bluuebunny/crossref_metadata_2025 huggingface dataset:
Failed Suction Termination of Pregnancy: Case Reports and Review
Authors: Barker G. K. , Wade K. J.
Published: February 2008

EDITORIAL COMMENT: A specialist abortionist once remarked to the editor that it was unwise to terminate a pregnancy before 7 weeks'gestation, especially in a nullipara since cervical softening may be minimal and cervical dilatation difficult. Some operators believe that injection of 2 ml of 1% lignocaine into the cervix at each of the 4, 8 and 12 o'clock positions facilitates dilatation and lessens the risk of damage to the cervix. Copious bleeding does not guarantee that a pregnancy has been dislodged; histology of tissue obtained should be a routine practice although the presence of chorionic villi is not a guarantee against an ongoing pregnancy. We agree with the authors' conclusion that ultrasonography at the postabortal check‐up visit is essential if the uterine size is larger than expected, or if pregnancy symptoms persist.

Summary: This paper presents two case reports of failed suction termination of first trimester pregnancies which occurred at Geelong Hospital over a short period of time and thus drew our attention to this very difficult problem. The international experience with such failed terminations is then reviewed, with discussion of the recognized associations, prevention and management of such cases.
A Rare Case of Endodermal Sinus Tumour of the Vagina in an Infant
Authors: SenGupta S. K. , Murthy D. P. , Martin W. M. C. , Klufio C.
Published: February 2008

EDITORIAL COMMENT: We accepted this sad case report for publication to remind readers that persistent vaginal bleeding in an infant requires investigation to exclude the rare primary malignancies of cervix and/or vagina.

Summary: A rare case of endodermal sinus tumour (EST) of the vagina in a 1 year 5 months old Papua New Guinean female is described and the literature on vaginal ESTs in childhood is briefly reviewed.
The Effects of Chronic Maternal Hypotension During Pregnancy
Authors: Ng Peng H. , Walters William A. W.
Published: February 2008

Summary The relationship between chronic maternal hypotension and obstetric outcome was examined retrospectively in a group of 134 pregnant women and compared with a normotensive control group. The hypotensive women had significantly increased risks of delivery before the 38th week of gestation, lower birth‐weight of babies for gestational age, and postpartum complications. In addition, the rates of preterm delivery before 37 weeks' gestation, birth‐weight less than 2,500 g and significant meconium‐staining of the amniotic fluid were higher in the hypotensive group, although these results did not reach statistical significance.

These data support the need for a prospective study of the effects of chronic hypotension during pregnancy.
Fetal Arrhythmias: A 3‐Year Experience*
Authors: Rajadurai V. Samuel , Menahem Samuel
Published: February 2008

Summary Eight cases of fetal arrhythmia were seen over a 3‐year period. Two had atrial and/or ventricular extrasystoles, 1 had complete atrioventricular block and 5 had tachyarrhythmias ‐ 3 supraventricular tachycardia, 1 atrial flutter and 1 ectopic atrial tachycardia. All had structurally normal hearts. Nonimmune hydrops fetalis was the initial presentation in 3 of the 5 cases with tachyarrhythmias. There were 2 deaths ‐a stillbirth and a neonatal death, while 2 others required neonatal intensive care. The 6 survivors have remained well and are now off treatment.

The diagnosis, careful assessment and management of a fetal arrhythmia may lead to a successful outcome. The complexity of the problems experienced may warrant early referral to a tertiary centre where the overall management of the mother, fetus and neonate, may be undertaken.
Inflammatory Bowel Disease Presenting in Pregnancy
Authors: Morton Mark R.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it reports an unusual case of ulcerative colitis occurring for the first time during pregnancy. In the discussion the author reviews the literature on ulcerative colitis and Crohn disease in pregnancy, these being the 2 important examples of inflammatory bowel disease encountered in pregnant women.

Summary A case of inflammatory bowel disease (IBD) presenting in pregnancy is described. Despite previous reports of severe fulminating disease in this type of patient, this woman did well with an uncomplicated course; she responded to standard medical therapy and there were no fetal complications.

IBD should not be a contraindication to pregnancy unless the disease is poorly controlled. Pregnancy does not increase the risk of relapse of IBD, but should this occur it is more likely in the first trimester or in the postpartum period.

Treatment of IBD in pregnancy should be much the same as in the nonpregnant woman. Corticosteroids and sulphasalazine are safe in pregnancy and are the mainstays of medical treatment. Surgery should proceed for the usual indications of toxic megacolon and perforation. In the group requiring surgery fetal mortality is considerable but the maternal outcome is improving. Patients presenting with IBD in pregnancy may have more severe disease but recent reports suggest that the outcome for mother and infant in this group is improving.
Human Menopausal Gonadotropins in the Treatment of Unexplained Infertility
Authors: Hughes Graeme J. , Garrett Donald K. , Lowy Margo
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it describes treatment of patients with unexplained infertility by a drug regimen that appeared to have satisfactory results; 25 of 91 women treated became pregnant and 20 livebirths resulted. It should be noted that, as in most papers reporting results of infertility treatment, there was no control series. Women with unexplained infertility often ask what comes next, when pregnancy does not occur after all investigations are found to be normal. Many are aware of the availability of ovulation induction, GIFT and IVFprogrammes. It seems to us that there is no consensus on how long a couple with normal tests should persevere before being accepted as candidates for sophisticated management. We beg our readers to offer us reports of results of controlled trials of conservative management versus the new technologies in management of these couples. We need such data so we can advise our patients wisely.

Summary : Ninety one patients with unexplained infertility were treated with human menopausal gonadotrophin (HMG) and human chorionic gonadotrophin (HCG). The overall pregnancy rates were 29% per patient and 11% per cycle. In patients under the age of 37, the rates were 40% per patient and 15% per cycle.

Many cycles (15%) were cancelled because of poor response to stimulation and by definition these women had normal cycles prior to stimulation.

Within 1 year of ceasing HMG treatment, 9 patients had conceived spontaneously and another 4 conceived by GIFT.
Urinary Bladder Carcinoma as Apparent Cause of Antepartum Haemorrhage in Pregnancy
Authors: KriplaniJ Alka , Buckshee Kamal , Karak A. K. , Gupta N.P.
Published: February 2008

EDITORIAL COMMENT: We were all taught as undergraduates to ask the woman with postmenopausal bleeding was she sure from which orifice the blood had issued. We have all seen a patient with endometrial carcinoma whose diagnosis was delayed while the urologist investigated her for ‘haematuria’. It is also true that urologists tell of the patient with carcinoma of the bladder whose diagnosis was delayed while the gynaecologist investigated her for postmenopausal bleeding presumed to arise from within the uterus. We know of no data that settles the question of whether urologist or gynaecologist is the greater sinner ‐ the message is to check the second system when the first tests negative.

This paper was accepted for publication not only for its rare interest but to remind readers that urinary and genital tract bleeding can be confused in obstetric as well as in gynaecological practice. This case reminded the editor of a 41‐year‐old para 8, referred at 38 weeks' gestation as a nonbookedpatient to the Royal Women's Hospital, Melbourne, with a history of recurrent bleeding considered to be due to placenta praevia, for which she had been hospitalized for many weeks. This patient was cachectic and dying from a Stage 4 carcinoma of the cervix; review of the records revealed that on April 26, 1963 she was delivered of a surviving infant by classical Caesarean section performed because the growth massively involved the lower uterine segment and bladder. She was then treated unsuccessfully with pelvic irradiation and died from uraemia and sepsis 4 months after delivery.

Summary A 34‐year‐old multipara presented with painless profuse genital bleeding during the third trimester of pregnancy in a state of haemorrhagic shock. Haematuria because of urinary bladder carcinoma was found to be the cause of bleeding. Cystoscopy was useful for accurate diagnosis as well as for achieving haemostasis. This case emphasizes the possibility and importance of haematuria when dealing wtih a patient with antepartum haemorrhage.
Transitional Cell Carcinoma in a Urethral Diverticulum
Authors: Catalano S. , Jones I.
Published: February 2008

EDITORIAL COMMENT: We accepted this case report not just because of its rare anecdotal interest but also because it has a useful discussion which will help readers to diagnose urethral diverticulum when it presents, usually in a patient with recurrent urinary tract infection.
Free Full‐Thickness Vaginal Epithelium Graft in Correction of Recurrent Genital Prolapse
Authors: Zacharin Robert F.
Published: February 2008

Summary: Recurrence of a cystocele, rectocele or enterocele following a previous vaginal repair procedure can be an awkward problem to correct. This preliminary report suggests a simple yet very effective method of dealing with such defects.
A Comparison of Tiaprofenic Acid, Mefenamic Acid and Placebo in the Treatment of Dysmenorrhoea in General Practice
Authors: Tilyard M. W. , Dovey S. M.
Published: February 2008

Summary: The efficiency and side‐effects of tiaprofenic acid, mefenamic acid and placebo were compared in the treatment of primary dysmenorrhoea. The trial was a double‐blind prospective randomized 3‐way crossover study during 6 successive menstrual cycles following a 2‐cycle run‐in period and involved 50 women with primary dysmenorrhoea selected from 96 volunteers between 16 and 35 years of age. Overall pain was significantly less (p <0.05) on treatment with tiaprofenic acid than on treatment with mefanemic acid, placebo, or the women's usual treatments. Both active treatments were well tolerated but more side‐effects were reported during treatment with mefenamic acid.
A Case of Intrauterine Fetal Death Associated with Maternal Campylobacter coli Bacteraemia
Authors: Farrell D. J. , Harris M. T.
Published: February 2008

EDITORIAL COMMENT: We accepted this case report for publication to remind readers that intrauterine infection can cause fetal death even though the membranes are intact; of course in patients with vaginal discharge in the second trimester it is often uncertain whether or not the membranes are ruptured. We support the authors' statement that the placenta should always be sent for histological and microbiological analyses when the infant is stillborn or born in poor condition; it is also suggested that a Kleihauer test be performed on the mother's blood in such cases since fetomaternal haemorrhage is more common than previously believed. Although permission for autopsy may occasionally not be granted, the placenta should always be available for examination. Indeed the editor has never heard of parents refusing to have a placenta examined and it is doubtful if their permission for such examination is required. Indeed in many centres it is recommended that after all deliveries the placenta should be kept refrigerated within a plastic bag for 1 week in case a clinical complication arises in the baby or mother which indicates its further examination. Our legal consultant informs us that placentas, like surgical specimens, are the property of the hospital. Testing for Aids antibodies is a special situation since it is a community expectation that this will not be performed without consent following adequate counselling. The occasional couple may have a birth plan which includes taking the placenta home for special disposal; this wish should be respected but does not preclude examination of the organ.

Summary: Campylobacter species are known to cause infectious abortion in domestic animals. In humans, Campylobacter are an important cause of enteritis, an occasional cause of systemic infection and have had a rare association with abortion and perinatal infection. A case history of spontaneous abortion, at 26 weeks' duration, associated with maternal bacteraemia, due to Campylobacter coli is presented. Transmission, pathogenesis, treatment, and the need for further investigation are discussed.
The Diagnosis of Marginal Placental Abruption in Placenta Praevia Using Transvaginal Sonography
Authors: Haines Christopher J. , Stock Anthony
Published: February 2008

EDITORIAL COMMENT The timing of delivery inpatients with recurrent antepartum haemorrhage before practical fetal maturity (37 weeks' gestation) has always required clinical judgement and still does, unless the patient is in labour, or haemorrhage is so severe that conservative management is clearly contraindicated ‐ or the fetus dead, or doomed by irremediable malformations. At earlier gestations maternal and fetal welfare must be assessed (full blood examination and coagulation screen for the mother, and cardiotocography ± biochemical testing of fetoplacental function for the fetus). Estimation of fetal pulmonary maturity may be assessed and maturity enhanced by betamethasone therapy if appropriate. These comments apply not only to patients shown by ultrasonography to have placenta praevia, but also to those where there is evidence of retroplacental bleeding and hence placental separation. This report presents the possible value of transvaginal sonography in patients with recurrent antepartum haemorrhage.

The mother was delivered at 35 weeks' gestation and the baby was growth retarded (the Victorian tenth percentile for birth‐weight at 35 weeks is 1,760 g), although this was apparently not recognized before delivery. The timing of delivery was apparently not based upon cardiotocographic or biochemical evidence of fetal compromise. We consider that recurrent antepartum haemorrhage indicates Caesarean delivery, irrespective of the site of the placenta, because of the risk of placental separation in labour. However, the timing of delivery in such patients remains a topic for clinical argument in obstetric practice.
An Unusual Case of Retrograde Ejaculation
Authors: Steigrad Stephen J.
Published: February 2008

Summary: Despite normal seminal analyses obtained for assay by masturbation, persistent negative postcoital tests led to the testing of postejaculatory urine following normal intercourse. This disclosed an unusual problem of retrograde ejaculation occurring only during intercourse. The mechanism for this selective form of retrograde ejaculation is unknown.
Perinatal Mortality in a Tertiary Obstetric Institution
Authors: Fliegner John R. H.
Published: February 2008

EDITORIAL COMMENT: Readers may wish to ponder on the remarkably good results achieved in the Royal Women's Hospital Birth Centre where according to an enquiry made by the Editor electronic fetal heart rate monitoring is not performed. This casts some doubt on the Author's opinion that the low intrapartum mortality rate reported in this series from the Royal Women's Hospital is due to fetal heart rate monitoring in labour!

Reply from Author: The 2 groups i.e. the Women's Hospital Birth Centre and the Public Hospital patients are in no way comparable. Patients attending the Royal Women's Hospital Family Birth Centre are a highly selected low risk group. Women with any significant risk factors are excluded e.g. hypertension, antepartum haemorrhage, prolonged pregnancy, low oestriol excretion, abnormal antenatal CTG, decreased fetal movements, meconium‐stained liquor, Syntocinon infusion, slow progress in labour and abnormality on auscultation of the fetal heart in labour.

Despite these rigid criteria, there are still a number of asphyxiated babies born in the centre and there have even recently been 2 perinatal deaths. Perhaps this low rate of neonatal asphyxia would have been even lower with intrapartum CTG monitoring in these very low risk women.

Summary: At the Royal Women's Hospital, Melbourne in the 3 years 1987–1989 analysis of the records of 13,347 public patients revealed an overall perinatal wastage of 20.8 per 1,000 births. This seemingly high figure resulted from the fact that 45% of losses occurred in nonbooked and emergency admissions. Many patients were referred with major complications of pregnancy, especially gross prematurity, lethal congenital malformations and intrauterine deaths. During the 3‐year period 74% of perinatal losses occurred before 33 weeks' gestation and only 10% were after 37 weeks. By comparison at a Victorian State level, 47% of perinatal deaths occurred before 33 weeks and more than 35% after 37 weeks' gestation. The major causes of perinatal wastage in both groups were similar. At the Royal Women's Hospital in the 3‐year period lethal congenital abnormalities accounted for 19.1% of fetal wastage, premature labour, premature rupture of the membranes and cervical incompetence 16.2%, multiple pregnancy 14.7%, antepartum haemorrhage 14.0% and hypertensive disorders 9.7%. During the 3‐year period 7.7% of hospital stillbirths were intrapartum compared to 27% for the State of Victoria.

The stillbirth rate in Victoria has declined over the past decade, but to a lesser extent than the neonatal death rate. Over the 3‐year period 1987–1989 the ratio of stillbirths to neonatal deaths was 3 to 2, and in 1989 there were nearly twice as many stillbirths as neonatal deaths (424 versus 240). Furthermore, 55% of stillborn infants in Victoria had birth‐weights of more than 1,500 g compared to the Royal Women's Hospital figure of 36%. It is clear that future improvement in perinatal mortality rate must be aimed at the prevention of stillbirths in mature pregnancies.
Excessive Birth Weight and Maternal Glucose Tolerance A 19‐year Review
Authors: Shelley‐Jones David C. , Beischer Norman A. , Sheedy Mary T. , Walstab Janet E.
Published: February 2008

Summary: The incidence of birth‐weight of 4,540 g (10 lb) or more rose from 0.87% in the years 1971 to 1977 to 1.16% in the 12 years from 1978 to 1989 with a concomitant increase in hyperglycaemia in our antenatal population. The relationship between excessive birth‐weight and maternal glucose tolerance was investigated in the light of these observations.

The results from glucose tolerance tests performed routinely during the pregnancies of 510 women who delivered infants with a birth‐weight of 4,540 g or more were compared with those from a control series of 5,003 women with consecutively tested pregnancies. Glucose tolerance in subsequent pregnancies was also compared with the control series, and in 1991 the study group women were investigated for emergence of permanent diabetes mellitus.

Excessive birth‐weight was associated with maternal hyperglycaemia (p < 0.05) but not with gestational diabetes; 79% of infants with birth‐weight ≥ 4,540 g were born to mothers who were not hyperglycaemic. There was no increase in glucose intolerance in subsequent pregnancies in the study group and only 2 of 49 women with follow‐up testing had diabetes mellitus.

Birth‐weight ≥ 4,540 g occurred in 1.1% of the total population and 1.1% of women with gestational diabetes, and was related to maternal hyperglycaemia in about 1 in 5 cases. The increased incidence of excessive birth‐weight infants was not related to the increased incidence of gestational diabetes in our pregnant population. Birth‐weight ≥ 4,540 g had a poor association with later development of diabetes.
Expected Gain in Body Mass and Onset of the Menarche
Authors: Stanton Warren R. , Kelly Jane L. , Bunyan Deborah A. , Silva Phil A.
Published: February 2008

Summary: Fertility is dependent on sexual maturity, which is associated with a number of factors, including body mass. In this study the Body Mass Index (BMI) was used to estimate body fat in a large sample of 13‐year‐old New Zealand girls. Nearly half of the subjects (46%) had experienced the menarche. Expected gain in body mass was calculated from growth rates at earlier ages and used to examine whether deviation from the expected gain was associated with the onset of the menarche. In general, the results show an association between the menarche and gain in body mass. However, many girls who failed to achieve their expected gain had experienced the menarche (18%), indicating that the relationship between body weight and the menarche may not be causal or is mediated by other factors.
Risk Factors and a Risk Scoring System for the Prediction of Malignancy in Ovarian Cysts
Authors: Tay Sun‐Kuie , Tan Yin‐Yin
Published: February 2008

Summary: A retrospective study was carried out on 396 patients who presented with ovarian masses. Sixty five (16%) patients were found to have ovarian malignancy while the rest either had benign ovarian tumours (n = 159), endometriotic cysts (n = 130), physiological cysts (n = 20) or inflammatory masses (n = 7). The relative risk for ovarian malignancy among these patients increased significantly (p < 0.001) after the age of 40 years. The presence of ascites, abdominal distension, urinary complaints and loss of appetite and weight were significant individual risk factors for malignancy. Ultrasound image of a complex cyst is also associated with increased risk of malignancy in an ovarian mass. None of the individual risk factors was discriminatory between a benign and malignant cyst. However, these factors can be combined to form a 20‐point risk scoring system. The risk of malignancy in an ovarian cyst increased with increasing scores. In this study, the median scores were 3 for benign cyst, 7 for borderline malignancy and 12 for malignant cysts. Using a total score of 7 as a cut off point, one can detect 75% of malignant cysts with a specificity of 84.1%, a positive predictive value of 47.5% and a negative predictive value of 94.6%. It is concluded that the majority of malignant ovarian cysts can be identified preoperatively to allow arrangement and planning of an optimal surgery.
Danazol in the Treatment of Menorrhagia: The Effect of a 1 Month Induction Dose (200 mg) and 2 Month's Maintenance Therapy (200 mg, 100 mg, 50 mg or placebo)
Authors: Need Jillian A. , Forbes Kevin L. , Milazzo Louise , McKenzie Elaine
Published: February 2008

Summary: This paper highlights the difficulties of recruiting subjects to objective menstrual blood loss (MBL) studies. Such difficulties may explain the relative paucity of such studies in the literature. Eleven women with objectively assessed evidence of menorrhagia were treated for 1 month with an induction dose of 200 mg of danazol (Danocrine). Subsequently the women were randomly assigned to receive 50,100 or 200 mg of danazol or placebo for 2 months of maintenance dosing. Follow‐up with objective assessment of MBL was continued for 3 months after cessation of maintenance dosing.

Danazol 200 mg as an induction dose significantly reduced MBL. The maintenance dose of 200 mg during the following 2 months produced a further decrease in MBL and in some cases amenorrhoea. The lower maintenance dosages of 50 mg and 100 mg were associated with a variable response.

The study was unable to determine whether any beneficial effect of the maintenance dosages of danazol could be maintained following cessation of therapy since the study numbers had become too small. It appears, however, that there is unlikely to be any persisting benefit once therapy has ceased.
Stress Management and Infertility
Authors: Shepherd Judy
Published: February 2008

Summary: The author through personal experience has gained knowledge in the area of infertility and stress management. Her professional background supports the experiences, emotions and management techniques encountered with sound theoretical knowledge.

This article deals with some of the procedures confronting a couple who experience infertility problems. It aims to explain and qualify common emotional responses experienced by couples and offers stress management strategies to improve their coping ability.
Placenta Praevia Percreta Invading the Urinary Bladder
Authors: Sanders R. R.
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication for readers to contrast the pros and cons of conservative management of placenta praevia percreta when hysterectomy appears a formidable undertaking and haemorrhage from a partially separated placenta does not render immediate hysterectomy a necessity. The author was very careful to avoid disturbance of the placenta at Caesarean section. The author's letter to the editor quoted experience of a fatal case of placenta praevia percreta and the editor unfortunately can say the same. The deaths from placenta praevia percreta as stated in most triennial reports of Maternal Deaths in Australia usually occur because of failure to achieve lasting haemostasis at the time of Caesarean section followed by further surgery when the patient has lost a large quantity of blood (1985–1987 report; p24). The finesse used in this successfully treated patient is only feasible when haemorrhage has not occurred. We have previously commented that when performing hysterectomy for placenta praevia percreta it is probably wise to perform classical Caesarean section, close the uterus with the placenta undisturbed, and proceed to hysterectomy, perhaps with elective incision of the bladder wall if there is no plane between it and the lower uterine segment (see Editorial Comment. Aust NZ J Obstet Gynaecol 1991; 31: 71; see also Obstetrics and the Newborn, Beischer NA, Mackay EV, WB Saunders, Second Edition 1986; pi04 for photographs of a patient with a placenta praevia percreta treated as described above). Whenever the eventual hysterectomy is performed the main prerequisite, apart from a skilled anaesthetist and appropriate resuscitation facilities, is a surgeon familiar with radical pelvic surgery; this usually means a gynaecological oncologist.

Summary: A case of placenta praevia percreta involving the urinary bladder is presented. A classical Caesarean section was performed at 35 weeks' gestation but the placenta was left in situ and an elective hysterectomy was successfully performed 2 weeks postpartum.
Bilateral Radial Nerve Palsies from Use of a Birth Frame
Authors: Nichols C. R.
Published: February 2008

Summary: A case of bilateral radial nerve palsies associated with the use of a birth frame is reported.
Postmenopausal Endometrioma and Hormonal Replacement Therapy
Authors: Goh J. T. W. , Hall B. A.
Published: February 2008

EDITORIAL COMMENT: We accepted this case as its message will interest readers. Rarely the postmenopausal woman who is not taking hormone replacement therapy will present with obstruction of bowel or ureter due to chronic inflammation caused by inactive endometriosis (A, B).

Macafee CHG, Greer HLH. Intestinal endometriosis: a report of 29 cases and a survey of the literature. J Obstet Gynaecol Br Commonw 1960; 67: 539–555.

Lam AM, French M, Charnock FM. Bilateral ureteric obstruction due to recurrent endometriosis associated with Hormone Replacement Therapy. Aust NZ J Obstet Gynaecol 1992; 32: 83–84.

Summary: This case of postmenopausal endometrioma following hormonal replacement therapy (HRT) demonstrates the often forgotten possibility of reactivation of endometriosis with HRT. The diagnosis of endometriosis should be considered in a postmenopausal woman who presents with pelvic pain and mass whilst on HRT.
Breech Presentation in South Australia, 1987–1989
Authors: Jonas Oswald , Roder David
Published: February 2008

Summary: This study compares the maternal, obstetrical, labour and pregnancy outcome characteristics of 2,412 breech‐presenting births with 17,946 vertex‐presenting births. Mothers of babies presenting as breeches were significantly more likely to have had a previous miscarriage, an obstetric complication, a threatened miscarriage or threatened labour during the current pregnancy, or Caesarean section than mothers of babies with vertex presentation. The babies presenting as breeches had significantly more neonatal morbidity and perinatal mortality. They showed higher rates of suspected intrauterine growth retardation, prematurity, low birth‐weight, low Apgar scores and congenital anomalies. The overall perinatal mortality for breech presentations was almost 9 times higher than for vertex presentations. Unconditional multiple logistic regression analysis showed that, even after adjusting for low birth‐weight and the presence of congenital anomalies, breech presentation still showed a statistically significant association with perinatal death.

The study alludes to the possibility that breech presentation, in a significant number of cases, may not be coincidental but a marker for some preconceptional or prenatal disturbance.

The study also shows am excess of breech presentations in females which is unexplained and may point to a genetic or hormonal susceptibility of the fetus.
The Significance of Recurrent Polyhydramnios
Authors: Beischer Norman , Desmedt Els , Ratten Graeme , Sheedy Mary
Published: February 2008

Summary: A study of 30 women who had polyhydramnios in more than 1 pregnancy revealed that 8 of the 36 resultant pregnancies (22.2%) were associated with diabetes mellitus, 14 (37.8%) with fetal macrosomia, and the perinatal mortality rate was 16.2% (6 of 37). The incidence of major fetal malformations or abnormalities was 18.9% (7 of 37); 4 of the 6 deaths resulted from malformations (anencephalus (2), hydrocephalus (1), nonimmune hydrops (1)), and the other 2 deaths were from hyaline membrane disease associated with prematurity. Recurrent polyhydramnios occurred in 1 in 1,720 pregnancies. The onset was acute in 3, subacute in 2 and chronic in 31, the perinatal deaths in these categories being 2, 1 and 3 respectively. The risk of recurrent polyhydramnios is the risk of fetal malformation and premature delivery. The latter may be preventable by prompt therapy with indomethacin, and serial amniocentesis if this therapy fails.
Induction of Labour in Pregnancy Complicated by Cardiac Disease
Authors: Sau A. K. , Vasishta K. , Dhar K. K. , Khunnu B.
Published: February 2008

EDITORIAL COMMENT": We accepted this paper for publication so readers could review their thoughts on induction of labour in women with cardiac disease; a series of 450 women with organic heart disease during pregnancy was required to provide the 21 cases presented. A woman with cardiac disease can rapidly go into heart failure after delivery and, since a physician is never present fin the editor's experience) the obstetrician must know what to do in this circumstance. Prophylaxis is preferable. Therefore all except Grade I cases (murmur without symptoms) merit delivery in the sitting position with the legs held horizontally by 2 assistants; oxygen and morphine should be available and aminophylline 250–500 mg by slow intravenous injection is one regimen used to anticipate and prevent the onset of failure with delivery of the placenta. These women withstand blood loss poorly and, in our view, intravenous oxytocin 5–10 units is recommended after completion of the second stage. If cardiac failure occurs the woman should be sat upright, given oxygen, morphine 15 mg preferably intravenously, and digitalized(1 mg in divided doses. I. V. over 24 hours). Intravenous frusemide (40–80 mg) is a rapidly‐acting diuretic that is also recommended and was given as a routine to all women in the present study, the drug being administered at the time of induction and at the onset of the second stage of labour.

Summary: Twenty one pregnant patients with cardiac disease had induction of labour for various obstetric reasons with a modified oxytocin infusion method. All of them went into labour and delivered within 20 hours. Twenty patients delivered vaginally. Three neonates had birth asphyxia (Apgar score < 7) and 1 of them died on the 4th day from prematurity. No adverse effect of oxytocin infusion on maternal cardiac status was observed and all of the women went home in good condition. Induction of labour with a modified oxytocin infusion is a safe and effective alternative for selected gravidas with cardiac disease where elective delivery is warranted.
ECG Waveform Analysis in Intrapartum Fetal Monitoring
Authors: Loh F. H. , Arulkumaran S.
Published: February 2008

Summary: Intrapartum cardiotocography (CTG) has a high false positive rate and, in the absence of facilities for fetal scalp blood sampling, is associated with increased operative deliveries for ‘fetal distress.

It is presently possible to obtain a representative fetal ECG signal using the fetal scalp electrode. There is renewed interest in fetal ECG waveform analysis in the hope that it will improve the specificity of detecting intrapartum fetal hypoxia when there is an abnormal fetal heart rate pattern. Two portions of the fetal ECG are potentially useful: the ST waveform (T/QRS ratio) and the PR interval correlated with the RR interval.

Animal experiments suggest that changes in the ST waveform, increase in the T wave amplitude in particular, reflect myocardial anaerobic metabolism. Clinical studies have shown poor correlation between the T wave changes and fetal heart rate changes. There is also concern that the sensitivity of the ST waveform changes for fetal acidaemia may be poor.

More information is required before its use is incorporated into routine clinical practice.
Postoperative Vomiting Factors in IVF Patients
Authors: Coburn R. , Lane J. , Harrison K. , Hennessey J.
Published: February 2008

Summary: Postoperative vomiting patterns were documented in 504 patients having general anaesthesia for oocyte retrieval for in vitro fertilization or related procedures and compared with patient preoperative history and expectations, response to ovarian hyperstimulation, and details of the anaesthesia. The results showed that the likelihood of vomiting was related to peak plasma oestradiol level and the patient's expectation based on previous experience of anaesthesia.
Side‐Effects and Complications of Outpatient Hysteroscopy
Authors: Finikiotis George
Published: February 2008

Summary: Outpatient hysteroscopy and biopsy was performed on 403 occasions. Complications were rare (<1%). Side‐effects occurred in 70% of patients but rarely required treatment. Preoperative explanation of the type, severity and frequency of side‐effects reduces patient anxiety at the time when side‐effects occur.
Active Chronic Peptic Ulcer Disease Complicated by Gastric Outlet Obstruction in Pregnancy
Authors: Goh Judith T.W. , Flynn Michael B. , Florin Timothy H.J.
Published: February 2008

Summary: A case of active peptic ulcer disease in a primigravida at 29 weeks' gestation is presented, with a literature review. This particular case was complicated by gastric outlet obstruction, a complication which has not been previously reported in the obstetric literature. Although an uncommon diagnosis in pregnancy, the investigations for peptic ulcer disease should be actively pursued. Treatment can prevent serious complications.
Pregnancy Complicated by the Antiphospholipid Syndrome
Authors: Munday David N. , Jones Warren R.
Published: February 2008

Summary: A patient with previously undiagnosed antiphospholipid syndrome (APS) developed atypical severe preeclampsia at 31 weeks' gestation. Other complications of pregnancy included intrauterine growth retardation, thrombocytopenia and fetal distress necessitating urgent delivery of a live infant. There was a prior history of unexplained jugular venous thrombosis. Prophylaxis against thrombosis was commenced immediately postoperatively and no postpartum complications occurred.

Recent evidence supports the use of antepartum prophylaxis with low dose heparin in patients with APS. The role of low dose aspirin, either alone or in combination with heparin, is yet to be determined. Human immunoglobulin may be useful in selected cases. Early diagnosis is a key factor in their management.
Fetal Blood Sampling and Its Complications Related to the Indications for Fetal Blood Sampling
Authors: Anandakumar C. , Annapoorna V. , Chee Wong Yee , Chia Dawn , Bongso Ariff , Ratnam S. S.
Published: February 2008

Summary: A prospective study on fetal blood sampling (FBS) was conducted in the Fetomaternal Medicine Division of the Department of Obstetrics and Gynaecology at the National University Hospital, Singapore. FBS was performed on 159 occasions in 156 women between January, 1988 and December, 1991. The aim of this study was to identify the factors that were associated with an adverse outcome following the procedure.

Twenty four abnormal pregnancies were terminated; of the remaining 132 desired pregnancies the overall pregnancy loss was 44 (33.3%), which included those within 2 weeks and those after 2 weeks of the procedure and neonatal deaths. Fetal loss occurring within 2 weeks of the procedure is considered a procedure‐related loss which occurred in 19 (14.3%) of the 132 pregnancies. When the fetal loss occurred within 2 weeks of the procedure 89% had a major abnormality on ultrasonographic scanning.

The conclusion from our study is that the risks of FBS were increased in abnormal pregnancies, most likely due to the underlying pathology.
Posthysterectomy Rectal and Vaginal Prolapse, a Commonly Overlooked Problem
Authors: Barham Kevin , Collopy Brian T.
Published: February 2008

Summary: The existence of combined rectal and vaginal prolapse is more common than the literature would suggest. This paper outlines a further development in the operative management which has been applied to 24 patients with this problem. All had had a hysterectomy and most had had in addition one or more vaginal repairs. The common mode of presentation was one of pelvic pain (19 patients), sometimes severe, crippling and intractable and some form of protrusion (14 patients), difficult or unsatisfied defaecation and rectal incontinence (9 patients). The vaginal prolapse which always involved the vault and usually involved the lower vagina was usually found to be incomplete and the rectal prolapse complete (but occult).

The operative procedure essentially consists of a Wells type rectopexy which has a new modification in which the sling is extended to anchor the vaginal vault after correction of the enterocele by the abdominal approach. A vaginal repair is subsequently performed at the same operation where anterior or posterior vaginal prolapse persists. Important points in the procedure are the avoidance of sepsis (the vaginal vault is not opened during the procedure) and protection of the ureters by careful assessment of the lateral margins of the vaginal vault which is illuminated by transvaginal vault endoscopy. At this early stage operative morbidity has been minimal, relief of the pelvic symptoms has been most encouraging, but the length of follow‐up is short (range 6–30 months, average 15.6) and long‐term evaluation will be necessary as with all surgery for prolapse.
A Comparison of Early Pregnancy Failure and Ongoing Pregnancy Rates Between Fresh and Frozen Embryo Transfer Following In Vitro Fertilization
Authors: Bowman M. C. , Saunders D. M.
Published: February 2008

Summary: In order to compare pregnancy outcomes following fresh and frozen embryo transfer after invitro fertilization (IVF), a retrospective analysis of data from the Royal North Shore IVF Programme was performed. Six hundred and sixty seven embryo transfers following routine IVF were performed during 1991 and 1992. Four hundred and twenty fresh embryo transfers were performed during that period, resulting in a clinical pregnancy rate of 21%. In comparison, 247 frozen transfers, where the initial procedure was routine IVF, were performed, resulting in a clinical pregnancy rate of 16.6%. This difference was not significant. When varying numbers of transferred embryos in the 2 groups were taken into account, there was a significant difference in the proportion of ongoing viable fetuses per embryo returned for 1991, but not for 1992. Although there were a greater number of abortions and ectopic pregnancies in the fresh transfer group, these differences did not achieve statistical significance. The implications of improving results from frozen embryo transfer are discussed.
Amniotic Fluid Insulin Values in Women with Gestational Diabetes as a Predictor of Emerging Diabetes Mellitus
Authors: Weerasiri T. , Riley S. F. , Sheedy M. T. , Walstab J. E. , Wein P.
Published: February 2008

Summary: Amniotic fluid insulin levels were estimated in 30 women with insulin‐dependent diabetes, 216 with gestational diabetes and 27 with normal glucose tolerance. Results were correlated with birth‐weight, incidences of fetal macrosomia and neonatal hypoglycaemia, and the risk of the mothers with gestational diabetes developing diabetes mellitus on follow‐up.

The women with prepregnaney diabetes had significantly higher amniotic fluid insulin values and showed a significant correlation between raised liquor insulin values (>97th percentile) and hypoglycaemia in the infant (p = 0.039).

In the gestational diabetic pregnancies there were highly significant associations between elevated liquor insulin values and macrosomia (p <0.0045) and birth‐weight (p <0.00004), and a weak correlation with neonatal blood glucose levels (p = 0.042).

Women with gestational diabetes who later developed permanent diabetes mellitus had higher mean amniotic fluid insulin levels than those whose glucose tolerance remained normal on follow‐up (p ≤0.0072) and more of them had a level greater than the 97th percentile than those whose glucose tolerance remained normal (odds ratio 6.48, 95% confidence interval 1.51–27.8, p = 0.0094). However a high amniotic fluid insulin level was of less clinical value for detection of women destined to develop diabetes (7 of 25, 28%) than was the need for insulin therapy during pregnancy (18 of 39, 46%).
Continuous Intrapartum Fetal Monitoring: A Prospective Randomized Comparison of 2 Types of Fetal Scalp Electrode
Authors: Peres M. F. , Fisher C. C. , Leader L. R.
Published: February 2008

Summary: This trial was conducted to compare 2 commonly used fetal scalp electrodes with regard to ease of use, frequency and extent of neonatal injury and quality of cardiotocographic record. A randomized design was employed to study a group of 106 patients divided between a Surgicraft Copeland clip fetal scalp electrode (52 patients) and a Meditrace spiral single helix scalp electrode (54 patients). Patients were eligible for trial entry if they required an intrapartum fetal scalp electrode, at term with a singleton cephalic pregnancy. Ease of application was rated by the operator using a linear analogue score. Unidentified traces were reviewed independently for quality by 2 obstetricians and neonates were examined on day‐2 postpartum for injury. The Meditrace spiral fetal scalp electrode was significantly easier to apply (unpaired t‐test p <0.02). It also obtained higher ratings for trace quality (unpaired t‐test p <0.02). There were no serious neonatal injuries and no difference was found between the 2 electrodes in this regard.
Female Sterilization By the Vaginal Route: A Positive Reassessment and Comparison of 4 Tubal Occlusion Methods
Authors: Hartfield V. Jonathan
Published: February 2008

Summary: Over the last 15 years female sterilization by the vaginal route has been abandoned in favour of the abdominal approach via a laparoscope or a suprapubic incision. This was justified when the vaginal route was used for a fimbriectomy or a Pomeroy type of sterilization. The use of tubal occlusion methods designed for the laparoscope has simplified the technique of vaginal sterilization and lowered the morbidity.

Four hundred and ninety consecutive cases over an 18‐year period are reviewed. Four hundred and eighty five were completed vaginally. The methods used were Pomeroy with catgut, Falope ring, Hulka and Filshie clips. The Filshie clip was the most satisfactory. Vaginal sterilization is suitable for day care. The readmission rate was 1%. There was no case of pelvic infection in 177 clip cases but 5 in 173 where the Pomeroy technique was used. The pregnancy rate was highest with the Hulka clip. The overall rate was 1%. With clip methods strong analgesics were only required in 6% postoperatively and only 14% took any analgesic after returning home; consequently return to normal activities was rapid. The patient's weight was not related to operative difficulty when clips were used so the vaginal route may prove to be the method of choice in the obese. Filshie clip sterilization via the posterior fornix of the vagina could be the most cost‐effective method of sterilization available at present. The vaginal route needs reappraisal using contemporary methods of tubal occlusion.
Tuberous Sclerosis: An Unusual Hysterosalpingographic Appearance
Authors: Drew Jennifer E. , Steigrad Stephen J.
Published: February 2008

Summary: As part of the investigation of a 23‐year‐old nullipara with a history of tuberous sclerosis requesting inclusion on a donor oocyte programme, a hystero‐salpingogram was performed and showed an unusual cavity pattern. The uterus appeared normal at hysteroscopy and laparoscopy. The cause for this unusual cavity pattern remains a matter of conjecture.
Neonatal Alloimmune Thromboeytopenia: A Case Report and a Review of the Literature
Authors: Lee Angelie , Permezel Michael , Dennington Peta , Duke Trevor , Doyle Lex , Robinson Hugh
Published: February 2008

Summary: A 32‐year‐old woman in her third pregnancy underwent fetal blood sampling because of a previous child with neonatal thromboeytopenia. At 33 weeks' gestation, fetal thromboeytopenia was diagnosed. Treatment was instituted antenatally with serial fetal platelet transfusions and corticosteroid therapy. Delivery was by Caesarean section at 37 weeks' gestation. Neonatal treatment included further platelet transfusion and immunoglobulin infusion. Recovery of the neonate was complete on discharge from hospital 10 days after birth. The aetiology, diagnosis, clinical presentations and therapeutic options in cases of alloimmune thromboeytopenia are discussed.
Myocardial Infarction in a Young Indian Grandmultipara
Authors: Kannan P. , Raman S. , Ramani V. S. , Jeyamalar R.
Published: February 2008

EDITORIAL COMMENT": We accepted this case report for publication to remind readers that myocardial infarction or ischaemia can occur in women in the reproductive age group. In the 1988–1990 triennium in Australia there were 33 indirect maternal deaths, in 3 of which myocardial infarction or ischaemia was the primary cause.
Recurrence of Pelvic Abscess Associated with a Detached Filshie Clip
Authors: Robson Stephen , Kerin John
Published: February 2008

EDITORIAL COMMENT": We accepted this case for publication to inform readers of the possibility of a pelvic abscess occurring associated with a clip on the Fallopian tube. A case of multiple pelvic abscesses due to actinomycosis was recently reported in this journal (A) that showed some similarities to the case here described. It is agreed that pelvic abscesses associated with a foreign body require removal of the foreign body but the reviewer of this paper also cautioned that recurrent pelvic abscesses may cause chronic pelvic inflammatory disease which requires further surgery such as hysterectomy and salpingo‐oophorectomy. It is too early to conclude that this woman is cured of the pelvic infection.

(A) Garland SM, Rawling D. Pelvic actinomycosis in association with an intrauterine device. Aust NZ J Obstet Gynaecol 1993; 33: 96–98.