bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognosis of Congenital Diaphragmatic Hernia
Authors: Moore Amber , Umstad Mark P. , Stewart Michael , Stokes Keith B.
Published: February 2008

Summary: Congenital diaphragmatic hernia (CDH) contributes significantly to perinatal morbidity and mortality. This retrospective study examines the experience of a major teaching hospital to establish survival rates and factors influencing outcome. Survival rates were found to relate closely to the stage at which the diagnosis was made and the presence of associated anomalies. Ultrasound diagnosis early in pregnancy is associated with a higher mortality rate than diagnosis made late in pregnancy or after delivery. Logistic regression analysis and chi‐squared analysis did not establish to a significant degree that any factor, alone or in combination, was a reliable prognostic indicator. It is acknowledged, however, that figures in this series are small. Survival figures are presented to facilitate reliable parental counselling. In particular, the presence of associated major anomalies and the gestational age at which diagnosis is made are of critical importance in accurately counselling parents regarding the prognosis for survival. In this study, excluding terminations, the mortality rate for isolated CDH diagnosis before the 21st week was 45.5%, with a corresponding survival rate of 54.5%. Once the infant was liveborn, however, the survival rate rose to 68.0%, and if the infant survived transfer to a paediatric surgical unit, the survival rate in this study was 73.9%.
Factors Associated With Pain Following Operative Laparoscopy: A Prospective Observational Study
Authors: Healey Martin , Maher Peter , Hill David , Gebert Rowan , Wein Peter
Published: February 2008

Summary: An open prospective observational study was performed, aiming to measure symptom severity following operative gynaecological laparoscopy and explore any associated factors. Women having concomitant procedures were excluded. Each woman had standardized analgesia, completed a symptom diary for 7 days postoperation, and had a standardized form completed by the surgeon detailing the operation. Back pain, nausea and vaginal pain were found to not be of clinical significance. Cutting major vessels, ligaments, vagina or ovary had major impacts on postoperative symptoms. In the presence of a standardized analgesic regimen, symptoms did not resolve for at least 5 days.
Selection of Surgery or Radiotherapy as the Appropriate Single Modality of Treatment for Stage 1B and 2A Carcinoma of the Cervix
Authors: MacLeod Craig , Fowler Alan , Brien Peter O.
Published: February 2008

EDITORIAL COMMENT: The following letter by a group of radiation oncologists and the response by 2 gynaecological oncologists is printed as a clinical comment/controversy because these important clinical comments may be lost in the correspondence column.
A Phase II Trial of Carboplatin and Etoposide for Relapsed or Metastatic Carcinoma of the Cervix
Authors: Tebbutt Niall , Rischin Danny , Quinn Michael , Rome Robert , Millward Michael J. , Toner Guy C. , Bishop James F.
Published: February 2008

Summary: This study reports the results of a phase II trial of carboplatin 100 mg/m2 combined with etoposide 120 mg/m2 each given for 3 consecutive days every 28 days in women with recurrent or metastatic carcinoma of the cervix.

Seventeen eligible patients were treated between August, 1990 and May, 1993. In the 16 evaluable patients, there were 2 complete responses, and no partial responses with an overall objective response rate of 12.5% (95% confidence interval 1.6%‐38%). The main toxicities of this regimen related to myelosuppression and emesis. The combination of carboplatin and etoposide did not achieve either a better response rate or a substantially improved toxicity profile than is seen with single agent cisplatin.
Oral Medication for Post‐Caesarean Analgesia
Authors: Monagle J. , Molnar A. , Shearer W.
Published: February 2008

Summary: A regimen of morphine, paracetamol and aspirin administered orally was evaluated in 20 patients following Caesarean section; 18 of 20 reported no or mild impairment in their ability to care for their babies. There was a high level of satisfaction with 18 of 20 being very satisfied with their postoperative analgesia. There was a low incidence of side‐effects with this regimen. It was acceptable to both patients and staff.
Do Multiple Measurements Employing Different Ultrasonic Techniques Improve the Accuracy of Amniotic Fluid Volume Assessment?
Authors: Magann Everett F. , Chauhan Suneet P. , Whitworth Neil S. , Klausen Jack H. , Saltzman Andrew K. , Morrison John C.
Published: February 2008

Summary: This investigation was undertaken to determine if the accuracy of the ultrasound assessment of abnormal amniotic fluid volume (oligohydramnios or poly‐hydramnios) is improved by employing multiple sonographic amniotic fluid measurements. Four ultrasound techniques consisting of the subjective assessment (ultrasonic visualization without measurement), largest vertical pocket, amniotic fluid index and 2‐diameter pocket technique were performed followed by amniocentesis and dye‐dilution confirmation of amniotic fluid volume in 66 singleton pregnancies. The ultrasound accuracy to detect abnormal amniotic fluid volume ranged from 61% with the largest vertical pocket to 70% with the 2‐diameter pocket procedure used separately. Receiver operator characteristic curves demonstrated that combining the 4 ultrasonic measurements did not improve the accuracy of identifying amniotic fluid volumes.
Changes of Resistance to Activated Protein C in The Course of Pregnancy and Prevalence of Factor V Mutation
Authors: Mimuro Shigeko , Lahoud Robert , Beutler Lucinda , Trudinger Brian
Published: February 2008

Summary: The purpose of this study was to examine the changes in activated protein C (APC) anticoagulant activity during pregnancy and determine whether changes in APC could contribute to thrombosis in the placental bed in preeclampsia. We measured APC anticoagulant activity in 150 women with a normal pregnancy and 50 women with preeclampsia. There was a significant reduction in the mean APC sensitivity ratio (APC‐SR) during pregnancy (p<0.001). APC resistance in preeclampsia was significantly higher than in normal pregnancy (p<0.01). Amongst women with APC resistance the presence of the factor V Leiden mutation was significantly higher in the preeclampsia group than in the normal pregnancy group (p<0.01). It seems that both factor V Leiden mutation and APC resistance may be associated with the development of preeclampsia. These results suggest that APC resistance may be an important mechanism underlying placental bed pathology in pregnancy and may be associated with an increased tendency to develop preeclampsia in some women. Assay of APC resistance and factor V Leiden mutation should be performed in women with preeclampsia.
Successful Pregnancy in a Patient with Previous Bladder Exstrophy
Authors: Sharma Damyanti , Singhal Savita Rani , Singhal S.K.
Published: February 2008

EDITORIAL COMMENT: Usually we do not accept anecdotal case reports for publication. Chambers twentieth century dictionary defines an anecdote as ‘a short narrative of an incident of private life’. Readers can decide if this case is anecdotal. There appears to be a lot left unsaid about this woman's private life, if not her private pans. She was admitted to hospital as a nonbooked emergency case in labour. The symphyseal separation shown in figure 2 clinched our decision to accept the case for publication. The editor did not see such a case in 38 years of obstetrics practice.

Summary: Bladder exstrophy is an unusual congenital anomaly. Patients becoming pregnant with such anomaly after surgical repair are even rarer. The present case reports a lower segment Caesarean section delivery of a living healthy baby in a woman who had been operated on for bladder exstrophy at the age of 18 years. This is the first case of this type seen in our institution in 35 years.
The Use of Large Loop Excision of the Transformation Zone in Management Problems of Cervical Intraepithelial Neoplasia
Authors: Ehsani N. , Golbang P. , Papadakis T. , Scurry J. , Muldowney L. , Allen D. , Planner R.
Published: February 2008

Summary: We studied 2 groups of women whose management is controversial: those with cervical intraepithelial neoplasia (CIN) grade 2 or 3 on smear, but only CIN grade 1 or no abnormality on target biopsy (Group 1), and those with persistent CIN grade 1 on smear and up to CIN 1 on biopsy (Group 2). We set out to assess whether large loop excision of the transformation zone (LLETZ) was an acceptable method of treating these 2 groups of women. A review of 100 consecutive patients was undertaken. There were 71 women in Group 1 and 29 women in Group 2. The LLETZ procedures were performed under local analgesia and no immediate problems were encountered. Delayed haemorrhage requiring vaginal packing and admission to hospital occurred in 1 patient. In Group 1, histopathology of the LLETZ biopsies showed CIN 2 or 3 in 29 (40.8%) of the women, CIN 1 in 24 (33.8%) and no CIN in 18 (25.3%), and in Group 2, CIN 2 or 3 was seen in 5 (17.2%) of the women, CIN 1 in 11 (37.9%) and no CIN in 13 (44.8%). At 12 months completed follow‐up, 4 patients in Group 1 had recurrent CIN 1 or equivocal CIN 1 and 1 patient from Group 2 had recurrent CIN 1, giving an overall recurrence rate of 5 of the 94 patients who completed follow‐up (5%). We concluded that LLETZ was a useful procedure in both groups. In Group 1 the provision of a histological diagnosis on the LLETZ biopsy was a check on the accuracy of the cervical smear report. In Group 2, LLETZ offered the advantage of rapidly returning the smear to normal in most patients, and the diagnosis and treatment of those women who actually had a high‐grade lesion.
The Incidence of Abnormal Findings from Intrapartum Cardiotocogram Monitoring in Term and Preterm Labours
Authors: To William W.K. , Leung W.C.
Published: February 2008

Summary: A retrospective analysis of 514 consecutive labours delivering 530 babies over a period of 18 months was conducted by a high‐risk pregnancy team in a tertiary teaching unit to compare the incidence of abnormal findings from intrapartum monitoring between labours occurring before and at or after 34 weeks' gestation. Those delivered by elective Caesarean section, or Caesarean section at the onset of labour because of contraindications to labour and vaginal delivery, and those with congenitally malformed fetuses were excluded. Tracings were scored using the FIGO 1987 guidelines. Seventy‐four labours and 83 babies delivered before 34 weeks, and 440 labours and 447 babies delivered after 34 weeks in the study. There was a slightly higher incidence of suspicious CTG tracings (33.7% versus 19.6%, OR 2.66, 95% CI 1.6–4.4) in the preterm group, due mainly to decreased baseline variability (p < 0.001, OR 3.57, 95% CI 1.8–6.9), but the incidence of other pathological patterns did not differ. Using the same set of criteria for interpretation, there was a higher incidence of abnormalities from continuous cardiotocogram monitoring in the preterm group compared to term labours, but the intervention rate for fetal distress was not significantly increased. Appropriate interpretative criteria for intrapartum monitoring of preterm labours should be devised.
Accuracy of Automated Blood Pressure Recorders in Pregnancy
Authors: Brown Mark A. , Robinson Arlene , Buddie Megan L.
Published: February 2008

Summary: Automated blood pressure recorders are used with increasing frequency by pregnant women, mostly without proper evaluation of their accuracy. We compared blood pressures (BP) recorded by 2 automated noninvasive devices, the Spacelabs 90207 ambulatory blood pressure monitor and the OMRON HEM 705 CP portable selfinitiated device, with blood pressures recorded by routine sphygmomanometry in 79 pregnant women either considered ‘at risk’ for preeclampsia or with mild hypertension in pregnancy. The Spacelabs device tended to overestimate systolic BP by a mean 11 (SD = 8) mmHg and diastolic BP by 5 (SD = 7) mmHg for phase 5 pressure (p < 0.001) but was similar to routine BPs for diastolic phase 4 pressures. The OMRON device tended to underestimate diastolic (phase 4) pressure by 4 (SD = 6) mmHg (p < 0.001) but gave similar systolic and diastolic (phase 5) pressures to routine sphygmomanometry. However, for both devices there was considerable individual patient variability in accuracy. When using these devices to record a limited number of blood pressure recordings, as in this study, we suggest that individual comparison with mercury sphygmomanometry be made in each pregnant woman before accepting the validity of these recordings.
Intrapartum Fetal Oxygen Saturation Monitoring in Congenital Fetal Heart Block
Authors: Begg Lisa , East Christine , Chan Fung Yee , Brennecke Shaun
Published: February 2008

Summary: Conventional intrapartum electronic fetal heart rate monitoring is not informative in certain fetal conditions because the electronically‐monitored fetal heart rate pattern is uninterpretable in terms of reflecting fetal normoxia. Such fetal conditions include various cardiac dysrrhythmias and some central nervous system abnormalities. Difficulties with intrapartum fetal welfare surveillance in such conditions often lead to operative delivery as a precautionary measure. We report 2 cases of intrapartum fetal oxygen saturation monitoring in the presence of congenital complete heart block (CCHB), using the Nellcor N400/FS14 oxygen saturation monitoring system. Mean intrapartum fetal oxygen saturation (FSpO2) was 32% (SEM ± 1%) in the first case and 48% (SEM ± 0.3%) in the second case. In both cases, vaginal delivery of otherwise healthy infants was achieved. Fetal pulse oximetry is a promising new technique which directly measures fetal oxygenation without reference to fetal heart rate patterns. It may assist in the intrapartum fetal welfare assessment in conditions such as complete heart block, thereby helping to avoid otherwise unnecessary operative delivery.
Use of a Focussed Teen Prenatal Clinic at a Military Teaching Hospital: Model for Improved Outcomes of Unmarried Mothers
Authors: Perez Romeo , Patience Troy , Pulous Elizabeth , Brown Gwen , McEwen Ann , Asato Amy , Hume Roderick , Calhoun Byron C.
Published: February 2008

Summary: We evaluated the utility of a focussed, multidisciplinary adolescent clinic in improving perinatal outcomes. The study population included all delivering unmarried teenagers (13–19 years) from January 1, 1993 to December 31, 1995 attending the focussed adolescent obstetrical clinic compared to a similar cohort of married teenagers (13–19 years), married 20–24 year‐old patients, and unmarried 20–24 year‐old patients. There were no statistical differences in chorioamnionitis, intrauterine growth retardation (IUGR), postpartum haemorrhage, maternal weight gain, mean gestational age at delivery, preterm delivery rates (<37 weeks), low birth‐weight (<2,500 g), Caesarean delivery, postterm delivery rates (>41 weeks), macrosomia (<4,000 g), placental abruption, chronic hypertension, alcohol use, Apgar scores or stillbirth rates or neonatal death rates among the 4 groups studied. Statistical differences were noted in mean delivery weights (p < 0.05), preeclampsia (p < 0.004), gestational diabetes (p < 0.01), history of substance abuse (p < 0.0001), tobacco use (p < 0.0001), and forceps delivery rates (p < 0.004). However, in the teen cohort none of these differences appeared to adversely affect perinatal outcomes in our patients. The focussed, adolescent obstetrical clinic appears to provide perinatal morbidities equal to a low‐risk, general population generating better than expected outcomes for pregnant teenagers.
Nonfreeing of the Lower Leaf of the Rectus Sheath at Caesarean Section: A Randomized Controlled Trial
Authors: Oguz Serdar , Sener Bilge , Özcan Sarp , Akyol Didern , Gökmen Oya
Published: February 2008

EDITORIAL COMMENT: This vignette draws attention to a detail of surgical technique familiar to all surgeons who perform the Pfannenstiel incision. Freeing the insertion of the pyramidalis muscles from the rectus sheath is often untidy and can cause considerable haemorrhage. Our literature search confirms the opinion of the reviewers of this paper that nonfreeing of the lower leaf of the rectus sheath at Caesarean section is a new idea and so this brief ‘randomized controlled trial’ was accepted for publication. One reviewer wondered if the trauma to the pyramidalis muscles often encountered at Caesarean section is due to variation in the level (i.e. distance above pubic symphysis) of the transverse skin incision, or variation in the anatomy of the pyramidalis muscles. Readers will accept the shorter time interval to reach the abdominal cavity with the technique described but may wonder if the time from entry of the abdomen to exit of the fetus from the uterus was affected, especially in cases of repeat Caesarean section where scar tissue might affect the ease of manipulation. One reviewer of this manuscript stated that the concept of not separating the rectus sheath from the underlying muscles is not entirely new since S. Joel Cohen advocated the technique in 1972 (Joel Cohen, S. A technique of abdominal and vaginal hysterectomy based on time and motion studies. Heinemann, London 1972, p10).
Uterovaginal Prolapse Associated with Rectal Prolapse
Authors: Kriplani Alka , Banerjee Neelam , Kriplani Ajay Kumar , Roy Kallol Kumar , Takkar Deep
Published: February 2008

EDITORIAL COMMENT: There are hundreds of papers in the literature dealing with the surgical management of rectal prolapse, but that of combined Uterovaginal prolapse and rectal prolapse is another matter (A). This paper describes the management of combined Uterovaginal and rectal prolapse using vaginal and laparoscopic approaches at 1 ‘sitting’ (anaesthetic). We accepted this paper for publication because it has 2 messages for readers: (i) remember to exclude rectal prolapse in women with Uterovaginal prolapse especially when there is a history of severe pelvic pain, difficult or unsatisfied defaecation and/or rectal incontinence. Incidentally and importantly, rectal prolapse can be hidden by a Sims speculum and thus overlooked when the woman is asked to ‘bear down’ to display her Uterovaginal prolapse! The Editor had such an experience in 1963 in 1 of the numerous ‘short cases’ in the Clinical Gynaecology examination for the degree of Master of Gynaecology, University of Melbourne, held at the Royal Melbourne Hospital and arranged by Mr Leslie Gleadell and Mr Ian Mcdonald, the senior gynaecologists of the hospital. It was a unique experience to be involved in a clinical examination with 4 very senior examiners and a ward full of patients, some with extraordinary lesions, in order to test just 2 candidates, namely Norman Beischer and Ian Johnston! For readers with an interest in medical history this was the first clinical examination for the MGO degree in the University of Melbourne. The examiners were Professor Lance Townsend, Professor Lawrence Wright, Mr Walter Johnstone and Mr Leslie Gleadell. (ii) laparoscopic surgery is being used more frequently and is an alternative to the open approach in the management of rectal prolapse.

(A) Barham K, Collopy BT. Posthysterectomy rectal and vaginal prolapse, a commonly overlooked problem. Aust NZ J Obstet Gynaecol 1993; 33: 300–303.

Summary: A case of combined genital prolapse and rectal prolapse in a 55‐year‐old multipara is reported. The mixed prolapse was treated by vaginal hysterectomy with pelvic floor repair and laparoscopic rectopexy at the same sitting. The feasibility of combined treatment of genital prolapse by the vaginal route and of rectal prolapse by laparoscopic rectopexy is emphasized.
Uterus Didelphys, a Rare Cause for Tubal Sterilization Failure
Authors: Sharma Damyanti , Singhal Savita Rani , Singhal S.K.
Published: February 2008

EDITORIAL COMMENT: : We accepted this case report for publication because uterus didelphys and its often‐associated longitudinal vaginal septum can cause a variety of complications in the practice of obstetrics and gynaecology. When performing tubal ligation the surgeon would search for the second Fallopian tube and presumably could, as suggested in this paper, misdiagnose one half of the didelphys as a unicomuate uterus. The fold of peritoneum between bladder and sigmoid colon could obscure the other uterine horn. When the editor was a resident with Lance Townsend at The Royal Women's Hospital, Melbourne, in the 1950's, when abortion by the medical profession was not readily available, we had to cope with a patient with an unwanted pregnancy in one horn of her uterus didelphys, a condition unknown to her doctors when they had inserted a Grafenberg ring into the other horn for contraception. The vaginal septum can lead to diagnosis by causing dyspareunia and obstructed labour. The editor has also diagnosed the condition when performing a Manchester repair in a postmenopausal woman. In this case it was not until the cervix was amputated that the laterally‐displaced vaginal septum and the second cervix it had hidden from view, was first recognized. This woman had used one half of her vaginal and uterine complement for coitus, conception and delivery of her children without symptoms due to extreme lateral displacement of the vaginal septum. See also Editorial Comment. Uterus didelphys with unilateral imperforate vagina and ipsilateral renal agensis. Aust NZ J Obstet Gynaecol 1991; 31: 288.

Summary: Uterus didelphys is a rare congenital anomaly. It can result in a variety of misadventures even in the hands of an expert. The present case reports uterus didelphys as the cause for tubal sterilization failure. This is the first case of this type seen in our institution in 35 years.
Ovarian Dermoid Cyst Leakage — A Cautionary Tale
Authors: Edwards Andrew G. , Lawrence Anthony , Tsaltas Jim
Published: February 2008

Summary: This case illustrates that when a dermoid cyst is punctured, an immediate operative laparoscopy or laparotomy should be performed, along with lavage, to avoid the problems associated with dermoid cyst contents spillage.
The Use of Reproductive Health Services by Young Women in Australia
Authors: MBBS Tanjina Mirza , Kovacs Gabor T. , McDonald Peter
Published: February 2008

Summary: Retrospective analysis of clinical data from 8 State/Territory Family Planning Organizations (FPO) was conducted to determine the reproductive health services used by young women. Between July, 1996 and June, 1997, a total of 185, 879 client visits were recorded at FPO clinics, of which 72,303 (39%) were by young clients. The results showed that young women tended to use a combined oral pill, postcoital pill and spermicides more than those older than 25 years (p < 0.05). Young women were also more likely to use services for management of sexually transmitted disease (STD), counselling for HIV, STD and sexual assault (p < 0.05). However, there were considerable differences among the 3 groups of women: Aboriginal clients, those who did not speak English at home, and those who were born outside Australia. This study confirms that young women are using FPO services especially for emergency/postcoital contraception, STD screening and counselling. FPOs need to continue their existing role of providing reproductive and sexual health services catering to the need of this special segment of the population.
Labour Outcome of Low‐risk Multiparas of 40 Years and Older. A Case‐control Study
Authors: Wong S.F. , Ho L.C.
Published: February 2008

Summary: Between January 1, 1994 and December 31, 1997 a total of 76 low‐risk multiparas of 40 years and older with spontaneous onset of labour were delivered and were compared with 152 younger (25–30 years‐old) low‐risk multiparas of similar parity in a case‐control study. The labour and perinatal outcomes of the 2 groups were compared. The duration of the 0first stage of labour was longer (233 minutes versus 149 minutes, p < 0.0005) in the older women. Significantly more labours of older multiparas were complicated by intrapartum fetal distress (6.6% versus 1.3%, p < 0.05); received intramuscular analgesia (11.8% versus 2.6%, p < 0.01); and had operative deliveries (17.1% versus 4.6%, p < 0.01). The incidence of instrumental delivery (11.8% versus 3.9%, p < 0.05) and Caesarean section (5.3% versus 0.7%, p < 0.05) were higher among older multiparas. The incidences of Syntocinon augmentation of labour, prolonged second stage, episiotomy and third stage complications such as perineal tear, primary postpartum haemorrhage, and retained placenta were similar in both groups. Both groups had similar perinatal outcomes. These women should be treated as others with high‐risk pregnancies with appropriate careful attention during labour such as continuous fetal heart rate monitoring. They should be counselled to be made aware of the increased risks during labour.
Haematological Effects of Betamethasone Treatment in Late Pregnancy
Authors: Wallace Euan M. , Ekkel Karen , Cotter Therese , Tippett Christine , Catalano John
Published: February 2008

Summary: To assess the maternal haematological effects of betamethasone administered in late pregnancy, an automated full blood count was performed before and daily for 5 days after betamethasone in 25 women with a singleton pregnancy between 23 and 33 weeks' gestation. From a mean (±SD) baseline level of 11.0 ± 2.2 ± 109/L, the total white cell count increased significantly to 13.2 ± 2.9 ± 109/L and 13.5 ± 3.1 ± 109/L on the first and second day after treatment respectively, returning to baseline on day 3 (p < 0.0001, ANOVA). These changes represented a mean increase in the neutrophil count of 35% and a mean decrease in the lymphocyte count of 23%. While there was considerable intersubject variation in the extent of the changes, this study has quantified the leucocytosis induced by betamethasone in late pregnancy, information that may assist with the clinical evaluation of a woman at risk of preterm delivery.
Outcome of Pregnancy in Women with Idiopathic Thrombocytopenic Purpura
Authors: Al‐Jama Fathia E. , Rahman Jessica , Al‐Suleiman Suleiman A. , Rahman Mohammad Sayedur
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it provides useful information concerning idiopathic thrombocytopenic purpura (ITP) in a centre in which cordocentesis and fetal scalp‐blood sampling for antepartum assessment of fetal blood platelet counts is not performed. The results in this series of 28 pregnancies were excellent in that the only fetal loss was an intrauterine death at 32 weeks' gestation; it is difficult to see how antepartum testing could have prevented this death even if it was due to ITP. The series includes a mother who may have lost 3 previous infants from intracranial haemorrhage due to ITP. This woman was thereafter delivered in 2 pregnancies by Caesarean section, with both infants surviving, their cord blood platelet counts being shown in the footnote to table 2 provided by the authors after reading the original editorial comment. The authors do not favour Caesarean section as the preferred method of delivery in women with ITP, because of the fetal risk of intracranial haemorrhage, unless the maternal blood platelet count is <50 ± 109/L. However in this series the mothers of 3 of the 4 infants born with cord blood platelet counts <50 ± 109/ had platelet counts at delivery <50 x ± 109/L and 2 had platelet counts <151 ± 109/L. The authors also remind us that women with ITP require special management for safe Caesarean section.

Summary: The obstetric management and haematological problems in 28 pregnancies of 23 mothers with idiopathic thrombocytopenic purpura (ITP) are analyzed. There was no maternal death and only 1 stillbirth occurred in the series. Ten infants were born by Caesarean section and 18 were delivered vaginally. Neonatal cord blood platelet counts showed thrombocytopenia in 12 infants, but in only 4 (14.3%) was the cord blood platelet count <50 ± 109/L. None of the 27 liveborn infants died, although 4 required supportive treatment with corticosteroids and IgG. No maternal characteristics could be used to predict the neonatal platelet count. These results are comparable with other studies reported in the literature. The rarity of poor neonatal outcome in mothers with ITP does not justify obstetric intervention solely on the basis of their platelet counts. The management of patients should be individualized and carefully planned.
Third Degree Anal Sphincter Tears: Risk Factors and Outcome
Authors: Wood Jane , Amos Lutty , Rieger Nick
Published: February 2008

Summary: The aim of this retrospective study was to determine the incidence, risk factors and anal symptoms related to third degree tears after vaginal delivery. There were 9, 631 vaginal deliveries during the 5‐year period studied, with 116 (1.2%) having a third degree tear. Statistically significant risk factors for a third degree tear were primiparity, forceps delivery, episiotomy, fetal birth‐weight greater than 4,000 g and increased duration of the second stage of labour. Eighty four of the 116 women were able to be interviewed, and 21 (25%) had anal symptoms related to the tear. Only 3 women had sought help for their symptoms. Twelve women experienced anal incontinence and 2 more required delayed repair of the anal sphincter for incontinence. Third degree tears are a major cause of perinatal and postnatal morbidity. Attention needs to be directed to the prevention of such tears by awareness of the women at risk and to better follow‐up and counselling of the women sustaining a tear.
The Place of Laparoscopic Surgery in Surgical Gynaecology
Authors: Wood Carl , Maher Peter
Published: February 2008

Summary: This review was undertaken to ascertain whether the low usage of laparoscopic surgery in gynaecology resulted from unacceptable complication rates and long operating times. The safety and efficacy of laparoscopic surgery has been compared to that of laparotomy. Reports of controlled or comparative trials of laparoscopic gynaecological surgery for adhesions, infertility, ectopic pregnancy, oophorectomy, myomectomy and laparoscopically‐assisted vaginal hysterectomy (LAVH) have been reviewed between 1984 and 1997. Although further multicentre controlled trials may improve the assessment of complication rates for both laparotomy and laparoscopy procedures, laparoscopy appears to be as safe as laparotomy and generally has the advantage of shorter hospital stay and earlier return to normal activities. Except for LAVH, operating times of laparoscopic surgery are similar to that of laparotomy.
‘Acute’ Residual Ovary Syndrome
Authors: MD Ajay Rane , MB Omi Ohizua
Published: February 2008

Summary: This development of pathology in conserved ovaries is defined as the residual ovary syndrome (ROS). It consists of pelvic pain, pelvic mass, dyspareunia as a single or a cluster of symptoms. It is estimated that at least 5% of patients will develop ROS and require surgery for it following hysterectomy. We describe a case of ROS in a 41‐year‐old woman who developed an abdominopelvic mass the size of a pregnancy of 24 weeks' gestation within 11 weeks of hysterectomy and right salpingo‐oophorectomy. At laparotomy, the mass was found to be a huge benign ovarian cyst measuring 11.5 ± 11.0 ± 14.1 cm. Histology showed benign thick‐walled follicular cysts. ROS can occur ‘acutely’, our case having the shortest latent period of onset ever reported.
Hysterectomy with Ovarian Conservation: Effect on Bone Mineral Density
Authors: Larcos George
Published: February 2008

Summary: A cross‐sectional study was undertaken in 58 consecutive women with premenopausal hysterectomy and ovarian conservation (Group 1) and 59 randomly selected women with natural menopause (Group 2) to determine the effect of hysterectomy on bone mineral density (BMD). Subjects were similar in age, height, weight, body mass index (BMI), exercise levels, family history of osteoporosis and smoking levels, but not years since hysterectomy or menopause (Group 1 = 14.9 ± 10.8 years versus Group 2 = 9.8 ± 8.7 years; p = 0.005), age at hysterectomy or menopause (Group 1 = 42.3 ± 7.3 years versus Group 2 = 45.9 ± 6.9 years; p = 0.008) or current alcohol consumption (Group 1 = 13.8% versus Group 2 = 39%; p = 0.002). Dual X‐ray absorptiometry of the raw (unadjusted) lumbar spine and femoral neck BMD were similar for the 2 groups: lumbar spine = 0.947 ± 0.179 g/cm2 (Group 1) versus 0.958 ± 0.203 g/cm2 (Group 2) (p = 0.76) and femoral neck = 0.825 ± 0.127 g/cm2 (Group 1) versus 0.815 ± 0.146 g/cm2 (Group 2) (p = 0.71). Multivariate linear regression revealed that factors other than hysterectomy were associated with lumbar spine and femoral neck BMD. Thus, prior hysterectomy with ovarian conservation has no adverse effect on lumbar spine or femoral neck BMD.
Oral Methotrexate in the Management of Refractory Interstitial Cystitis
Authors: A. Moran Paul , L. Dwyer Peter , P. Carey Marcus , F. Maher Christopher , J. Radford Nicolas
Published: February 2008

Summary: To establish the safety and efficacy of low‐dose oral methotrexate in treating refractory interstitial cystitis, 9 women who fulfilled internationally accepted criteria for the diagnosis of interstitial cystitis were enrolled in a prospective study. All had proven unresponsive to conventional treatment modalities. Assessment by pain score and frequency volume charts was performed pretreatment and up to 6 months during therapy. No significant adverse side effects were noted. At the end of follow‐up, 4 women had noted a subjective improvement in bladder pain and wished to continue on methotrexate, 4 women noted little change and 1 woman reported a worsening of symptoms. Overall there was a significant reduction in pain score (p = 0.047) posttreatment. However, there was no significant difference in urinary frequency per 24 hours (p = 0.40), maximum voided volume (p = 0.089) or mean voided volume (p = 0.59). Methotrexate significantly improved bladder pain in women with interstitial cystitis, although no significant change was found in voiding pattern.
A Cervical Ectopic Pregnancy Managed by Medical Treatment and Angiographic Embolization
Authors: Wong Y.H. , Liang E.Y. , . Ng T.K , Lau K.Y.
Published: February 2008

Summary: Medical treatment in the form of systemic methotrexate with or without local methotrexate/potassium chloride is effective for early cervical pregnancy. It should be the treatment of choice in suitable cases. Haemorrhagic complications can be effectively managed by angiographic embolization. A case report illustrating these points is presented.
Pregnancy and Cirrhosis of the Liver
Authors: Aggarwal Neelam , Sawnhey Harjeet , Suril Vanita , Vasishta Kala , Jha Mamta , Dhiman R. K.
Published: February 2008

Summary: Pregnancy in patients with cirrhosis of the liver is uncommon. We reviewed 9 pregnancies in 7 patients with cirrhosis. One patient conceived within 1 month of diagnosis and in another the disease was diagnosed during the index pregnancy. Four patients has associated portal hypertension and 1 of them concieved after lienorenal shunt. Complications associated with these pregnancies were jaundice (1) jaundice plus ascites (2) and gastrointestinal bleeding (1). In 2 patients endoscopic sclerotherapy was done during the index pregnancy. The incidence of preterm delivery was 50% (4 of 8) and the majority (75%) occurred in pregnancies where associated complications were present. There was 1 maternal death in the postpartum period due to fulminant hepatic failure.
Endometrial Ossification in Infertile Patients — Report of 3 Cases
Authors: Mohan Harsh , Nada Ritambhra , Mohan Praveen , Punia R. S. , Malhotra Sarla
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because endometrial bone formation is an interesting pathological condition and its relationship to infertility is of interest. Our only publication on this subject (A) was a case of a woman with secondary infertility who had had a previous termination. In this case the woman became pregnant in the cycle following curettage and removal of the bony fragment in the uterus which was presumably retained fetal tissue. The present case reports are different and the authors have reviewed the other associations of endometrial bone formation reported in the literature including those associated with uterine tumours. N.B.
Uptake of Down syndrome screening in an Australian Vietnamese population
Authors: Nagle Cate , McCarthy Pauline , Wallace Euan M
Published: February 2008

Summary: It has been previously shown that the uptake of prenatal diagnosis by Victorian women of a non‐English speaking background is significantly lower than that of comparable English speaking women. To explore this further we have examined the uptake of Down syndrome screening and diagnosis by Vietnamese women attending a community‐based antenatal clinic in metropolitan Melbourne over a two year period. Of the 207 women studied, 161 (78%) were offered screening or diagnosis and of these women 139 (86%, 95%CI 81–92%) accepted the offer, representing 67% (95% CI 61–74%) of the entire population. Of the 127 women who had screening, rather than diagnosis, 12 (9%) had an ‘increased risk’ result. Eleven of these women accepted diagnosis. We also explored the reasons why 45 (22%) of women were not offered screening. Almost half (44%) of these women first attended the clinic at a too advanced stage of gestation but in 25 women there were no obvious reasons. These results are discussed in the context of current prenatal screening and diagnostic practice in Victoria and simple recommendations made.
Urachal abscess and infected bladder diverticulum
Authors: Gard Gregory B , Mavai Roxanna , Bertrand Monique A
Published: February 2008

Summary: Urachal abscess is an uncommon condition with protean features and often presents a diagnostic challenge to clinicians. This case report describes a 41‐year‐old woman with severe multiple sclerosis who was referred to a gynaecological oncology service with the presumed diagnosis of advanced ovarian cancer. A diagnosis of urachal abscess and infected bladder diverticulum was made by a combination of imaging modalities and a percutaneous biopsy. It is important to be aware of this entity, as the presentation varies widely and when diagnosed early the condition may be treated appropriately by relatively minor surgical intervention.
Antenatal transfer of rural women to perinatal centres
Authors: Roberts Christine L , Henderson‐Smart David , Ellwood David A , Group****** High Risk Obstetric and Perinatal Advisory Working
Published: February 2008

Summary: The aim of this study was to describe antenatal transfers of rural women to perinatal centres, and among transferred women, to assess the use of selected evidence‐based therapies and determine the predictors of preterm and imminent births. The clinical records of rural women antenatally transferred to perinatal centres in NSW and the ACT during 1997–1998 were reviewed. Of 453 rural antenatal transfers, 408 (90%) were emergency transfers. Increasing remoteness was associated with increased rates of antenatal transfer but not with a lower probability of giving birth. Of all transferred women, 64% delivered; 58% of preterm transfers delivered preterm and of those delivering preterm, 76% delivered within 7 days.

Although the main reason for antenatal transfer was the possibility of preterm birth, women presenting with preterm contractions only were less likely to deliver preterm (OR = 0.2,95% CI 0.1‐0.4) or ≤. 7 days (OR = 0.3,95% CI 0.2‐0.5) than women with any other presenting symptoms. The overall usage of effective interventions (antenatal steroids, antibiotics for PPROM and β‐mimetie tocolysis to delay birth) among antenatally transferred rural women was high, but there is room for increased; uptake prior to transfer.
Fetal growth charts for Aboriginal fetuses
Authors: Humphrey Michael , Holzheimer Deborah
Published: February 2008

Summary: The study aimed to determine whether fetal growth parameters in Aboriginal pregnancies are such that separate fetal growth charts are necessary for their appropriate care. We designed a prospective study of a cohort of Aboriginal women presenting for antenatal care before 20 weeks gestation (ultrasound proven) and a reference cohort of Caucasian women.

Four remote North Queensland communities served by the Far North Regional Obstetric and Gynaecological Service (FROGS) and the antenatal clinic at Cairns Base Hospital took part in the survey.

One hundred and four Aboriginal and 101 Caucasian women with no known medical factors affecting fetal growth or gestation were recruited, and 96 Aboriginal and 96 Caucasian women completed the study. Measurements took the form of longitudinal percentile charts of fetal biparietal diameter, abdominal circumference and femur length.

Ultrasound measurements of fetal biparietal diameter, abdominal circumference and femur length were obtained 3 to 5 times during Aboriginal and Caucasian pregnancies, where the gestation was established by ultrasound before 20 weeks gestation, and no known medical conditions which affect fetal growth were present in the mother. There were no statistical or clinically important differences in biparietal diameter, femur length and abdominal circumference of Aboriginal and Caucasian fetuses.

We concluded that there is no reason to use separate fetal growth charts when examining Aboriginal fetal growth.
Parental decision‐making differences between patients in two healthcare systems for choroid plexus cysts
Authors: Apodaca Christina C , Jr Roderick F Hume , Evans Wendy J , Martin Laura S , Evans Mark I , Calhoun Byron C
Published: February 2008

Summary: We evaluated the medical‐sociological implications of parental perception of risk and decision‐making choices for prenatally ascertained choroid plexus cysts (CPC) between two obstetric populations.

The Wayne State University (WSU) Reproductive Genetics database and the Madigan Army Medical Center (MAMC) experience were reviewed to compare the rates of aneuploidy and invasive testing for cases with CPC. Aneuploidy rates were compared between those with isolated CPC, CPC with advanced maternal age (AMA), and CPC associated with multiple anomalies.

In the WSU cohort 186 cases were identified, of whom 27 (15%) declined invasive fetal testing. In the remaining 159 cases, aneuploidy was present in 2/132 (1.5%) isolated CPC, 3/11 (27%) CPC with AMA, and 15/16 (93%) CPC with multiple anomalies.

In the MAMC cohort 107 cases were identified, of whom 99 (92%) declined invasive fetal testing. No aneuploidy cases were found in the 3/12 AMA cases or 5/95 non‐AMA cases that underwent amniocentesis.

The two cases of aneuploidy with isolated CPC cannot be ignored, and provide an estimated attributable risk of at least 0.8%, a higher risk than 38 years of age. However, the parental sociologic context may be as important for decision‐making as the genetic‐prognostic risk.
Management of vaginal agenesis: review of 10 years practice at a tertiary referral centre
Authors: Robson Stephen , Oliver Gillian D
Published: February 2008

Summary: Vaginal agenesis is an uncommon congenital anomaly, and is often associated with agenesis of the uterus and fallopian tubes. Recent reports suggest that non‐surgical methods to create a neovagina offer advantages when assisted reproductive treatments are used in the adult life of these women. We have reviewed the management of 39 women with congenital vaginal agenesis to assess the outcomes of neo‐vaginal creation. In 25 women with total Müllerian agenesis, creation of a neovagina using progressive perineal dilatation alone was very successful in women motivated by a sexual relationship.
An experience with transvaginal sonography in gynaeeologic tumour surveillance
Authors: Carter Jonathan
Published: February 2008

Summary: Surveillance of gynaeeologic cancer patients treated with a curative intent involves frequent presentations by the patient for a targeted history, detailed general and pelvic examination, including Pap smear. One of the aims of such surveillance is to detect potentially curable recurrences early to allow the initiation of further therapy, hopefully to attain eradication of the recurrent tumour.

Six cases are presented where the prudent use of transvaginal sonography (TVS) was found to be useful in the exclusion of recurrent tumour in patients with symptoms; early diagnosis in patients who were asymptomatic; confirmation of disease in those with symptoms; to evaluate patients with obliterated upper vaginas due to therapy, and follow‐up of those with confirmed recurrence as a form of disease marker.
Oophorectomy at the time of surgery for moderate endometriosis: a survey of Australian gynaecologists
Authors: Dover Richard W , Chen Jack , Torode Hugh
Published: February 2008

Summary: The decision to perform bilateral oophorectomy at the time of surgery for endometriosis is dependent upon many factors, one of which is the opinion of the surgeon concerned. At present there is no consensus on this subject, and in an attempt to document current opinion, we performed a postal survey of all Fellows of RANZCOG living within Australia.

The questionnaire presented the Fellow with a clinical scenario describing moderate endometriosis, and then asked him/her to select their preferred option for each of a number of anatomical areas.

Out of 1050 questionnaires, 688 (65.5%) were returned. Analysis of these replies suggests that current opinion supports a conservative approach to surgery, with only 27.5% of Fellows electing to perform a hysterectomy in conjunction with bilateral oophorectomy.
Outcome of pregnancies complicated by pre‐gestational diabetes mellitus
Authors: Gunton J E. , McElduff A , Sulway M , Stiel J , Kelso I , Boyce S , Fulcher G , Robinson B , Clifton‐Bligh P , Wilmshurst E
Published: February 2008

Pregestational diabetes mellitus (DM) is associated with adverse fetal and maternal outcomes. Studies suggest that optimal control of diabetes before and during pregnancy minimises these risks. There are few recent reviews of outcomes of pregnancies complicated by DM in Australia.

Ninety‐three pregnancies in women with DM at our hospital since 1989 were identified. We collected data for maternal age, type of diabetes, duration of therapy, complications of diabetes, maternal complications of pregnancy and fetal outcomes including malformations. The rate of pregnancy planning with optimal glycaemic control at conception was low in our population, particularly in patients with Type 1 diabetes.

Women who smoked had worse glycaemic control, and a higher rate of miscarriage. There was a high rate of Caesarean section, particularly in those women with Type 1 diabetes (77.4%). The rate of Caesarean section was lower in planned pregnancies. There were no perinatal deaths. The number of neonates with major congenital anomalies was high (13%) in the Type 1 population.

It is important to increase the rates of prepregnancy planning and to optimise glycaemic control before pregnancy. In many cases there has been a long interval between diagnosis and pregnancy, so all women with diabetes should receive counselling at frequent intervals about pregnancy and the importance of planning. Women who planned their pregnancies had improved outcomes, with decreased rate of Caesarean section, better glycaemic control and better neonatal Apgar scores. Women with diabetes should not smoke during pregnancy because of the increased risk of miscarriage and poorer glycaemic control.
Incisional hernia in a 5 mm laparoscopic port site incision
Authors: Kwok Adrian , Lam Alan , Ford Robert
Published: February 2008

Herniation of omentum or bowel through laparoscopic incision sites is uncommon. Herniations through 5 mm ports sites are very rare, with less than a handful described in the literature. Undoubtedly however, with the increasing interest