bluuebunny/crossref_metadata_2025 huggingface dataset:
The Management of Severe Preeclampsia with Intravenous Magnesium Sulphate, Hydralazine and Central Venous Catheterization
Authors: Red Leslie L. , Ross Andrew , Kloss Michael , Paull John , Markman Leslie
Published: February 2008

EDITORIAL COMMENT; This paper reports satisfactory results in the management of severe preeclampsia in 46 patients using magnesium sulphate and hydralazine by intravenous infusion, and central venous catheterization for monitoring fluid balance. The reader may wonder what proportion of patients with preeclampsia warrant this type of intensive care. These patients were managed over a 3‐year interval and represent about 3% of patients with preeclampsia. In other words in 1,000 pregnancies about 100 patients will develop the signs of preeclampsia before or during labour, and in about 3 of the 100 the disease wilt be sufficiently severe to warrant the careful intensive management described in this paper.

Summary: A prospective study of patients with severe preeclampsia managed by magnesium sulphate infusion for eclampsia prophylaxis, hydralazine infusion for vasodilatation and central venous catheterization for fluid monitoring is reported. In this preliminary report of 46 patients, there was no episode of eclampsia following treatment, no maternal death, and hypertension was well controlled in all patients. Of the 51 babies born, there were 7 stillbirths, and 4 neonatal deaths; 6 of the 7 stillbirths were less than 30 weeks' gestation, and 23 of the 46 patients were delivered by Caesarean section.
Pregnancy Outcome in Women with Reflux Nephropathy — A Review of Experience at the Royal Women's Hospital Brisbane, 1977–1986
Authors: Weaver Edward , Craswell Peter
Published: February 2008

Summary: The outcome of pregnancy was examined, retrospectively, in women with a diagnosis of reflux nephropathy attending The Royal Women's Hospital from January, 1977 to August, 1986. Of 15 women, 10 were known to have had the disease antepartum and 5 were diagnosed postpartum. On the basis of plasma creatinine concentration prior to pregnancy, 10 patients had 22 pregnancies with normal renal function and 5 patients had 7 pregnancies with plasma creatinine concentrations ranging from 0.12 to 0.17 mmol/1.

The pregnancies of the women with normal renal function were complicated by urinary tract infections, while those with impaired renal function were associated with preeclampsia. The perinatal mortality for both groups were zero. A relatively low incidence of vesicoureteric reflux was found in 12 of the offspring who were subjected to micturating cystourethrography (mild reflux in 1 of 24 ureters).
Chlamydia Trachomatis Isolation in Women Attending a VD Clinic in Auckland, New Zealand
Authors: Willmott F. E. , Say P. Janet , Hookham A. B.
Published: February 2008

EDITORIAL COMMENT: Chlamydial infection is an important cause of chronic pelvic inflammation and sterility. Isolation rates are 20–60% in women attending VD Clinics and 2–6% in those attending Family Planning Clinics. It is less certain how important this infection is in other gynaecological patients. All practitioners should consult their bacteriologist so that they can arrange the appropriate test for identification of this small, Gram‐negative intracellular bacterium (that escapes detection on routine study) in patients with persistent vaginal discharge or pelvic pain.

Summary: Chlamydia trachomatis was isolated from 120 of 504 women (24%) attending a VD clinic at Auckland Hospital. Epidemiological correlates indicated a sexual mode of transmission. The only symptom of significance was lower abdominal pain. Cervicitis was more common in women with chlamydia, especially if they were on hormonal contraceptives. Chlamydia was isolated more commonly in women with gonorrhoea (52%) and genital warts (37%). The high incidence of asymptomatic and unsuspected infection emphasizes the need for routine chlamydial culture in VD clinics.
Human Papilloma Virus Infection and Associated Intraepithelial Neoplasia of the Cervix, Vagina and Vulva
Authors: Planner R. S. , Hobbs J. B.
Published: February 2008

EDITORIAL COMMENT: This issue contains reports of 3 studies indicating that a cervical smear indicative of wart virus disease or of cellular abnormalities short of dysplasia may be associated with intraepithelial neoplasia of any degree (CINICIN3). The following statement on cervical smear reporting procedures endorsed by the Royal Australian College of Obstetricians and Gynaecologists could be regarded as unduly conservative in the light of this recent information.

CERVICAL SMEAR REPORTING PROCEDURE

The problem of doctors repeating smear tests month after month on patients who have abnormal tests because of no firm recommendation by the pathologist involved, prompted the endorsement of the following recommendations by the Victorian Cytology Service:

i That when a cytological prediction is made of established dysplasia, of any degree, with or without papilloma or wart virus infection, and whether or not the patient is pregnant, the recommendation should read ‘Colposcopic evaluation is recommended’.

ii When a cytological prediction of papilloma or wart virus infection is made, without evidence of established dysplasia, in the first instance the recommendation should be ‘Please repeat smear in 6 months’.

iii If evidence of papilloma or wart virus infection persists, a second 6‐monthly smear may be recommended. If the changes are present in the third smear, indicating persistence of a lesion for 12 months, the recommendation should be ‘In view of the persistence of the changes, colposcopic evaluation should be considered’.

Summary: A prospective colposcopic and histological study was performed on 333 patients with cytologically detected human papilloma virus infection (HPV) without cytological evidence of associated intraepithelial neoplasia. The colposcopic changes seen in the cervix, vagina and vulva were documented and target biopsies were taken from abnormal areas in these 3 sites. Colposcopic and histological evidence of HPV infection was found in the cervix of 314 patients (94%), vagina in 274 patients (82%) and vulva in 146 patients (44%). Histologically proven cervical intraepithelial neoplasia was found in 94 of 333 patients biopsied (28%), vaginal intraepithelial neoplasia in 3 of 333 patients biopsied (0.9%) and vulval intraepithelial neoplasia in 9 of 146 patients biopsied (6.2%). This study identified the colposcopic changes of HPV infection to be widespread throughout the lower female genital tract. The diagnosis of intraepithelial neopiasia undetected by cytology in 28% of patients with HPV infection indicates that such patients require colposcopy and target biopsy according to the colposcopic findings.
Management of Squamous Atypia (Borderline Nuclear Abnormalities): Repeat Cytology or Colposcopy?
Authors: MRCOG Sun Kuie Tay , MRCPath David Jenkins , Singer Albert
Published: February 2008

Summary: A prospective cytological, colposcopic and histological study was conducted in 44 women with cervical cytology showing borderline nuclear abnormalities insufficient for the diagnosis of dyskaryosis. Atypical squamous epithelium was found on colposcopy in 41 patients and cervical intraepithelial neoplasia (CIN) was diagnosed on histology in 33 patients (75%) including 10 with CIN 3. Repeat cytology obtained under colposcopic vision was negative in 12 (33.4%) patients with CIN. The high prevalence of CIN in smears showing only borderline nuclear abnormalities and the high false negative rate of repeat cytology indicate that colposcopy should be the first line of management for these patients.
CA125 Serum Levels and Secondary Laparotomy in Epithelial Ovarian Tumours
Authors: Rome Robert M. , Koh Hoon , Fortune Denys , Cauchi Maurice
Published: February 2008

EDITORIAL COMMENT: Late presentation of ovarian cancer remains a major problem in gynaecology and stimulates the search for an accurate tumour marker; a simple blood test at the time of regular gynaecological examination (cervical cytology, bimanual pelvic palpation, examination of the breasts) is what is needed! Cytology of fluid aspirated from the pouch of Douglas was found to be impractical and ultrasonography, although still to be fully evaluated, is unlikely to be costeffective. The ideal tumour marker would serve as both a screening test in asymptomatic women to detect early stage disease and as an accurate monitor of therapeutic response obviating the need for second‐look laparotomy. As shown in this paper, CA125 lacks the sensitivity required to fulfil these 2 aims due to the inability to detect small volume tumour. Serial measurements of this tumour marker may serve to indicate therapeutic response in patients with advanced disease, supplementing clinical and radiographic assessment but second‐look laparotomy still remains the most satisfactory means of establishing response to therapy.

Summary: CA125 serum levels were assayed prior to 57 secondary laparotomies for ovarian epithelial tumours. Tumour was present in all 16 patients with an elevated level > 35 U/ml but the absence of tumour was incorrectly predicted in 15 of the 33 (45.5%) patients with CA125 levels < 35 U/ml. For these patients the CA125 level was elevated in 14 of 20 (70%) with tumour greater than 1.5 cm, 1 of 7 (14.3%) with macroscopic tumour less than or equal to 1.5 cm and 1 of 4 (25%) with microscopic tumour. Tumour was resectable to less than or equal to 0.5 cm in 7 of 12 (58.3%) patients with CA125 < 35 U/ml, 2 of 4 (50%) with CA125 in the range 35–100 U/ml and only 1 of 11 (9.1%) with CA125 > 100 U/ ml (p < .05). The CA125 level was elevated in 1 of 13 (7.7%) patients with less than 15 cm3 of tumour compared with 16 of 18 (88.9%) patients with 15 cm3 of tumour or more (p < .0001). The correlation between the CA125 serum level and the tumour volume was almost statistically significant (r =+ 0.31, p = .053). The level of CA125 was normal in all 8 patients with mucinous tumours — 4 of whom were found to have tumour at secondary surgery. Those patients in whom the CA125 level is normal or slightly elevated (up to 100 U/ml) are most likely to benefit from the second‐look laparotomy as they are significantly more likely either to be free of tumour or to have tumour which is resectable to 0.5 cm or less. We conclude that CA125 assay is a useful test when secondary laparotomy is envisaged.
Cone Biopsy of the Cervix: Does Surgical Technique Influence Cytological Follow‐up?
Authors: Grace Helen F. , Pattison N. S.
Published: February 2008

Summary:A 10‐year experience of cone biopsy of the cervix was reviewed to determine whether the surgical method used delayed the diagnosis of recurrent disease. Although there is a trend to selective ablation of cervical intraepithelial neoplasia, cone biopsy is a necessary adjunct to the colposcopist and remains the technique used by many gynaecologists. Two surgical techniques were compared:
Ibuprofen is a Useful Treatment for Primary Dysmenorrhoea
Authors: Fraser Ian S. , McCarron Gay
Published: February 2008

Summary: A double‐blind crossover placebo‐controlled trial over 6 cycles in 38 Australian women has confirmed that ibuprofen is a valuable drug for the treatment of primary spasmodic dysmenorrhoea. This drug was highly effective when given in a dosage of one 400mg tablet at the first sign of pain or bleeding followed by further 400mg tablets every 4 to 6 hours for the duration of expected symptoms. Side‐effects were mild and noted with equal low frequency during placebo treatment.
The Pap Smear Revisited
Authors: Shield P.W. , Daunter B. , Wright R.G.
Published: February 2008

Summary: Papanicolaou smear screening for cervical cancer has become an established practice in most developed countries. This is because the cervix is relatively accessible to investigation and treatment, and early stages in the morphogenesis of cervical cancer are both recognizable and easily treated.

The Pap smear is a valid test. It is simple, relatively inexpensive, reliable, and free of risk. Although the test has far from perfect sensitivity, it has high specificity, and false‐positive results are rare. In most reported series, the majority of false‐negative results have been found to be attributable to collection errors rather than laboratory errors. Despite the importance of Pap smear screening, controlled prospective trials have not been undertaken to determine its efficiency in reducing cervical cancer incidence and mortality. However, countries with well‐organized programmes, wide population coverage and correct follow‐up appear to have had some impact on mortality from cervical cancer. Nevertheless, coverage of high‐risk groups, particularly women over 40 years of age, remains the greatest problem.

Recommendations on the frequency of testing vary considerably. Statistical models indicate triennial testing may deliver almost all of the effectiveness of annual testing at a substantially reduced cost, but the numerous reports of false‐negative results argue strongly in favour of annual screening. It is possible that these problems may be solved in the future by increasing the sensitivity of the test and/or by the use of additional tests.
Delay Times to Definitive Diagnosis After an Abnormal Pap Smear
Authors: Mitchell Heather , Medley Gabriele
Published: February 2008

Summary: The delay between the issuing of an abnormal cytology report and the subsequent histological diagnosis has been studied for women diagnosed with carcinoma in situ, microinvasive cancer and invasive cancer in Victoria during 1985–1986. The median delay was 0.75 weeks for women with invasive cancer, 6.2 weeks for women with microinvasive cancer and 4.9 weeks for women with carcinoma in situ. Little variation was apparent with the type of practitioner taking the smear or with the area of residence of the woman. Ten of the 235 women in this study had delays of greater than 20 weeks. Five of these women were ultimately shown to have microinvasive or invasive cancer where the cytology report had indicated a lesser degree of neoplastic change. It is possible that the lessions progressed during this time.
The Natural History of Human Papillomavirus (HPV) Atypia of the Cervix
Authors: Rome Robert M. , Chanen William , Pagano Ross
Published: February 2008

Summary: This study examines the natural history of human papillomavirus (HPV) atypia of the cervix in 259 untreated patients who were followed for 3 to 74 months (median 18 months). Progression to cervical intraepithelial neoplasia (CIN) occurred in 41 patients (15.8%) — all but 3 progressions occurred within the first 24 months of follow‐up. In no patient did invasive cancer develop during this study. Persistence occurred in 39.4% and regression in 44.8% patients. An increasing number of regressions were noted with the passage of time. Progression to histologically confirmed CIN which occurred in 23 of 46 (50%) patients in whom both the cytological and colposcopic assessment at the first visit suggested CIN did so significantly more frequently than when either the cytology or colposcopy alone suggested CIN (11 progressions in 83 patients‐13.3%, p < .00001) or when neither cytology nor colposcopy suggested CIN (7 progressions in 119 patients‐5.9%, p < .000001). We recommend that patients with both cytological and colposcopic features suggestive of CIN should be treated even though HPV atypia only is reported on biopsy. Those who are not treated should be followed closely until regression occurs and consideration should be given to treating those patients in whom the abnormality persists longer than 2 years.
Evaluation of Preinduction Scoring Systems
Authors: Dhall K. , Mittal S. C. , Kumar Anita
Published: February 2008

Summary: Two hundred patients requiring induction of labour were assigned a preinduction score according to Dhall's criteria and Bishop's criteria. A score of 9 or more (Dhall) and 6 or more (Bishop) had favourable outcomes with successful induction in more than 90% of patients and an induction delivery interval (IDI) of less than 12 hours. In multiparas a Dhall score of more than 7 had a sensitivity and specificity of 88.6% and 90.0% respectively in predicting induction outcome compared to Bishop score sensitivity of 86.3% and low specificity of 47.4%. Correlation of the score with IDI as a dependent variable also showed that the Dhall score had a better predictive value than the Bishop score.
Determinants of Birth‐weight in the New Territories of Hong Kong
Authors: Rogers M.S. , Wong F.W.S. , Chang A.M.Z.
Published: February 2008

Summary: Weights of babies born in the Prince of Wales Hospital, Hong Kong, in its first 2 years of operation were studied, and compared with previous reports.

Birth‐weight in Hong Kong appears to have increased significantly in recent years. The method of data collection effects reference standards of birth‐weight. The effect of different methods of data collection and statistical treatment of data for providing reference standards of birth‐weight are discussed.

In this series average birth‐weight increased by 6.8 g per year of maternal age, 13.3 g per cm of maternal height, 42.5 g per previous baby and 104.9 g per week of gestational age; males were 110 g heavier than females. The effects of parity became significant at 35 weeks, and that of maternal age and height at 36 weeks; the effect of fetal sex was significant from 38 weeks onwards.
The Low Birth‐weight Infants of Saudi Adolescents: Maternal Implications
Authors: Al‐Sibai M. Hisham , Khwaja Suraiya S. , Al‐Suleiman Suleiman A. , Magbool Gadi
Published: February 2008

Summary: Maternal factors and perinatal outcome of low birth‐weight (≤ 2,500g) infants of 46 adolescent mothers was studied and compared with 160 adolescents who delivered infants weighing > 2,500g. The significant factors found in the low birth‐weight group were anaemia, small maternal physique and preterm delivery. Expectedly, the perinatal mortality rate was significantly increased in low birth‐weight infants.
SCC Tumour Marker and Its Relationship to Clinical Stage in Squamous Cervical Cancer
Authors: Henry R. J. W. , Dodd J. K. , Tyler J. P. P. , Houghton C. R. S.
Published: February 2008

Summary: Seram from 103 patients with histologically proven squamous cell cervical carcinoma were analysed for the presence of tumour marker, SCC antigen. Although values ranged between 0.2–109.7ng/ml the majority of cases (75%) fell below 7.9ng/ml. There was no relationship between SCC antigen values and clinical stage. The high false negative rate (29%) of this marker in patients with proven disease would preclude its use as a diagnostic screen.
Granular Cell Tumours of the Vulva
Authors: Raju G.C. , Naraynsingh V.
Published: February 2008

Summary: Granular cell tumours occur in a variety of sites, including the vulva. Origins from myogenic, histiocytic, fibroblastic and neurogenic elements have been proposed. Female preponderance suggests that oestrogenic hormones are involved.

Seven cases of granular cell tumours of the vulva have been studied. In none was the correct diagnosis made preoperatively. They were solitary lesions and local excision was curative. Paraffin sections of these cases were studied by peroxidase‐ antiperoxidase method for myoglobin, lysozyme, alpha‐1‐antitrypsin and S‐100 protein localization. Antimyoglobin, antilysozyme and anti‐alpha‐1‐antitrypsin antibodies were not localized in these tumours; however, S‐100 protein was localized in all of them. These results agree with previous data that suggest a neurogenic origin for granular cell tumours.
Acute Puerperal Inversion of the Uterus — An Obstetric Emergency
Authors: Rachagan S.P. , Sivanesaratnam V. , Kok K.P. , Raman S.
Published: February 2008

EDITORIAL COMMENT: This paper carries the important messages about acute inversion of the uterus. Firstly do not pull on the umbilical cord unless the uterine fundus is contracted and palpable — it is the abdominal, not the cord‐pulling hand, that provides the ‘control’ in delivery of the placenta by controlled cord traction. Likewise the traction should not be excessive — if the placenta does not quickly deliver, pass a catheter, and the miracle occurs (and so it seems, so prompt is the response, even though it is an everyday experience), the placenta no longer being imprisoned either in uterine fundus, or lower segment by cervical oxytocin‐induced contraction. The second message is to replace the inverted uterus as soon as it is diagnosed and before removing the placenta if it is still attached — this gives a firmer ‘fundus' for the fist to push against after general anaesthesia relaxes the uterus for correction of the inversion. With incomplete inversion (11 of the 15 cases in this report) the placenta has usually been delivered by strong (? too strong) controlled cord traction and the dimple in the still palpable uterine fundus has not been noted — the inversion is felt in the upper vagina like a large broad‐based endocervical polyp when vaginal examination is performed because of postpartum haemorrhage. In the editor's experience of one such case the inversion was rapidly manually corrected once the uterus was relaxed by halothane, with immediate cessation of haemorrhage.

Summary: Over a 17‐year period, 15 patients with acute puerperal inversion of the uterus were managed at the University Hospital, Kuala Lumpur, an incidence of 1 in 4,836 delveries. Injudicious traction on the umbilical cord before the uterus was well contracted, was probably the most important causative factor. Haemorrhage was more severe when removal of the placenta was done prior to correction of the inversion. Either the hydrostatic method or manual replacement were used but more often a combination of both techniques was found necessary. With careful management of the third stage of labour, this complication can be avoided.
Amniotic Fluid Embolism — 2 Case Reports and a Review of Maternal Deaths From This Cause in Australia
Authors: Ratten Graeme J.
Published: February 2008

Summary: Amniotic fluid embolism (AFE) is a dramatic, rare and frequently lethal complication of pregnancy. Perusal of the National Health and Medical Research Council reports on Maternal Deaths in the Commonwealth of Australia for the years 1964–1984 (1–7) shows that there have been 1,193 maternal deaths in this 21‐year period, of which 54 (4.5%) were due to AFE. This paper presents data regarding these deaths and also describes 2 cases of AFE which occurred at Caesarean section performed for placenta praevia, one of which was lethal.
Maternal Mortality at the Women's and Children's Hospital, South Okkalapa (1978–1982)
Authors: FRCOG Ma Khin Kyi
Published: February 2008

EDITORIAL COMMENT: In 1982–1984 the maternal mortality rate in Australia was 13.16 per 100,000 confinements; of the 94 deaths 42 were directly attributable to pregnancy and childbirth, 25 were indirect and 25 were from incidental causes. There was only 1 death associated with abortion, the numbers in the 6 previous triennia beginning 1964–1966 being 45, 25, 25, 2, 5 and 3. These figures are provided for the reader to contrast with those presented in this paper from Burma which considers, without equivocation, the clinical details of 44 maternal deaths in one major hospital, 1978–1982. Abortions accounted for 50% of the deaths. Excluding these the maternal mortality rate was 98 per 100,000 maternities. The author has firm views on proper definitions of parity, abortion and maternal mortality and these are stated. This paper has been published with minimal editorial interference — it was considered that readers would appreciate the unabridged case histories, especially that of the death resulting from falling astride a bamboo spike.

Summary: The maternal deaths between the years 1978 and 1982 were studied. There were 22,468 maternities and 10,623 abortion patients treated at the hospital. There were 44 maternal deaths; 22 due to abortion and 22 due to other causes. The maternal mortality rate including abortions was 1.33 per 1,000 maternities and that excluding abortions 0.98 per 1,000. The abortion was 2.0 per 1,000 abortions treated at the hospital. To reduce maternal mortality, ways and means should be found to reduce the abortion deaths, most of which were avoidable.
Chorioamnionitis: How Useful is the Determination of C‐Reactive Protein?
Authors: Kornman L. , Jacobs V. , Hodgson R. P. , Godfrey J. , Dunlevy L. , Tyler J. P. P. , Baird P. J. , Hudson C. N.
Published: February 2008

Summary: This study was designed to derive the predictive value of C‐reactive protein (CRP) in peripheral venous serum of patients admitted to hospital with suspected premature rupture of the membranes (PROM). CRP was assayed by each of 4 separate methods and the results have been compared for accuracy and practical value with respect to clinical outcome and the histopathology of the placenta. Of the 4 techniques used only the latex test had characteristics suitable for a diagnostic screen. While the results were only semiquantitative, when comparisons were made to other techniques no significant change in clinical diagnosis would have been made. The results have confirmed that chorioamnionitis and preterm labour are often associated, but in some instances the extent of inflammatory infiltration was greater than might have been expected from the short time interval between documented membrane rupture and delivery. Thus it may be speculated that some cases of PROM are secondary to, rather than causative of, infection. Finally it is suggested that a controlled therapeutic trial of active intervention in those cases of PROM with elevated CRP in the absence of other clinical parameters suggestive of intra‐uterine infection should be undertaken.
Pregnancy Outcome in Maturity Onset Diabetes at Young Age (MODY)
Authors: Dicker Dov , Yeshaya Arie , Feldberg Dov , Samuel Nurith , Karp Moshe , Goldman Jack A.
Published: February 2008

EDITORIAL COMMENT: The point of this paper is that the authors wish to classify separately those patients aged less than 25 years known to be diabetic before the onset of pregnancy, who when not pregnant can be managed without insulin — presumably these patients can maintain normal blood sugar levels by diet alone when not pregnant. The authors have not explained why age is a criterion for classification. In other words the MODY group of diabetics are a subgroup of noninsulin dependent diabetics (type 2) who previously have been divided into nonobese and obese groups. The 1978 update of White's classification of pregnant women with diabetes has 15 categories and ‘its increasing complexity may have impaired its usefulness’1. This warning is quoted so that we do not become distracted front the principles of obstetric management of diabetics: (1) prepreghancy counselling with stabilization of blood glucose levels before conception (2) good pregnancy control (3) monitoring of fetal condition in late pregnancy (oestriol assay, cardiotocography, ultrasonography) and (4) timing of delivery according to maternal and fetal condition. Unless obstetric complications dictate earlier intervention, pregnancy is allowed to go to full term (40 weeks). If insulin is required we favour induction of labour at 38 weeks' gestation after amniocentesis for estimation of the L/S ratio; before any elective induction the L/S ratio should be measured if there is doubt about fetal maturity.

Williams Obstetrics 17th Edition. Prichard JA, MacDonald PC, Gant NF, Norwalk, Conn; Appleton‐Century‐Crofts 1985; p 599.

Summary: Diabetes mellitus is not a single disease, but rather a syndrome comprised of a variety of diseases characterized by hyperglycaemia. Indeed it has a heterogeneous nature.

Maturity Onset Diabetes of the Young or MODY is an unusual, mild type of hyperglycaemia, which develops in young women, (below the age of 25), who do not require insulin.

This study describes 10 pregnancies in MODY women, who are compared to a group of patients with insulin‐dependent diabetes mellitus (IDDM), a group with gestational diabetes, and a control group of normal, healthy pregnant women. Our group of pregnant MODY patients proved to have an intermediate form of diabetes, more severe than gestational diabetes and yet not as severe as insulin‐dependent diabetes mellitus. Mean duration of diabetes was shorter and mean daily insulin requirement (during pregnancy) was lower among MODY patients in comparison to IDDM gestants. Moreover the frequency of maternal complications and Cae‐sarean deliveries in MODY patients were lower than in the IDDM group, but higher when compared to the gestational diabetes group.
Shoulder Dystocia: Risk Factors and Prevention
Authors: Hassan Adnan A.
Published: February 2008

EDITORIAL COMMENT: Shoulder dystocia or impacted shoulders occurs in 2 4 per 1,000 deliveries in most reports. However, in this editor's opinion, some difficulty with delivery of the shoulders is encountered in 20 — 40 per 1,000 vaginal deliveries, and is often the result of occipitoposterior position with nonrotation of the shoulders. In this series of 41 cases there were 14 operative vaginal deliveries but, to my surprise, arrest of the occiput posterior to the transverse diameter did not rate a mention! Shoulder dystocia should be anticipated when a fetal head which is on view in the occipitoanterior position at the height of a contraction, recedes to the midpelvis and rotates to the occipitolateral position after the contraction (and the mother's voluntary expulsive efforts) ceases. The problem is probably more common with epidural analgesia, and should be anticipated in all midforceps deliveries, especially when there are signs of cephalopelvic disproportion. The author states that ‘the majority of cases of shoulder dystocia can be anticipated;’ he infers that elective Caesarean section should be performed when clinical judgement plus ultrasonographic assessment indicates fetal birth‐weight of 4,500 g or more — in this series of 19,000 vaginal deliveries, shoulder dystocia occurred in approximately 1 in 5 such infants. The clinician must be alert to recognize the 1 in 100 fetus that will have a birth‐weight of 4,500 g or more. Another indication for elective Caesarean section to avoid shoulder dystocia is the multipara who suffered this complication in a previous delivery and again has a fetus of ample proportions.

Summary: Failure of the shoulders to deliver after delivery of the head is known as shoulder dystocia.

The risk factors associated with its occurrence were examined in women delivering vaginally at Jordan University Hospital. The profile of the patient most likely to present with shoulder dystocia was determined to be a multiparous, obese patient, over 42 weeks' gestation in a pregnancy complicated by preedampsia or diabetes with an infant weighing 4,500 g or more.

Neonatal complications were noted to be high. There was no maternal death but 4 stillborn infants were delivered and 1 died in the immediate neonatal period.
Increased Incidence of Respiratory Distress Syndrome in Infants Following Pregnancies Complicated by Hypertension
Authors: Bowen Jennifer R. , Leslie Garth I. , Arnold John D. , Jones Michael P. , Gallery Eileen D. M.
Published: February 2008

Summary: We assessed the relationship between maternal hypertension during pregnancy and the incidence of respiratory distress syndrome (RDS) in 263 infants born at 32 weeks' gestation or less. Two‐hundred and twenty‐three mothers were normotensive and 40 were hypertensive. RDS occurred significantly more commonly in infants of hypertensive mothers than in controls (60% vs 33%; p = 0.001). The association between maternal hypertension and an increased rate of RDS remained after adjustment for differences between groups with respect to gestational age, mode of delivery, administration of antenatal steroids and other complications of pregnancy, except for delivery in the absence of labour. The increased rate of RDS related to the severity of hypertension but did not relate to the duration of hypertension or to maternal treatment with beta‐blockers. In those infants who developed RDS there was no significant difference in the severity of the illness between the hypertensive group and the controls.
Umbilical Cord Knots And Encirclements
Authors: McLennan Harold , Price Elva , Urbanska Maria , Craig Nellie , Fraser Monica
Published: February 2008

EDITORIAL COMMENT: This paper confirms that a long umbilical cord is more likely to become knotted or encircle the fetal neck. Because these cord complications seldom harm the fetus, clinicians should look for other causes of birth asphyxia or ‘unexplained’ stillbirth. Greater awareness of spontaneous fetomaternal haemorrhage may eventually lead to diagnosis sufficiently early to permit effective treatment (Fliegner JRH, Fortune DW, Barrie JV. Occult fetomaternal haemorrhage as a cause of fetal mortality and morbidity. Aust NZJ Obstet Gynaecol 1987; 27: 158–161). Other circumstances where cord entanglements may distant the clinician away from the real cause of corrective fetal compromise include intrauterine infection, maternal drug therapy, haemorrhage from vasa praevia and diaphragmatic hernia.

Summary: Although cord knots and/or encirclements account for 1 in 10 stillbirths of infants weighing 2,500 g or more, no problem due to this cause was encountered in a prospective study of 1,115 vaginal deliveries. In this study there were 6 cases of cord knot (0.5%) and 158 of cord encirclement (14.2%). The range of cord length was 27 — 122 cm, the 10th, 50th and 90th percentiles being 40, 52 and 69 cm respectively. In this study there was no clinical warning (fetal distress) of cord encirclement or knot during pregnancy, labour or delivery.
Hysterosalpingography in Infertility — An Experience of 3,631 Examinations
Authors: Acton Christine M. , Devitt Jacinta M. , Ryan Elizabeth A.
Published: February 2008

EDITORIAL COMMENT: The introduction of chromotubation — laparoscopy with instillation of methylene blue through the cervix — has in many centres replaced hysterosalpingography as the primary procedure for investigation of tubal patency in patients with infertility. Proponents of laparoscopy emphasize the value of inspection of the tubes for evidence of disease and assessment for suitability for repair if the tubes are occluded. Several studies comparing findings at laparoscopy and hysterosalpingography have reported that laparoscopy frequently finds significant tubal pathology when the salpingogram was reported as normal.
Further Evaluation of First Morning Urinary Oestrogen in Monitoring Gonadotrophin Therapy
Authors: Tang Grace W. K. , Chan Steven Y. W.
Published: February 2008

EDITORIAL COMMENT: These authors previously reported that a first morning urinary oestrogen to creatinine ratio correlates well with 24‐hour urinary oestrogen excretion (13). This paper reports the successful application of this assay in monitoring the ovarian response to gonadotrophin therapy.

Summary: Efficient gonadotrophin therapy requires both biochemical and ultrasonic measurements of ovarian response. Biochemical monitoring can take the form of measurement of plasma oestradiol levels or urinary oestrogen excretion. Levels of first morning urinary oestrogen to creatinine ratio have been shown to correlate well with 24‐hour total urinary oestrogen excretion. Such urine collection is not cumbersome and is less invasive than daily venepuncture. Eighty gonadotrophin treatment cycles were evaluated by first morning urinary oestrogen to creatinine ratio and ultrasound scanning of follicles. Analysis confirmed that the ratio correlated significantly both with plasma oestradiol and 24‐hour urinary oestrogen levels. The administration of the ovulating dose of human chorionic gonadotrophin depended primarily on ultrasonic demonstration of the presence of mature follicles in the ovaries. There was no increased incidence of multiple gestation or hypersti‐mulation syndrome in 135 treatment cycles. It is concluded that first morning urinary oestrogen to creatinine ratio is a convenient and cheap method of efficient biochemical monitoring of ovarian response to gonadotrophin therapy.
Permanent Partial Blindness in the Puerperium An Unusual Manifestation of Cerebral Vascular Accident in Pregnancy
Authors: Ilancheran A. , Bharatham G. , Ratnam S. S.
Published: February 2008

EDITORIAL COMMENT: This well documented case of cerebral infarction during the puerperium causing permanent partial blindness was accepted for publication because of its unique interest. There is no message regarding prevention; the patient did not have cardiovascular risk factors and the single episode of hypertension and proteinuria at 38 weeks' gestation seems quite unrelated to the complication which occurred 2 weeks after delivery.
First Pregnancy at 47 Years of Age After 20 Years of Amenorrhoea
Authors: Lam S. Y. , Martin M. , Evans J. H. , Baker H. W. G. , Pepperell R. J.
Published: February 2008

EDITORIAL COMMENT: This sad case is a reminder that patients with secondary amenorrhoea who do not wish to become pregnant require adequate contraceptive advice.
Vaginally Administered 16,16‐Dimethyl‐PGEl‐Methyl Ester (Gemeprost) to Induce Termination of Pregnancy after the First Trimester
Authors: Ford Robert M
Published: February 2008

Summary: The results of the first 40 patients, whose pregnancies were terminated using Gemeprost vaginal suppositories are presented. The indication for termination of pregnancy was either fetal abnormality, or fetal death in utero. The mean gestational age was 20.9 ± 4.4 weeks. 82.5% of patients were delivered within 24 hours, following a mean number of 3.9 ± 1.3 pessaries. Side‐effects were uncommon, and the procedure was well tolerated, with 30% of patients requiring no analgesia, and 60% receiving narcotic analgesia only. The results obtained compare favourably with the overseas experience with this method. Augmentation with oxytocic agents is of questionable value, and routine evacuation of the uterine cavity, under general anaesthesia seems unnecessary. Administration is simple and well tolerated by patients, and this method of pregnancy interruption appears safe, efficient and superior to extra‐amniotic infusion of PGF2α.
Contribution of Prematurity and Low Birth‐Weight to Neonatal Death in Chinese and Western Populations
Authors: Drew John H. , Beischer Norman A. , Walstab Janet E. , Liang S. T. , Stronge John M.
Published: February 2008

Summary: This paper analyses the contribution of low birth‐weight (birth‐weight between 500 and 2,500 g) and prematurity (gestation < 37 weeks) to neonatal death in Chinese and Western populations. The incidences of low birth‐weight in the Tsan Yuk Hospital, Hong Kong, the State of Victoria, and the Mercy Maternity Hospital, Melbourne, were 4.63%, 4.29% and 5.66% respectively and the incidences of prematurity were 2.08%, 4.89% and 7.42% respectively. The neonatal mortality rate (per 1,000 livebirths) for premature infants born in Victoria was 64, 89 for those born at the Mercy Maternity Hospital and 119 for the Tsan Yuk Hospital. This paper has demonstrated that a striking differences exists in prematurity rates between Chinese and Western populations, and also that the mortality rate of premature infants is lower in Western populations. If the reason for the lower incidence of prematurity in the Chinese population could be determined and the mortality of premature infants maintained in the Western population, a significant lowering of perinatal mortality would result. Studies to determine causes for premature births in Chinese and Western populations should therefore be undertaken.
Microbiological Profile of the Cervix in 1,000 Sexually Active Women
Authors: Kovacs G.T. , Westcott M. , Rusden J. , Asche V. , King H. , Haynes S.E. , Moore E.K. , Hall B.E.
Published: February 2008

EDITORIAL COMMENT: The take‐away message from this careful study is that of 1,000 women attending a family planning clinic, microbiological study isolated Mycoplasmas in more than 50%, Chlamydia in 5% and gonorrhoea in about 0.5%— although only 16% of the women presented because of pain, discharge or suspicion of sexually transmitted disease. In those patients with 2 or more sexual partners in the past year the incidence of mycoplasma infection was somewhat higher but the risk of chlamydial infection was doubled. In the 25% of women with symptoms, Gardnerella was cultured in 40% and Candida in only 20%. How does one apply this information to ordinary gynaecological or general practice? If a patient presents with vaginal itch and discharge, unless she has obvious clinical signs of Candida, she should be prescribed a course of a tetracycline (Chlamydia, Mycoplasmas, gonorrhoea) and metronidazole (Gardnerella, trichomonas). This is shotgun therapy but the only alternative is more sophisticated bacteriological investigation of outpatients — 2 cervical swabs for Chlamydia and a third in Amies transport medium for culture of Neisseria gonorrhoeae and the genital mycoplasmas, and for Gardnerella and other anaerobes. The final comment is that it is uncertain if any treatment is indicated when culture reveals Mycoplasmas or Gardnerella, especially if the patient is asymptomatic — it would be mindboggling if doctors should accept that almost 50% of asymptomatic women who attend for contraceptive advice harbour vaginal organisms that require treatment.

Summary: One thousand consecutive women who attended the Richmond Family Planning Association Clinic and who were to undergo a vaginal examination were asked to participate in a large prospective microbiological study. Participants were questioned about their sexual activity during the previous 12 months and any apparent signs of sexually transmitted disease. On examination the cervix was inspected for evidence of inflammation, ectopy or discharge and cervical swabs were taken for microbiological assessment.

Chlamydia trachomatis was isolated in 5.1 % of women tested while Ureaplasma urealyticum and Mycoplasma hominis were found in 48.8% and 16.4% of women respectively. Significant associations were found between the number of sexual partners during the previous 12 months and the incidence of all 3 organisms. The carriage rate of the genital mycoplasmas was significantly affected by the type of contraception. In addition the association between the presence of the genital mycoplasmas and pelvic and cervical abnormalities was determined.
Cervical Pregnancy: Hysterectomy Avoided With the Use of a Large Foley Catheter Balloon
Authors: Hurley Victor A. , Beischer Norman A.
Published: February 2008

Summary: A case of cervical pregnancy in the late first trimester is reported where hysterectomy was avoided, when it seemed inevitable in the face of heavy uncontrolled haemorrhage. Having read the cases reporting easy control of massive haemorrhage from the expanded cervix in such cases by a Foley catheter, we decided to try this recently reported technique — it was magically effective.
Uterine Activity in Spontaneous Labour with Breech Presentation
Authors: Arulkumaran S. , Ingemarsson I. , Gibb D. M. F. , Ratnam S. S.
Published: February 2008

EDITORIAL COMMENT: In this unusual and interesting study the authors found that uterine activity in patients with breech presentation is similar to that in patients with vertex presentations, when controlled for parity (nulliparas versus multiparas). The study did not consider the type of breech presentation, although one might expect labour to be more coordinate and effective with a breech with extended legs than with a complete breech. It is interesting to note that the authors practise amniotomy in the active phase of labour when the breech presents ‘provided that cord presentation or a high presenting part is excluded’. In this group of patients the authors did not employ either epidural analgesia or oxytocin enhancement of labour. The authors make the point that normal uterine activity in patients with breech presentation does not guarantee safe breech delivery. Readers should note that in this series criteria for inclusion included normal pelvic and fetal dimensions, and spontaneous onset of labour.

Summary: Uterine activity was quantified for patients who had a breech presentation, spontaneous labour and a vaginal delivery. Results were studied according to parity and in relation to cervical dilatation. The multiparas with breech presentation overall had lower uterine activity compared to nulliparas when the whole labour was considered. These values were compared with control patients with vertex presentation who had spontaneous normal labour and vaginal delivery. The median uterine activity values in breech presentation were not significantly different from control nulliparous or multiparous patients. Among the breech deliveries, irrespective of parity, mean Apgar scores at 1 and 5 minutes were over 6 and cord arterial blood pH values were above 7.15, but these results were significantly lower than the contol cases with vertex presentation. The uterus performs similar uterine activity in spontaneous normal labour whether the fetus presents as a vertex or breech, when controlled for parity.
The Treatment of Symptomatic Benign Breast Disease with Danazol
Authors: Ramsey‐Stewart George
Published: February 2008

EDITORIAL COMMENT: Breast disease should concern all obstetricians and gynaecologists as well as general practitioners, since patients often report their breast symptoms at the time of attendance for a Papanicolaou smear. It is natural that the patient expects the one practitioner to advise her regarding prevention/ early diagnosis of cancer of the breast and cervix. Since 5–8% of women develop carcinoma of the breast and fewer than 1 in 10 breast lumps are found on biopsy to be malignant, breast pathology is too common and important to be ignored in this journal. The more common symptoms of breast pain and tenderness also warrant consideration. Many patients with breast symptoms require only reassurance, although the investigations available for screening for breast cancer will often require discussion (1).

Summary: A prospective randomized double blind trial, using danazol in a dose of 200 mg twice a day, was carried out on 80 women presenting with severe cyclical symptomatic benign mammary dysplasia. Standardized scores for 4 parameters of disease severity (breast pain, breast tenderness, breast nodularity and breast cysts) were defined and measured monthly on all patients admitted to the trial. Using nonparametric statistical analysis, significant improvement in breast pain, tenderness and nodularity, was found in both the double blind and crossover arms of the trial. An insufficient number of patients presented with breast cysts to draw any conclusions regarding the efficacy of danazol on cysts. Six months of treatment may produce a more sustained response, than 3 months of treatment. Danazol appears to be efficacious in managing patients with severe breast symptoms due to benign disease.
Caesarean Section in South Australia, 1986
Authors: Jonas O. , Chan A. , MacHarper T.
Published: February 2008

Summary: A profile of Caesarean section in South Australia was obtained by analysing the 19,800 births in the perinatal statistics collection in 1986. The Caesarean confinement rate was 19.0%, of which 9.0% were elective sections and 9.9% emergency sections. The rates were highest in large metropolitan hospitals. Elective rates were highest in metropolitan private hospitals, among older women, among those with a previous perinatal death or where a fetal malpresentation occurred. Emergency sections were more common in primigravidas, non‐Caucasian women, those with a poor pregnancy history, few antenatal visits and a medical or obstetric complication of pregnancy. The obstetric complications most commonly encountered with Caesarean sections were fetopelvic disproportion, fetal distress, malposition or malpresentation, pregnancy hypertension and uterine inertia. Neonates born by emergency section were more likely to be premature, or low birth‐weight and to manifest depression of vital signs compared with vaginal births. They also required more intensive resuscitation and neonatal care, and neonatal death occurred more frequently. Morbidity was much lower in neonates born by elective than emergency section.