bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effects of Danazol After Endometrial Resection: Results of a randomized, placebo‐controlled, double‐blind study
Authors: Erian M.M. , Thomas I.L. , Buck R.J. , Lewin M.W. , Coglan M. , Battistutta D.
Published: February 2008

Summary: We report the results of a controlled, randomized, prospective, ‘double blind’ evaluation of the effect of danazol treatment in 120 patients after hysteroscopic endometrial resection. After endometrial resection, the women were allocated to 1 of 3 groups: Group A—placebo; Group B—high‐dose danazol (600 mg daily); Group C—low‐dose danazol (200 mg daily) plus placebo tablets. Tablets were specifically manufactured for the study, were identical in appearance, and were supplied in individual prepackaged boxes. The duration of treatment was 3 months and patients' compliance was noted. Amenorrhoea, dysmenorrhoea and premenstrual tension symptoms were assessed for each group by 1 or 2 independent gynaecologists at follow‐up intervals of 6 weeks, 3, 6 and 12 months. A statistically‐significant increased rate of amenorrhoea was found in patients who received treatment with the higher‐dose danazol (600 mg day) following endometrial resection. While not statistically significant, the same trend was noted with the low‐dose danazol. This result should influence our clinical management of women with menorrhagia, and the long‐term results on the same cohort of patients are awaited with interest.
Microlaparoscopy for Suspected Pelvic Pathology A comparison of 2mm versus 10mm laparoscope
Authors: Evans Susan F. , Petrucco Oswald M.
Published: February 2008

Summary: This study presents an independently‐assessed comparison of the laparoscopic view obtained using a 2mm versus 10mm laparoscope in women with suspected pelvic pathology. Fifteen female volunteers booked for laparoscopy with clinical evidence of pelvic abnormality according to clinical findings and/or pelvic ultrasound were recruited for this study. Sequential observations were carried out by independent observers for clinically significant differences. Although discrepancies were noted in 3 patients the view obtained with the 2mm microendoscope was considered to be comparable to that obtained with the 10mm telescope. The cases with discordant findings included mild or minimal endometriosis and distal tubal disease. The results of this study suggest that microendoscopy is likely to be entirely adequate for many routine laparoscopic procedures and sterilization.
Fetal Brain Death Syndrome: A Case Report and Literature Review
Authors: James Susan J.
Published: February 2008

Summary: This case describes a new feature of fetal brain death syndrome, abnormal movements mimicking fetal convulsions being subsequently found to be decerebrate hypertonicity in a brain‐dead fetus. It also confirms the diagnostic criteria of fetal brain death, both clinical and ultrasonic. The development of polyhydramnios both prior to and after the presumed neurological event is suggested as an association with the diagnosis of fetal brain death. Increased awareness of this event and the heterogeneity of the presentation may prevent further unnecessary Caesarean sections, as to date only 4 of the 10 cases in the literature were diagnosed prenatally. Utilization of techniques such as fetal blood sampling should be considered to further delineate the diagnosis.
Thyroxine Abuse: An Unusual Case of Thyrotoxicosis in Pregnancy
Authors: Wark H. , Wallace E.M. , Wigg S. , Tippett C.
Published: February 2008

Summary: Eating disorders and the associated behavioural problems and drug abuse are uncommon in pregnancy. When they do occur they are often unrecognized because of denial but when significant may pose a risk to both the mother and her fetus. This case illustrates a number of problems that may be encountered in women with eating disorders in pregnancy, including prolonged and recurrent metabolic disturbances and diuretic abuse. In particular it illustrates the derangements of thyroid function seen in pregnant women with eating disorders and reminds us that when a cause for thyrotoxicosis remains obscure, thyroxine abuse should be considered and explored.
A Case Report of Sheehan Syndrome Presenting with Diabetes Insipidus
Authors: Kan Andrew K.S. , Calligerous Danny
Published: February 2008

Summary: Hypopituitarism caused by necrosis of the physiologically enlarged pituitary gland of pregnancy following postpartum haemorrhage was first described by Sheehan (1). Although manifestations of the clinical syndrome are most often caused by deficiencies of hormones of the anterior pituitary gland, involvement of the posterior lobe of the pituitary gland although rare has been described (2,3). This is a report of a case of diabetes insipidus developing within 24 hours postpartum in a grand multipara who had an elective lower segment Caesarean section for twins.
Mid‐trimester Ultrasound Diagnosis of Isolated Talipes Equinovarus: Accuracy and Outcome for Infants
Authors: Woodrow N. , Iran T. , Umstad M. , Graham H.K. , Robinson H. , MD L. de Crespigny
Published: February 2008

Summary: Seventeen fetuses were diagnosed with isolated congenital talipes equinovarus (CTEV) on mid‐trimester ultrasound at the Royal Women's Hospital, Melbourne, between January, 1992 and December 1995. Sixteen of the 17 cases had an amniocentesis performed and all karyotypes were normal. The remaining case was phenotypically normal, except for a clubfoot. None of the pregnancies was complicated by any of the recognized intrauterine environmental causes of CTEV. Four of the babies were delivered prematurely and all survived the neonatal period. Six (35%) infants did not have CTEV at birth, although 2 had postural varus feet. Nine of the 11 infants who did have CTEV at birth were treated within days of birth with plaster of Paris for periods of 6 to 12 weeks. Two infants required no further treatment, 5 required orthotics and 2 required surgery. The other 2 infants with CTEV at birth were treated with orthotics at 8 weeks of age. All infants were considered to have an excellent result at the 2 year follow‐up. Seven (41%) of the prospective parents received antenatal counselling by an orthopaedic surgeon and the lack of study on outcome following an ultrasound diagnosis of CTEV was the impetus for our work.
Five Successful Deliveries Following 9 Consecutive Spontaneous Abortions in a Patient with Wilson Disease
Authors: Mustafa Mohamed Siddig , Shamina Abdulrahman Hassan
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication because it surely presents the ultimate evidence of an association between recurrent spontaneous abortion and untreated Wilson disease, in a woman with great reproductive stamina.
A Casemix Cost Comparison of 2 Treatments For Ectopic Pregnancy
Authors: Lowe Philip J.M. , Mamers Pamela M. , Sturrock Timothy V. , Healy David
Published: February 2008

Summary: In this paper a retrospective cost comparison between laparoscopic treatment of ectopic pregnancy and conventional laparotomy under casemix funding has been performed. The total mean cost of laparoscopic treatment was $2,930 while the total mean cost of laparotomy was $4,259 per patient.
The Significance of Amniotic Fluid Interleukin‐6 Levels in Preterm Labour
Authors: Kara Mustafa , Özden Selçuk , Arioglu Petek , Çetin Ahmet
Published: February 2008

Summary: This study was performed to determine the prevalence of subclinical intraamniotic infection in patients with preterm labour and intact membranes, and to evaluate the significance of interleukin‐6 levels for diagnosis and prognosis of tocolysis failure, amniocentesis‐delivery interval and neonatal mortality and morbidity. Transabdominal amniocentesis was performed on 74 randomly‐selected patients with preterm labour and intact membranes. The prevalence of amniotic fluid infection in this group was found to be 33.7% (25 of 74). The most sensitive test to identify the intraamniotic infection was found to be the measurement of interleukin‐6 level. However the most specific test was confirmed to be Gram staining. Interleukin‐6 level measurement was the best test to correlate with positive amniotic fluid culture and histological chorioamnionitis. Also, interleukin‐6 level measurement had the advantage of predicting preterm delivery risk and neonatal complications compared to the other tests.
Hepatitis C — Role of Perinatal Transmission
Authors: Garland Suzanne M. , Tabrizi Sepehr , Robinson Priscilla , Hughes Chris , Markman Les , Devenish Wayne , Kliman Len
Published: February 2008

Summary: To evaluate the role of perinatal transmission in the spread of hepatitis C virus (HCV), we screened a cohort of pregnant intravenous drug using (IVDU) women for HCV antibody detection; where seropositive HCV RNA detection by polymerase chain reaction (PCR) was found we followed the infants longitudinally for HCV antibody and HCV RNA. Serum prevalence for HCV for this population was 80% with HCV RNA detected in 50%. Recruitment and follow‐up over a 3‐year period of a cohort of 83 seropositive women, their 91 newborns and 16 siblings of newborns, showed that there had been a 3% perinatal transmission rate with 1 sibling also infected. These positive cases were defined as transient in 1 case (HCV RNA positive by PCR at 1 month, but seronegative and HCV RNA negative at 10 months of age), 2 unevaluable (HCV RNA positive at 2 months of age, but patients lost to follow‐up), and 1 chronic infection in a child at 34 months (positive HCV RNA and seropositive 34‐month sibling). Maternal HCV RNA levels for those with infected infants was a mean 40‐fold greater than those whose babies were uninfected, although this did not reach statistical significance. Of the remaining infants, the majority (93%) had lost passively acquired maternal antibodies by 9 months of age and all by 12 months. Of 18 women who were HCV seropositive and breast feeding (66% of whom were HCV RNA positive in their sera), none had detectable HCV RNA in breast milk. Hence we conclude that transmission of HCV from mother to infant appears to be of low frequency and positivity appears to correlate with maternal circulating viral load.
Polyglandular Autoimmune Syndrome Type 2 Presenting for the First Time During Pregnancy
Authors: Mathur G. , Fulcher G. , Pollock C. , Ferry J.
Published: February 2008

EDITORIAL COMMENT: We asked the authors to explain what a Schilling test was and they provided the following explanation. The Schilling test is used to determine whether there is failure of vitamin B12 absorption due to a lack of gastric intrinsic factor. The patient is given radioactive labelled vitamin B12 orally and unlabelled vitamin B12 by intramuscular injection. The portion of administered radioactivity excreted in the urine over a 24‐hour period provides a measurement of B12 absorption. Patients with B12 deficiency secondary to pernicious anaemia will have low excretion of administered radioactivity. The test is then repeated adding intrinsic factor to the oral dose of labelled vitamin B12. In pernicious anaemia the absorption of the vitamin will now approach normal.

Summary: We report a case of polyglandular autoimmune deficiency presenting during pregnancy which was associated with a favourable outcome for both mother and fetus (apart from fetal growth retardation) with appropriate replacement therapy and adequate steroid cover at the time of delivery.
Pseudocyesis and its Modern Perspective
Authors: Trivedi A. N. , Singh S.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because we have not reported previously on pseudocyesis, which is a rare condition, especially if ‘first trimester cases’ are excluded where there has been confusion with interpretation of intervals of amenorrhoea. These cases can occur at the climacteric when elevated levels of LH can give a false positive HCG test result with older methods of assay and add further to the temporary clinical confusion. The classical clinical picture, unlike the 3 cases reported in this paper, is said to be the nullipara approaching the time of the climacteric who is anxious to conceive. Queen Mary's case must be the most famous on record and also the best documented by means of the serial bulletins issued for her loyal subjects concerning the progress of her royal pregnancy (A). The editor can remember only 1 case of ‘late pregnancy’ pseudocyesis in 40 years of obstetric practice. This woman was finally convinced of her nonpregnant status by failure of a fetal skeleton to show on an abdominal X‐ray. This was many years ago. This test was claimed to be definitive. One wonders how these women coped thereafter. We agree with the authors that follow‐up, not necessarily by a psychiatrist, is important. In the editor's experience pseudocyesis of late pregnancy is less common than advanced true normal pregnancy in a nullipara aged more than 40 years, married for many years, who presents with abdominal pain and finds out to her delighted surprise that she is in labour at term and shortly thereafter produces a surviving normal infant. The reviewers of this paper did not agree with the suggestion that curettage would be an appropriate procedure to convince a woman with pseudocyesis that she was not pregnant. However, the authors, having read this editorial comment, stated that curettage is mentioned in the pseudocyesis literature (4).

(A) Dewhurst J. Royal Confinements. Weidenfeld and Nicolson, London. 1980; 28–29.
A Randomized Clinical Trial Comparing Oral Misoprostol With Synthetic Oxytocin or Syntometrine in the Third Stage of Labour
Authors: M. Cook Colleen‐ , Spurrett Brian , Murray Henry
Published: February 2008

Summary: This is a multicentre, blocked, randomized trial to compare the efficacy of oral misoprostol 400μg with current injectable uterotonic agents (oxytocin/Syntometrine) used prophylactically in the third stage of labour. Main outcome measures were blood loss, use of a second uterotonic agent and difference in haemoglobin level from antepartum to postpartum. Data analysis from 863 women showed a statistically significant increase in both the mean blood loss (p < 0.001) and the rate of postpartum haemorrhage > 500mL, (RR 2.72: 95% Cl 1.73–4.27) in the misoprostol group compared to the oxytocin/Syntometrine group. The use of a second uterotonic agent was higher in the misoprostol group (RR 2.89: 95% Cl 2.00–4.18) as well as a greater decrease in postpartum haemoglobin (p = 0.015). Oral misoprostol 400μg is significantly less effective than the traditional intramuscular uterotonic agents currently used and therefore cannot be considered as a viable option to these agents in the management of the third stage of labour.
Induction of Labour After 1 Previous Caesarean Section
Authors: FRCSI Orla M. McNally , MRCPI Michael J. Turner
Published: February 2008

Summary: The aim of this study was, after induction of labour in women with a previous Caesarean section, to compare the outcome in women with a history of a previous vaginal delivery with women who had never delivered vaginally. A retrospective analysis was performed over a 2‐year period, in a Dublin teaching hospital. One hundred and three women who had had 1 previous lower segment Caesarean section had labour induced. Particular attention was given to delivery outcome, history of a vaginal delivery, cervical effacement at induction, influence of epidural analgesia, indication for induction and incidence of uterine rupture. The repeat Caesarean section rate after induction was 20.4%. Of the 51 women who had never previously delivered vaginally, the repeat section rate was 37.3% compared with only 3.9% of the 52 women who had previously delivered vaginally (p < 0.01). Fourteen women who had never delivered vaginally had an uneffaced cervix at induction and the repeat Caesarean section rate in this group was 64.3%. The commonest indication for induction was a postdates pregnancy. The use of epidural analgesia was greater in women who had never delivered vaginally. There were 2 cases of uterine scar rupture. Induction of labour following Caesarean section is associated with a significantly higher incidence of repeat Caesarean section in women who have not had a previous vaginal delivery. If the cervix is not effaced at induction, the repeat Caesarean section rate is higher than if the cervix has started to efface.
Gestational Diabetes Mellitus. At What Time Should the Postprandial Glucose Level be Monitored?
Authors: G Moses Robert , M Luca Elizabeths , Knights Sallyanne
Published: February 2008

Objective: To compare selected pregnancy outcomes for women with gestational diabetes mellitus (GDM) with management based on testing either 1 hour or 2 hours postprandially according to the ADIPS recommendations.

Methods: Prospective study of consecutive women referred for the medical management of their GDM. Women were allowed to select whether they would test either 1 hour postprandial with a target glucose of <8.0mmol/L or 2 hours postprandial with a target glucose of <7.0mmol/L. Changes to diet and the introduction and adjustment of insulin therapy were designed to maintain postprandial glucose levels below these targets.

Results: 166 women elected to test 1 hour postprandial and 101 elected to test 2 hours postprandial. There were no significant demographic differences between these 2 groups. The fetal birth weight, percentage of women requiring insulin and the total daily dose of insulin were similar in both groups.

Conclusions: For women with GDM, monitoring either 1 hour or 2 hours postprandially led to similar outcomes. This would suggest that the ADIPS recommendations are equivalent and therefore women can choose the most convenient time for their postprandial monitoring.
Estimation of Oxidative Products of Nitric Oxide (nitrates, nitrites) in Preeclampsia
Authors: MD Nayana Pathak , MD Harjeet Sawhney , MD Kala Vasishta , MD S. Majumdar
Published: February 2008

Summary: Oxidative products of nitric oxide, serum nitrates and nitrites were estimated in 50 primigravidas with preeclampsia and in 50 gestation and age‐matched normotensive primigravidas. Thirty three (66%) of these women had mild preeclampsia and 17 (34%) had severe preeclampsia. Serum nitrate and nitrite levels were significantly higher in preeclamptic women (nitrates—15± 1.17; nitrites—11.82± 1.16μmol/L) than in the normotensive pregnant women (nitrates 11.82± 1.16; nitrites—5.08± 0.47μmol/L, p < 0.001). In preeclamptic women, serum nitrate and nitrite levels correlated with the severity of the disease (mild preeclampsia nitrate—14.46± 1.98; nitrite 6.21± 0.84μmol/L, severe preeclampsia nitrate—16.65± 3.64; Nitrite—6.87± 1.56μmol/L). In preeclampsia there was significant positive correlation between nitrate and nitrite levels and diastolic blood pressure and proteinuria.
A New Indication for Breech Extraction
Authors: Hassanien Tawhid
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because the author describes a novel technique that may be useful at Caesarean section. It is noteworthy that this patient had a general anaesthetic, which in the editor's opinion is a very good idea when the head is deep in the pelvis and Caesarean section is decided upon. It is always wise in such cases where a spare pair of hands is available (e.g. midwife, medical student or theatre nurse) to have the person scrubbed up with a hand in the vagina so that when the uterus is incised the head can be pushed up from below. One can only agree with the author that the operator's hand alongside the head, when the uterus is already retracted, poses the risk of extension of the lower uterine segment incision and formidable haemorrhage. It is also wise of course to do a vaginal examination of the patient in labour after she is anaesthetized before Caesarean section because sometimes there has been jkrther unexpected progress since the last examination. The editor has done, and so will many of readers likewise have done, quite easy forceps deliveries under such circumstances when they had planned to do a Caesarean section. Only further information concerning a larger, number of patients will tell us whether breech extraction is always reasonably easily effected under the circumstances described in this patient. Probably the procedure is much easier when the patient has a general anaesthetic rather than epiduralanalgesia where the uterus is not relaxed. This type of delivery is a variety of internal version breech extraction except that the baby is being rotated out of the uterus rather than inside it. When the head is high at elective Caesarean section, many obstetricians, including the writer of this editorial comment, peorm internal version breech extraction to deliver the baby. Often this procedure is remarkably easy but sometimes it can be very dificult or impossible. This statement is made in case the, same may apply in the circumstances described in this patient. We need more a on this manoeuvre before the indication for its performance in a case of obstructed labour with the vertex presenting can be recommended. N.B.
Development of a customised birthweight standard for ethnic Chinese subjects
Authors: Pang MW , Leung TN , Sahota DS , Lau TK , Chang Allan MZ
Published: February 2008

Summary: A model to establish customised birthweight standards for the Chinese population was developed, using data from a cohort of 1564 Chinese women with normal singleton pregnancies. Multiple regression analysis was performed using maternal height, weight, parity, gestation at delivery and fetal sex as independent (predictor) variables. From this, a customised ideal birthweight for each baby can be estimated, and the normality of the actual birth‐ weight can be evaluated according to this, rather than from population standards.

The results of this study show that birthweights are strongly influenced by maternal characteristics, confirming conclusions from similar studies in other ethnic populations. The overall mean birth‐ weight at 280 days of gestation was 3252 g, which was smaller than that of the Caucasian population. Birthweight increased with maternal height (5.1 g/cm), maternal booking weight (10.2 g/kg) and gestation at delivery (18.3 g/day from 280 days). Babies from women who had two previous deliveries weighed 145.2 g more than the nulliparous. Male babies were 84.8 g heavier than females. Adjustment using these results produces a customised ideal birthweight for each baby.

When compared with population based standards, customised birthweight standards identified significantly fewer small for gestational age (SGA ‐ birth‐ weight below 10th centile, McNemar Chi square = 19.1, p c 0.01) and fewer large for gestational age (LGA ‐ birthweight above 90th centile, McNemar Chi square = 23.7, p < 0.01) cases.
Patterns of medication use during and prior to pregnancy: the M A P study
Authors: Henry Amanda , Crowther Caroline
Published: February 2008

Summary: We interviewed 140 pregnant women of any gestational age attending antenatal clinics at the Women's and Children's Hospital in Adelaide during September‐October 1999 to elicit information about their patterns of medication use during and in the 3 months prior to their current pregnancy.

Demographic information, information on women's prescribed, non‐prescribed, and non‐medicinal drug use during and in the 3 months prior to pregnancy, and information about both their general sources of information on medication use and their specific reasons for medication uptake/cessation during pregnancy were obtained.

The women used an average of 0.7‐0.8 prescribed and 2.3‐2.6 non‐prescribed medications (total 3.1–3.3) in the 3 pregnancy trimesters, compared with 1.0 prescribed and 2.2 non‐prescribed prior to pregnancy. Use of a prescribed or non‐prescribed medication was 96–97% across trimesters.

Simple analgesics, vitamin/mineral supplements, and antacids were the most commonly taken medications. Antibiotics were the most commonly prescribed medication. Use of class A medications increased during pregnancy while use of non‐class A medications decreased. Peri‐conceptional folate supplementation was 31%.

Alcohol consumption and cigarette smoking decreased after diagnosis of pregnancy. Both prescribed and non‐prescribed medication use is common during all trimesters of pregnancy However, overall use changes little compared with pre‐pregnancy values. Rates of peri‐conceptional folate supplementation are low.
Endometrial adenocarcinoma ‐ presenting pathology is a poor guide to surgical management
Authors: Petersen Rodney W , Quinlivan Julie A , Casper Gabrielle R , Nicklin James L
Published: February 2008

Summary: We aimed to evaluate the correlation between the histological grade of endometrial cancer diagnosed on endometrial biopsy or curettage, with the definitive grade and stage of lesion as determined by surgery and histopathological examination and to make recommendations about the suitability of conservative surgery based on preoperative determination of the grade of endometrial adenocarcinoma.

A retrospective review of all patients with endometrial adenocarcinoma presenting to the Queensland Centre for Gynaecological Cancer from l January 1996 to 31 December 1998 was undertaken. Clinical and pathological data was abstracted from medical records and case notes of 460 patients. All histological specimens were prospectively reviewed by a panel consisting of gynaecologic pathologists, gynaecologic oncologists and other doctors involved in the treatment of patients with gynaecological malignancies. The percentage of patients whose management would have been optimised by full surgical staging at the time of initial surgery was calculated.

Only 60%, 71%, and 84% of the patients with a presenting diagnosis of grade 1, 2 and 3 endometrial adenocarcinomas respectively had this confirmed on final histopathology. Furthermore, using established criteria, 30%, 46% and 100% of patients presenting with grade 1, 2 and 3 endometrial adenocarcinoma required full surgical staging at the time of their primary surgery.

There is poor correlation between the pre‐operative grade of endometrial cancer and the grade as determined on analysis of the resected uterus. The correlation is poorest with grade 1 endometrial adenocarcinoma, where strongest consideration is given to conservative surgery and the avoidance of subspecialty referral. There is a strong argument that all patients with a diagnosis of endometrial cancer made on endometrial biopsy or curettage, regardless of grade of malignancy, should be offered surgery where the option to perform concurrent comprehensive surgical staging is available.
Successful pregnancy outcome following first trimester pelvic inflammatory disease
Authors: Stitely Michael L , Gherman Robert B
Published: February 2008

Summary: Pelvic inflammatory disease rarely complicates pregnancy. Although few in number, most of the previously reported cases have resulted in spontaneous abortion or intrauterine fetal demise. At 5 weeks gestation, a 20 year old gravida 2 para 1 underwent uterine curettage and diagnostic laparoscopy for a suspected ectopic gestation. Seventeen days later, she presented with severe bilateral lower abdominal pain, cervical motion tenderness, uterine tenderness, and bilateral adnexal tenderness. After 84 hours of intravenous cefazolin, gentamycin, and clindamycin, the patient had resolution of all symptoms. She then completed 14 days of outpatient antibiotic therapy with oral cephalexin. At 39 weeks gestation, she delivered a 3611 g male fetus via spontaneous vaginal delivery. Successful pregnancy outcome can occur after first trimester pelvic inflammatory disease.
Preoperative diagnosis of dehiscence of the lower uterine segment in patients with a single previous Caesarean section
Authors: Suzuki Shunji , Sawa Rintaro , Yoneyama Yoshio , Asakura Hirobumi , Araki Tsutomu
Published: February 2008

Summary: Preoperative diagnoses were checked during surgery in 39 patients who underwent elective repeat Caesarean section with (n = 20) and without (as control, n = 19) a preoperative diagnosis of wall dehiscence (thinning) of the lower uterine segment (LUS). All patients were examined manually and by ultrasonography at 36 weeks gestation before labour. A preoperative diagnosis of wall dehiscence was made when the wall thickness was less than 2 mm and/or the patient felt pain and tenderness in the LUS. Surgical findings of dehiscence were j defined as a subperitoneal separation of the uterine I scar in the LUS. The sensitivity and specificity of our ultrasonographic evaluations were found to be 100% and 83% (p < 0.05), respectively. On the other hand, there were no surgical findings of dehiscence in patients who felt pain and tenderness in the LUS with a wall thickness greater than 2 mm, nor among those in the control group.
The utilisation of nuchal translucency as a prenatal marker of Down syndrome, 1993–1999
Authors: Mulvey Sheila F , Atchison William G , Grimwade James C , Renou Peter M , Shekleton Paul A , Wallace Euan M
Published: February 2008

Summary: A sample of 6038 obstetric ultrasound referrals and reports between January 1993 and June 1999 in a single Melbourne private ultrasound practice was reviewed to determine whether the referral and reporting pattern for nuchal translucency (NT) measurement has changed. The proportion of both 10–14 week ultrasound scans and mid trimester fetal anatomy scan referrals increased significantly over the study period (p < 0.001 and p < 0.001, respectively). There was also a significant increase in NT reporting and the number of specific referrals for an NT measurement over the study period (p = 0.01 and p < 0.001, respectively). If current trends continue it is likely that the 10–14 week scan for NT measurement will become a routine component of antenatal care. Therefore, as a matter of urgency, it is imperative that the best and most cost‐effective screening strategy for Down syndrome in an Australian population is defined
Changes in the plasma activities of protein C and protein S during pregnancy
Authors: Oruç Semra , Saruç Murat , Koyuncu Faik M , Özdemir Ertan
Published: February 2008

Summary: The objective of the study was to determine the changes in the plasma activities of protein C and protein S that occur during normal pregnancy. In this prospective cross‐sectional study, plasma activities of protein C and protein S were measured in 32 normal pregnant women in the first, second and third trimester and 6 weeks after delivery. There was a significant fall in protein C and protein S activities during normal pregnancy compared with the post‐puerperal period. The activities of protein C and protein S also gradually decreased through‐out pregnancy (p < 0.01).

Increasing plasma volume during normal pregnancy and its dilutional effect might play some role in the low activities of protein S observed. The normal falls in protein S and protein C activities make it difficult to diagnose protein S and C deficiency during pregnancy. Based on our findings, if a woman has a thromboembolic event during pregnancy, testing for a definitive diagnosis of protein C or protein S deficiency or functional failure should be delayed until at least 6 weeks postpartum.
Prevalence of gestational diabetes mellitus in polycystic ovarian syndrome (PCOS) patients pregnant after ovulation induction with gonadotrophins
Authors: Vollenhoven Beverley , Clark Suzanne , Kovacs Gabor , Burger Henry , Healy David
Published: February 2008

Our aims were:

1 To investigate if women with PCOS who become pregnant using gonadotrophins have a higher incidence of gestational diabetes mellitus (GDM) compared to spontaneously pregnant matched control women,

2 To compare the prevalence of GDM in PCOS women with that in women with hypo/eugonadotrophic hypogonadism and in unexplained infertility and

3 To investigate differences in pregnancy outcomes between the groups.

This was a retrospective case‐control study. Women with PCOS were matched with a control by age, BMI, and ethnicity. There were 60 women with PCOS, 11 with hypogonadotrophic hypogonadism, 6 with eugonadotrophic hypogonadism, and 12 with unexplained infertility. Control women were those who attended a major public hospital for antenatal care and delivery. We found no difference in the prevalence of GDM between the PCOS (22%) and the controls (17%) or between the PCOS and other groups. Women with GDM (diet or insulin controlled) had a significantly higher BMI than women without GDM (p = 0.019). There was no difference in pregnancy outcomes between the groups. There was a significant dependence of babies' birth weight on mother's BMI (p <0.001).
Vaginal birth after Caesarean section: an Australian multicentre study
Authors: Appleton Bill , Targett Christopher , Rasmussen Michael , Readman Emma , Sale Fiona , Permezel Michael ,   the VBAC Study Group
Published: February 2008

Retrospective analysis of medical records and individual case review was undertaken at 11 major obstetric hospitals for a 5 year period from July 1992 to June 1997 to investigate rates of vaginal birth after Caesarean section (VBAC), the occurrences of uterine rupture, and the outcomes for mother and infant following rupture.

Total deliveries were 234,015, of which 21,452 or 9.2% were associated with one or more previous Caesarean sections. Within this scar group, 5419 patients or 25.3% were delivered vaginally.

There were 62 cases of significant uterine rupture with no maternal deaths. Perinatal mortality with rupture was 25% and serious maternal complications (usually hysterectomy) occurred in 25% of those with uterine rupture. In women attempting vaginal delivery after a previous lower segment Caesarean section, the uterine rupture rate was estimated at 0.3%, with 0.05% experiencing a perinatal death and 0.05% requiring a hysterectomy.

Although VBAC rates in Australia remain lower than many overseas reported series, rates are increasing. While rupture continues to be associated with serious adverse outcomes, the incidence of rupture during trial of labour is low and appears to be associated with a better outcome than rupture of an unscarred uterus.
Misoprostol versus dinoprostone for cervical priming prior to induction of labour in term pregnancy: a randomised controlled trial
Authors: Rowlands Shelley , Bell Robin , Donath Sue , Morrow Sarah , Trudinger Brian J
Published: February 2008

Summary: A prospective randomised controlled trial was performed to compare the efficacy and safety of intrav‐aginal misoprostol to that of intravaginal dinoprostone when used for cervical priming prior to the induction of labour; 126 women were recruited to the study and randomised to receive either intravaginal dinoprostone (n = 63) or misoprostol (n = 63) for cervical priming prior to induction of labour. The mean time from insertion of the priming agent to vaginal delivery was significantly shorter in the misoprostol group (925.8 versus 1577.6 minutes), the mean duration of the active length of labour was significantly shorter in the misoprostol group (353.7 versus 496.8 minutes) and more women in the misoprostol group delivered in less than 12 hours (92% versus 76.5%).

Women in the misoprostol group were less likely to require a repeated dose of prostaglandin for cervical priming and less likely to require oxytocin for augmentation of labour. There was no difference in the number of women who were delivered vaginally or by Caesarean section between the two groups. More women developed hyperstimulation during labour in the misoprostol group; however there was no difference between the groups in neonatal outcome in respect to low cord pH or Apgar score at delivery or admission to the neonatal special care nursery.
Is there an interaction between cervical length and cervical microbiology in the pathogenesis of preterm labour?
Authors: Dowd Jennifer , Permezel Michael , Garland Suzanne , de Crespigny Lachlan
Published: February 2008

Summary: Transvaginal ultrasound of the cervix is increasingly used to estimate cervical length during pregnancy. Initially used to determine a possible need for cervical suture, the technique has been shown to be of value in the prediction of preterm delivery. In addition, bacterial vaginosis has been shown to be associated with an increased risk of preterm delivery. We hypothesised that shortening of the cervix and potential cervical pathogens, in particular the presence of bacterial vaginosis, act synergistically in the pathogenesis of premature labour. Three hundred and sixteen women were recruited for prospective longitudinal follow‐up, with both transvaginal ultrasound and cervical bacteriology performed at approximately 18 and 28 weeks gestation. A strong correlation was found between a shortened cervix and preterm delivery (p < 0.02 at 18 weeks; p < 0.001 at 28 weeks). Women with both a short cervix and cervical pathogens had the highest risk of preterm delivery (43%), although not significantly greater than a short cervix with normal cervical flora (31% preterm delivery). In the presence of a normal cervical length, preterm delivery rates in the presence of normal flora and potential cervical pathogens were much lower (9% and 5% respectively).
Fetal thyrotoxicosis after maternal thyroidectomy
Authors: Duncombe Gregory J , Dickinson Jan E
Published: February 2008

Summary: Thyroid disease commonly presents in women in their reproductive years. Maternal, fetal and neonatal outcomes are very good if the diagnosis is made early and appropriate management pathways are established. In the uncommon situation of concurrent maternal and fetal disease, the key management issues involve recognition of the involvement of the fetus and close intensive surveillance of both mother and fetuslneonate using a multi‐disciplinary approach. This approach, utilising a combination of serial ultrasound of the fetus and serial biochemical testing for the mother, allows for the accurate titration of medical therapy to both patients.
Amoebic liver abscess in pregnancy
Authors: Read Kerry M , Kennedy‐Andrews Sue , Gordon David L
Published: February 2008

Summary: We describe the case of an amoebic liver abscess (ALA) presenting in the third trimester of pregnancy which raised both diagnostic and treatment dilemmas as well as being associated with preterm labour.

Amoebic liver abscess is caused by the protozoan organism Entamoeba histolytica which is endemic in many parts of the developing world. Invasion of the colonic mucosa results in the clinical syndrome of amoebic dysentery and in some cases dissemination to the liver or other organs occurs resulting in abscess formation.1

Amoebic liver abscess is a rare complication of pregnancy and there are few reports in the world literature, these being mostly from endemic areas.2‐3‐4‐5 We present here the case of a Caucasian female who presented with an amoebic liver abscess in the third trimester of pregnancy, thirteen months after returning to Australia from a short holiday in Bali.
The management of extremely premature infants and the perceptions of viability and parental counselling practices of Australian obstetricians
Authors: Mulvey Sheila , Partridge J Colin , Martinez Alma M , Yu Victor YH , Wallace Euan M
Published: February 2008

Summary: The attitudes of Australian obstetricians to the resuscitation of extremely premature infants are reported. A structured questionnaire including questions regarding antenatal parent counselling, resuscitation practices, survival rates and personal attitudes about life support was distributed to obstetricians working in Australian hospitals with a Level 3 nursery. Eighty‐nine (48 % response rate) replies were received from 12 units located in seven major cities.

Obstetricians are more likely to discuss resuscitation with prospective parents with increasing gestation with a major shift occurring at 23–24 weeks' gestation. They strive for consensus with parents regarding resuscitation options and they act upon the opinion of both the prospective parents and their paediatric colleagues. Threat of litigation rarely influences the decision to limit resuscitation of an extremely preterm infant. Obstetricians may underestimate the prognosis for extremely preterm infants. The data presented offer useful insights into current attitudes and practice of tertiary hospital obstetricians.
Relationship between birthweight and repeated courses of antenatal corticosteroids
Authors: Lam PM , Yuen PM , Lau TK , Leung TN
Published: February 2008

Summary: A retrospective study was conducted in a university teaching hospital to review the association between birthweight and the number of courses of antenatal corticosteroids received in 236 singleton pregnancies. Those pregnancies complicated with pregnancy‐induced hypertension, preeclampsia, diabetes mellitus and intrauterine growth restriction were excluded. The results showed that the birthweight ratio (calculated as the baby's birthweight divided by the median birthweight for that gestational age) was negatively correlated with the number of courses of corticosteroids received. Further, exposure to four or more courses of antenatal corticosteroids was associated with a significant reduction in birthweight ratio and a three‐fold increase in the risk of being small‐for‐dates compared to those exposed to one to three courses.
Screening for gestational diabetes mellitus: can we be more efficient?
Authors: Kyle CV , Cundy TF
Published: February 2008

Summary: In a retrospective review of 471 patients screened for gestational diabetes mellitus (GDM) in a community laboratory, we compared 50g polycose screening test results with those of the 75g oral glucose tolerance test (GTT). The rate of GDM diagnosis was compared using criteria promulgated by the New Zealand Society for Study of Diabetes (NZSSD), Australian Diabetes in Pregnancy Society (ADIPS) and World Health Organisation (WHO).

In those with borderline screening results (7.8‐8 mmol/L) the rate of GDM diagnosis using NZSSD criteria was low (2.8%) compared with higher screening test results (≥8.1 mmol/L), where the rate was 7.4%. Corresponding rates were 7.5% and 13.5% using ADIPS criteria and 5.6% and 12.4% using WHO criteria.

The predictive value of a positive 50 g screening test is therefore low, especially for the higher New Zealand criteria. In women with borderline screening results no subject had a two‐hour plasma glucose of 9.0 mmol/L or more on oral GTT. This suggests that the current screening cut‐off of 7.8 mmol/L might be raised to 8.1 mmol/L, resulting in a 25% reduction in the number of glucose tolerance tests. Those with significant risk factors such as macrosomia, however, still warrant greater clinical suspicion and closer follow‐up.
Factors influencing the choice of hysterectomy
Authors: Shao Jenny Bin , Wong Felix
Published: February 2008

Summary: A retrospective review ot women undergoing hysterectomy between May 1998 and April 2000 was performed. Multiple logistic regression analysis was used to identify factors influencing the choice of hysterectomy performed. Two independent factors, the surgeons' expertise and the concomitant adnexal surgery, had a strong influence on the decisionmaking process regarding type of hysterectomy. Generalist gynaecologists tended to perform either an abdominal hysterectomy (AH) or a vaginal hysterectomy (VH) while non‐generalist gynaecologists were more likely to perform laparoscopic hysterectomy (LH). Patients undergoing a hysterectomy along with adnexal surgery had a far greater chance of undergoing either an AH or a LH as opposed to a VH. In addition, patients who had bigger uterus were more likely to undergo an AH versus a VH as compared to those with a small uterus. Patients aged 50 or older had more chance of undergoing a VH than a LH.
Variation in cervical cancer screening by region, socio‐economic, migrant and Indigenous status in women in New South Wales
Authors: Wain Gerard , Morrell Stephen , Taylor Richard , Mamoon Hassan , Bodkin Nora
Published: February 2008

Summary: The purpose of this study was to estimate the extent of association of cervical screening in NSW women with socio‐economic status (SES), rurality, and proportions of non‐English speaking background (NESB) and Indigenous status.

Data on women who had at least one Pap test over two years (January 1998‐December 1999) were obtained from the NSW Pap test Register. Each local government area (LGA) was allocated to categories of population proportions of NESB and Indigenous status, a rurality classification based on population density and remoteness, and to an SES quintile. The odds ratios (OR) of having a Pap test were estimated and confounding adjusted by multiple logistic regression analysis. Implied Pap test rates in urban NESB and in rural Indigenous women were estimated from the modelled estimates.

The adjusted OR for a Pap test in large rural centres (1.14) was significantly higher than those for metropolitan or capital city residents (0.9 and 1.0 respectively). Adjusted OR for a Pap test in other rural centres (0.73) and other remote areas (0.64) were significantly lower than those for metropolitan or capital city residents. In urban populations the lowest OR were in areas with both low SES and high proportion of NESB. The lowest OR for Pap screening in rural populations occurred in the most remote areas with the highest proportion of Indigenous women. For urban NESB women the biennial Pap test rate was estimated as 50oo and for rural Indigenous women 29%, compared with the NSW average of 59oo.
Fetal congenital complete heart block: prophylaxis with intravenous gammaglobulin and treatment with dexamethasone
Authors: Wong Judy PL , Kwek Kenneth YC , Tan Jackie YL , Yeo George SH
Published: February 2008

Summary: We report a case of complete fetal heart block in a 35‐year‐old Chinese woman known to be positive for anti‐SSA/Ro and anti‐SSB/La antibodies. She had fetal hydrops leading to intrauterine death in her first pregnancy. Prophylactic intravenous immunoglobulin, given at 14 and 18 weeks' gestation, as well as oral dexamethasone, commenced at 24 weeks' gestation, allowed continuation of the pregnancy until 34 completed weeks of gestation. An external pacemaker was inserted in the baby on the first day of life. Two‐and‐a‐half months later, a permanent pacemaker was inserted.
Differences and trends in obstetric interventions at term among urban and rural women in New South Wales: 1990–1997
Authors: Roberts Christine L , Algert Charles S , Peat Brian , Henderson‐Smart David
Published: February 2008

The aim of this study was to compare the management of term births among rural and urban women, including the effect of indigenous status and out‐of‐area‐birth for rural women. Data were obtained from the NSW Midwives Data Collection (MDC), on 619,298 women who gave birth to a live, singleton infant at term (37–45 weeks gestation) from 1 January 1990 to 31 December 1997. Compared with urban non‐indigenous women, rural women and indigenous women had lower rates of obstetric interventions both before birth (induction of labour, planned Caesarean section and epidural) and at the time of birth (Caesarean after labour, instrumental delivery and episiotomy). This was especially true for rural women giving birth in the their local area. The differing pregnancy risk profile of rural women did not explain the differences in intervention rates but differences were partly explained by higher rates of epidural anaesthesia in urban areas.