benghazi, in eastern Libya, killed U.S. Ambassador Christopher Stevens and three other Americans, and raised questions about the adequacy of security in far-flung posts.


The panel, led by veteran diplomatic heavyweight Thomas Pickering, is expected to consider whether enough attention was given to potential threats and how Washington responded to security requests from U.S. diplomats in Libya.


A determination that top State Department officials turned down those requests, as Republican congressional investigators allege, could refuel criticism - and possibly even end some officials' careers.


Also in the balance is the future of funding for embassy security and of a policy, known as "expeditionary diplomacy," under which envoys deploy to conflict zones more often than in the past.


Central questions raised after the Benghazi attack include why the ambassador was in such an unstable part of Libya on the anniversary of the September 11 attacks.


The board, which meets at the State Department, could determine whether security was at fault or whether Stevens and the State Department emphasized building ties with the local community at the expense of security concerns in a hostile zone.


Secretary of State Hillary Clinton has pledged to make some of the report's findings public.


NO. 19


Benghazi is the 19th accountability review board convened by the State Department since 1988 to investigate attacks on U.S. diplomatic facilities. Until now, only the report on the deadly 1998 bombings of U.S. embassies in Kenya and Tanzania has been made public.


Attacks in Pakistan and Iraq triggered the most review boards - three each - followed by Saudi Arabia with two. In addition to Kenya and Tanzania, there was one each for violence in Peru, Honduras, Greece, the Philippines, Bolivia, Jordan, Gaza, and Sudan.


The five-person independent board usually includes retired ambassadors, a former CIA officer and a member of the private sector. It has the power to issue subpoenas, and members are required to have appropriate security clearances to review classified information.


"The board is meeting and is hard at work. We have decided to keep the deliberations confidential to preserve the integrity and objectivity of the board's work in accordance with the statute providing for its activity," Pickering said in a statement.


ARBs, as they are known, are not expected to take cookie-cutter approaches but to review issues specific to each diplomatic post.


"In the case of Lima, the issue that arose above all those other issues was what was the purpose of the attack? I guess this is also a Benghazi question," Quainton said.


"Was it an attempt to assassinate the ambassador - meaning me - or was it an attack on one of the official symbols of U.S. power flying the U.S. flag, the ambassador's residence in my case, and the consulate in Benghazi. And that is partly a question of intelligence," he said.


Quainton added that he "happily was some distance away" at the time of the Lima attack, which killed three Peruvian policemen. Stevens by contrast was in the lightly defended Benghazi post, became separated from his security men, and died of apparent smoke inhalation.


FIXING PROBLEMS OR ASSIGNING BLAME?


The Africa accountability boards did not single out any U.S. government employee as culpable, but found "an institutional failure of the Department of State and embassies under its direction to recognize threats posed by transnational terrorism and vehicle bombs worldwide."


The report recommended improving security and crisis management systems and procedures.


Philip Wilcox, a member of the Nairobi board, said the State Department took its recommendations to heart.


"Security is never something that can be absolutely achieved. And to provide absolute security for American embassies and American diplomats abroad would be to shut down our overseas operations," said Wilcox, now president of the Foundation for Middle East Peace.


"There is no way to enable diplomats to do their work, to meet with foreign officials, foreign citizens, to move around the country, with total security," he said.


Lawmakers and administration officials have praised Stevens for being the type of diplomat who ventured out to meet with Libyans of all walks of life.


The job, diplomats say, is always a balancing act between trying to forge local ties and heeding security concerns.


One former U.S. diplomat, who would speak only on the condition of anonymity, said the underlying concept of accountability review boards from the beginning was a belief that it had to be somebody's fault and to assign blame.


But Wilcox sees value in the process.


"As a result of the accountability review board that I served on, more money was appropriated, a great many steps were taken to fulfill the recommendations in the report," he said. "So it's not true these are vain, useless exercises."


(Editing by Warren Strobel and Mohammad Zargham)



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Golf: Rose, Scott to face off at Australian Open






SYDNEY: England's Justin Rose and Adam Scott of Australia will face off in a pairing in the opening two rounds of the Australian Open, teeing off at The Lakes in Sydney on Thursday.

Rose and Scott are the top drawcards at the A$1.25 million ($1.3 million) tournament but the spotlight will also be on Chinese teen sensation Guan Tianlang - the youngest player ever to qualify for the US Masters.

World number four Rose, who finished second behind top-ranked Rory McIlroy at last month's World Tour Championship in Dubai, will play the opening 36 holes alongside Scott, seventh in the rankings.

"It is a great draw for me. I regard Adam as one of my best friends out on Tour," Rose said on Wednesday.

"The great thing is that you play the golf course. You are not really eye-to-eye or head-to-head, especially on days one and two."

Scott beat England's Ian Poulter by four shots at Melbourne's Kingston Heath last month to win the Australian Masters for the first time, saying it made up "in a small way" for his capitulation at this year's British Open, when he blew a four-shot lead over the last four holes at Royal Lytham.

The top-ranked Australian said he will probably use his broomstick putter as he chases a second Australian Open crown at the event, co-sanctioned by the PGA Tour of Australasia and OneAsia.

Scott played his practice round at The Lakes on Tuesday without his trusty long putter.

"I'll probably putt with the long putter," he said on Wednesday.

"The other one I was messing around with was my first go and it's not quite what I wanted. It is not quite set up right for me.

"I'll have another go at another time if I feel I need to."

World golf's two law-making bodies, the R&A and USGA, have proposed to outlaw "anchored" putting, where the club is pivoted by a player's belly or chest, by 2016.

Chinese phenomenon Guan, 14, plans to use the Australian experience as preparation for his appearance at the US Masters in April.

"I think (it will be good preparation for the Masters) because it's a pretty big tournament," said Guan, who won last month's Asia-Pacific Amateur Championship.

"To play with some of the world's greatest players, I want to enjoy everything about it - the course and all the stuff they do. Just get to know all about it," he added.

Tom Watson, the eight-time Major winner who is also playing in Sydney, said there was a chance that Guan would not fulfil his potential although he did not think that would be the case.

"This young man has been cultured into golf. I've read some of his history. Golf is his life. We have seen a lot of golf prodigies, many of whom did not make it. Is there a danger of that? Yes, there is.

"But if I had that chance at 14, I'd jump at it. I'd be at Augusta quicker than you could spit."

Australian left-hander Greg Chalmers is defending his Australian Open title.

- AFP/de



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DA case: Jagan Reddy's judicial remand extended till Dec 19

HYDERABAD: A special CBI court here on Wednesday extended till December 19 the judicial remand of YSR Congress Party president Y S Jaganmohan Reddy and other accused in connection with the alleged disproportionate assets case involving him.

Jaganmohan Reddy, arrested by CBI on corruption charges and presently lodged in Chanchalguda prison here, was produced under heavy security before the First Additional Special Judge for CBI cases, along with former AP minister Mopidevi Venkata Ramana Rao, industrialist Nimmagadda Prasad and others.

The court extended their judicial custody by another fourteen days.

AP minister Dhramana Prasad Rao, who is also an accused in the case, appeared before the court.

The CBI court had yesterday dismissed the bail application of Jaganmohan Reddy. He has moved another bail plea in the Andhra Pradesh High Court, which will come up for hearing on December 11.

In another development, the court extended the judicial remand of former Karnataka minister Gali Janardhan Reddy, his brother-in-law B V Srinivas Reddy and another accused Mehfuz Ali Khan in the illegal mining case involving Obulapuram Mining Company (OMC) till December 19.

The court also extended the judicial remand of some of the accused, including Sunil Reddy, in the Emaar scandal.

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Study: Drug coverage to vary under health law


WASHINGTON (AP) — A new study says basic prescription drug coverage could vary dramatically from state to state under President Barack Obama's health care overhaul.


That's because states get to set benefits for private health plans that will be offered starting in 2014 through new insurance exchanges.


The study out Tuesday from the market analysis firm Avalere Health found that some states will require coverage of virtually all FDA-approved drugs, while others will only require coverage of about half of medications.


Consumers will still have access to essential medications, but some may not have as much choice.


Connecticut, Virginia and Arizona will be among the states with the most generous coverage, while California, Minnesota and North Carolina will be among states with the most limited.


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Online:


Avalere Health: http://tinyurl.com/d3b3hfv


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Subway Push Murder Suspect Implicated Self: Police













A suspect believed to be responsible for throwing a man into the path of an oncoming New York City subway train who was taken into custody today has made statements implicating himself, police said.


According to Deputy Commissioner for Public Information Paul Browne, the suspect has been questioned by police since at least early afternoon and while the suspect is in police custody, he has not been officially charged.


Police are continuing to question the suspect and more lineups have been scheduled for tomorrow, Browne said.


Police have not released the suspect's name but began questioning him Tuesday afternoon about the death of Ki-Suck Han, 58, of Queens, N.Y.


Han was tossed onto the subway track at 49th Street and Seventh Avenue around 12:30 p.m. Monday after Han confronted a mumbling man who was alarming other passengers on the train platform. Han tried to scramble back onto the platform, but was crushed by an oncoming train.


The suspect fled the station, prompting a police dragnet for a man described by witnesses and see on surveillance video as a 6-foot-tall, 200-pound black man wearing dreadlocks in his hair.


Witnesses tried to revive the victim after he was hit and provided descriptions of the suspect to police.


Dr. Laura Kaplan, medical resident at Beth Israel Medical Center who was standing on the platform during the incident rushed to give Han aid after he was hit, she said in a statement released by her medical practice today.






New York Police Department













Bystanders Pull Mom, Son From Subway Tracks Watch Video







"A security guard and I performed 3-4 minutes of chest compressions. I hope the family may find some comfort in knowing about the kindness of these good Samaritans, as they endure this terrible loss," Kaplan said.


"I would like the family to know that many people in the station tried to help Mr. Han by alerting the subway personnel," she said.


Kaplan said she wanted to console the family of Han, who she called "a brave man trying to protect other passengers that he did not know."


The suspect had reportedly been mumbling to himself and disturbing other passengers, according to ABC News affiliate WABC. Police told WABC that the suspect could be mentally disturbed.


The suspect could be heard arguing with Han just moments before he hurled Han onto the track bed, according to surveillance video released by the police. The suspect is heard telling the victim to stand in line and "wait for the R train."


A freelance photographer for the New York Post was on the platform and said he ran towards the train flashing his camera hoping to alert the train to stop in time, but the train caught Han against the shoulder deep platform wall.


The photographer, R. Umar Abbasi, caught an eerie photo of Han with his head and arms above the platform and staring at the oncoming train.


Han was treated by EMS workers on the platform for traumatic arrest and rushed to Roosevelt Hospital, where he was pronounced dead, according to the Fire Department of New York.


"I just heard people yelling. The train came to an abrupt stop about three-quarters into the station and that's when I heard a man was hit by a train," Patrick Gomez told ABC News affiliate WABC.


Police set up a command post outside the train station Monday night searching nearby surveillance cameras to try and get a clear image of the suspect, reports WABC. They said Tuesday that the investigation is ongoing.


Anyone with information is asked to call Crime Stoppers at 1-800-577-TIPS (8477). The public can also submit tips by logging onto the Crime Stoppers website at www.nypdcrimestoppers.com or by texting their tips to 274637 (CRIMES) then enter TIP577. All calls are strictly confidential.



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Israel says will stick with settlement plan despite condemnation

JERUSALEM (Reuters) - Israel rejected concerted criticism from the United States and Europe on Monday over Prime Minister Benjamin Netanyahu's decision to expand settlement building after the United Nations' de facto recognition of Palestinian statehood.


Washington urged Israel to reconsider its plan to erect 3,000 more homes in the occupied West Bank and East Jerusalem, saying the move hindered peace efforts with the Palestinians.


Britain, France, Spain, Sweden and Denmark summoned the Israeli ambassadors in their capitals to give similar messages.


An official in Netanyahu's office said Israel would not bend. "Israel will continue to stand by its vital interests, even in the face of international pressure, and there will be no change in the decision that was made," the official said.


Angered by the U.N. General Assembly's upgrading on Thursday of the Palestinians' status in the world body from "observer entity" to "non-member state", Israel said the next day it would build the new dwellings for settlers.


Such projects, on land Israel captured in a 1967 war, are considered illegal by most world powers and have routinely drawn condemnation from them. Approximately 500,000 Israelis and 2.5 million Palestinians live in the two areas.


In a shift that raised the alarm among Palestinians and in world capitals, Netanyahu's pro-settler government also ordered "preliminary zoning and planning work" for thousands of housing units in areas including the "E1" zone east of Jerusalem.


Such construction in the barren hills of E1 has never been put into motion in the face of opposition from Israel's main ally, the United States. Building in the area could bisect the West Bank, cut off Palestinians from Jerusalem and further dim their hopes for a contiguous state.


Israeli television stations reported Jerusalem's district planning commission would soon approve plans for several thousand more housing units, including more than 1,000 Israel had shelved two years ago after angering Washington by publishing the plans before a visit by Vice President Joe Biden.


The settlement plan, U.N. Secretary-General Ban Ki-moon said, would deal "an almost fatal blow" to a two-state solution to the Israeli-Palestinian conflict.


French President Francois Hollande said he was "extremely concerned" and Washington made clear it would not back such Israeli retaliation over the U.N. vote, sought by Palestinians after peace talks collapsed in 2010 over settlement building.


"We urge Israeli leaders to reconsider these unilateral decisions and exercise restraint as these actions are counterproductive and make it harder to resume direct negotiations to achieve a two state solution," White House spokesman Jay Carney told a briefing.


Ahead of a Netanyahu visit this week, Germany, considered Israel's closest ally in Europe, urged it to refrain from expanding settlements, and Russia said it viewed the Israeli moves with serious concern.


RETALIATION


Israeli Finance Minister Yuval Steinitz said Israel could not have remained indifferent to the Palestinians' unilateral move at the United Nations.


"I want to tell you that those same Europeans and Americans who are now telling us 'naughty, naughty' over our response, understand full-well that we have to respond, and they themselves warned the Palestinian Authority," he said.


Palestinian chief negotiator Saeb Erekat said building in E1 "destroys the two-state solution, (establishing) East Jerusalem as the capital of Palestine and practically ends the peace process and any opportunity to talk about negotiations in the future".


The United States, one of the eight countries to vote alongside Israel against the Palestinian resolution at the General Assembly, has said both were counterproductive to the resumption of direct peace talks.


In Europe, only the Czech Republic voted against the status upgrade while many countries, including France, backed it. Netanyahu plans to visit Prague this week to express his thanks.


In the Gaza Strip, Sami Abu Zuhri, spokesman for the governing Hamas Islamist movement, called the settlements "an insult to the international community, which should bear responsibility for Israeli violations and attacks on Palestinians".


Israeli police arrested three Jewish settlers on Monday whom they suspect of arson and other crimes against Palestinian property in the West Bank, including the torching of a car.


Attackers have often proclaimed they are exacting a "price tag" for steps taken against the settler movement by Palestinians, or by the Israeli government.


Alongside the settlement plans, Israel announced it would withhold about $100 million in Palestinian tax revenues from the Palestinian Authority, which exercises limited self-rule in the West Bank, saying Palestinians owed $200 million to Israeli firms.


"These are not steps towards peace, these are steps towards the extension of the conflict," Spanish Foreign Minister Jose Manuel Garcia-Margallo said.


Only three weeks ago, Netanyahu won strong European and U.S. support for a Gaza offensive that Israel said was aimed at curbing persistent cross-border rocket fire.


Favored by opinion polls to win a January 22 national election, he brushed off the condemnation and complaints at home that he is deepening Israel's diplomatic isolation.


Netanyahu told his cabinet on Sunday that his government "will carry on building in Jerusalem and in all the places on the map of Israel's strategic interests".


But while his housing minister has said the government would soon invite bids from contractors to build 1,000 homes for Israelis in East Jerusalem and more than 1,000 in West Bank settlement blocs, the E1 plan is still in its planning stages.


"No one will build until it is clear what will be done there," the minister, Ariel Attias, said on Sunday.


Israel froze much of its activities in E1 under pressure from former U.S. President George W. Bush, and the area has been under the scrutiny of his successor, Barack Obama.


Israel cites historical and Biblical links to the West Bank and Jerusalem and regards all of the holy city as its capital, a claim that is not recognized internationally.


(Additional reporting by Crispian Balmer, Dan Williams, Nidal al-Mughrabi in Gaza, Jihan Abdalla in Ramallah, Steve Gutterman in Moscow, Gareth Jones in Berlin, John Irish and Elizabeth Pineau in Paris and Tim Castle in London; writing by Jeffrey Heller; editing by Philippa Fletcher)


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Indian retail reforms face parliament debate






NEW DELHI: The Indian government on Tuesday braced itself for a test of strength as parliament debated reforms ahead of a vote on allowing in foreign supermarkets, a policy that has revitalised opposition parties.

The Congress-led government believes it has the numbers to win a vote in the lower house expected on Wednesday, and hopes that victory will enable it to push ahead with further reforms to tackle the slowing economy.

Parliament was deadlocked for days during the current winter session as opposition lawmakers held noisy protests demanding a vote on the retail policy. The government conceded even though the reform requires only cabinet approval and has already been declared law.

Supporters of the arrival of chains such as Walmart, Tesco and Carrefour say it could revolutionise shopping in India, with consumers shifting to large supermarkets, and improve India's antiquated food-supply chain.

But the decision has been attacked by the opposition as a sellout to foreigners that will force family-owned stores, which currently dominate India's retail landscape, to shut.

The Congress-led coalition lost its majority in September when a regional ally exited the government over the policy.

Although the non-binding vote will not affect the government's ability to enact the policy, Prime Minister Manmohan Singh would suffer a major public setback if it fails to win enough support from lawmakers.

Indian media on Tuesday reported that Congress should win the vote in the lower house, but would rely on support from regional parties to win a vote in the upper house expected on Friday.

"We are confident of the numbers," parliamentary affairs minister Kamal Nath told reporters. "I urge all parties to reject the politics of it and vote against the politics in the house."

Singh's push for pro-market reforms comes as the government faces a sharply slowing economy, a gaping fiscal deficit and high inflation, which has stoked pressure on the left-leaning alliance.

The media has dubbed the reforms push a second "big bang" following Singh's efforts when he was finance minister to begin opening India's economy to the world two decades ago.

While the retail decision did not require a parliamentary vote to become law, the government's other proposals to open up the insurance and pensions markets to wider foreign investment will need lawmakers' approval.

- AFP/de



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Uproar in Parliament over Gujarat gas deal

NEW DELHI: With Gujarat in the midst of polls, chief minister Narendra Modi was on Tuesday brought into a controversy by agitated Congress members in Parliament who created uproar over a news report alleging irregularities in a gas deal by the state government.

The Lok Sabha and the Rajya Sabha saw Congress members waving copies of an article in a news magazine with the headline: "Sweet deals are made of gas" and raising slogans against Modi from the aisle, with some even threatening to troop into the Well.

The article spoke of a "dubious" company registered in Barbados enjoying a windfall of Rs 20,000 crore at the cost of Gujarat tax-payers in the wake of an agreement inked under Modi's watch.

The Lok Sabha was adjourned till 1230 hours and the Rajya Sabha till 1400 hours.

BJP members were on their feet protesting against the Congress action but were dissuaded by their leaders including L K Advani who asked them not to raise counter-slogans and maintain restraint.

The Congress had on Monday demanded an answer from Modi over a report alleging that his government gave a foreign company stake in a gas exploration project virtually for nothing.

It said the Barbados-based company did not pay a single penny for the 10 per cent stake given to it by the Gujarat government.

Noting that the story in the news magazine raised certain questions, which Gujarat government and especially the chief minister must answer, the Congress had asked, "Who is the beneficiary?"

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Fossil fuel subsidies in focus at climate talks

DOHA, Qatar (AP) — Hassan al-Kubaisi considers it a gift from above that drivers in oil- and gas-rich Qatar only have to pay $1 per gallon at the pump.

"Thank God that our country is an oil producer and the price of gasoline is one of the lowest," al-Kubaisi said, filling up his Toyota Land Cruiser at a gas station in Doha. "God has given us a blessing."

To those looking for a global response to climate change, it's more like a curse.

Qatar — the host of U.N. climate talks that entered their final week Monday — is among dozens of countries that keep gas prices artificially low through subsidies that exceeded $500 billion globally last year. Renewable energy worldwide received six times less support — an imbalance that is just starting to earn attention in the divisive negotiations on curbing the carbon emissions blamed for heating the planet.

"We need to stop funding the problem, and start funding the solution," said Steve Kretzmann, of Oil Change International, an advocacy group for clean energy.

His group presented research Monday showing that in addition to the fuel subsidies in developing countries, rich nations in 2011 gave more than $58 billion in tax breaks and other production subsidies to the fossil fuel industry. The U.S. figure was $13 billion.

The Paris-based Organization for Economic Cooperation and Development has calculated that removing fossil fuel subsidies could reduce carbon emissions by more than 10 percent by 2050.

Yet the argument is just recently gaining traction in climate negotiations, which in two decades have failed to halt the rising temperatures that are melting Arctic ice, raising sea levels and shifting weather patterns with impacts on droughts and floods.

In Doha, the talks have been slowed by wrangling over financial aid to help poor countries cope with global warming and how to divide carbon emissions rights until 2020 when a new planned climate treaty is supposed to enter force. Calls are now intensifying to include fossil fuel subsidies as a key part of the discussion.

"I think it is manifestly clear ... that this is a massive missing piece of the climate change jigsaw puzzle," said Tim Groser, New Zealand's minister for climate change.

He is spearheading an initiative backed by Scandinavian countries and some developing countries to put fuel subsidies on the agenda in various forums, citing the U.N. talks as a "natural home" for the debate.

The G-20 called for their elimination in 2009, and the issue also came up at the U.N. earth summit in Rio de Janeiro earlier this year. Frustrated that not much has happened since, European Union climate commissioner Connie Hedegaard said Monday she planned to raise the issue with environment ministers on the sidelines of the talks in Doha.

Many developing countries are positive toward phasing out fossil fuel subsidies, not just to protect the climate but to balance budgets. Subsidies introduced as a form of welfare benefit decades ago have become an increasing burden to many countries as oil prices soar.

"We are reviewing the subsidy periodically in the context of the total economy for Qatar," the tiny Persian gulf country's energy minister, Mohammed bin Saleh al-Sada, told reporters Monday.

Qatar's National Development Strategy 2011-2016 states it more bluntly, saying fuel subsides are "at odds with the aspirations" and sustainability objectives of the wealthy emirate.

The problem is that getting rid of them comes with a heavy political price.

When Jordan raised fuel prices last month, angry crowds poured into the streets, torching police cars, government offices and private banks in the most sustained protests to hit the country since the start of the Arab unrest. One person was killed and 75 others were injured in the violence.

Nigeria, Indonesia, India and Sudan have also seen violent protests this year as governments tried to bring fuel prices closer to market rates.

Iran has used a phased approach to lift fuel subsidies over the past several years, but its pump prices remain among the cheapest in the world.

"People perceive it as something that the government is taking away from them," said Kretzmann. "The trick is we need to do it in a way that doesn't harm the poor."

The International Energy Agency found in 2010 that fuel subsidies are not an effective measure against poverty because only 8 percent of such subsidies reached the bottom 20 percent of income earners.

The IEA, which only looked at consumption subsidies, this year said they "remain most prevalent in the Middle East and North Africa, where momentum toward their reform appears to have been lost."

In the U.S., environmental groups say fossil fuel subsidies include tax breaks, the foreign tax credit and the credit for production of nonconventional fuels.

Industry groups, like the Independent Petroleum Association of America, are against removing such support, saying that would harm smaller companies, rather than the big oil giants.

In Doha, Mohammed Adow, a climate activist with Christian Aid, called all fuel subsidies "reckless and dangerous," but described removing subsidies on the production side as "low-hanging fruit" for governments if they are serious about dealing with climate change.

"It's going to oil and coal companies that don't need it in the first place," he said.

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Associated Press writers Abdullah Rebhy in Doha, Qatar, and Brian Murphy in Dubai, United Arab Emirates, contributed to this report

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Karl Ritter can be reached at www.twitter.com/karl_ritter

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Kate's Illness Sometimes Linked to Twins













Hyperemesis gravidarum, the reason newly pregnant Kate Middleton is in the hospital, is a rare but acute morning sickness that results in weight loss and accounts for about 2 percent of all morning sickness, doctors say.


The condition is sometimes associated with women having twins, experts said.


Women diagnosed with hyperemesis gravidarum have lost 5 percent of their pre-pregnancy weight, or 10 pounds, said Dr. Ashley Roman, a professor and OB/GYN at New York University Langone Medical Center.


It poses little danger to the tiny heir, doctors said.


"It's traditionally thought that nausea and vomiting is a sign of a healthy pregnancy," Roman said


Dr. Nancy Cossler, an OB/GYN at University Hospitals in Ohio said the condition does not cause loss of pregnancy or birth defects, but it can be a torture to endure.


"The biggest problem with this is how it interferes with your life," Cossler said. "Constantly feeling sick and puking is difficult."


Click here to read about other women with hyperemesis gravidarum.


Hyperemesis gravidarum is thought to be caused by higher levels of the pregnancy hormone, hCG, or human chorionic gonadotropin, Cossler said. Extra hCG can often be brought on by carrying more than one fetus, she said.






Chris Jackson/AFP/Getty Images











Kate Middleton Pregnant, Admitted to Hospital Watch Video









Kate Middleton, Prince William Expecting Their First Child Watch Video









Prince William and Kate Middleton's Big News Watch Video





In other words, it could be a sign that Middleton is carrying twins. Although there's very little data on twins and hyperemesis gravidarum, one study showed that women carrying twins had a 7.5 percent higher risk of experiencing the acute morning sickness, Roman said.


The extreme morning sickness is usually diagnosed about nine weeks into the pregnancy, and in most cases resolves itself by 16 or 20 weeks, Roman said. In rare cases, it can last the whole pregnancy.


"As the pregnancy is in its very early stages, Her Royal Highness is expected to stay in hospital for several days and will require a period of rest thereafter," a statement from St. James Palace said. Prince William is at the hospital with Middleton, according to the Britain's Press Association.


Click here for photos of Kate through the years.


Roman said doctors prescribe vitamins and ginger capsules at first. If that doesn't stop the vomiting, they will prescribe antihistamines and stronger anti-nausea medications.


Women with hyperemesis gravidarum are also treated with fluids, said Dr. Jessica Young, an OB/GYN at Vanderbilt University. But if left untreated, a pregnant woman who is severely dehydrated for a long period of time could die, "just like any person," Young said.


In extreme cases in which the woman is losing weight and unable to eat, doctors will treat her with intravenous nutrition, Young said.


Hospital stays can vary, and women will often have to be admitted more than once before the condition passes, doctors said.


Hyperemesis gravidarum is somewhat mysterious because some expectant mothers have acute morning sickness during only one of their pregnancies, but have no morning sickness for subsequent pregnancies.


There is a chance that higher levels of hCG, which likely caused Middleton's nausea, could be a sign of a molar pregnancy instead of twins, Cossler said. This would mean Middleton is carrying only a benign growth in her uterus instead of a fetus, or she is carrying a fetus with abnormal DNA and a benign growth. Neither is considered a viable pregnancy.


However, Cossler said molar pregnancies become apparent early on, and doctors would already know whether Middleton had one.


"They would not have released this information," Cossler said of the birth announcement. "I'm certain that they have already eliminated both of those [types of molar pregnancies]."



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