bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidural Analgesia and Fetal Heart Rate Abnormalities
Authors: Umstad Mark P. , Ross Andrew , Rushford Debra D. , Permezel Michael
Published: February 2008

Summary: Lumbar epidural analgesia is frequently associated with fetal heart rate abnormalities. Fluid preloading prior to the procedure significantly reduces the incidence of abnormal fetal heart rate patterns (p = 0.02). The mechanisms of these changes are discussed and the importance of maternal hypotension is evaluated. Fluid preloading and continuous electronic fetal monitoring should be considered routine for all women undergoing this procedure.
Caesarean Section Anaesthesia and the Apgar Score
Authors: Boyle R.
Published: February 2008

EDITORIAL COMMENT": We accepted this paper for publication because it carefully challenges a commonly expressed clinical opinion regarding the optimal anaesthesia for delivery at Caesarean section of the low birth‐weight infant. Our anaesthetist reviewer commented that the indication for Caesarean section was not considered and emphasized that Apgar scores have a poor correlation with fetal well‐being and should not therefore be considered as incontrovertible evidence for or consequence of poor operating conditions or birth trauma. A number of facts relating to general anaesthesic agents and their effects on the neonate are mentioned in the discussion. However, the extremely important concept of aortocaval compression and its effect on maternal cardiac output, peripheral resistance and the placental circulation was not.

Summary: Retrospective comparison of epidural and general anaesthesia by a multivariate analysis of 1 and 5 minute Agar scores did not show that general anaesthesia improves operating conditions for Caesarean section or reduces fetal trauma for preterm and term infants.
Cervical Ripening Induces Labour Through Interleukin 1β
Authors: George Susan Shanthi , Matthews Jiji , Jeyaseelan L. , Seshadri Lakshmi
Published: February 2008

Summary: In order to study the Interleukin 1β (IL‐1β) levels in mechanical cervical ripening with Foley catheter, IL‐1β levels in amniotic fluid of 12 women before and after cervical ripening were compared with those in 23 women in spontaneous active labour. IL‐1β was present in 81.8% of patients after cervical ripening and in none prior to it. In women with spontaneous labour 69.6% had immunodetectable IL‐1β. Women with spontaneous labour and those sampled after cervical ripening had similar IL‐1β levels in the amniotic fluid. Cervical ripening with Foley catheter is associated with high levels of IL‐1β and this probably induces labour.
Diagnosis and Management of Extrauterine Pregnancies
Authors: Sinosich Michael J. , Torode Hugh , Saunders Douglas
Published: February 2008

Summary: This study was based on 16 women provisionally diagnosed as having extrauterine pregnancies. Of these, 13 (81.3%) were confirmed as positive at operation. Patients were managed according to 1 of 3 regimens; 1) methotrexate (n = 4), 2) methotrexate followed by surgery (n = 3) and 3) surgery (n = 6). Serial blood samples, collected before and after treatment, were analyzed for ovarian (oestradiol, E2; progesterone, P4) uterine (placental protein 14, PP14) and placental markers (chorionic gonadotrophin, HCG; pregnancy‐associated plasma protein‐A (PAPP‐A). Of the pretreatment samples, only 30.4% and 41.7% were depressed for PP14 and HCG, respectively. By contrast, the diagnostic value of PAPP‐A (77.8%) and P4 (87.5%) was greater. Biochemical monitoring of treatment was best achieved with trophoblastic derived antigens (HCG), whereas antigens of maternal origin demonstrated widely varied responses. This study established the effectiveness of chemotherapy for treatment of tubal pregnancies as an alternative to surgery, but if a biochemical marker is required, the marker of choice is HCG.
Serial Human Chorionic Gonadotrophin Determination in the Diagnosis of Ectopic Pregnancy
Authors: Grønlund Bo , Marushak Andre
Published: February 2008

Summary: Serial human chorionic gonadotrophin (HCG) determinations were made in 21 patients with ectopic pregnancy (EUP) and in 29 patients with early intrauterine pregnancy (IUP) to examine the increase in HCG values. The median slope of the HCG rise for the patients with EUP was 116 IU/1/2 days and 4,220 IU/1/2 days in patients with IUP. The slopes were significantly different (p < 0.05). Using a discrimination limit of 980 IU/1/2 days, the predictive value of a slope below this limit was 90% in EUP compared to the control group of intrauterine pregnancies. Determination of the slope of HCG rise may be of value in early recognition of ectopic pregnancy in patients with increasing HCG levels below the ultrasonographic discriminatory zone. An international agreement on discrimination limits and unity of HCG algorithms is suggested.
Women and AIDS
Authors: Schuman Paula , Sobel Jack D.
Published: February 2008

Summary: The number and proportion of women infected with the human immunodeficiency virus (HIV) and with the acquired immunodeficiency syndrome (AIDS) have increased rapidly throughout the last decade. Despite these increases, the scientific community has focused limited research attention on women living with HIV infection. Data from studies of predominantly gay/bisexual men may not reliably be extended to women; studies of the natural history of HIV infection in women are needed. Obstetrician‐gynaecologists are increasingly called upon to diagnose HIV infection in women and provide care in both clinical and research settings. In this review we discuss the serodiagnosis of HIV infection in women; the impact of pregnancy on HIV disease progression; transmission of HIV infection from mother to offspring; gynaecological infections and malignancies which may manifest differently in HIV‐infected women; and clinical care of women living with HIV.
Acute Tocolysis for Fetal Distress: Terbutaline Versus Magnesium Sulphate
Authors: Magann Everett F. , Cleveland Robert S. , Dockery James R. , Chauhan Suneet P. , Martin James N. , Morrison John C.
Published: February 2008

Summary: Forty‐six women in active labour who developed fetal distress requiring abdominal delivery were randomized to receive 0.25 mg of terbutaline (subcutaneously) or magnesium sulphate as a 4‐g bolus (intravenously) to decrease uterine activity. The terbutaline‐treated group in contrast to the magnesium sulphate‐treated group had reduced uterine activity as measured by Montevideo units (p <0.002). This decrease in uterine activity was noted more rapidly in all 23 patients who received terbutaline, 1.8 ±0.74 minutes compared to 7.5 ±2.1 minutes in the 16 of 23 patients (magnesium sulphate‐treated women) in whom a decrease in uterine activity occurred (p <0.001). Umbilical cord arterial blood pH at delivery was less than 7.20 in only 2 of the 23 patients treated with terbutaline versus 7 of the 23 in the magnesium sulphate‐treated group. We conclude that terbutaline is an effective and more rapid‐acting tocolytic agent to arrest uterine activity prior to delivery for fetal distress.
External Cephalic Version at Term
Authors: Goh Judith TW. , Johnson Cathryn M. , Gregora Michael G.
Published: February 2008

Summary: The case notes of women with singleton term (37 weeks' gestation and beyond) breech presentation and delivery were retrospectively reviewed. Thirty‐two of the 72 women in the study group had attempted external cephalic version at term, with a success rate of 53% (17 women). The Caesarean section rate was significantly lower in the group which had attempted ECV compared to the group which did not.
Pseudosinusoidal Fetal Heart Rate Pattern and Fetal Anaemia: Case Report and Review
Authors: Neesham Deborah E. , Umstad Mark P. , Cincotta Robert B. , Johnston Diana L. , McGrath Gabrielle M.
Published: February 2008

Summary: The association of a pseudosinusoidal fetal heart rate pattern with fetal anaemia is reported. A system of classifying this cardiotocographic feature as minor, intermediate or major is discussed. The clinical correlates of each of these gradings and the differentiation from a true sinusoidal fetal heart rate pattern are presented.
Acceptance of Mementos of Fetal and Perinatal Loss in a South Australian Population
Authors: Khong T. Y. , Hill F , Chambers H. M. , Staples A. , Harry C.
Published: February 2008

Summary: A package of mementos of a fetal or perinatal loss has been shown to help with the grieving process. The level of acceptance and the factors influencing acceptance of these mementos in a South Australian population was examined over a 27‐month period. Data were available on 447 women and the acceptance rate was 79.6%. Major influences on the acceptance of mementos were maternal age and gestational age. Mothers in the 20–30 year age group were more likely to accept mementos than younger and older mothers. This age‐related effect was more noticeable among genetic terminations and neonatal deaths than among spontaneous abortions or stillbirths. Memento acceptance of miscarriages and stillbirths over 20 weeks' gestation was significantly greater than for younger gestation. These findings may have an impact on the psychosocial management of perinatal loss. The high level of acceptance of these mementos is encouraging and vindicates our current practice which we recommend to others involved in the management of perinatal loss.
Laparoscopic Removal of Dermoid Cysts Using Endopouch
Authors: Yuen P. M. , Rogers M. S.
Published: February 2008

EDITORIAL COMMENTS: We accepted this paper for publication since like other articles in this issue, it describes another laparoscopic technique available to the gynaecologist. However, reviewers of this paper wish to remind readers that cystic teratomas are often too large for this retrieval bag technique (> 7cm) and more importantly that the standard operation for cystic teratomas in premenopausal women is ovarian cystectomy with preservation of the ovary and ovarian function. In our experience enucleation of a cystic teratoma with conservation of the ovary is always possible unless the tumour has undergone torsion and is necrotic. Moreover, enucleation of an ovarian cyst can be performed by laparoscopic technique (A).

A. Wood C, Maher P, Hill D. Gynaecological endoscopy. RACOG continuing education Resource Unit 100, 1993.

Summary: Laparoscopic oophorectomy was successfully performed in 6 patients with ovarian dermoid cysts. The use of Endopouch eliminates the risk of spillage and the need to extend the wound. The duration of operation ranged from 60 to 90 minutes and all patients were discharged within 48 hours with minimal pain and no complications.
Laparoscopic Modified Radical Hysterectomy and Lymphadenectomy Simulating Open Operation for Stage 1A2 Cervical Carcinoma
Authors: Jobling T. , Wood C.
Published: February 2008

EDITORIAL COMMENT": This paper gives a fine technical description of a modified radical procedure performed laparoscopically for a very early carcinoma of the cervix. The initial results of the operation in terms of blood loss and time in hospital are impressive. The paper does not however attempt to answer what we think are the most important issues raised by the advent of laparoscopic surgery. Unfortunately the comparison of open and laparoscopic surgery for gynaecological cancer cannot be measured in terms of immediate postoperative morbidity or mortality. The efficacy of this treatment can only be ascertained in following up these patients over several years and determining overall survival and tumour recurrence patterns. That being the case it is difficult to see how informed consent can be obtained from patients undertaking laparoscopic procedures for gynaecological cancer. We are not able to tell these patients that overall cure rates are as good as with conventional therapy and the potential for litigation looms high should this turn out not to be the case.

One would expect the results of treatment for the patient presented in this paper to be excellent, as many would consider that a simple hysterectomy would have been adequate therapy. While these patients with very early lesions may be suitable candidates to refine the technique needed for this radical surgery once again the problem of informed consent is a concern. This is such a problem that the Gynecologic Oncology Group in the United States of America is holding a workshop to consider the ethical issues raised by laparoscopic surgery for gynaecological cancer. We believe that there is a place for radical laparoscopic surgery but are equally certain that its place has not yet been defined.

Summary: A 31 year old patient with Stage 1A2 cervical carcinoma underwent a laparoscopically modified radical hysterectomy and pelvic lymphadenectomy simulating the open operation. The operative technique is described. The operative time was 7 hours and 40 minutes. The patient was discharged on the third post‐operative day. The procedure warrants further evaluation.
Cushing Syndrome Complicating Pregnancy
Authors: Kriplanl A. , Buckshee K. , Ammini A.C.
Published: February 2008

Summary: A case of Cushing syndrome in a 25‐year‐old female diagnosed during pregnancy is presented. The pregnancy was complicated by diabetes mellitus, pregnancy induced hypertension, prematurity and intrauterine growth retardation. The patient underwent transphenoidal pituitary adenectomy after delivery for removal of a large pituitary adenoma. The mother and infant are well 10 months after delivery.
Ketorolac Versus Fentanyl for Gynaecological Day‐Case Surgery
Authors: Monagle J. , Wongprasartsuk P. , Shearer W.
Published: February 2008

Summary: The effectiveness of fentanyl and ketorolac in providing analgesia for day‐case gynaecological procedures was evaluated in 55 healthy volunteers in a single blinded fashion. Fentanyl (1 mcg/kg iv) and ketorolac (30 mg im) were administered immediately following induction of anaesthesia. Anaesthesia was standardized with propofol, nitrous oxide and enflurane. Outcome variables assessed were pain, additional analgesic requirements, and incidence of postoperative nausea and vomiting. All variables were recorded at 15 minutes, 2 hours and 24 hours postoperatively. There was no significant difference between the 2 groups with respect to any of the measured variables. Both drugs were ineffective as sole analgesic agents in half of their respective groups. It may be that a combination of these drugs, providing a multireceptor approach to analgesia, will prove to be more effective.
A Case of Polymyositis and Invasive Squamous Cell Carcinoma of the Uterine Cervix
Authors: Armes Jane E. , Rome Robert , Östör Andrew G. , Dennett Xenia
Published: February 2008

Summary: To our knowledge, this is the fifth reported case of invasive cervical neoplasia associated with idiopathic inflammatory myopathy and illustrates the importance of cervical examination in women with polymyositis.
Gestational Diabetes and Follow‐up Among Immigrant Vietnam‐born Women
Authors: Henry O. A. , Beischer N. A. , Sheedy M. T. , Walstab J. E.
Published: February 2008

Summary: Gestational diabetes is associated with an increased risk of fetal macrosomia and perinatal death. Immigrant mothers from Vietnam who delivered in the Mercy Hospital for Women between January 1,1979 and December 31,1990 were investigated to assess their risk of gestational diabetes, the factors that were associated with gestational diabetes, and the prevalence of diabetes mellitus on follow‐up. These mothers were compared with Australian‐born mothers attending the same hospital and who delivered in the same period. Using a logistic regression model, gestational diabetes was found to be more common in Vietnam‐born mothers who were older, who were primigravidas, or were underweight and the risk of gestational diabetes increased over the time period of the study. The adjusted relative risk of gestational diabetes for Vietnam‐born women was 1.43 (95% confidence limits 1.10, 1.86) compared with Australian‐born women. The incidence of gestational diabetes was 7.8% (144 of 1,839) in Vietnam‐born mothers and 4.3% (1,173 of 27,086) in Australian‐born mothers. Vietnam‐born mothers also had a greater risk of diabetes mellitus on follow‐up; 25% (17 of 68) of those with follow‐up testing had developed diabetes mellitus within 9 years of diagnosis of gestational diabetes, in comparison with an incidence of 9% (52 of 581) of Australian‐born mothers with follow‐up testing. Vietnam‐born mothers should have glucose tolerance testing performed during pregnancy to detect gestational diabetes and those diagnosed should have long‐term follow‐up to detect the development of diabetes mellitus.
Corticosteroids for Enhanced Fetal Lung Maturation in Patients with HELLP Syndrome: Impact on Neonates
Authors: Magann Everett F. , Graves Glen R. , Roberts William E. , Blake Pamela G. , Morrison John C. , Martin Jr James N.
Published: February 2008

Summary: This study was undertaken to determine retrospectively, in women with the HELLP syndrome, the perinatal effects of corticosteroid administration for promotion of fetal lung maturity. Twenty‐seven of 427 women with the HELLP syndrome treated between 1980 and 1991 received a full course of steroids prior to preterm delivery. They were compared to 27 control patients with the HELLP syndrome matched for maternal age, severity of disease, gestational age, race, and sex of the fetus. Respiratory distress requiring mechanical ventilation occurred in 13 of 27 neonates who received steroid administration and in 23 of 27 who did not receive steroids (p<0.001). The average stay in the neonatal intensive care unit was 29.8 ± 50.6 days for the steroid‐treated group and 45.2 ± 35.3 days for the group without steroid use (p = NS). The incidence of neonatal deaths, intraventricular haemorrhage type III and IV, necrotizing enterocolitis, and retrolental fibroplasia was greater in the control group but the difference was not statistically significant.
Normal Ranges for Doppler Flow Velocity Waveforms from Maternal Uterine and Fetal Umbilical Arteries
Authors: Duggan Paul , McCowan Lesley
Published: February 2008

Summary: A longitudinal study of Doppler flow velocity waveforms (FVW's) measured 4‐weekly from 18–36 weeks' gestation from maternal uterine and fetal umbilical arteries is reported.
Term Breech Delivery: Does X‐ray Pelvimetry Help?
Authors: Biswas A. , Johnstone M. J.
Published: February 2008

Summary: Over a 3‐year period a retrospective audit was performed of all uncomplicated singleton breech presentations at term to assess the role of X‐ray pelvimetry. The review included 267 term breech presentations. Seventy‐seven women (Group A) delivered in a consultant unit where X‐ray pelvimetry was not used for decision making regarding the mode of delivery; 125 women (Group B) delivered in 2 consultant units where X‐ray pelvimetry was always used, and 65 women (Group C) delivered in a fourth consultant unit where X‐ray pelvimetry was used selectively. Obstetric outcome was measured in terms of mode of delivery. Short‐term neonatal outcome was assessed by Apgar score at 5 minutes, evidence of birth trauma and admission to the neonatal special care unit for more than 24 hours. Significantly fewer women (12.9%) had an elective Caesarean section in group A compared with the other 2 groups (27.2% in group B and 33.8% in group C; p<0.05). The vaginal delivery rates following a trial of labour were not significantly different (79.1% for group A, 65.9% for group B and 65.1% for group C) and neonatal outcome was similar in all groups. It is concluded that fewer Caesarean sections were done, without adversely affecting the neonatal outcome, when X‐ray pelvimetry was not used to select the mode of delivery of uncomplicated singleton breech presentation at term. Satisfactory progress in labour is the best indicator of pelvic adequacy.
Induction of Labour: Does Internal Tocography Result in Better Obstetric Outcome than External Tocography
Authors: Chia Y. T. , Med M , Soon S. B. , Norshida S. , Ratnam S. S.
Published: February 2008

Summary: A prospective randomized study was undertaken to evaluate the benefit of intrauterine catheters in induced labour. Two hundred and thirty nine women who had induced labour were studied. The patients in one group had intrauterine catheters inserted and oxytocin was titrated to achieve the 75th percentile of uterine activity observed in spontaneous normal labour according to parity. Contractions were assessed by external tocography in the other group and oxytocin was titrated to achieve 6 to 7 contractions per 15 minutes each lasting >40 seconds. Mean maximum dose of oxytocin, mode of delivery, Apgar score < 7 at 5 minutes, cord arterial blood pH < 7.15 and admission to neonatal intensive care unit did not differ significantly in the 2 groups. In conclusion, women who had intrauterine catheters did not have a shorter duration of labour, lower dose of oxytocin, fewer operative deliveries or fewer babies in poor condition at birth compared with those who had external tocography in induced labour.
Pregnancy Complicated by Maternal Phenylketonuria
Authors: Peat Brian
Published: February 2008

Summary: Pregnant women who have elevated levels of serum phenylalanine are more likely to have a spontaneous abortion or to give birth to an infant with congenital cardiac anomalies, symmetrical growth retardation, microcephaly and mental retardation than pregnant women with normal levels of this amino acid (1).

Nine pregnancies in 7 women were managed in conjunction with the staff of the Children's Hospital, Sydney. In 6 patients, satisfactory serum levels of phenylalanine were attained and 6 offspring are all normal at follow‐up, ranging from 15 years to 1 year. The 2 children of the poorly controlled mother were of low birth‐weight and both had microcephaly at birth. The poor control of serum phenylalanine was due to poor compliance with the strict dietary regimen.

It is concluded that dietary control of serum phenylalanine levels below 600 umol/1 in pregnant women with PKU is possible and desirable and may improve perinatal and long‐term outcome.

This requires close co‐operation between paediatrician, dietician, obstetrician and patient. Further data are required to confirm these findings in larger numbers and to provide long‐term neurological follow‐up.
Heterosexual transmission: A Growing Risk factor for HIV Spread
Authors: Gabriel V. , Packhanr D. R.
Published: February 2008

Summary: The risk of human immunodeficiency virus (HIV) spread by heterosexual contact is emerging as a risk factor for women in Sydney in the 1990's. As shown by this study, heterosexual exposure to the virus accounted for 40% of women in Western Sydney acquiring the disease between 1989–1991 inclusive, compared with O% in 1982–1985 inclusive. Further public awareness of this mode of transmission and information on safe sex practices is necessary to limit the spread of the AIDS virus.
Menopause Before 40 ‐ Premature, but Not Always Permanent
Authors: Eden John A.
Published: February 2008

Summary: Seventy‐five women with premature menopause presented to a reproductive endocrinologist over a 3‐year interval. Thirty‐five had an identifiable cause, usually a chromosomal defect, autoantibodies or cytotoxic chemotherapy. Forty had no apparent cause and of this group 5 conceived on hormone replacement therapy (HRT). Overall, this group of oestrogen deficient women had spent nearly half of their meno‐pausal years to date, not on HRT.
Septic Pelvic Thrombophlebitis: An Unusual Treatable Postpartum Complication
Authors: Keogh John , MacDonald Dermot , Kelehan Peter
Published: February 2008

Summary: Septic pelvic thrombophlebitis is an uncommon but serious postpartum complication occurring in about 1 in 2,000 pregnancies, characterized by pain, antibiotic resistant fever and tachycardia. In about 50% of cases a pelvic mass is present which is usually right‐sided (especially when the ovarian vein is involved). It is estimated to cause 18 maternal deaths per million pregnancies in the United States.

Use of contrast enhanced CT scanning and a trial of heparin therapy increases the diagnostic certainty.

It is particularly important because surgical management which may otherwise be suggested because of a spiking fever and a mass seems to be associated with a poorer prognosis than does conservative management.
Sexuality and Pregnancy An Interview Study
Authors: Barclay Lesley M. , McDonald Peter , O'Loughlin John A.
Published: February 2008

Summary: This paper reports the interview research which formed the basis for a large, recently completed study of sexuality and pregnancy by questionnaire. Semistructured interviews were conducted with 25 couples who presented at a large hospital antenatal clinic in the first trimester. Of these couples, 15 participated in second trimester interviews and 12 couples were interviewed between 38 and 40 weeks' gestation.

The results showed a substantial decline in sexual interest amongst women that was not matched by their male partners but was reflected in a marked reduction in frequency of intercourse. The range of sexual activities also diminished during pregnancy. The majority (19 or 76%) regularly practised oral sex and 3 men (12%) regularly practised anal intercourse. A key observation is that 7 males (28%) did not always achieve orgasm during sexual intercourse per se.
Antepartum Screening and Non‐selective Intrapartum Chemoprophylaxis for Group B Streptococcus
Authors: Jeffery Heather E. , Mcintosh E. D. G.
Published: February 2008

Summary: The efficacy of antibiotic chemoprophylaxis in labour for all maternal carriers of Group B streptococcus with respect to the neonatal mortality and morbidity was analyzed. The intervention consisted of a policy of maternal screening for Group B streptococcus at 28 weeks' gestation by a low vaginal swab, cultured on to nonselective media. If positive, all carriers were treated with intrapartum ampicillin regardless of other obstetric risk factors. The main outcome measures were studied prospectively for 16 months before and for 32 months after instituting the intervention. These included the incidence of early‐onset Group B streptococcal infection as defined by either a blood culture or a symptomatic neonate with a positive urinary streptococcal antigen test, the mortality and the morbidity.

Intrapartum ampicillin significantly reduced the incidence of early‐onset Group B streptococcal disease, from 2.0 to 0.37 per 1,000 livebirths for neonates with a positive blood culture (p < 0.03), and from 4.9 to 1.5 per 1,000 livebirths for symptomatic infants with a positive urinary antigen test (p < 0.004) and the attributable morbidity, namely, neonates who were: admitted to a level 2 or 3 unit (p < 0.004); treated with antibiotics (p < 0.004); preterm (p < 0.04); ventilated (p < 0.01). Seventy five per cent of the maternal population was overall actually screened and the carriage rate was 12%. No serious adverse reactions to ampicillin were observed.

Significant reduction in early‐onset neonatal Group B streptococcal disease has occurred concurrent with antepartum screening and nonselective intrapartum chemoprophylaxis.
Relationship of Fetal Macrosomia to a 75g Glucose Challenge Test in Nondiabetic Pregnant Women
Authors: Khan Khalid S. , Syed Amber H. , Hashmi Firasat A. , Rizvi Javaid H.
Published: February 2008

Summary: We determined in nondiabetic women, the relationship of plasma glucose values obtained 2 hours after a 75 g oral glucose challenge test (GCT) at 16–20 weeks' gestation, with the incidence of macrosomia in term deliveries (37–41 weeks' gestation). From 1988–1990, in a systematic screening programme data collected prospectively from 1,331 women were analysed retrospectively. Women with gestational diabetes or impaired glucose tolerance (n = 53) were excluded. The rest (n = 1,278) had no evidence of glucose intolerance including 1,215 women with normal plasma glucose by GCT (< 7.8 mmol/L 2 hours after 75 g oral glucose load) and 63 women with abnormal GCT but no abnormal value at a glucose tolerance test. The GCT values were divided into 5 groups: Group A (< 4.5 mmol/L), B (4.5‐5.5 mmol/L), C (5.6‐6.6 mmol/L), D (6.7‐7.7 mmol/L) and E (> 7.8 mmol/L). The variables studied were age, parity, gestational age at delivery and incidence of macrosomia.

Using <4 kg birth‐weight as the definition of macrosomia, the incidence increased from 1.2% to 9.5% with increasing plasma glucose values in the GCT from Group A (< 4.5 mmol/L) to E(> 7.8 mmol/L). Similar trends of increasing incidences from 7.2% to 15.8% and 2.9% to 9.5% were noted when 90th and 95th birth‐weight percentiles, respectively were used as definitions of macrosomia. The test of linear trend in this association was significant (p < 0.01). These results were not influenced by parity or gestational age at delivery.

These data provide new information to help explain the biology of macrosomia and also highlight the need for stricter criteria for diagnosis and treatment of glucose intolerance.
Laparovaginal Hysterectomy
Authors: Wood Carl , Maher Peter , Hill David , Lolatgis Nick
Published: February 2008

Summary: The technique and complications of 141 patients having laparovaginal hysterectomy in private practice are reported.

Abdominal hysterectomy was avoided in the 110 patients having preliminary laparoscopic surgery for pelvic disease, ovarian removal, or a uterus larger than 12cm. Postoperative morbidity included pulmonary embolus (3), vesicovaginal fistula (2) and pelvic haematoma (4). The frequency of complications was less than that reported after abdominal or vaginal hysterectomy.

The surgical technique changed during the series; the operative care of the bladder and ureter requires particular attention. A larger number of patients in a variety of centres require study before the laparoscopic procedure can be determined to be as safe as abdominal or vaginal hysterectomy. The laparoscopic procedure has the potential to replace the majority of abdominal hysterectomies.
The Value of Hysteroscopy
Authors: Gillespie Arnold , Nichols Amanda
Published: February 2008

Summary: This study is a report of the first 200 diagnostic hysteroscopic procedures undertaken on 191 patients, in the Gynaecological Outpatient Department of a busy general hospital. One hundred and sixty examinations were conducted successfully. The study demonstrated that outpatient hysteroscopy is valuable to the patient by avoiding hospitalization and general anaesthesia, valuable to the nursing and medical staff by increasing job satisfaction and valuable to the hospital by reducing expensive inpatient costs. The potential reduction to the Australian national health budget, by the adoption of outpatient hysteroscopy instead of inpatient dilatation of the cervix and curettage, is calculated to be in excess of $60,000,000 per annum.
Outpatient Management of Bartholin Gland Abscesses and Cysts with Silver Nitrate
Authors: Yüce Kunter , Zeyneloglu Hulusi Bülent , Biikulmez Orhan , Kisnisci Hüsnú A.
Published: February 2008

Summary: This study reports results of 52 patients with Bartholin abscesses or cysts who were managed by silver nitrate stick insertion into the cyst or abscess cavity for 48 hours. All patients showed complete healing within 15 days. However, 2 (3.8%) had recurrences within the first 2 months; 1 of these patients was treated with excision and the other by repetition of the same method with no further complaints. Silver nitrate application for Bartholin cysts or abscesses was found to be an effective, simple, inexpensive and the least anaesthetic requiring procedure, which can easily be carried out in the outpatient setting.
A Case of Successful Use of Reproductive Technology for a Couple with Subfertility Due to Retrograde Ejaculation, Where Artificial Insemination had Failed
Authors: Kovacs G. T. , Lawrence M. , Burden J. , Poulos C.
Published: February 2008

Summary: A case history of a couple where the infertility was due to retrograde ejaculation is presented; when conventional treatment with artificial insemination using sperm isolated from postejaculatory urine failed, IVF and GIFT technology was applied. This resulted in a pregnancy which unfortunately failed at 3 months, unrelated to the method of conception. This case report highlights the possible use of IVF/GIFT for yet another type of male subfertility.
The Global View of Reproductive Health
Authors: Fathalla Mahmoud F.
Published: February 2008

Summary: Reproductive health is a condition in which the reproductive process is accomplished in a state of complete physical, mental and social well‐being and is not merely the absence of disease or disorders of the reproductive process. The Daily Reproductive Health News in our global village does not paint a bright picture.

The past few decades have witnessed a revolution in reproductive behaviour, with a major expansion in contraceptive use in developing countries. Between 1960‐65 and 1985‐90, the number of contraceptive users in all developing countries has increased from an estimate of 31 million to 381 million. The major expansion in contraceptive use in developing countries has consequences for the quality of life, for the present and for the future, for the society at large and for the individuals and their families.

Major challenges, however, still lie ahead. There is a major unmet need for family planning. The rhetoric about population and family planning is not matched by allocation of resources.
Prostaglandins and Progesterone Receptor Antagonists in Human Fertility Regulation
Authors: Healy David L.
Published: February 2008

Summary: Anti‐progesterone medicines have now been extensively studied for human fertility regulation. The combination of the anti‐progesterone Mifepristone with prostaglandin analogues such as Gemeprost and Misoprostol have been used in several European centres for medical abortion. Used before nine weeks gestation, these medicines have similar efficacy to surgical abortion. In addition, administration of progesterone antagonists within five days of unprotected intercourse appear effective in pregnancy prevention. Anti‐progesterone medicines are not currently available in Australia. The introduction of progesterone receptor antagonists and modern prostaglandins would save approximately $10,000,000 per year to the Australian Health Budget. Furthermore, the introduction of progesterone receptor antagonists for emergency contraception would have even greater financial and emotional savings for Australian women. In Australia, when known carcinogens can be purchased over the counter, it is surely time for Australians to consider effective emergency contraception bought over the counter.
Long‐Term Prognosis of Women with Abnormal Glucose Tolerance in Pregnancy
Authors: Lee C.P. , Wong H.S. , Chan F.Y. , Pun T.C. , To W.K. , Lam Y.H. , Baldwin S. , Wong V.C.W.
Published: February 2008

Summary: A 6‐year‐follow‐up of 193 Chinese women with abnormal glucose tolerance (75 g OGTT, WHO criteria) during pregnancy was compared with a control group of 58 women with normal glucose tolerance during pregnancy in the same period. In the study group, 18 (9.3%) had diabetes and 38 (19.7%) had impaired glucose tolerance i.e. 56 (29.0%) had abnormal glucose tolerance compared with 3 (5.2%), 5 (8.6%) and 8 (13.8%) respectively in the control group. The incidence of abnormal glucose tolerance was significantly higher in the study group. In the study group, the serum glucose (fasting 6 mmol/L or above, 2 hours 11.0 mmol/L or above) during pregnancy and at 6 weeks postpartum were predictive of the development of diabetes. Age, obesity, history of diabetes in first degree relatives, previous baby over 4 kg, body mass index at follow‐up, recurrent abnormal glucose tolerance during pregnancy and use of oral contraceptives within 6 months of follow‐up were not.
Labour Induction with Intracervical Prostaglandin E2 Gel and Intravenous Oxytocin in Women with a Very Unfavourable Cervix
Authors: Misra Madhusmita , Vavre Sulabha
Published: February 2008

Summary: Two hundred and sixty‐three gravid women having a very unfavourable cervix and requiring labour induction were studied; 80 primigravidas and 56 multigravidas were administered a single dose of intracervical prostaglandin E2 gel (PGE2) and 72 primigravidas and 55 multigravidas had labour induced with an escalating oxytocin infusion. After 24 hours 73.8% of the primigravidas induced with PGE2 had delivered vaginally compared with only 52.8% of those induced with oxytocin. The incidence of Caesarean sections was very high (47.2%) in the primigravidas receiving an oxytocin infusion. In the multigravidas, there was no significant difference in the proportion of women who had delivered vaginally within 24 hours and in the percentage of Caesarean sections in the 2 induction groups. After 12 hours, a significant increase in the cervical score was seen in all women receiving PGE2 intracervically. The fetal outcome and perinatal mortality were not affected by the mode of induction. Intracervical PGE2 appears to be more effective than oxytocin in inducing labour in primigravidas having an unfavourable cervix, whereas in multigravidas, both methods appears to be equally effective.
Colour Doppler Imaging of the Uteroplacental Circulation in the Mid‐Trimester: Features of the Uterine Artery Flow‐Velocity Waveform that Predict Abnormal Pregnancy Outcome
Authors: Fay Roger A. , Ellwood David A. , Bruce Suzanne , Turner Anne
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it presents data on the use of colour Doppler imaging in a screening test in healthy nulliparas to assess whether abnormal pregnancy outcome can be identified. Unexpectedly there were 4 perinatal deaths in this series and table 4 indicates that in the only case in which the perinatal death was potentially avoidable the 24‐week uterine Doppler studies were normal. There is mounting evidence that Doppler imaging of uteroplacental circulation is useful in the management of identified high‐risk pregnancies but the value of the method as a screening test remains unproven. If larger studies confirm the reliability of this investigation to detect patients who are destined to develop preeclampsia then a possible application of this is identification of women who warrant prophylactic aspirin therapy since recent results show that aspirin therapy is not indicated routinely in nulliparas

Summary: The accuracy of raised Resistance Index (RI) and early diastolic notching (EDN) of mid‐trimester uterine artery flow velocity waveforms in predicting abnormal pregnancy outcome was assessed in a prospective longitudinal study using colour Doppler imaging at 14, 18, and 24 weeks. In 106 healthy nulliparas with a singleton pregnancy studied; 70 had a normal pregnancy outcome, 34 had an abnormal pregnancy outcome, and 2 were lost to follow‐up. EDN was more sensitive than raised RI at predicting subsequent abnormal pregnancy outcome but raised RI was more specific at 14 and 18 weeks. Sensitivities were highest for the pregnancies with the more severely abnormal outcomes. Uterine artery Doppler studies in the mid‐trimester can predict abnormal pregnancy outcome. The presence of an early diastolic notch is an important feature when defining an abnormal or high resisitance uteroplacental circulation.
Determinants of Maternal Mortality in Eclampsia in India
Authors: Arora Raksha , Ganguli R. P. , Swain S. , Oumachigui A. , Rajaram P.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication to remind readers of the savage toll on maternal life that can be claimed by eclampsia when there is inadequate antenatal care in the detection and management of cases of preeclampsia. In the 22 years from 1971–1993 there were 108,476 deliveries and 60 cases of eclampsia at the Mercy Hospital for Women, an incidence of 0.06% or 1 in 1,808 deliveries and the maternal mortality rate was 5% (3 of 60). In this large series from India of 271 cases, the maternal mortality rate was 7.8% and the incidence of eclampsia was 1 in 115 deliveries (0.87%). The authors refer to other series of eclampsia in India where the incidences of eclampsia were as high as 4.6% of all deliveries. These high incidences of eclampsia are largely explained by referral of complicated cases to major centres and expectedly the series reported here contains a very high proportion of cases of antepartum eclampsia. Where antenatal care facilities are better most cases of eclampsia occur intrapartum and the distribution of the 60 cases at the Mercy Hospital for Women was 19 (32%) antepartum, 14 (23%) intrapartum and 27 (45%) postpartum whereas in the series from India the distribution was 128 (47%) antepartum, 85 (31%) intrapartum and 58 (22%) postpartum. The causes of death in these cases of eclampsia were similar to those which occur in developed countries. The take‐away message for readers is that we must continue our antenatal vigilance to detect the signs of preclampsia and manage these patients appropriately.

Summary: Two hundred and seventy‐one pregnant mothers with eclamptic seizures admitted in a tertiary level teaching institution in South India over a period of 9 years from 1984 to 1992 were critically analysed with a particular reference to maternal mortality. The incidence of eclampsia was 0.87% of the total hospital deliveries (1 in 115 deliveries) and was increasing in consecutive years. Seventy per cent of the patients were primagravidas and more than 95% of them had not received antenatal care and were alarmingly unaware of any kind of examination during pregnancy. Eclampsia accounted for 20.9% of all maternal deaths during the same period and the case mortality rate was 7.8%. There is an urgent need to impart special training in antenatal care to non‐obstetrician doctors as well as paramedical staff working in the community and to provide health education to the community to reduce mortality from eclampsia.
Choroid Plexus Cysts in Christchurch
Authors: Duff G.B. , Anderson N.G. , Evans L.J.
Published: February 2008

EDITORIAL COMMENT: The issue of ultrasound markers of aneuploidy is extremely complex. Surprisingly, the most promising marker would appear to be nuchal oedema between 10 and 14 weeks. Many soft signs of aneuploidy have been suggested which might be detected at a mid‐trimester ultrasound examination. These include nuchal oedema, choroid plexus cysts, pyelectasis (mild renal pelvic dilatation), echogenic bowel, relative shortening of long bones and reduced ear length (brachycephalus is less likely). There is probably a slightly higher risk of trisomy for each of these markers, but the incidence is low unless more than one marker is seen or unless it is seen in association with a fetal anomaly. The authors of this paper have suggested that the decision in relation to amniocentesis for choroid plexus cysts should be made by the obstetrician in consultation with the patient and knowledge of local data. If this is the policy, increasing numbers of couples will be faced with the information that their fetus is ‘abnormal’ on ultrasound which is followed by the predictable extreme anxiety. Another approach is that choroid plexus cysts warrant a very careful fetal ultrasound examination by a practitioner using high resolution equipment who is expert at detecting fetal anomalies, particularly congenital heart anomalies. If no other marker or anomaly is found, most would consider choroid plexus cysts to be normal variants. To offer amniocentesis for all these markers potentially opens a mine‐field resulting in increasing numbers of procedures and many couples undertaking a pregnancy in which their thoughts are inappropriately focused on an ‘abnormality’.

Lachlan de Crespigny, Melbourne.

Summary: Amongst 173 fetuses diagnosed in the second trimester as having one or more choroid plexus cysts, there was only 1 (0.58%) with a probable chromosomal anomaly. If a choroid plexus cyst was the only abnormality seen at ultrasound examination prior to 20 weeks' gestation, then there were no fetuses with either trisomy 18 or trisomy 21. If there was another abnormality seen as well as the choroid plexus cyst, then the risk of aneuploidy was 1 of 3. The association between choroid plexus cysts and aneuploidy in a community‐wide study in Christchurch was significantly less than that reported in 5 recently published papers.

When choroid plexus cysts are diagnosed women should be referred for high resolution ultrasound examination to look for other signs of aneuploidy. The presence of an additional abnormality, seen on ultrasound examination, is a strong indication for amniocentesis. If choroid plexus cysts are isolated we do not believe amniocentesis should be offered routinely but the management of the choroid plexus cysts by the obstetrician should be based on consultation with the patient and the knowledge of the local prevalence of the association between sonographically isolated choroid plexus cysts and aneuploidy.
Vaginal Agenesis and the Embryology of Vaginal Epithelium
Authors: Fliegner John R.H.
Published: February 2008

EDITORIAL COMMENT: We have accepted this paper for publication because we hope that readers will enjoy the discussion about the embryology of the vagina. Although the hymen has stratified squamous epithelium on both superior and inferior surfaces there are reported cases (A) of a transverse vaginal septum above the level of the hymen where the superior surface was covered by columnar epithelium and the inferior surface by squamous epithelium (figure A, 1 and 2). One interpretation of this finding is that the columnar epithelium was derived from Mullerian duct tissue and thus, that the squamous epithelium of the vagina arises by replacing Mullerian duct tissue. There is controversy regarding whether this second epithelium arises from endoderm of the urogenital sinus, mesoderm of the Wolffian ducts or ectoderm of the cloacal membrane (B). Recently a case of double uterus with 1 side having a blind vagina was seen in the University Department at the Mercy Hospital for Women. With this article in mind biopsies were taken from the vaginal walls in the side that had the haematocolpos. The biopsies showed columnar epithelium similar to endocervical epithelium. The editorial committee referred this article for opinion from anatomists and embryologists at the University of Melbourne, Department of Anatomy and Cell Biology and their comments are included as an addendum to this paper. Some of the arguments presented are not easy to follow and the editor considers that a convincing case is yet to be made to reverse the traditional teaching on the embryology of the vagina.

Stewart AD. Cryptomenorrhoea due to a transverse vaginal septum. Aust N Z J Obstet Gynaecol 1968; 8: 45–48.

Deppisch LM. Transverse vaginal septum. Histologic and embryologic considerations. Obstet Gynecol 1972; 193–198.

Summary: A review has been made of 29 cases of vaginal agenesis treated by the Sheares technique of vaginoplasty at the Royal Women's Hospital, Melbourne since 1976. Spontaneous epithelialization of the neovagina is rapid providing the newly created space is kept patent by regular dilatation. The process is usually complete by the 10th to 12th postoperative week. A review of the embryology of vaginal epithelium suggests that it is entirely of urogenital sinus origin. In cases of vaginal reconstruction where no grafting technique is employed it seems likely that epithelial rests are responsible for the rapid epithelialization that occurs.