bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical and Laboratory Studies in Cholestasis of Pregnancy
Authors: Fliegner John R. H.
Published: February 2008

Summary:A prospective study was made of 44 patients with cholestatic jaundice of pregnancy. Serial urinary oestriol, pregnanediol and plasma progesterone levels were measured in addition to liver function tests. Spontaneous premature labour occurred in 41% of patients, and there were three unexplained stillbirths (7%). Whilst the occurrence of premature labour and the severity of pruritus was often related to the degree of hyperbilirubinaemia and cholestasis, this was not invariable. Furthermore, perinatal wastage did not correlate closely with the disturbance of liver function or with steroid levels within 72 hours of delivery.
Screening for Psychological Disturbance amongst Gynaecology Patients
Authors: Worsley A. , Walters W. A. W. , Wood E. C.
Published: February 2008

Summary: The utility of screening patients attending a gynaecology clinic for emotional and social disturbances has been investigated. Ninety‐seven patients completed 2 inventories dealing with mental state and role problems. Patients who showed evidence of psychological disturbance reported significantly more role problems, and were less likely to be given orthodox gynaecological treatment. Only 40 patients' conditions were clearly diagnosed. It is concluded that psychological screening of patients attending a public hospital gynaecology clinic provides additional information of an important nature in regard to their clinical management. Further research is necessary to improve diagnosis and treatment amongst gynaecology patients.
Proliferating Ovarian “Epithelial” Tumours: A Clinico‐Pathological Analysis of 144 Cases
Authors: Russell P. , Merkur H.
Published: February 2008

Summary: : In a 25‐year period, 144 patients with proliferating epithelial ovarian tumours were treated at the King George V Memorial Hospital. These tumours were classified according to the World Health Organisation (WHO) Histological Classification of Ovarian Tumours and subsequently divided into 4 grades of proliferation, again on histological criteria. The tumours were staged at laparotomy in accord with the recommendations of the International Federation of Gynecology and Obstetrics (FIGO). Follow‐up data, analysed by a life‐table method, were correlated against histological type of tumour, histological grade of proliferation, clinical/laparotomy stage, and mode of surgical therapy.

Stage 1 proliferating tumours may be treated by surgery alone, including unilateral salpingo‐oophorectomy in selected cases. Stage 2 and Stage 3 tumours should be treated similarly to invasive ovarian carcinomas of the same stage, despite their overall favourable prognosis.
Menstrual Characteristics of 2,343 Women Attending the Shepherd Foundation
Authors: Wood C. , Larsen L. , Williams R.
Published: February 2008

Summary: Menstrual characteristics of 2,343 women attending the Shepherd Foundation Health Testing Centre have been analyzed utilizing a computer system of data analysis. The incidence of menstrual pain was, 43% and premenstrual tension 75%. The best estimate of normal cycle length was 21–35 days, 1.5% of women having cycles less than 21 days. The duration of menstrual loss was 1–7 days, 3% of women bleeding for more than 7 days. Utilizing the various responses to questions concerning menstrual and cycle length, menstrual pain and premenstrual tension, 150 patterns were found, the 10 most common patterns accounting for 40% of the population; most of the latter patterns included menstrual pain and premenstrual tension. Authorities disagree upon the definitions of normal menstruation and there are serious implications from the lack of knowledge in this area, both for the individual patient and the cost of health care. The formation of a health committee to determine national standards for defining normal menstruation is advocated.
Spontaneous Rupture of the Spleen in Late Pregnancy
Authors: Henderson P. R. , Keeping J. D.
Published: February 2008

Summary: Two cases of spontaneous rupture of the spleen are described. The first patient presented with fetal distress in the second stage of labour; the second with hypovolaemic shock. Both mothers and babies survived.
The Effect of Maternal Smoking on Neonatal Leucocytes
Authors: Harrison K. L.
Published: February 2008

Summary: Results are presented showing an association of maternal smoking during pregnancy with a reduction in the numbers of circulating neutrophils in their infants. It is postulated that such infants may be more susceptible to infection.
Haemolytic Disease of the Newborn in Western Australia 1974 to 1976
Authors: Vieira B. I. , Murdock C. J. , Hendry P. J. , Stanley F. , Davey M. G.
Published: February 2008

Summary: The prophylactic use of anti‐Rh (D) immunoglobulin has resulted in a marked decline in the incidence of Rh haemolytic disease of the newborn (HDN) since its introduction in 1968. Nevertheless, cases still occur. Those recorded in the metropolitan area of Western Australia in the 3 years, 1974 to 1976, have been studied in detail. There were 29 cases of ABO haemolytic disease, among which there were no deaths, and 56 cases of Rh haemolytic disease with 9 perinatal deaths. Nearly half of the mothers of the infants with Rh HDN were first immunised before anti‐D became available; a quarter had not been given anti‐D when it was requried, and a few had formed Rh antibodies in their first pregnancy or despite treatment with anti‐D.
Use of Vaginal Prostaglandin Gel before Induction of Labour
Authors: Murphy A. J. , Jalland M. , Murphy A. J. , Quinn M. A.
Published: February 2008

Summary: Tylose gel containing either 1.5 mg, 3.0 mg or 10.0 mg of prostaglandin Fact was inserted into the posterior vaginal fornix of 165 patients on the evening before induction of labour. A control group of 100 patients received the gel alone. There was a significant reduction in the induction‐delivery interval in nulliparae receiving at least 3.0 mg of prostaglandin, whereas, in multiparae all doses achieved this effect. There was also a significant reduction in the incidence of forceps delivery in nulliparae who received 3.0 mg or more of the prostaglandin gel; however, there was no difference in the incidence of spontaneous labour, epidural anaesthesia or Caesarean section between the patients who received prostaglandin or those receiving gel alone.
The Effect of Intravaginal Prostaglandin F2α on Labour after Spontaneous and Artificial Rupture of the Membranes
Authors: MacLennan Alastair H. , Green Roslyn C.
Published: February 2008

Summary: The effect on labour of 50 mg intravaginal PG F2α or a standard intravenous oxytocin regimen was compared in 2 randomised trials involving a total of 83 patients, 23 of whom had experienced spontaneous rupture of the membranes (S.R.O.M.) and 60 of whom had artificial rupture of the membranes (A.R.M.) to induce labour. In each trial, labour had not been initiated by membrane rupture alone. In both trials only 20% of the patients receiving PG F2α required further augmentation of labour with intravenous oxytocin. The mean length of labour in patients receiving PG F2α was 2.5 hours shorter in the A.R.M. trial and 3.0 hours shorter in the S.R.O.M. trial than the mean length of labour in patients receiving intravenous oxytocin (P < 0.01). In the A.R.M. trial, the PG F2α‐treated group had significantly less analgesic requirements (P < 0.001). Although more normal deliveries occurred in the patients treated with PG F2α than oxytocin in both trials, die numbers did not reach statistical significance.

No side effects occurred in the PG F2α‐treated patients or their babies and this method was much preferred by patients and nursing staff alike.
Outpatient Laparoscopic Sterilisation: Comparison Between Electrocautery and Clip Application
Authors: Hughes Graeme , Smith Ian
Published: February 2008

Summary: In a personal prospective series of 504 day‐case laparoscopic sterilisations in 1977 ‐ 78, unipolar tubal electrocoagulation was compared with spring‐loaded clip application. Two patients who had cautery required laparotomy because of serious bleeding and one because of accidental bowel diathermy. Clip application was free from serious complications, but caused more postoperative pain. The majority of patients were performing normal or light household duties within 24 hours of sterilisation.
Artificial Donor Insemination Frozen Versus Fresh Semen
Authors: Leeton J. , Selwood T. , Trounson A. , Wood C.
Published: February 2008

Summary: The results of artificial insemination by fresh and frozen donor semen (A.I.D.) are reported.

Life table conception results were 66.3 ±3.8 after 6 months for the fresh semen group. Similar results for 2 consecutive programmes of A.I.D. of frozen semen were 44.0 ± 4.6 and 64.2 ± 3.4, respectively. The latter group's cumulative pregnancy rate is high and probably reflects improvement in both sperm preservation and insemination techniques. Using improved freezing techniques, the results of A.I.D. with frozen semen are equal to those with fresh semen.
A Review of Women Requesting Reversal of Tubal Sterilization
Authors: Murray John
Published: February 2008

Summary: At the Women's Hospital, Crown Street in the past 4 years 64 women who requested reversal of tubal sterilization have been studied. Some of their characteristics at the time of sterilization and the reasons for their request for reversal are examined.

It would appear that relatively young women of low parity whose reasons for sterilization are primarily socioeconomic in association with an unstable martial state are those most likely to request reversal. Furthermore, postpartum sterilization in such women is more likely to lead to requests for reversal than interval sterilization.

The overwhelming reason for requesting reversal is the establishment of a new marital relationship. However, there is a small group whose reason is the death of the antecedent child, usually a cot death, under the age of 6 months.
Early Diagnosis of Meckel's Syndrome
Authors: Fisher C. C. , Warren P. S.
Published: February 2008

Summary: Meckel's syndrome is a disorder of polygenic origin inherited as an autosomal recessive. The main features are microcephaly, occipital encephalocoele with associated midline facial defects, renal' and limb anomalies. The diagnosis has previously been made ultrasonically by the repeated demonstration of small head size. In this instance a renal anomaly was demonstrated and used to confirm the diagnosis.
Fallopian Tube Prolapse After Abdominal Hysterectomy
Authors: Thomson J. D.
Published: February 2008

Summary: Prolapse of a Fallopian tube through the vaginal vault following abdominal hysterectomy is a rare complication. A case is described in which the patient presented with a spurious symptom and which illustrates certain characteristic features of the condition with regard to aetiology and clinical findings.
Monoamniotic Twin Pregnancy Complicated by Massive Fetal‐Maternal Haemorrhage
Authors: Verco C. J. , Jones W. R.
Published: February 2008

Summary: An unusual case is presented in which a term monoamniotic monochorionie twin pregnancy was complicated by a massive fetal‐maternal haemorrhage resulting in the simultaneous death of both twins. Monoamniotic monochorionie twins and massive fetal‐maternal haemorrhage are reviewed and discussed.
Phaeochromocytoma and Pregnancy — An Updated Appraisal
Authors: Schenker Joseph G. , Granat Menachem
Published: February 2008

Summary: Phaeochromocytoma in pregnancy carries a considerable risk to the mother and is even more dangerous to the fetus. It should, therefore, be kept in mind as a possible cause of hypertension in pregnancy and appropriate laboratory tests undertaken.

The data presented in the literature indicate that the early diagnosis of phaeochromocytoma in pregnancy decreases maternal mortality markedly and fetal mortality less significantly.

Diagnostic measures to localize the tumour before delivery are limited; radiation exposure to the fetus will be minimized by the adjunctive use of ultrasound and CAT scanning.

If the diagnosis is made before 20–24 weeks, the tumour should be excised without delay and pregnancy interrupted or allowed to continue, depending on circumstances. After the 24th week, the pregnancy should usually be continued under adequate adrenergic blockade until fetal maturity is achieved.

Labour and vaginal delivery should generally be avoided. Caesarean section and careful removal of the tumour at the same time are recommended.
Effects of Betel Chewing on Pregnancy Outcome
Authors: de Costa Caroline , Griew Antony R.
Published: February 2008

Summary:The antenatal records of 400 Papua New Guinean women who had chewed betel throughout pregnancy were examined and the patients' performance in labour and the condition of the baby at birth and in the post‐natal period were studied. Each mother was matched for parity and province of birth with a control who had never chewed betel, whose pregnancy and infant were similarly studied. The findings are a significantly higher mean birth‐weight for the control group and a lower incidence of neonatal jaundice in the study group.
Haemolytic Disease of the Newborn Associated with Anti Cw
Authors: Hughes W. , Pussell P. , Klarkowski D.
Published: February 2008

Summary: A female newborn child of a 34‐year‐old mother of blood group A Rh D positive developed a raised serum bilirubin on the third day after birth. Her direct Coomb's test was strongly positive and the causative agent was identified to be anti‐Cw in both the maternal serum and on the fetal cells. The father's phenotype was Cw positive. The baby recovered successfully with phototherapy and exchange transfusion and has developed normally since discharge.
Cornual Pregnancy … Diagnosis Before Rupture A Report of 2 Cases
Authors: Maher P. J. , Grimwade J. C.
Published: February 2008

Summary: Two cases of cornual pregnancy are presented. In both, the diagnosis was suggested by ultrasound and confirmed by laparoscopy before rupture had occurred. As a result, surgical management was planned appropriate to the needs of each patient.
Attitudes to the Management of Hypertension in Pregnancy: A Survey of Australian Fellows
Authors: Trudinger Brian J. , Parik Ivana
Published: February 2008

Summary: Fellows of The Royal Australian College of Obstetricians and Gynaecologists were surveyed to determine current practice in the management of hypertensive disease of pregnancy. Eight hundred and seventy Fellows were sent a questionnaire and there was a 74.1% response. There was in the majority of clinical situations a uniformity of response. This was especially so with the more serious clinical situations. Variations in response were particularly evident in choice of drug therapy. The year of obtaining specialist qualification and the State of practice accounted for most variation in survey results. There was uncertainty about the value of antihypertensive therapy to the fetus.
What do Expectant Mothers Want?: A Preliminary Report on Consumer Demand for Obstetric Services
Authors: Skuja E. , Grudzinskas J. G. , Skuja K.
Published: February 2008

Summary: A sample of 150 expectant mothers participated in pilot work for a large scale survey designed to identify and explain factors governing consumer demand for obstetric services in Australia. Preliminary findings indicated demand was greatest for practices which foster postnatal involvement with the newborn; medical intervention was in least demand and respondents were relatively indifferent to delivery room innovations characteristic of Leboyer births. A factual knowledge of childbirth, rather than childbirth experience (parity), explained a substantial proportion of the variation in consumer demand. Results suggested that expectant mothers' needs are not consistent with the attitudes toward maternity care expressed by obstetricians and their critics in much of the current literature.
Pregnancy‐Associated Plasma Protein Levels at Term in Normal Pregnancy, Preeclampsia and Essential Hypertension
Authors: Griffin J. F. T.
Published: February 2008

The levels of protein associated with pregnancy (placental specific β1 glycoprotein, SP1 and pregnancy associated ‐α2‐ globulin, α2‐PAG), immune function (complement, C3c) and inflammation (ceruloplasmin, C), were studied at term in groups of patients with normal and complicated primigravid and multigravid pregnancy. The levels of SP, and C3c were similar in all the groups studied. In patients matched for parity, the levels of α2‐PAG were significantly lower than normal in preeclamptic primigravidas and in multigravidas with a history of preeclampsia in their first pregnancy. Ceruloplasmin levels were significantly elevated in preeclampsia patients and in patients with essential hypertension. It is suggested that reduced plasma α2‐PAG may be of prognostic value and have a role in the aetiology of preeclampsia whereas increased ceruloplasmin levels may be no more than an acute phase reactant resulting from pathological changes due to hypertension.

The dramatic changes in the mother during pregnancy are reflected in marked alterations in maternal plasma proteins from early postconception until after parturition. Considerable research has been carried out to establish the role of these proteins in normal pregnancy and to determine their relevance in pregnancy associated pathology. The present work was designed to assess the role of pregnancy specific β‐globulin (SP1) (Bohn, 1971) which is produced by trophoblastic tissue (Home et al., 1976), and pregnancy associated α2 globulin (α2‐PAG) which has been found in the plasma of pregnant women (MacLaren et al., 1959; Bohn, 1971; Stimson and Eubank‐Scott, 1972) and in malignancy (Stimson, 1974). In addition to these proteins, ceruloplasmin, an acute phase reactant (Goldstein et al., 1979) has been found to be elevated in pregnancy (Markowitz et al., 1955) and in autoimmune conditions (Scudder et. al., 1978). Elevated levels of ceruloplasmin have been found in severe preeclampsia by comparison with normal pregnancy (Fattah et al., 1976). To test the hypothesis that preeclampsia has an immune aetiology, the by‐product of complement activation (C3c), known to be elevated in immune complex disease (Scudder et al., 1978) was also studied in normal and complicated pregnancy.

In an attempt to determine whether any of these proteins could be of relevance in pregnancy hypertension, a comparative study involving normal pregnant women, preeclampsia patients and pregnant women with essential hypertension was carried out. An additional comparison was made between plasma protein levels in primigravid preeclampsia patients. and compromised multigravidas who had a history of preeclampsia as primigravidas, to determine if any of these proteins could give an insight into a genetic predisposition of women to develop this disease.
Control of Gonadotropin Secretion by Steroid Hormones in Male Castrates: Site of Oestradiol Action
Authors: Goh H. H. , Karim S. M. M. , Ratnam S. S.
Published: February 2008

Four normal healthy castrated male transsexuals who were not on hormone therapy for at least 4 months volunteered for this study. Each subject received 3 infusions at weekly intervals – the first consisting of LHRH alone, the second of LHRH and oestradiol and the third of oestradiol alone. Venous blood samples were collected at 20‐minute intervals 1 hour before the start and during the whole period of infusion. Plasma concentrations of FSH, LH and oestradiol were measured by radio‐immunoassay. On an average, 100 μg of LHRH enhanced the area under the LH secretion curve by 177% and under the FSH curve by 68%. Oestradiol had a differential effect on the endogenous secretion of LH and FSH, suppressing them by 53% and 18%, respectively. Similarly, the LHRH‐stimulated release of LH was significantly inhibited to a greater extent (42%) than that of FSH (23%, P < 0.05; paired t test). Such an observation and in the light of our acceptance of the single releasing hormone theory, suggests that the differential actions of oestradiol on the secretions of FSH and LH are due to mechanisms residing in the pituitary.
Menstrual Pattern and Fertility After Treatment for Anovulatory Infertility
Authors: Thomas A. K. , Forrest M. S.
Published: February 2008

Sixty‐four patients who had been treated for anovulatory infertility and subsequently conceived were reviewed. Information was obtained on subsequent menstrual pattern, contraception used, treatment required to achieve a further pregnancy and the interval to any such pregnancy. Almost half the group had regular cycles following delivery but 2 patients had a recurrence of post oral contraceptive amenorrhoea. Most patients conceived without treatment within 2 years of the initial pregnancy but 10 again required ovulation induction. It is concluded that there is no long‐term irreversible suppression of hypothalamic function in this group of patients and, once a pregnancy has been achieved, the prognosis for future fertility without therapy is good.

Anovulatory infertility generally has a favourable prognosis (Thomas and Forrest, 1980). However. follow‐up studies on menstrual function and fertility after the induced pregnancy are scarce. Nonetheless. such information is important if proper advice is to be given to the patient regarding her subsequeni fertility and contraceptive measures which may be required. With this in mind we undertook a follow‐up of patients with anovulatory infertility to ascertain their contraceptive practices and fertility after having had a pregnancy as a result of treatment. following delivery. In addition they were asked if they had conceived again and, if so, how long it took to do so and any treatment used to assist conception. At the time of follow‐up, the interval from completion of the index pregnancy to the survey varied from 1 to 7 years. Statistical analysis of the results was undertaken using Chi‐squared testing, after pooling small groups of similar data to allow for valid analysis.
The Acute Clinical Features of Retrograde Menstruation
Authors: Reti Leslie L. , Byrne G. D. , Davoren Ruth A. M.
Published: February 2008

The acute effects of retrograde menstruation were studied by endoscopy and cytology. The findings suggest that spillage of menstrual blood into the peritoneal cavity is painful. The technique of making this diagnosis is discussed and the therapeutic implications considered.

Sampson (1921) suggested that menstrual blood containing fragments of endometrium might pass along the fallopian tubes in a retrograde manner and thus reach the peritoneal cavity. This phenomenon has subsequently been considered to account for the development of endometriosis (Sampson, 1921; Hughesdon, 1972) and possibly even endometrioid carcinoma of the ovary (Feroze, 1976). Any obstruction to the efflux of menstrual blood, including relative cervical stenosis, fibromyomas or congenital defects will favour retrograde menstruation.

At the time of menstrual spillage onto the peritoneum does the patient experience pain? Or, is this a ‘clinically silent’ event? What proportion of the normal population have retrograde menstruation, and of those who do, what proportion have clinically detectable signs of blood in the peritoneal cavity?

This study was undertaken to answer these clinical questions.
Cyproterone Acetate and the Treatment of Hirsutism
Authors: Fraser Ian S. , Shearman Rodney P. , Allen Janet K. , McCarron Gay
Published: February 2008

Forty‐two women with hirsutism completed 12 months of treatment with cyproterone acetate and ethinyl oestradiol given in a reverse sequential regimen. A highly significant improvement was recorded in the whole group using the Ferriman and Gallwey scoring system. Ten patients recorded a poor response whereas 19 recorded a good or very good result. Patients from groups with polycystic ovarian disease and idiopathic hirsutism recorded equally beneficial responses. Fasting plasma triglycerides rose significantly after 12 months. Other lipids were largely unaffected although a small fall in high density lipoprotein‐cholesterol was detected at mid‐cycle. No other biochemical abnormalities were found. Circulating levels of testosterone and 17 hydroxyprogesterone were suppressed during treatment. Side‐effects were not prominent. This appears to be a very useful medication for a clinical problem which hitherto has been difficult to treat.
Prognostic Predictions of Threatened Abortion. A Comparison Between Real‐time Ultrasound, Clinical Assessment and Urinary Human Chorionic Gonadotrophin (HCG)
Authors: Ping So Kon
Published: February 2008

Seventy patients admitted to hospital before the 14th week of pregnancy with a diagnosis of threatened abortion were studied. A comparison of ultrasonography, clinical assessment, and urinary HCG levels revealed the superiority of ultrasound scanning in predictive accuracy and as an aid to clinical management, particularly after the 9th week of gestation.
Trends in Teenage Pregnancy in Australia, 1971–1981
Authors: Siedlecky Stefania
Published: February 2008

Summary: Between 1971 and 1981 the age‐specific birth rate among Australian teenagers declined by 49%, faster than in any other age group. This is a reflection of several trends – a decline in the total number of pregnancies indicating better use of contraception, a marked decline in marital births as both the planned births and the ex‐nuptially conceived births fell, and a rise in the rates of abortion among teenagers. Since nuptial births declined faster than ex‐nuptial births the proportion of ex‐nuptial births among teenagers rose from 32% to 57%. However, unmarried teenagers have consistently shown lower rates of ex‐nuptial births than other age groups. The options available to young women faced with unplanned pregnancy appear to be changing in emphasis – abortion or single parenthood rather than adoption or forced marriage. The decline may have halted since 1980 and several social factors which may be contributing to the various trends are discussed.
Errors in the Measurement of Blood Pressure
Authors: Fleming Susan E. , Horvath John S. , Korda Andrew
Published: February 2008

Summary: The effect of posture on blood pressure measurement in pregnant and non‐pregnant subjects was studied. In non‐pregnant patients undergoing cardiac catheterization, central blood pressure remained unaltered with a change from the supine to the lateral position. However in all subjects studied, an apparent decrease in both systolic and diastolic blood pressure occurred when measured in the upper arm in the lateral position. This fall is artifactual and does not represent a change in blood pressure.

It is concluded that blood pressure measurements in the lateral position are inaccurate.
Hyperprolactinaemic Amenorrhoea in Hong Kong
Authors: Tang Lawrence C. H. , Sung M. L. , Ma H. K.
Published: February 2008

Summary: In a retrospective study of 595 patients attending the Menstrual Disorder Clinic from January, 1978 to December, 1981, 92 patients (15.5%) had raised serum prolactin (PRL) levels (>25 ng/ml) on 2 or more separate occasions with a mean (±S.E.M.) value of 67.1 ± 2.5 ng/ml. Galactorrhoea was found in 27.2% of the hyperprolactinaemic patients. Primary amenorrhoea was observed in 1 patient (1.1%) with serum PRL level of 68 ng/ml. Secondary amenorrhoea of longer than 6 months' duration occurred in 61 patients (66.3%) with mean PRL level 84.2±3.3 ng/ml. The 30 patients (32.6%) with irregular menstruation had a mean PRL level of 47.2±3.3 ng/ml.

Investigations revealed that 43 patients (46.7%) had idiopathic hyperprolacti naemia, 14 patients (15.4 %) had drug induced hyperprolactinaemia and 1 patient (1.1%) had hypothyroidism; 18 patients (19.5%) had suspected pituitary microadenoma and 16 patients (17.2%) had abnormal radiographic findings. Bromocriptine treatment was given to 38 patients, 13 with abnormal tomographic findings (mean serum PRL>100ng/ml); 18 with suspected pituitary microadenoma (mean serum PRL 94±2.7 ng/ml) and 7 with idiopathic hyperprolactinaemia (mean serum PRL 65±4.7 ng/ml). All patients (38/38) responded to treatment with restoration of menstruation and cessation of galactorrhoea within 1 to 3 months. Mean PRL level was 21.6±5.2 ng/ml at the time of response. Thirteen patients subsequently became pregnant and all delivered healthy babies.
Infantile Pyknocytosis: A cause of intrauterine haemolysis in 2 siblings
Authors: Maxwell D. J. , Seshadri R. , Rumpf D. J. , Miller J. M.
Published: February 2008

Summary: Infantile pyknocytosis, a rare cause of intrauterine haemolysis and potential perinatal death, is described and the relevant literature reviewed. Treatment consists of preterm delivery with exchange transfusion as necessary to control the haemolytic process and hyperbilirubinaemia.
Incidence Of Post‐Operative Deep Vein Thrombosis In Gynaecological Oncology
Authors: Crandon Alex J. , Koutts Jerry
Published: February 2008

Using 125I‐fibrinogen scanning the incidence of post‐operative DVT amongst patients with gynaecological malignancy was shown to be 37,9% which is substantialy higher than the 10% to 15% expected in a general gynaecological population. Twenty per cent of the total group studied had isotopic evidence of bilateral venous thrombosis post‐operatively. The inaccuracy of clinical diagnosis was demonstrated, and also the need to investigate both limbs if thrombosis was suspected. The incidence of post‐operative DVT was found to be significantly lower in smokers (11.5%) compared with non‐smokers (68.4%) (p<0.00025).
Pregnancy After Renal Transplantation
Authors: Hall B. A. , Morrison J. , Keeping J. D.
Published: February 2008

The results of a series of 6 pregnancies (including 1 set of twins) in renal transplant patients are presented with a review of the relevant literature. There were no fetal anomalies or deaths, or episodes of renal compromise or graft rejection. The important complications were hypertension (4), prematurity (4) and fetal growth retardation (2).
Spontaneous Rupture Of A Uterus At 16 Weeks' Gestation
Authors: Blumenthal Norman J. , Goldberger Shmuel B.
Published: February 2008

A case report of spontaneous rupture of a normal unscarred uterus at 16 weeks' gestation due to no apparent cause is presented. This is the earliest spontaneous rupture of the uterus documented and similar cases reported in the literature are reviewed. The aetiology and methods of treatment are discussed.
Antenatal Cardiotocography in the Evaluation of Fetal Well‐Being
Authors: Visser G. H. A.
Published: February 2008

Summary: Antenatal fetal heart rate monitoring is a reliable tool to detect the fetus at risk. In the interpretation of records, however, due account must be taken of maturation and fetal behavioural status. In this article the normal heart rate pattern throughout gestation is described. Visual quantitative and descriptive scoring systems are compared and the consequences of interobserver variability in assessing antenatal heart rate records are discussed. It is postulated that there is only a small — if any — place for oxytocin stress testing. Finally the clinical implications of the different fetal heart rate patterns are presented.
Intrauterine Devices and Pelvic Inflammatory Disease
Authors: McCarthy Terry , Roy A. C. , Ratnam S. S.
Published: February 2008

Summary: There is convincing clinical evidence that PID is more common in IUD users than in users of other contraceptive methods. There appears to be a smaller but significant increase when IUDs are compared with sexually active noncontraceptive users. However, the incidence of PID severe enough to warrant hospitalization is only of the order of 1 to 2 per 1,000 women per year. The question which remains is whether beyond this low figure of moderate and severe desease there is a much higher incidence of subclinical PID which may result in complications for IUD users. Development of a marker such as C‐Reactive protein or the split complement component C3d to detect mild PID would prove invaluable in the elucidation of several crucial problems in the clinical management of women using IUDs.
Endocrinology of Ovarian Stimulation for In Vitro Fertilization
Authors: Kerin J. F. , Warnes G. M. , Quinn P. , Kirby C. , Godfrey B. , Cox L. W.
Published: February 2008

Summary: Understanding of the endocrinology of in vitro fertilization has advanced rapidly in the past 5 years. Despite a multitude of ovarian stimulation regimens a particular regimen has not demonstrated a marked superiority. In principle the achievement of high FSH levels during the early follicular phase to recruit a maximum number of follicles with a tolerable degree of asynchrony for final maturation is confined to a limited time span or ‘FSH window’ of about 3 to 4 days before negative E2 feedback induces below‐threshold FSH levels, thereby condemning all subsequent follicles in that cycle to atresia. It appears that one can widen and/or amplify the ‘FSH window’ too far from gross hyperstimulation resulting in the recruitment of many follicles with an intolerable degree of asynchrony. This may lead to a defective endocrine environment for the oocytes contained within these follicles or an abnormal luteal environment and an increased frequency of fertilization, cleavage and implantation failure.

Whichever regimen is used, the stimulation should ideally be sufficient to promote the development of at least 3 follicles beyond 18mm diameter at the time of OPU. This can be expected to result in at least 2 embryos to be available for transfer. Monitoring of follicular response by a combination of E2 and ultrasonic parameters is recommended so that the administration of HCG is given close to the anticipated endogenous rise of LH. This can be achieved by detecting a reduction in the rate of E2 rise (to plateau). A plateau in E2 in the absence of follicles of preovular diameter (e.g. < 18mm) may be followed by a secondary acceleration phase and associated follicle growth. Timing of OPU from the start of the LH surge tends to result in embryos which give rise to a higher pregnancy rate. This natural timing of OPU may give the recruited follicles time to achieve their maximum potential by correction of asynchrony and development of better oocytes. Permitting the natural mid‐cycle events to occur may also minimize disruption of the critical follicular to luteal phase transition period. Luteal phase deficiencies as detected hormonally do not appear to be a feature of either moderate Clomid or Clomid+HMG stimulation regimens, provided women with disordered follicular phase endocrine responses are identified and not subjected to laparoscopy. Luteal phase plasma progesterone concentrations in the conceptual cycles begin to diverge from the nonconceptual groups by day +5 after OPU and become significantly higher by day +10. This difference is likely to be a result of successful implantation rather than an intrinsic luteal defect in the nonconceptual cycles.
Assessment and Hormonal Treatment of the Luteal Phase of In Vitro Fertilization Cycles
Authors: Yovich John L. , Stanger James D. , B.Sc. Jeanne M. Yovich , SRN Ann I. Tuvik
Published: February 2008

Summary: Luteal phase lengths and hormonal profiles (progesterone, oestra‐diol‐17 beta, beta HCG and prolactin) have been documented in 77 cases derived from a series of patients undergoing IVF. Nineteen pregnancies were generated during this series and 12 healthy infants have already been delivered. Luteal phase lengths were 14.5pM 0.5 days with 14.3% demonstrating mid‐luteal progesterone levels of less than 31 nmols/1, considered to be low for successful conception. A random study of luteal support regimens comparing HCG or medroxyprogesterone acetate (MPA) with nil therapy was studied in a series of 44 consecutive embryo transfers during which 10 pregnancies were achieved. No difference was noted in the pregnancy rates for the 3 groups but the pregnancy outcome was better in those who had HCG support and this was more apparent in the overall series of 19 pregnancies. A significant luteotrophic effect was noted with HCG support regimens whilst MPA appeared to have a luteal suppressant action. Six pregnancies which aborted with blighted ova were derived from cycles in which the luteal phase progesterone levels were low raising the possibility that a poor hormonal environment may predispose to blighted ova.
Unexplained Infertility and the Possibilities of Management with In Vitro Fertilization and Embyro Transfer
Authors: Leeton J. , Mahadevan M. , Trounson A. , Wood C.
Published: February 2008

Summary: The aetiology of idiopathic infertility largely appears to lie within the female genital tract. The causes may be related to psychological, hormonal or biological factors that could influence sexual behaviour or function of the cervix, uterus, tubes or ovaries. Carefully controlled prospective studies are needed to evaluate diagnoses and therapy. Management of cases of long‐standing idiopathic infertility in an IVF programme is indicated if the pregnancy rates of the programme are greater than 10%, as it will aid in both diagnosing the underlying cause as well as offering a significantly higher chance of pregnancy than either expectancy or other treatments.
Improved Glucose Tolerance in Gestational Diabetic Women on a Low Fat, High Unrefined Carbohydrate Diet
Authors: Sc Christopher J. Nolan B Med
Published: February 2008

Summary: In a randomized cross‐over study 5 gestational diabetic women were tested on a low fat, high unrefined carbohydrate (HC) diet and a low carbohydrate (LC) diet for a period of 4 days each. Glucose tolerance was shown to be significantly improved on the HC diet compared to the LC diet (p <0.05). Urinary glucose output was 50% lower on the HC diet (1.3 ±pM 1.1 mmol/d) than on the LC diet (2.6 ±pM 3.0 mmol/d), although this difference was not statistically significant. Fasting free fatty acid levels were significantly lower on the HC diet (HC 590 ±pM 270 μmol/1, LC 690 ±pM 270 μmol/1; p <0.02); as were the fasting cholestrol levels (HC 5.9 ±pM 1.1 mmol/1, LC 6.3 ±pM 1.1 mmoi/I; p <0.01). Fasting plasma glucose, 2 h postprandial plasma glucose, and fasting plasma triglyceride levels did not differ on the 2 diets. These pilot study results suggest that diets low in fat and high in unrefined carbohydrate content are beneficial to the management of women with gestational diabetes.
The Relationship Between Gestational Age and Birth‐Weight in Twin Pregnancy
Authors: Fliegner John R. , Eggers Thomas R.
Published: February 2008

Summary: Analysis is made of fetal growth in 563 twin pregnancies. The birth‐weight of a twin is affected by the duration of pregnancy and zygosity. Intrauterine growth and weight is the same as a singleton pregnancy up to a gestational age of 32 weeks. After this stage fetal growth slows markedly. The growth curves of both twins are similar with an increasing tendency towards growth retardation in twin 2 after 39 weeks' gestation. Intrauterine growth retardation, as represented by the 10th percentile line, for twin 1 joins l,094g at 31 weeks, l,836g at 36 weeks and 2,428g at 40 weeks' gestation. The corresponding figures for twin 2 are l,131g, l,875g and 2,337g respectively.
Acute Feto‐Maternal Transfusion—Diagnostic Considerations
Authors: Mor‐Yosef Shlomo , Granat Menachem , Cividalli Gabriel , Peleg Ofra
Published: February 2008

Summary: A sinusoidal fetal heart rate pattern followed by severe deceleration was encountered in a fetus at 39 weeks' gestation during antepartum fetal non‐stress testing. The only indication for fetal monitoring was a maternal complaint of cessation of fetal movements. The abdominally‐delivered newborn was found to be severely anaemic and the cord was tightly wrapped round its body. A path ophysio logical mechanism for massive feto‐maternal transfusion is suggested. Various laboratory tests were utilized to identify the condition, quantitate the amount of transfusion, and estimate the time of its occurrence. Globin synthesis studies in maternal blood indicated that a significant fetal blood loss had occurred within 24 hours of delivery. The significance of these findings as applied to the clinician is discussed.
The Use of Donor Eggs and Embryos in the Management of Human Infertility
Authors: FRACOG J. Leeton , PhD A. Trounson , FRACOG C. Wood
Published: February 2008

Summary: The use of donor eggs and embryos is indicated in those infertility cases where the recipient's eggs are either absent, unavailable or inappropriate for in vitro fertilization (IVF) and embryo transfer (ET) programmes. Donor eggs may be fertilized by either the sperm of the recipient's husband (donor egg programme) or by donor sperm (donor embryo programme), in vitro or in vivo and may be transferred as either fresh or frozen‐thawed embryos. Human pregnancies and livebirths have recently been reported following the donation of embryos fertilized both in vitro and in vivo. The development of this new technique will allow the achievement of normal pregnancy in infertile women who hitherto had no possible chance of pregnancy.
Comparative Study of Total Urinary Oestrogen and First Morning Urinary Oestrogen in Monitoring Gonadotrophin Therapy
Authors: Tang Grace W. K. , Chan Steven Y. W.
Published: February 2008

Summary:Total 24‐hour urinary oestrogen has been used extensively and proven to be reliable in monitoring gonadotrophin therapy for induction of ovulation. However, the method is time consuming for the patient and incomplete collection, as expected, is not uncommon, hence interfering with the treatment result. Oestrone‐3‐glucuronide in first morning urine samples has been shown to correlate well with plasma oestradiol‐17 β levels during normal menstrual cycles. A comparative study was made to examine the correlation between the levels of 24‐hour urinary oestrogen and first morning urinary oestrogen in patients on gonadotrophin therapy. Creatinine levels were also determined to exclude the factor of variable excretion of oestrogen. The correlation thus found is highly significant (p < 0.001). Hence first morning urinary oestrogen to creatinine ratios may be used to replace 24‐hour urinary oestrogen in biochemical monitoring of gonadotrophin therapy.
Progression of Squamous Carcinoma in Situ of the Vulva to Invasive Carcinoma After Systemic Bleomycin Therapy*
Authors: Ostor A. G. , Sfameni S. F. , Kneale B. L. , Fortune D. W.
Published: February 2008

Summary: Progression of squamous carcinoma in situ of the vulva to invasive carcinoma, in the same area, after systemic Bleomycin therapy, is described. Such progression is an exception and not the rule in the natural history of this disease. Conservative therapy should be used, especially in young women.
Prenatal Diagnosis of Duodenal Atresia Using Third Trimester Amniotic Fluid Immunoreactive Trypsin
Authors: Legge Michael , Potter Howard C.
Published: February 2008

A previous report (1) demonstrated that the fetal exocrine pancreas is capable of trypsin synthesis in the second trimester and that amniotic fluid immunoreactive trypsin concentration decreased with advancing gestation. Later work (2), confirmed these earlier findings and further investigated the significance of second trimester amniotic fluid immunoreactive trypsin in fetal abnormalities.
Hydatidiform Mole In Victoria: Aetiology and Natural History
Authors: Olesnicky G. , Long A. R. , Quinn M. A. , Pepperell R. J. , Fortune D. W. , Kneale B. L. G.
Published: February 2008

Summary: A retrospective study was made of 455 patients referred to the Hydatidiform Mole Register of the Royal Women's Hospital from 1973 — 1982 who fulfilled the criteria for diagnosis of hydatidiform mole. The incidence of hydatidiform mole was 1:1,357 livebirths in Victoria. Age greater than 40 years (P < 0.001), nulliparity (P < 0.005) and parity greater than 4 (P < 0.001) were the only predisposing factors found. An association with artificial insemination with donor semen was also noted (P < 0.025). The need for further treatment for persistent trophoblastic activity (13.6% of patients) was independent of the method of evacuation employed and of gestation at evacuation. Only 2 cases of histologically proven postmolar choriocarcinoma occurred, one of which was also the only death recorded from all patients registered following a molar pregnancy.
Cigarette Smoking, Alcohol Consumption and Fetal Outcome in Tasmania 1981–82
Authors: Lumley Judith , Correy J. F. , Newman N. M. , Curran J. T.
Published: February 2008

Summary: Analysis of cigarette smoking and alcohol consumption patterns recorded in pregnancy could not detect a harmful effect of alcohol at levels below 2 glasses a day. Total abstainers fared very slightly worse than those who drank occasionally. Smoking was associated with lower birth‐weight and a worse fetal outcome independent of socioeconomic status, parity, maternal age or alcohol consumption. There was evidence of an interaction between smoking and adverse social and parity factors in low birth‐weight.
Single Dose Tinidazole Prophylaxis in Hysterectomy
Authors: Crosthwaite A. H. , Hurse Allison B. , McDonald I. A. , Miles Helen M. , Pavillard E. R.
Published: February 2008

Summary: The results of this randomized double blind, placebo controlled trial of a single oral dose of 2 g tinidazole or placebo approximately 12 hours before hysterectomy showed the incidence of infective morbidity in patients who received placebo was 12.2% compared with 1.9% in patients who received tinidazole, (p = 0.045). The mean serum concentration of tinidazole at the time of surgery was 35 mcg/ml, which was well in excess of the minimum concentration required to inhibit all of the 95 anaerobes isolated in this study. Serum tinidazole concentration remained adequately inhibitory for at least 24 hours after surgery. The ability of tinidazole prophylaxis to reduce further our already low rate of febrile morbidity was considered a worthwhile gain. It is now Unit policy to give this agent prophylactically to all patients if the integrity of the vagina is likely to be breached at the time of surgery.
Pregnancy Induced Hypertension Complicated by Thrombocytopenia, Haemolysis and Elevated Liver Enzymes (HELLP) Syndrome. Renal Biopsies and Outcome
Authors: Beller Fritz K. , Dame Withold R. , Ebert Christa
Published: February 2008

Summary: Twelve patients are presented with the symptomatology of haemolysis, elevated liver enzymes and low platelet count (HELLP syndrome). Only 3 patients experienced a progressive course; the rest did not differ from a group of 130 patients suffering from severe preeclampsia. There was no significant difference in the concentration of plasma fibrinogen, fibrinogen monomer complex and antithrombin III. Two patients were treated with heparin without improvement of the coagulation data or the severity of the disease. The subgrouping of very severe preeclampsia may be desirable, but it is felt that this group is insufficiently characterized by the symptomatology of HELLP. The evaluation of better criteria may allow identification of subgroups of preeclamptic patients with severe prognostic criteria.
Another Look at Initiation of Human Parturition
Authors: Roy Ashim C. , Kottegoda Sri R. , Ratnam Shan S.
Published: February 2008

Summary: Despite our moderate understanding of the physiology of the initiation of labour in various animal species, notably ruminants and rodents, the mechanism in man remains enigmatic. In the initiation process in the human the major role is apparently taken by the placental and fetal membranes, while the fetus may modulate the timing of labour. This review sets out to examine current knowledge of the process of initiating and maintaining parturition in the human.