bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultrasound Guided Chorion Biopsy in Antenatal Diagnosis of Genetic Disorders
Authors: Anderson John C. , Trent Ronald J. , Boogert Antheunis , Smith Arabella , Shearman Rodney P.
Published: February 2008

Summary: The technique of transcervical chorion biopsy was evaluated in women about to undergo therapeutic termination of pregnancy. The trophoblast biopsy catheter (Portex) under real‐time ultrasound guidance was the most reliable in obtaining chorionic villi. The overall success rate for chorion biopsy was 73% in the first 100 patients studied.
Urinary Voiding Patterns of Apparently Normal Women
Authors: Glenning Peter P.
Published: February 2008

Summary: A survey of 886 women who considered themselves to be normal was carried out to determine voiding habits in the population and the prevalence of urinary incontinence of any degree. Eighty‐eight percent voided at 3–6 hourly intervals. Increasing age did not affect the frequency of micturition but parturition did. Nocturia was present in 18% but increased with age. Thirty‐two percent of the study group admitted to having had one or more episodes of incontinence. Having borne a child increased the prevalence of incontinence but increasing age did not. There was a small but significant occurrence of apparent sphincter weakness in nulliparae.
The Effect of Porcine Relaxin Vaginally Applied at Human Embryo Transfer in an In Vitro Fertilization Programme
Authors: MacLennan A.H. , Kerin J.F.P. , Kirby C. , Grant P. , Warnes G.M. , Cox L.W. , Bryant‐Greenwood G. , Greenwood F.
Published: February 2008

Summary: It has been suggested that the polypeptide hormone relaxin is an early pregnancy factor which facilitates implantation and pregnancy maintenance. To test this hypothesis a double blind randomized placebo controlled trial was conducted where 2 mg purified porcine relaxin or distilled water was given in a vaginal gel on the day of embryo transfer and again 3 days later in a human in vitro fertilization (IVF) programme. There were 96 patients in the randomized trial and 73 patients who were treated concurrently in the same IVF programme acted as a further control group. Of the 51 patients who received relaxin, 10 pregnancies were confirmed and 8 continued successfully. In the 45 patients treated with placebo 10 pregnancies were also confirmed and 6 continued successfully. Amongst the 73 patients concurrently treated outside the trial 14 achieved a pregnancy and 10 continued to term. Thus, porcine relaxin given in these circumstances in a human IVF programme did not appear to improve or interfere with the pregnancy rate. Possible factors that affected the implantation rates in this trial are discussed.
Alcohol in Breast Milk
Authors: Lawton Margaret E.
Published: February 2008

Summary: At fixed intervals after the ingestion of alcohol by 8 nursing mothers, sets of breast milk and blood samples were collected and their alcohol levels compared. One set of milk samples was solely hind‐milk while the remainder were fore‐milk samples. The results showed that alcohol appeared quickly in both fore‐ and hind‐milk at a level equivalent to or higher than the corresponding blood samples. Elimination of alcohol from the milk was closely related to its elimination from blood and was unaffected by breast feeding. However, despite this, the large dilution of the alcohol contained in the milk by the baby's body water renders the baby's resultant blood alcohol level very low in all but the most extreme cases.
The Incidence of Cytomegalic Inclusion Disease (CID) in an Obstetric Teaching Hospital, 1975–1984
Authors: Hatherley Lawrence I.
Published: February 2008

Summary: A low incidence (1 in 4,000) of neonatal CID was found in 47,320 consecutive live births at an obstetric hospital over a decade. The mortality was high, 5 of 16 neonates died in hospital and, of those discharged, 7 were left with severe cerebral and/or ophthalmic handicaps. Minor, remediable conditions were also found in 7 infants. Previous studies have indicated that CMV infection occurs in 1–2% of all pregnancies and 10% of the infected neonates have signs of CID at birth.

A highly significant increase in the incidence of antenatal complications was found in mothers delivered of cytomegalovirus (CMV)‐infected infants which may have compounded the effects of the viral disease on the fetus. A CMV‐specific defect in the maternal and neonatal immune systems is discussed.
Chemosensitivity Testing of Ovarian Cancer: Results of a Rapid in Vitro Biochemical Assay
Authors: Khoo S. K. , Hurst T. , Webb M. J.
Published: February 2008

Summary: There is a need for a predictive test which will assist in the selection of an effective cytotoxic drug and thereby, provide a means of avoiding unnecessary drug‐induced toxicity and tumour resistance. In the present study, the viable fraction of the tumour cell suspension from ovarian cancer was used as targets for the effect of the drug, cisplatin, in a 3‐hour in vitro assay. DNA synthesis was measured by the incorporation of 3H‐thymidine as an index of proliferative activity and RNA synthesis by the incorporation of 3H‐uridine as an index of protein metabolism. There was a good correlation between cell activity as determined by the uptake of thymidine and uridine. The degree of drug inhibition was variable over the spectrum of tumour histologic types; thymidine uptake was significantly inhibited by cisplatin in 53% of serous cystadenocarcinomas, and uridine uptake in 21% of tumours. A clear difference in drug effect was observed between those patients who showed clinical response and those who did not. These results support the value of this assay as an indicator of drug sensitivity of the tumour.
Laparoscopically Directed Appendicectomy
Authors: Fleming J. Stewart
Published: February 2008

Summary: A technique is described where appendicectomy is performed under laparoscopic guidance. The acutely inflamed organ may be removed in this manner, with postoperative stay being reduced to 3 days or less. Where there is questionable or no pathology of the appendix, postoperative stay following laparoscopically directed appendicectomy is no longer than for diagnostic laparoscopy alone, raising the controversial issue of whether the non‐inflamed appendix should be removed at the time of laparoscopy.
Genital Chlamydial Infection—Our Commonest Sexually Transmissible disease
Authors: Bradford David L.
Published: February 2008

Editorial Comment: This review contains 4 important take away messages about chlamydial infection of the female genital tract that warrant emphasis:

The infection is more common than gonorrhoea and often coexists with it.

It can cause a frothy vaginal discharge easily mistaken for trichomonal infection, but more often is asymptomatic at first.

It can cause tubal damage, chronic pelvic inflammatory disease, pain and sterility.

Adequate treatment requires a 10‐day course of tetracycline or erythromycin.
Gestational Diabetes—Infant Malformations and Subsequent Maternal Glucose Tolerance
Authors: Farrell Jan , Forrest Jill M. , Storey G. N. Bruce , Yue D. K. , Shearman R. P. , Turtle J. R.
Published: February 2008

Summary: The frequency of abnormal glucose tolerance in the first 12 months after gestational diabetes was found to be 33.3%, which is much higher than previously accepted. Women with gestational diabetes (Group 1 = 54 requiring insulin, Group 2 = 32 treated with diet alone) attending a metropolitan teaching hospital over a 3 1/2 year period were followed‐up after delivery to determine their subsequent glucose tolerance. Of 86 seen 3 months after delivery, 2 had developed insulin‐dependent diabetes mellitus (IDDM) and 2 noninsulin dependent diabetes mellitus (NIDDM), diagnosed by glucose tolerance testing. Another 38 returned for follow‐up glucose tolerance testing at 12 months; of these 3 had impaired glucose tolerance (IGT), 7 had NIDDM, and one who had had NIDDM at 3 months now showed IGT after 9 months dietary treatment. Thus, 12 months after delivery, the cumulative prevalence of abnormal glucose tolerance was 14/42 (33.3%), 10 of the 42 being frankly diabetic (26%). Of the remaining 44 patients, 21 have not yet reached 12 months or were pregnant again, and 23 did not attend for glucose tolerance testing.

Although the trend was for gestational diabetes mellitus (GDM) to recur earlier and more severely in subsequent pregnancies, in 3 instances the diabetes did not recur.

Major congenital malformations occurred in 4 of the 86 babies (4.7%); minor malformations were found in a further 13 (15%) with no difference in frequency between Group 1 and Group 2.
The Long‐Term Follow‐up of Women with Gestational Diabetes
Authors: Grant Peter T. , Oats Jeremy N. , Beischer Norman A.
Published: February 2008

Summary: Four hundred and forty‐seven women who had gestational diabetes have been retested at intervals from 1 to 12 years following diagnosis; 49 (11%) were found to be diabetic and 35 (7.8%) had impaired glucose tolerance using the WHO criteria. An abnormal glucose tolerance test in the puerperium and obesity at the time of retesting had significant associations with abnormal glucose tolerance at follow‐up. However, the best predictive factor of the likelihood of the development of significant hyperglycaemia was the recurrence of gestational diabetes in a subsequent pregnancy, since 28% of these women were diabetic and a further 4% had impaired glucose tolerance at the time of follow‐up. These findings indicate that the criteria used for the diagnosis of gestational diabetes at the Mercy Maternity Hospital, Melbourne (1‐hour ≥ 9 mmol/1 together with a 2‐hour ≥ 7 mmol/1) are appropriate for an Australian population.
Birth‐weight Patterns in Aboriginal and Non‐Aboriginal Singleton Adolescent Births in Western Australia, 1979–83
Authors: Stanley Fiona J. , Maug Sue
Published: February 2008

Summary: Births to Aborigines and teenagers are known to be at a higher risk of low birth‐weight (LBW) than those to non‐Aboriginal and older women. Data on singleton birth‐weight and gestational age by maternal age and race were analysed from the West Australian Midwives Notification of Birth system for 1979–1983. The main aim of the analysis was to describe the patterns of preterm birth (PTB) and intrauterine growth retardation (IUGR) in these births.

Aboriginal teenage fertility was much higher than that for non‐Aborigines and seemed to be rising. Many more young teenagers giving birth were Aboriginal than Caucasian. Contrary to expectation, the majority of the LBW births in both racial groups were due to PTB not IUGR. There was an increasing trend to PTB with decreasing maternal age in both Aborigines and non‐Aborigines.

These data should be considered preliminary due to the difficulties of estimating gestational age and in categorizing IUGR. They may have implications in terms of further research into the aetiological pathways and prevention of LBW in Australia.
Chorionic Villus Sampling: Cytogenetic Experience in Preliminary Investigations and in 50 Diagnostic Cases
Authors: Stewart Lesley A. , Purvis‐Smith Stuart G. , Wass Debbie M.
Published: February 2008

Michael J. Bennett,4,8

Summary: The results of preliminary cytogenetic investigations of chorionic villus sampling (CVS) and its diagnostic application in 50 cases are reported. Preliminary investigations included the effect of short delays between biopsy and processing, levels of mitotic activity related to variations in processing, the incidence of tetraploidy, correlation of the karyotype of the chorionic villi with that of the fetus, and the results of banding studies. A protocol was then designed for application to diagnostic CVS.

The 50 diagnostic cases included 4 with male karyotypes which were terminated due to a family history of an X‐linked disorder, 1 trisomy 21, 1 trisomy 18, the finding of 1 aberrant cell out of 50 in an otherwise normal analysis, a 45, XY, t (13;21) karyotype, 2 fragile X negative karyotypes and in one case the presence of mosaicism was detected in chorionic villi and subsequently not confirmed at am‐niocentesis. The karyotype on the chorionic villi was 46XY/47XY + 3.
Vacuum Extractor: A Safe Instrument?
Authors: Ngan Hextan Y. S. , Tang Grace W. K. , Ma H. K.
Published: February 2008

Summary: One thousand five hundred and twenty‐six records of deliveries with vacuum extractor in 1982 and 1983 in the Hong Kong University Department of Obstetrics and Gynaecology were reviewed. Vacuum extractor was found to be easy and safe to use even by inexperienced house‐staff. Vacuum extractor was especially useful in the delivery of malpositioned fetal heads because of its mechanism of allowing autorotation. Its advantage of not occupying extra space in the pelvis was most beneficial to the relatively smaller Chinese pelvis. Maternal injury was uncommon. Fetal scalp injury like cephalhaematoma was not uncommon but serious scalp injury was infrequent. Perinatal mortality rate attributed to the instrument was low (0.6/1,000). However, in order to achieve safety to the mother and fetus, strict rules in application of the vacuum extractor must be observed.
Fetal Intravascular Transfusion for Severe Erythroblastosis: Effects on Haematology and Survival
Authors: Doyle Lex W. , Cauchi Maurice , de Crespigny Lachlan Ch. , Robinson Hugh , Barrie Jean , Yong Jan , Quinn Michael A.
Published: February 2008

Summary: Since February 1984, 8 fetuses (including a set of hydropic twins) with severe erythroblasts in the second trimester have received intravascular transfusions guided by ultrasound. These transfusions were associated with a decreasing fetal reticulocytosis, a decreasing proportion of circulating fetal haemoglobin and a decreasing mean fetal red corpuscular volume. All infants were born alive at an average of 5.5 weeks after the first transfusion; 3 infants died, including the hydropic twins and another with lethal congenital anomalies. All 5 survivors r'equired simple transfusions for up to 54 days after birth because of prolonged bone marrow suppression. In severe erythroblastosis in the second trimester, direct intravascular transfusion using ultrasound guidance promises to improve fetal outcome.
Topical Interferon Cream for the Treatment of Herpes Genitalis: A Double‐blind Controlled Trial
Authors: Batcheler L. M. , Bonham D. G. , Collins R. , Liddell H. S.
Published: February 2008

Summary: Thirty‐five women with primary herpes genitalis and 34 women with recurrent herpes genitalis were treated with either placebo, or β Interferon cream (20,000iu/g). In comparison with the placebo group, the treatment group showed no benefit in either symptom relief, speed of healing of lesions or length of viral shedding time from lesions.
Antenatal Screening for Congenital Infection with Rubella, Cytomegalovirus and Toxoplasma
Authors: Sfameni Salvatore F. , Skurrie Ian J. , Gilbert Gwendolyn L.
Published: February 2008

Summary: The sera of 3,463 pregnant women were screened, at the first antenatal visit, for antibodies to rubella, cytomegalovirus (CMV) and Toxoplasma gondii. Rubella antibodies were detected in 97.5%, CMV antibodies in 71% and toxoplasma antibodies in 45% of women. Asymptomatic toxoplasmosis occurred during pregnancy in 3 of 609 (0.5%) and primary CMV infection in 5 of 338 (1.5%) initially seronegative women whose sera were retested at the end of their pregnancies. The observed incidence of toxoplasmosis was similar to that calculated on the basis of the age‐related prevalence of antibodies found in this study. On the basis of these observations it is estimated that congenital toxoplasmosis and congenital CMV infection due to primary maternal infection each occurs in up to 2/1,000 infants in this community. Very few of these infants have obvious abnormalities at birth, but follow‐up studies elsewhere have shown that many of them suffer significant long‐term sequelae.
Congenital Limb Deficiency: Maternal Factors in Pregnancy
Authors: Kricker Anne , Elliott Jane , Forrest Jill , McCredie Janet
Published: February 2008

Summary: Maternal factors in pregnancy were examined in a case‐control study of 155 children with limb deficiencies (longitudinal and transverse) born 1970–1981 inclusive and 274 matched normal controls. Vomiting of pregnancy was associated with an increased risk of longitudinal limb reduction defects. Gestational bleeding has long been known for its association with perinatal mortality, low birth‐weight and prematurity; limb deficiencies have also been noted. In the present study the pattern of bleeding differed between women in the transverse and longitudinal groups, with the possibility of a causal role for bleeding in the aetiology of longitudinal but not transverse defects. There was a significant statistical risk associated with respiratory infections comparable with the reported association of congenital limb deficiency and influenza from Finland.
Maternal‐Infant Attachment: a Developmental Perspective
Authors: Psych Peter G. Mertin BA M.
Published: February 2008

The selective video recording of neonates in the Intensive Care Unit of the Queen Victoria Hospital, Adelaide (1) arose in part from an evolving understanding of the idea of ‘bonding’. The bonding theory, most popularly associated with Klaus and Kennell (2), advocates a ‘sensitive period’ which is an optimal time for the development of the maternal‐infant bond, and which facilitates good mothering. In their own words,
Low Vertical Uterine Incision in Caesarean Section
Authors: George Lourdes St , Kuah K. B.
Published: February 2008

EDITORIAL COMMENT: The classical operation is performed in 1–2% of Caesarean sections usually for transverse lie, failure of development of the lower segment (prematurity 5 breech presentation), dense adhesions, large veins over the lower segment (placenta praevia), constriction ring and invasive carcinoma of the cervix. The classical operation is likely to be performed more often than formerly because more very premature infants (26–32 weeks' gestation) are being delivered by Caesarean section — in these pregnancies the lower segment is often poorly formed, especially when there is the combination of fetal growth retardation, oligohydramnios and breech presentation. This paper has 2 important messages: firstly that in only 11 of 3,420 (0.3%) Caesarean sections was a vertical uterine incision necessary; secondly that in all II cases a low vertical uterine incision was possible. Personal preference determines practice in obstetrics. This paper suggests that we should resist the temptation to incise the upper uterine segment and, if a vertical incision is needed, the technique described in this paper warrants consideration. The type of anaesthesia is also important. The problem of a poorly formed lower segment can usually be anticipated — if halothane is employed to relax the uterus, a vertical uterine incision is less likely to be required. Since these operations are performed for fetal indications it is essential that delivery of the fetus is gentle with minimal risk of overmoulding which may result in intracranial haemorrhage.

Summary: Eleven of the 3,420 Caesarean sections performed in Westmead Hospital, Sydney during a 6‐year period from 1979 to 1985 were by a low vertical uterine incision. All the others were the standard transverse lower segment operation except for 1 which was a postmortem classical Caesarean section. There are indications when the preferred lower segment Caesarean section with a transverse incision should be avoided in the interest of the mother and baby. A low vertical incision has more advantages and less dangers than a classical fundal incision. It is prudent to defer the decision regarding the type of incision until the uterus is inspected intraoperatively. If access to the lower uterine segment is limited by prematurity, an obstructing lesion, a transverse lie, or if the presenting part is high and difficulty in delivering the baby is anticipated, a low vertical incision should be considered.
Mid‐Cavity Occipitoanterior Forceps Delivery — Laufe and Barnes Forceps Compared
Authors: Marshall Brett J. , Healy David L.
Published: February 2008

Summary: Laufe forceps are divergent forceps designed to reduce compressive forces upon the fetal skull during delivery from the pelvic outlet. Here we have undertaken a retrospective matched analysis in which Laufe (N = 75) and Barnes (N = 75) forceps were used for occipitoanterior mid‐cavity forceps delivery. Our aim was to compare fetal and maternal outcome following use of these 2 types of forceps in the mid‐pelvis. Fetal morbidity, categorized by trauma, low Apgar score or jaundice, was present in 31 of 75 infants delivered by Laufe forceps and in 47 of 75 infants delivered by Barnes forceps (p < 0.01). Overall, maternal morbidity was statistically similar between the 2 groups although perineal trauma was more frequent in the Laufe group (p < 0.05). We concluded that there appeared to be an improved fetal outcome following occipitoanterior mid‐cavity delivery using Laufe forceps compared with Barnes forceps. These initial findings imply that in situations of fetal compromise, where forceps delivery from an occipitoanterior position in the mid‐cavity is indicated, that Laufe forceps might be chosen.
No Episiotomy?!
Authors: Thompson Derrick J.
Published: February 2008

EDITORIAL COMMENT: Episiotomy is an important and common operation. Some practitioners perform the procedure almost as a routine, others avoid it almost at any price and claim that the operation is seldom necessary. The advocates of episiotomy claim that its performance when the head k safe& accessible must, by hastening delivery, avoid hypoxia that can cause perinatal death or intellectual impairment. Other considerations are maternal discomfort (painful perineum, subsequent dyspareunia) and the possibility that overstretching of the perineum to avoid episiotomy may predispose to prolapse. This paper re‐examines the mechanism of delivery of the head and advocates maintenance of flexion to avoid a perineal tear — it concentrates on pressure on the occiput and anterior vagina thus directing pressure away from the perineum. The method warrants consideration.

Summary: A method is presented which with careful manipulation of the vagina around the crowning head reduces the incidence of an episiotomy or a perineal tear. Using the method described, the overall result obtained was an intact perineum in 68% of vaginal deliveries (which included forceps deliveries). An episiotomy was performed in only 7% of deliveries — all associated with the use of forceps.
Immunogenetic Studies in Habitual Abortion
Authors: Cauchi M. N. , Koh S. H. , Tait B. , Mraz G. , Kloss M. , Pepperell R. J.
Published: February 2008

EDITORIAL COMMENT: Readers must judge whether their patients with habitual abortion warrant referral for the type of investigation and immunotherapy reported here. These patients are often anxious to explore every avenue to achieve a successful pregnancy. Many techniques are available with convincing and prestigious advocates. The treatment of infertility at its best is one of the marvels of modern scientific medicine — but there is a warning, many (most!) papers on the treatment of infertility lack controls, which makes it difficult to judge reported results. These comments apply to in vitro fertilization and embryo transfer, artificial insemination, tuba1 surgery, cervical ligation, ovulation induction, and immunotherapy. It is commonplace for couples with blocked tubes, anovulation and/or poor seminal quality/quantity to conceive happily, unexpectedly and successfully without treatment!

Summary: Recent evidence suggests that immunological factors could play a role in the aetiology of habitual abortion. In this study, 71 couples with habitual abortion (i.e. more than 3 successive abortions) were investigated. Sharing of HLA‐A, B, DR between partners was not found to be significantly increased. Anti‐HLA antibodies in women against their partners' lymphocytes were found in 18.3%. After immunization with 107‐108 lymphocytes obtained from husband or unrelated donor, there was a seroconversion rate cf 61% in those without antibodies initially. This was not dependent on the number of cells injected, source of cells, degree of sharing of HLA antigens or whether the couple were primary aborters (i.e. having had no advanced pregnancy), or secondary aborters. Seven pregnancies have resulted following the immunization procedure so far, 5 occurring in cross‐match positive patients and 2 in cross‐match negative. Growth retarded infants resulted from the pregnancy of 1 primary aborter and 2 secondary aborters.
The Outcome of Hyperemetic Pregnancies Complicated by Transient Hyperthyroidism
Authors: MRCOG T. T. Lao , MRCOG R. K. H. Chin , PhD A. M. Z. Chang
Published: February 2008

Summary: Thirty‐nine patients presenting with hyperemesis gravidarum were studied and the subsequent course and outcome of pregnancy between patients with normal and abnormal thyroid funcion was compared. Seventeen patients (43.6%) developed transient hyperthyroidism, for which a short course of antithyroid treatment was required in 2 patients. There was no difference in the outcome of pregnancy between patients with normal and abnormal thyroid function.

The results suggest that while antithyroid treatment is effective for symptomatic control, it is unnecessary in the majority of patients since the condition is self‐limiting, and the outcome of pregnancy not adversely affected by the transient hyperthyroidism in hyperemetic patients.
Routine Screening of Gynaecological and Obstetric Patients for Chlamydia Trachomatis
Authors: El‐Sheikh M. Magdy , Sengupta B. S. , Bakir T. M. F. , Hossain A.
Published: February 2008

EDITORIAL COMMENT: There is much discussion regarding the selection of tests which should be performed on all antenatal patients. Many centres perform routine cervical cultures in late pregnancy to detect Group B beta‐haemolytic streptococci since approximately 1 in 2,000 babies acquire a clinical infection with this organism and the infection is fatal in approximately 50% of cases. However, the prevalence of chlamydia trachomatis reported in this study suggests that the detection of this organism is at least as important, in both obstetric and gynaecological patients. Now that a simple accurate method of enzyme immunoassay recognition of chlamydial infection is available, it is important that large populations of antenatal and gynaecological patients be studied to determine the prevalence and significance of the infection in any particular community. It is salutary to note that the data reported in this paper were gathered in a community where chastity is exemplary.

Summary: Chlamydia trachomatis infection of the cervix uteri was diagnosed in 9% of 221 gynaecological and obstetric patients. Infection occurred more commonly among obstetric (12.6%) than gynaecological patients (5.5%). In obstetric patients chlamydial infection was commoner in those complaining of excessive vaginal discharge or spontaneous premature rupture of the membranes. Chlamydial infection in gynaecological patients occurred in those with previous pelvic infection, menstrual disorders or excessive vaginal discharge. No cases of chlamydial infection were detected among intrauterine device users. The enzyme immunoassay we used is an easy and relatively quick method of diagnosis for genital chlamydial infection.
The Use of Prolonged Bladder Distension in the Treatment of Intractable Urinary Incontinence in Females with Detrusor Instability
Authors: FRCOG Andrew Korda , MRCOG Mark Krieger , MRCOG Peter Hunter
Published: February 2008

Summary: Fifty patients suffering from detrusor instability who failed to respond to anticholinergic treatment were treated with prolonged bladder distension. Twelve months after treatment 9 were symptom free, 15 improved and 26 remained symptomatically unchanged. Extraperitoneal bladder rupture occurred in 2 patients.
A Survey of the Management of Premature Labour by Australian Obstetricians
Authors: Trudinger Brian J. , Boshell Laurence
Published: February 2008

Summary: A survey of the practices of obstetricians in the management of premature labour was carried out. A questionnaire consisting of 16 clinical problems was drawn up. All Fellows and Members of the RACOG resident in Australia were surveyed by mail and 707 (74.3% of those in active practice) returned completed questionnaires. Results were analysed by State, seniority and practice size. The survey revealed many differences in management even in situations tested by clinical trials (e.g. premature rupture of membranes, use of steroids). There was uncertainty about when to attempt inhibition with tocolytics. Obstetricians had a more pessimistic view concerning neonatal survival than recent published neonatal results indicate. The role of chorioamnionitis seemed undervalued. There were many differences when results were analysed by State and seniority.
Fetal Heart Race and Maternal Cardiovascular and Catecholamine Responses to Dynamic Exercise
Authors: Cooper Karen A. , Hunyor Stephen N. , Boyce E. Stewart , O'Neill Maureen E. , Frewin Derek B.
Published: February 2008

Summary: Fourteen women performed treadmill exercise for continuous 10‐minute periods at levels of 2, 3 and 4 mets in the second and third trimester of pregnancy and again postpartum. The percentage increase in heart rate in response to exercise was similar during pregnancy and postpartum while systolic blood pressure was increased only during pregnancy. Maternal plasma noradrenaline levels at peak exercise increased 64% (p < 0.005), 42% (p < 0.005) and 29% (NS) in the 3 studies respectively compared to resting levels at these times. Ten women experienced increased uterine activity during the exercise or recovery periods. Fetal heart rate was increased (p < 0.05) by exercise but this was independent of uterine contractions and plasma noradrenaline levels.
Multifocal Invasive Carcinoma of the Vulva in a 25‐Year‐Old Woman With Bowenoid Papulosis
Authors: Planner R. S. , Andersen H. E. , Hobbs J. B. , Williams R. A. , Fogarty L. F. , Hudson P. J.
Published: February 2008

Summary: This case report documents malignant progression associated with wart virus infection of the vulva in a 25‐year‐old female. The initial condition of Bowenoid papulosis and carcinoma in situ of the vulva was diagnosed on colposcopic biopsies performed to investigate chronic pruritus and superficial dyspareunia. This condition failed to resolve with local ablative therapy and progressed over a period of 8 months to multifocal invasive carcinoma of the vulva requiring radical surgery. Deoxyribonucleic acid hybridization studies on the operative specimen revealed the presence of human papilloma virus type 16. The role of human papilloma virus in the aetiology of Bowenoid papulosis and neoplasia of the vulva is discussed.
Augmentation of Labour — Mode of Delivery Related to Cervimetric Progress
Authors: Arulkumaran S. , Koh C.H. , Ingemarsson I. , Ratnam S.S.
Published: February 2008

Summary: This study was designed to investigate the possible benefits, in terms of obstetric and neonatal outcome, of a prolonged augmentation period with oxytocin in patients with dysfunctional first stage of labour. The majority of patients (65.5% of nulliparas and 83.8% of multiparas) responded with satisfactory progress within the first 4 hours of augmentation and the Caesarean section rate was low in this group (1.3%). In those with unsatisfactory progress during the first 4 hours of augmentation a further 4 hour period of augmentation resulted in vaginal delivery for 50.7% of nulliparas with primary dysfunctional labour and 33.3% of those with secondary arrest in labour.
The Implementation of a Statewide Gynaecology Audit in Tasmania
Authors: Correy J.F. , Marsden D.E.
Published: February 2008

Summary: A successful Statewide audit of Obstetric and Neonatal data has operated in Tasmania since 1974. The experience and goodwill gained from the conduct of the survey has been used to establish an audit of all hospital admissions in the State for gynaecological complaints. This paper outlines the methods used in setting up the survey, and some of the results of its first full year of operation to indicate the scope and potential of such a study.
Epidural Bupivaeaine‐Pethidine Mixture Clinical Experience Using a Low‐dose Combination in Labour
Authors: Brownridge P. , RCOG D Obst
Published: February 2008

Summary: In an attempt to overcome some of the undesirable side‐effects and sequelae traditionally associated with epidural analgesia, various mixtures containing bupivacaine and pethidine have been examined during labour. Preliminary investigations suggested that a mixture containing bupivacaine 0.125% was the most promising combination, and accordingly a prospective survey was conducted in order to assess this mixture further; 100 mothers were included in the survey and clinical assessment included analgesic efficacy, side‐effects, degree of mobility, obstetric outcome and patient satisfaction.
Maternal Mortality in Bahrain with Special Reference to Sickle Cell Disease
Authors: Ei‐Shafei Affaf Mohammed , Sandhu Amarjit Kaur , Dhaliwal Jagajeevan Kaur
Published: February 2008

EDITORIAL COMMENT: This paper reports an analysis of 37 maternal deaths in a predominantly Arab population. Bahrain has excellent obstetric hospitals but not all patients avail themselves of these facilities — a situation not unknown in so called developed countries! Sickle cell disease has a maternal mortality rate of about 2% in Bahrain and accounted for 12 of the 37 deaths; the information regarding these cases should interest readers who have little experience of this important disease. The authors set high standards for themselves in their assessment of whether the cases considered had avoidable factors that might have minimized the risk of death. The maternal mortality rate was 33.9 per 100,000 livebirths; this figure is about double that in Australia, although it should be noted that incidental deaths (e.g. accidents, suicides, murders, malignancies), which account for about 30% of maternal deaths in Australia, were not considered. The authors' task was not made easier by the fact that autopsies were not performed because of the prevailing religious beliefs.

Summary: The maternal mortality in Bahrain during the 10‐year period, 1977 ‐ 1986, was 33.9 per 100,000 livebirths; the second 5‐year period showed a significant reduction (26.9) compared to the first 5‐year period (42.3). Haemorrhage, pulmonary embolism, hypertensive diseases of pregnancy and infection were the main causes of maternal mortality. Sickle cell disease was found to be an underlying cause in about one third of the maternal deaths. Avoidable factors were present in 38% of the cases, the majority being due to the failure of the patients to seek medical care or follow medical advice. Health education, premarital counselling and family planning were identified as significant factors in reducing the maternal mortality rate.
Intravenous Clonazepam in Eclampsia
Authors: Harding David L. , Leong Chee M.
Published: February 2008

EDITORIAL COMMENT: This is an unusual case of eclampsia in that it persisted in spite of sedation with conventional drug therapy and because myoclonic jerks occurred when her blood pressure rose above 130/90. This case has been accepted for publication to draw readers' attention to the possible value of clonazepam in patients with eclampsia. In many centres, especially in the United States, magnesium sulphate given by the intravenous route, is the main drug used in the treatment of severe preeclampsia and eclampsia. There are recent reports that Dilantin (sodium phenytoin) is also a useful drug, but only when used in much higher doses than has been recommended in the past. It is difficult to assess the value of a single drug in a patient who requires multiple drug therapy but the authors make a case for consideration of clonazepam in a patient whose convulsions persist in spite of the usual therapy.

Summary: A case of postpartum eclampsia is reported, controlled by intravenous clonazepam, a benzodiazepine anticonvulsant. Clonazepam was effective in controlling the myoclonic jerks, which were a feature in this patient, without producing excessive sedation. The literature reveals several reports on the use of clonazepam in severe preeclampsia, but its use in Australia has not been widely employed.
The Impact of an Instant Pregnancy Test Kit on the Operations of a Major Hospital Casualty Department
Authors: Baber Rodney J. , Bonifacio Michael , Saunders Douglas M.
Published: February 2008

Summary: The records of all patients on whom a casualty department pregnancy test was performed during the first 4 months of 1986 were retrospectively examined and compared with the records of all patients who in the first 4 months of 1987 had had an instant pregnancy test performed in the same casualty departement, to determine the impact of such a kit on diagnostic accuracy, operative procedures and related economic factors.
Postnatal Depression and Psychosis — A Mother and Baby Unit in a General Hospital
Authors: Kissane David , Ball JRB
Published: February 2008

Summary: The experience of a Mother and Baby Unit in a General Hospital Psychiatry Department in managing postnatal depression and puerperal psychosis over a 2‐year period is reviewed. In our community severe depressive illness will more often be referred to a Public General Hospital with a psychiatric service. The mean admission duration of 26 days for depressive illness was significantly lower than that previously reported by a Psychiatric Hospital. A significant delay in presentation appeared in half the cases, which could be reduced by attention to the family and past psychiatric history, especially the patient's relationship to her own mother indicating risk of puerperal mental disturbance.
Pap Smear Results of Victorian Teenagers, 1980–1987
Authors: Mitchell Heather , Medley Gabriele
Published: February 2008

EDITORIAL COMMENT: There are times when appraisal of the medical literature seems as difficult as that of articles in the lay press — whose story do you believe? This careful paper reporting a large series of patients is reassuring — there is no epidemic of human papillomavirus in Victorian teenagers since the prevalence in the last decade has remained at about 5%. For cervical intraepithelial neoplasia the figures are less reassuring but not alarming. Next we must ask our cytologists to provide similar comparative data for the other age groups in Victoria. Certainly this paper would indicate that the pessimism of the colposcopists due to investigation of patients referred to them is not the last word on human papillomavirus infection.

Summary: Pap smears reported by the Victorian Cytology (Gynaecological) Service between 1980 and 1987 for teenagers show a profile of abnormality which is similar to that for women for all ages. More than 90% of the cytology reports have consistently been reported as normal or showing minor benign abnormalities only. No evidence of an increasing rate of infection with human papillomavirus is apparent, with the infection rate as determined cytologically being constant at around 4% to 5% during 1981 to 1987. Some increase in the proportion of women having associated changes of CIN is apparent. No case of invasive cancer in teenagers has yet been confirmed. These data suggest that the teenagers in Victoria who are having Pap smears reported by the Victorian Cytology (Gynaecological) Service are not a high risk group for cervical cancer during their teenage years, but may be a high risk group during later years.
Changing Patterns of Caesarean Section
Authors: FRCOG Javaid H. Rizvi , MRCOG Sipra R. Chaudri
Published: February 2008

EDITORIAL COMMENT: This paper was accepted for publication because it presents data from one hospital in which, over a period of 10 years, the perinatal mortality rate fell by about 50% with only a modest increase in the Caesarean section rate from 8% to 9.9%. The authors outline the relative changes in elective and emergency Caesarean section in their hospital and examine the changing indications for Caesarean section. The variables discussed are important although the explanation for the change in practice remains elusive — for example it is difficult to understand how an increase in the primary Caesarean section rate (from 5.7% to 7.2%) was not followed by a commensurate increase in the incidence of repeat Caesarean section (from 2.3% to 2.7%).

Summary: There has been a substantial rise in the rate of Caesarean section in the last 20 years. There are many reasons for this increase, but it has been argued that the fall in perinatal mortality justifies a higher Caesarean section rate.

In this retrospective study 7,274 deliveries were reviewed and 650 Caesarean sections were analysed. There was only a marginal increase in the rate of Caesarean section (1.9%) during the 2 biennial periods studied (1974–1975 and 1984–1985), but overall perinatal mortality rate dropped by half during the second study period.

This study confirms that in recent years the indications for Caesarean section have altered, but the marked rise in the Caesarean section rate cannot be explained purely on medical grounds and is certainly not solely responsible for the very significant drop in the perinatal mortality rate.
Tamoxifen Treatment in Women with Failure of Clomiphene Citrate Therapy
Authors: Borenstein R. , Schwartz Z. Shoham , Yemini M. , Barash A. , Fienstein M. , Rozenman D.
Published: February 2008

Summary: Fourteen pregnancies were achieved with tamoxifen therapy in 12 women who failed to conceive with clomiphene citrate. There were no side‐effects and fewer treatment cycles were required than with clomiphene citrate treatment. Ovulation and cervical score with tamoxifen therapy were significantly higher (p< 0.005).
The Efficacy of Electrocoagulation Diathermy Performed Under Local Anaesthesia for the Eradication of Precancerous Lesions of the Cervix
Authors: Chanen William
Published: February 2008

EDITORIAL COMMENT: Elsewhere in this issue Merkur and Baird report the persistence of HPV infection in the majority of patients who originally presented because of an abnormal Papanicolaou smear. It is not easy to compare this with Chanen's paper because the method of treatment was different, and not all patients in Merkur and Baird“s series received treatment. However Chanen's paper reports almost complete eradication of HPV infection as well as associated intraepithelial neoplasia — in his series 62 % of patients (124 of 200) had evidence of HP V infection with or without intraepithelial neoplasia. Is the reader to conclude that electrocoagulation diathermy of the cervix can cure HPV infection, with or without associated intraepithelial neoplasia, in 98% of patients? Chanen's series had cytological and colposcopic follow‐up so one cannot challenge his results — one can only wonder why different centres are reporting such different results in treating what surely must be the same disease. A recent editorial comment in another journal stated ‘There is no satisfactory treatment of papillomavirus infections of the genital tract: Laser, cryosurgery and cautery have each been used, but recurrence rates are high … Problems associated with treatment of sexually transmitted human papillomavirus infections of the female genital tract are the use of surgical methods for treating a medical disease… (Obstet Gynecol Sum 1988; 43:679). The ultimate treatment of human papillomavirus will be to allow it to take its natural course when the patient has no symptoms, and no macroscopic or colposcopic visible lesions, except in those found to have the virus types that are associated with progression to cancer; perhaps a vaccine will ultimately be prepared to protect patients from such infections. In the patient who already has infection with human papillomavirus, treatment should be directed at exclusion of associated intraepithelial neoplasia and the treatment of such lesions.

Summary: This study demonstrates the feasibility of performing electrocoagulation diathermy with intracervical infiltration of local anaesthetic for precancerous lesions of the cervix. A technique suitable for office procedure without, need of any supplementary analgesia is described; 200 patients were treated in this fashion with results indicating the ability to obtain high primary cure rates with low morbidity similar to those previously obtained with general anaesthesia.
Plasma 19‐Hydroxyandrostenedione and Androstenedione Levels in Hydatidiform Moles and Early Pregnancies With and Without Hypertensive Diseases
Authors: Hähnel M. E. , Martin J. D. , Hähnel R.
Published: February 2008

Summary: Because of the association of preeclampsia with hydatidiform mole, and since levels of 9‐hydroxyandrostenedione (19‐OH‐A) and androstenedione (A) are raised in hypertensive diseases of pregnancy, we compared plasma 19‐OH‐A and A in hydatidiform mole patients with control early pregnant women. Both steroids were significantly elevated in 27 patients with partial or complete hydatidiform moles, as compared with the levels in 36 control pregnancies at similar stages of gestation.
A Comparative Study of Proliferating (Borderline) and Invasive Epithelial Ovarian Tumours in Young Women
Authors: Carter Jonathan , Atkinson Kenneth , Coppleson Malcolm , Elliott Peter , Murray John , Solomon John , Dalrymple Christopher , Tattersall Martin , Duval Peter , Russell Peter , Bannatyne Patricia
Published: February 2008

Summary: A series of 18 patients with proliferating or borderline ovarian tumours and 18 with invasive ovarian tumours is discussed. Proliferating tumours occurred at a younger mean age than invasive disease, and presented at an earlier stage, both contributing factors to their more favourable outlook. Histopathological assessment revealed that the majority of both proliferating and invasive tumours were of serous origin. Mucinous cell type occurred less often as did the endometrioid and clear cell types.

The management of the proliferating tumours involved ‘radical’ surgical procedures in 11 of 18 (61.6%) patients. Only 7 patients (38.8%) had conservative surgical procedures performed. Six patients (33%) had adjuvant chemotherapy while 2(11%) also underwent abdominopelvic irradiation. All patients with invasive disease had radical surgery and adjuvant chemotherapy and 2 also received abdominopelvic irradiation.

The fact that epithelial malignancies of the ovary do occur in younger women needs to be remembered by gynaecologists contemplating surgical procedures on younger patients with adnexal masses. Proliferating or borderline tumours tend to occur more frequently in the younger age groups, and contrary to the implication of their name, they are associated with significant morbidity and mortality.