bluuebunny/crossref_metadata_2025 huggingface dataset:
Hysteroscopic Metroplasty
Authors: Itzkowic DJ , Bennett MJ
Published: February 2008

EDITORIAL COMMENT: Septate uterus is a common obstetric problem often first diagnosed during pregnancy when oblique fetal lie with breech presentation is noted in an asymmetrical heart‐shaped uterus in the early third trimester. The diagnosis may also be made by hysterosalpingography in patients with habitual abortion, by early second trimester ultrasonography (although sometimes the ultrasonographer cannot identify the septum), or at the time of manual removal of a retained placenta. Most obstetricians have treated many patients with a septate uterus conservatively since the majority reproduce successfully. The question of metroplasty only arises when habitual abortion occurs. The remarkably few published series of metroplasties performed abdominally indicate that the operation is seldom performed. Hysteroscopic metroplasty seems so simple and effective that it appears reasonable to recommend it in any patient who has had 2 or more spontaneous miscarriages, especially if these occurred in the second trimester and resulted in the loss of a normally formed fetus. It is unlikely that a controlled trial on patients with a uterine septum and a history of spontaneous abortion will be performed to determine the extent to which metroplasty improves reproductive performance. In the case reported here readers may question whether the blighted ovum at 9 weeks' gestation, and spontaneous abortion at 9 weeks, were related to the uterine septum. The need for laparoscopy at the time of hysteroscopic metroplasty merits emphasis.
Cisplatin Chemotherapy of Ovarian Cancer: Is Short‐Term In Vitro Chemosensitivity Predictive of Long‐Term Patient Survival?
Authors: Khoo S. K. , Hurst T. , Webb M. J. , Dickie G. , Kearsley J. , Parsons P. G. , Mackay E. V.
Published: February 2008

Summary: The in vitro response to cis‐diamminodichloroplatinum (cisplatin) in primary culture of tumour samples obtained at surgery was studied in 61 patients with Stage III ovarian cancer who were also treated with cisplatin. The drug‐induced inhibitory effect on cell proliferation (measured by 3H‐thymidine incorporation) and metabolism (by 3H‐uridine incorporation) was assessed over a 3‐hour incubation. At ≥20% level of inhibition, the true prediction rate of survival by the proliferative assay was 72% among those with ‘sensitive’ tumours and of mortality was 66% among those with ‘resistant’ tumours; at ≥50% level of inhibition, the prediction rate of survival by the proiiferative assay increased to 88% but that of mortality decreased to 58%. The results with the metabolic assay were comparatively lower at all levels. When the amount of residual disease was taken into the determination of mortality rate, significant differences were found between ‘sensitive’ and ‘resistant’ tumours as defined by the proliferative assay in patients with no/minimal disease. The pattern of survival differed significantly between 3 subgroups of tumours, as defined by their responses to cisplatin in the proliferative and metabolic assays — the best survival was obtained in patients whose tumours were ‘sensitive’ in both assays.
Abruptio Placentae at The University of Nigeria Teaching Hospital, Enugu: A 3‐Year Study
Authors: Ozumba Benjamin C.
Published: February 2008

EDITORIAL COMMENT: This paper will remind readers about the clinical problems of abruptio placentae that accounts for about 20% of perinatal deaths and can threaten maternal life, usually by haemorrhage associated with blood coagulation failure. In the author's hospital in Nigeria which serves a population of 4 million, the incidence of abruption was 0.4% (81 of 81,215 confinements). This low incidence is partly accounted for by the strict clinical criteria for diagnosis (abdominal pain 85%, tenderness 88%) which in turn explained the high incidence of blood transfusion (93%) and high perinatal mortality rate (58%). These results are similar to those reported from the Maternity Hospital, University of Cape Town, 1986, where the incidence of abruption was 0.6% (149 of 25,402) and the perinatal mortality rate 55%. The incidence reported from the National Maternity Hospital, Dublin, 1986, was 0.3% (22 of 7,823) with a perinatal mortality rate of 59%, although blood transfusion was required in only 23% of patients. The prize for perinatal mortality associated with placenta! abruption must belong to Hong Kong — in the Queen Mary and Tsan Yuk Hospitals, 1983, the incidence of abruptio placentae was 0.3% and the associated perinatal mortality rate was 5%. It would seem that not only do the Chinese have low incidences of prematurity, fetal malformations and multiple pregnancy, but also fewer cases of severe abruption. At the Mercy Maternity hospital, Melbourne, there is a much higher incidence of abruption but here the diagnostic criterion is evidence of an old retroplacental clot at delivery — the incidence in this hospital, 1984–1986, was 2.2% (337 of 15,658) with a perinatal mortality rate of 15% and a blood transfusion rate of 17%. In the Melbourne series disseminated intravascular coagulopathy occurred in 1% of patients with abruption whereas in the author's series the incidence was 11%. The author concludes that good antenatal and intrapartum care minimizes the maternal and fetal hazards of placenta! abruption; he also gives the good advice that coagulation failure must be ruled out before embarking on Caesarean section in these patients.

Summary: A total of 81 cases of abruptio placentae treated in a 3‐year period at the University of Nigeria Teaching Hospital, Enugu is reported. The incidence of 0.44% found in the study is low when compared to reports from Europe. The outstanding clinical features were high parity, low incidence of renal failure, hypertension and proteinuria. The perinatal mortality of 58% is quite high while 2 mothers who were referred to the Teaching Hospital in poor condition died. Management was by rapid and adequate resuscitation by blood transfusion and delivery as soon as the diagnosis was made. The absence of maternal mortality amongst mothers who received antenatal care at the University Teaching Hospital emphasizes the need for adequate antenatal and intrapartum care in order to eliminate the complications of this obstetrical enigma.
Labour Induction with Low Dose PGE2 Vaginal Gel: Result of an Australian Multicentre Randomized Trial*
Authors: MacLennan Alastair , Fraser Ian , Jakubowicz Diana , Murray‐Arthur Frederick , Quinn Michael , Trudinger Brian
Published: February 2008

Summary: An open‐label, parallel, randomized study was conducted in 6 Australian hospitals involving 320 women near term who required induction of labour. Labour induction with 1 or 2mg of PGE2 in a vaginal triacetin gel repeated if necessary at 6 hours was compared to induction by amniotomy and intravenous oxytocin.

Analysis of the 2 groups confirmed matching with regards demographic and clinical data. A significantly longer and more variable mean induction to onset of established labour interval was recorded in the PGE2 group (6.7 ±4.8 versus 2.0± 1.1 hours. (p<0.001). The mean period of established labour was also longer (8.1 versus 6.0 hours, p<0.001) in the PGE2 group. However, 48% of PGE2 treated patients versus 29% oxytocin treated patients (p<0.01) were recorded as not experiencing strong contractions. Twelve hours after induction 65% of the PGE2 group and 93% of the oxytocin group were in established labour; 24% of the PGE2 treated group required subsequent augmentation with oxytocin. Spontaneous delivery occurred in 69% of PGE2 treated women and 62% of those treated with oxytocin (N.S.). Analgesic requirements were not statistically different between the groups. Fewer fetal heart rate abnormalities were recorded in the PGE, treated group (p<0.02). No serious and only minimal adverse events were recorded in either treatment group.
A Comparison of 2 Methods for Monitoring Gonadotrophin Therapy
Authors: Sallam Hassan N. , Bashmi Yousuf A.
Published: February 2008

Summary: One hundred and seventy nine (179) ovarian cycles from 52 patients treated with human menopausal gonadotrophins were retrospectively analysed. Eighty one (81) cycles were monitored by serial measurements of plasma oestradiol concentrations and 98 cycles were monitored by realtime ultrasound scanning of ovarian follicles. The results suggest that realtime ultrasonography, used alone, is a safe and effective method for monitoring gonadotrophin therapy.
Maternal Weight Gain, Smoking and Other Factors in Pregnancy as Predictors of Infant Birth‐weight in Sydney Women
Authors: Ash S. , Fisher C.C. , Truswell A.S. , Allen J.R. , Irwig L.
Published: February 2008

Summary: Two hundred and four (204) women attending a Sydney maternity hospital and their babies were followed throughout pregnancy in a study, which aimed: 1) to describe the distribution of maternal weight gain in present day Australian women and 2) to determine the effect of weight gain and other factors on birth‐weight.

Maternal weights and skinfold thicknesses were measured serially to give an indication of weight gain. Mean weight gain from conception to term was 14.2kg and mean birth‐weight was 3,442g.

Maternal predictors of birth‐weight such as maternal weight gain, parity, age, education, height, public or private booking status, smoking, prepregnancy weight, and sex of the infant and gestational age were explored using simple and multiple regression analysis. Weight gain was predictive of birth‐weight, each kg increase in total weight gain resulting in about a 30g increase in birthweight. Other strong predictors were gestational age, maternal smoking, sex of the infant and maternal parity. Maternal height was less strongly predictive and age and prepregnant weight were not predictive.

Smoking mothers had infants who were 268g lighter than those of nonsmoking mothers. However, smokers were also younger, shorter, had less education and were more likely to book as public patients than nonsmokers. After adjusting for all other predictors, the birth‐weight of infants whose mothers smoked, was still 224g less than that for nonsmoking mothers.
Outpatient Methadone Programme for Pregnant Heroin Using Women
Authors: Giles Warwick , Patterson Trudy , Sanders Frances , Batey Robert , Thomas David , Collins Jenny
Published: February 2008

Summary: A prospective study of pregnant narcotic users who attended the antenatal clinic at Westmead hospital was undertaken to determine the practicality and safety of an outpatient methadone programme for these women. Forty six women were commenced and managed on a methadone maintenance programme based at the Drug and Alcohol clinic at Westmead hospital (GROUP I), 12 women were maintained on long‐term methadone therapy by outside prescribers (GROUP II), 12 women not on methadone continued to use heroin through the pregnancy (GROUP III), 14 women used heroin intermittently (GROUP IV). These were compared with a group of 52 women who were non‐drug using (GROUP V). Women on the hospital based methadone programme had an earlier first antenatal clinic visit (p< 0.001) than those women on outside methadone programmes or on heroin and had a longer pregnancy (p< 0.001) than those women on heroin. The birth‐weights on babies delivered to women on the Westmead Methadone Programme were significantly higher than those on babies born to women using heroin (p<0.05). A disappointing aspect of the study was a lower number of antenatal clinic visits (p< 0.001) for all narcotic using women when compared with the comparison group. The outcome of the Westmead Methadone Programme women showed that better maternal and neonatal outcome followed entry into a hospital monitored methadone programme with attendant antenatal care.
Ureteric Obstruction by the Gravid Uterus
Authors: Carey Marcus P. , Ihle Benno U. , Woodward C. Susan , Desmedt Els
Published: February 2008

EDITORIAL COMMENT: Use of modern ultrasonographic techniques during pregnancy have given us a new understanding of the frequency and degree of physiological dilatation of the ureters and renal pelves, which is mainly right‐sided, and is mainly due to compression by the gravid uterus (Woo, Wan, Ma (la)). The recently available technology of ultrasonographically controlled placement of nephrostomy tubes, and ureteric stents from above, has dramatically changed the investigation and treatment of ureteric obstruction in pregnancy. This may account for the remarkable change in the apparent prevalence of pathological ureteric obstruction at the Mercy Maternity Hospital as reported in this paper; however, the successful treatment of these patients indicates that such management is appropriate.

For readers' perspective Table 1 was prepared from the 5 Clinical Reports of the Mercy Maternity Hospital, 1971–1986. Given the limitations of coding of minor procedures (removal of IUDs, treatment of vulvar warts, ovarian cysts found at Caesarean section), it can be seen that urological surgery, even cystoscopy, until recently, has seldom been performed in pregnancy in comparison with surgery for appendicitis or cholelithiasis.

One may wonder what happened to patients with ureteric obstruction in previous years! In 3 of the 6 patients reported here the condition was unilateral, and the main problem was pain and infection (Cases 4 and 5), with the possibility of permanent renal impairment. The important take away message is that bilateral ureteric obstruction due to compression by the gravid uterus (Cases 1 to 3), especially in patients with multiple pregnancy and/or polyhydramnios, can result in acute renal failure requiring immediate delivery to resolve the problem — although we can see no reason why nephrostomy tubes should not be inserted in such patients (eg Case 2) to improve renal function and allow prolongation of pregnancy, when fetal viability due to immaturity is in doubt.

Summary: This paper reports the only 6 cases of ureteric obstruction apparently caused by the gravid uterus diagnosed at the Mercy Maternity Hospital in the past 17 years, during which time there were 82,836 confinements. In 3 of the 6 cases there was clear radiographic evidence that the level of obstruction was at the pelvic brim. The rapid resolution of the ureteric obstruction shortly after delivery strongly suggested that the gravid uterus was the cause of the obstruction. Cases 1–3 were the only patients of 793 with polyhydramnios who developed bilateral ureteric obstruction and acute renal failure. In Cases 4 and 5 there was unilateral ureteric obstruction and pyelonephritis; in Case 4 a ureteric catheter was inserted from below, and in Case 5 a ureteric stent was inserted via a nephrostomy tube. In Case 6 a percutaneous nephrostomy tube was inserted.
The Effects of a Mother's Second Pregnancy on the Firstborn Child
Authors: Harris M.J. , John K. , Sharp R.
Published: February 2008

EDITORIAL COMMENT: This paper was accepted for publication because it reminded us of how little data are available on such matters of importance. The only comparable obstetric topic that comes to mind is the long‐term effect, on both spouses and their children, of the presence of the male at his partner's confinement. The mother's second pregnancy can indeed profoundly and permanently affect the firstborn child, and in turn the ‘guilty’ parents, who, in retrospect, handled the problem inappropriately. Image the serene, secure 12‐month‐old first baby son, sent away from home and parents to be cared for (expertly) by a stranger during his mother's second confinement; episodes of spurious labour add to the duration of the parting and when the child is collected to return home 4 weeks later he accepts, more or less, the father who collects him, but is deeply saddened and no longer his extroverted happy self. One has only to look at the face of a happy child to appreciate the enormity of the change. They arrive home; the mother greets him with great love, immediately rejected in a storm of tears as his pain is revealed, this being a matter not quickly resolved — this is not an imagined tale but an anecdote from the home of a member of your editorial committee! Of course when the mother goes to hospital the first child should preferably remain in his/her own home, preferably with people he/she knows (father, grandparents) — to be separated from both parents and home when too young to understand the events of the hour is to be avoided at almost any cost. This advice should be given to all expectant mothers during their second pregnancy. Many patients state that their first child's behaviour changes during their second pregnancy are due to changes in their own behaviour to the child, due to fatigue and / or loss of patience. We need more data on this subject, especially since most of what we hear is bad news, unless the first child is no longer a baby and anticipates with pleasure the arrival of a playmate. It is difficult to explain to a baby how things may change but we should try. Most mothers give much attention to anticipation of the first child's needs after the second is born, when she returns home. This paper indicates that there is room for improvement in the antenatal management of this situation and, in the editor's opinion, the care of the firstborn during the mother's absence from home at the time of her confinement.

Summary: Mothers in the last trimester of the second pregnancy admit to being less active, more tired and moody than previously. Many were more anxious than usual. Their first child frequently showed behavioural changes. Those surveyed were between 11/2 and 4 years of age and showed more clinging, sleep disturbance and misbehaviour with tantrums than expected. It is presumed that the mother's pregnancy induces anxiety in her child with consequent behavioural changes.
The Conservative Management of a Hydatidiform Mole with Coexistent Living Fetus. A Case Report
Authors: James Christopher
Published: February 2008

EDITORIAL COMMENT: This is the second case we have published of successful prospective management of hydatidiform mole with coexistent living fetus, although in both cases delivery by Caesarean section was required at 29–30 weeks' gestation. A similar successful case recently managed at the Mercy Maternity Hospital following ultrasonographic diagnosis at 16 weeks' gestation (because of hyperemesis gravidarum), also required emergency Caesarean section, at 34 weeks' gestation, because of antepartum haemorrhage due to ‘molar placenta praevia’; the infant was a healthy living female, birth‐weight 1,760 g (case details courtesy of Dr Ian Maclsaac). Khoo et al (10) recommended that such pregnancies be selected for conservative management by performing amniocentesis and determination of chromosomal karotype and amniotic fluid alpha fetoprotein level, a regimen that was put into practice in the case reported by Thomas et al (11) and in Maclsaac's case summarized above.
Philippino and Vietnamese Women — A Study of Intrapartum Differences
Authors: Howell Rosemary
Published: February 2008

Summary: The pregnancies of 140 Philippino women (168 deliveries) and 198 Vietnamese women (250 deliveries) were compared to those of Australian‐born women delivered at the Mater Mothers' Hospital, Brisbane over the 5‐year period 1980–1984 with the aim of detecting differences in their labour and mode of delivery. The Philippino women were predominantly married to Caucasian men whereas the Vietnamese women were married to Vietnamese men. The study assesses the clinical impression that this difference between the 2 groups affects intrapartum outcome. Birth‐weights of the babies of Philippino women followed the same pattern as those of Australian women while Vietnamese women delivered smaller babies. Philippino primiparas had increases in all parameters of labour studied, notably an increased Caesarean section rate, especially those performed in the second stage. Comparable increases were not found in either Philippino multiparas or Vietnamese women. Based on these results ‘relative’ cephalopelvic disproportion is postulated among the Philippino women.
Stage I Adenocarcinoma of the Uterine Cervix: Tumour Size, Grade, Lymph Node Metastases and 5‐Year Survival
Authors: Ayhan AH , Yüce Kunter , Tuncer Z. Selcuk , Urman Bulent , Ayhan Ayse
Published: February 2008

Summary: This study includes 22 cases of Stage I cervical adenocarcinoma. The lymph node metastases and 5‐year survival according to the size of lesion and grade of tumour were evaluated. The overall pelvic and para‐aortic lymph node metastases were found to be 31.8% and 0% respectively. Metastases in the pelvic lymph nodes were found in 16.6% of patients with lesions less than 2 cm and 50.0% of patients with lesions 2 cm or greater in size. Pelvic lymph node metastases were found to be 0% for Grade 1, 25% for Grade 2 and 46% for Grade 3 tumours. The overall 5‐year survival was 68.2%. This figure varied from 60% to 75% according to the size of lesion and from 61.5% to 100% according to the grade of tumour.
The IUCD‐assodated Incidence of Actinomyces israelii in the Female Genital Tract
Authors: Cleghorn A. G. , Wilkinson R. G.
Published: February 2008

EDITORIAL COMMENT: The gynaecological literature has in recent years carried a number of reports of pelvic inflammatory disease due to Actinomyces israelii, some with pelvic abscesses where surprisingly the infection was unilateral. This careful, large study provides readers with the incidence of colonization and clinical infection with Actinomyces israelii in women wearing IUCD's. This paper does not comment upon how often IUCD's should be changed but the data support the view that 4 years is long enough for any type of device. Readers should remember that there are other more common causes of pelvic infection (Chlamydia trachomatis and Neisseria gonorrhoeae) that can be activated by insertion of an IUCD. Acute or chronic pelvic inflammatory disease, with resultant tubal damage and consequent infertility, can also result from organisms of the Mycoplasma group, or an enteric pathogen, either aerobic (especially Escherichia coli) or anaerobic, especially one of the Bacteroides group. Because these organisms all respond to a course of tetracycline and metronidazole, these drugs are often prescribed empirically when an IUCD is inserted, especially if the patient is known to be promiscuous. The association between IUCD's and pelvic inflammatory disease seems a very good reason to advocate another method of contraception, especially in nulliparas.

Summary: Cervical swabs and in many cases also intrauterine contraceptive devices were examined from 973 women for the presence of Actinomyces israelii. It was detected in 11.6% of these women, the majority of whom were asymptomatic. The detection, however, of A. israelii in the female genital tract was associated with an almost 4‐fold increase in the incidence of pelvic inflammatory disease (PID), indicating that colonization may progress to an infection in a small number of women.

The incidence of A. israelii in the female genital tract of IUCD wearers was more than doubled when the IUCD was worn for longer than 4 years. The type of IUCD worn did not appear to be an important risk factor.

Immunofluorescent staining of cervical smears identified 64% of cases. Specific culturing for A. israelii or cytological screening of Papanicolaou smears in addition were required to increase the isolation rate to nearly 90%.
Teenage Pregnancy in Western Sydney
Authors: Bradford Jennifer A. , Giles Warwick B.
Published: February 2008

Summary: The obstetric performance of 121 young teenagers (less than 17 years of age) confining as public patients at Blacktown District Hospital was retrospectively compared with a randomly‐selected control group of older gravidas. These adolescents were less likely to be married, to be certain of their last menstrual period, to book into the hospital early or to attend the antenatal clinic regularly than their older counterparts. However, there was no difference in the rates of anaemia, spontaneous or operative delivery, gestational age at confinement, birth‐weight, perinatal mortality or neonatal morbidity rates. When the teenagers were compared with primigravidas from the control group, labour length was significantly shorter and the rates of preeclampsia were similar. These results are more optimistic than previous overseas reports regarding the obstetric performance of young adolescents.
Changes in Smoking and Drinking During Pregnancy
Authors: Hilton Christine A. , Condon John T.
Published: February 2008

EDITORIAL COMMENT: If maternal nicotine and alcohol usage really do cause more harm than the combination of diabetes, preeclampsia and all other conditions screened for routinely during pregnancy, then we must pay even more attention to these evils. To properly advise our patients we urgently require information regarding the degree of risk of mild to moderate indulgence, since about I in 3 women smoke and at least as many consume alcohol during pregnancy, often in the early weeks before the pregnancy has been suspected, and when the risk of teratogenesis would be expected to be greatest. Moreover, we must avoid needless panic of the patient who has now stopped drinking but had not done so in the few weeks before her symptoms of pregnancy began. Obviously prepregnancy counselling or general public education are necessary, but so too is data concerning the patient's chance of kicking the habit if this is her wish. This exploration of the problem in 40 patients indicates that it is easier to abstain from alcohol than nicotine, and some of the implications of this finding are discussed. A recent visit to the United States of America indicated that Australia certainly does not lead the world in legislative insistance that vendors of alcoholic beverages post warnings of the possibility of harmful effects on the fetus.

Summary: Changes in alcohol and nicotine usage during pregnancy are reported from a sample of 40 pregnant women, 28 of whom smoked prior to pregnancy and 32 of whom drank alcohol. Although most women wanted to reduce or stop their intake during pregnancy, the drinkers were far more successful in their attempt than the smokers. Thus, 85% of drinkers achieved or bettered their target behaviour (in terms of consumption), while 53% of smokers ‘failed’ in their attempt. Women can identify reasons which influence their smoking and drinking behaviour during pregnancy and, in particular, the amount of emotional attachment to the unborn child appears to be important. However, endorsement of a particular reason docs not appear to relate in any simple way to actual consumption, and a major disparity between health beliefs and actual behaviour was apparent. Implications for primary prevention programmes and future research are discussed.
Langerhans Cell Population in Early Invasive Squamous Cell Carcinoma Of The Uterine Cervix
Authors: Tay Sun Kuie , Jenkins David
Published: February 2008

Summary: Langerhans cell counts were performed using indirect immunoperoxidase staining for S100 protein in 10 cases of early invasive squamous cell carcinoma of the cervix and 20 controls from routine hysterectomy specimens. There was a significant (p<0.01) reduction in the number of Langerhans cells per unit sectional area of tumour tissue compared to the normal cervical epithelium. The density of Langerhans cells in the 3 patients with tumour metastasis in pelvic lymph nodes was further reduced. The low density of Langerhans cells in invasive squamous cell carcinoma compared to the normal state may reflect poor local immunosurv‐eillance and may be related to progression and spread of the tumour.
Transdermal Oestrogen for Postmenopausal Women: A Double Blind Crossover Comparative Study with Ethinyl Oestradiol
Authors: Pattison N. S. , Uptin T. , Knox B. , France J.
Published: February 2008

EDITORIAL COMMENT: The importance of postmenopausal symptoms and whether or not they can be safely controlled is undeniable — the 3 main considerations are patient compliance, complications and cost. This paper shows that transdermal administration of oestradiol was a clear winner in comparison with oral ethinyl oestradiol, although the important entity of osteoporosis was not addressed in this study. The findings reported in this paper are of more than academic interest; the trial warrants verification with a larger number of patients, and other oral oestrogen preparations (oestriol, oestrone, oestradiol) should be compared with transdermal and subcutaneous oestradiol therapy. We will be pleased to publish the findings of such studies in this journal. The pattern of uterine bleeding with different treatment regimens warrants careful documentation, since the return of menstruation is often the reason patients give for discontinuation of hormone replacement therapy.

Summary: A double blind crossover study of transdermal oestradiol (50ug/ day) and ethinyl oestradiol (20ug/day) was conducted with 25 postmenopausal women.

Transdermal oestradiol increased circulating levels of oestradiol and oestrone. Both preparations favourably improved patients' symptoms and vaginal cytology, lowered gonadotrophin levels and urinary calcium loss and gave a satisfactory menstrual pattern,

Transdermal oestradiol had no effect on measures of hepatic function whereas oral ethinyl oestradiol significantly altered levels of sex hormone binding globulin, plasma renin substrate and lipoproteins.

Transdermal oestradiol has a comparable beneficial effect on postmenopausal symptoms to ethinyl oestradiol without the adverse effects on hepatic proteins.
Epilepsy and Pregnancy ‐ A Review of 98 Pregnancies
Authors: Wilhelm James , Morris David , Hotham Neil
Published: February 2008

Summary: This study presents the clinical and management problems in 81 epileptic patients attending the Queen Victoria Hospital for 98 pregnancies between 1985 and 1988. Epileptic women were found to have a 26.1% risk of seizure deterioration during pregnancy and the single most important factor for predicting seizure prognosis was the severity of epilepsy prepregnancy. There was a significant increase in the complications of vaginal bleeding, preeclampsia, and preterm delivery, compared with a control group of women. Infants of epileptic mothers had an increased incidence of low birth‐weight and lower Apgar scores at 5 minutes. The congenital abnormality rate was 14.3% (9 major and 5 minor abnormalities). These results confirm that pregnant epileptic women are a high risk group.
Pain with Amniocentesis and Transabdominal CVS
Authors: de Crespigny Lachlan , Robinson Hugh P. , Ngu Andrew
Published: February 2008

Summary: Fifty consecutive patients undergoing transabdominal chorionic villus sampling (CVS) and 52 undergoing amniocentesis completed a questionnaire following the procedure to determine the amount of pain they experienced. Mild pain, discomfort only or no pain was reported by 96% undergoing amniocentesis and 90% with CVS. Moderate or severe pain was reported after completion of the CVS by 8% and following amniocentesis by 2%. Both procedures were well tolerated.
Perinatal Mortality in the Infants of Diabetic Women
Authors: White Bernadette M. , Beischer Norman A.
Published: February 2008

Summary: The causes of 50 perinatal deaths which occurred over an 18‐year period in the infants of women with either established (n = 205) or gestational (n = 2,442) diabetes were studied. The perinatal mortality rate in these groups was 5.4% and 1.6% respectively and the causes of deaths were similar in both groups. Intrauterine hypoxia was found to be the commonest cause of death, followed by congenital malformations and respiratory distress syndrome. The implications of these findings for measures to reduce such deaths are discussed.
Risk Factors for Neonatal Infection
Authors: Spaans Willem A. , Knox Andrew J. , Koya Hanifa B. , Mantell Colin D.
Published: February 2008

Summary: A retrospective case‐control study was designed to assess risk factors for neonatal infection. Nonprivate patients (8,215) who delivered in a period from January 1, 1983 to June 30, 1988 were studied. Ninety three cases of conjunctivitis (incidence 2.4/1,000), 104 cases of pneumonia (incidence 2.8/1,000), and 50 cases of sepsis (incidence 1.3/1,000) were identified. Group B streptococcus was cultured from septic neonates in 46%. Calculated Odds ratio's indicated prematurity/low birth‐weight (OR 6.9) and antepartum fetal tachycardia (OR 6.3) as important risk factors for pneumonia/ sepsis. Prematurity/low birth‐weight (OR 3.0) and an abnormal presentation in the birth canal (OR 2.8) were identified as risk factors for conjunctivitis. After testing all the risk factors found by univariate analysis in a logistic regression model tachycardia (chi2 35.21, p< 0.001) remained an independent predictor for neonatal pneumonia/ sepsis and abnormal vaginal presentation (chi2 7.58, p 0.006) for conjunctivitis.
The Effect of Patient Smoking Habit on the Outcome of IVF and GIFT Treatment
Authors: Harrison K. L. , Breen T. M. , Hennessey J. F.
Published: February 2008

EDITORIAL COMMENT: This paper provides strong evidence that infertile women who are smokers achieve significantly fewer successful pregnancies with treatment. This is yet another reason to advise smokers to conquer the habit, although worry about reproductive failure (perhaps the most potent of all anxieties) may result in increased difficulty in giving up this variety of drug addiction ‐ unfortunately this is likely to particularly apply to heavy smokers.

The morality/legality of withholding treatment from patients who request it, is questionable, even when they persist with habits that lessen their chances of success, yet insist that expensive modern technology (IVF‐ ET, GIFT) be made available to them. When patients pay for their treatment and are counselled regarding the chances of success or failure of the method, the problem is different, but remains. Some gynaecologists refuse to operate on patients for cure of stress incontinence of urine if they continue to smoke or remain grossly overweight. Some IVF units will not accept patients over 40 years of age or those whose command of English precludes ready understanding of complicated treatment regimens. How should we react when we see couples who request referral for treatment of infertility when we judge that a baby would be very unlucky to have such parents?

We agree with the authors' conclusion that vigorous attempts to convince infertile couples to stop smoking should be made well before they embark upon an assisted reproduction programme. A more important conclusion, if larger studies confirm these findings, is that the general public should be informed about the harmful effects of smoking on the reproductive process. Another comment is that infertile couples, smokers or not, often need counselling, especially when repeated treatment has failed; a clergyman, who was researching an address he was giving on IVF ‐ ET, once told the editor that he considered that there was inadequate counselling of infertile couples to accept their infertility!
Postabortal Pelvic Sepsis in Association with Chlamydia Trachomatis
Authors: Wein Peter , Kloss Michael , Garland Suzanne M.
Published: February 2008

EDITORIAL COMMENT: This paper reports that 5% of women having an elective termination of pregnancy, in Melbourne, in 1986, harboured Chlamydia trachomatis and that these women had triple the risk of postabortal sepsis. Expectedly the risk of postabortal sepsis when an IUD was inserted after termination was double in chlamydia positive women. Unless the problem of asymptomatic chlamydial infection is addressed in these women, many are likely to suffer impairment of fertility and/or the other miseries of chronic pelvic inflammatory disease. Although we accept the authors' statement that compliance for follow‐up is poor in such women, we are anxious to learn (and publish in this Journal) the state of tubal patency in such a group of patients. We also believe it is questionable practice to insert IUD's in nulliparas, especially after termination, unless there are unusual circumstances (repeated termination of unwanted pregnancies and refusal/inability to use other methods of contraception). The authors explain the need to use direct immunofluorescent staining for rapid diagnosis of chlamydial infection so that treatment with doxycycline can be commenced before termination is performed. Readers will have to scan the pages of Venereology to learn the more recent findings from the authors' clinic.

Summary: Cervical swabs for Chlamydia trachomatis culture were taken from 527 women presenting for elective termination of pregnancy. Twenty‐six patients (4.9%) harboured C. trachomatis; 21 (81%) of these were less than 25‐years‐old and 21 (81%) were nulliparas. Postoperative pelvic sepsis developed in 11.5% of chlamydia‐positive women, in contrast to 3.6% of chlamydia‐negative women. Consequently it is suggested that all patients, especially those younger than 25 years, presenting for termination of pregnancy or in whom an intrauterine device is to be inserted should be screened and have treatment commenced for C. trachomatis prior to the operative procedure.
Treatment of Ovulatory and Anovulatory Dysfunctional Uterine Bleeding with Oral Progestogens
Authors: Fraser Ian S.
Published: February 2008

Summary: Six anovulatory and 10 ovulatory women with dysfunctional uterine bleeding (DUB) were treated with cyclical oral progestogens (norethisterone or medroxypro‐gesterone acetate). Anovulatory women were treated from day 12–25 and ovulatory from day 5–25, in doses of 5–10mg 3 times daily. Measured menstrual blood loss was effectively reduced from control to treatment cycles in both anovulatory (control cycle 131ml; treatment 80 and 64ml) and ovulatory women (control cycles 110 and 113ml; treatment 76 and 71ml). Three women with ovulatory DUB did not show a useful response. Duration of bleeding was reduced in both groups and the pattern of loss changed. These regimens are effective forms of management for most women with ovulatory or anovulatory DUB.
The Changing Prevalence of Cervical Human Papilloma Virus Infection
Authors: Evans Susan , Dowling Kay
Published: February 2008

Summary: In order to determine the change in frequency of human papillomavirus infection (HPV) over a 10‐year period, cervical smears from 1978 were retrieved, cytologically reviewed and compared with cervical smears taken in 1988. In this way, the slides were reviewed using the same diagnostic criteria. The prevalence of HPV infection in the population assessed at Flinders Medical Centre, rose from 0.58% to 5.6% over this period.
Effect of Paraaortic Lymphadenectomy on 5‐Year Survival in Early Stage Cervical Cancer
Authors: Ayhan Ali , Tuncer Z. Selcuk , Ayhan Ayse
Published: February 2008

EDITORIAL COMMENT: In this study, there was no statistical difference in survival between the 137patients who underwent pelvic and paraaortie lymphadenectomy and the 141 who had pelvic lymphadnectomy alone at the time of radical hysterectomy. However, since the 2 groups were not randomized, and since all patients with positive paraaortie lymph nodes had extended field radiotherapy plus chemotherapy, it was not possible to evaluate if paraaortie lymphadenectomy conferred a survival benefit. The authors consider that paraaortie lymphadenectomy is an essential part of surgical staging in patients with early cervical cancer for the purpose of prognosis, but its effect on survival for the small proportion with involved paraaortie nodes remains unclear.

Summary: This study includes 278 patients with Stages 1 and 2 cervical cancer subjected to type 3 hysterectomy and lymphadenectomy. The incidence of lymph node metastasis and effect of paraaortie lymphadenectomy on 5‐year survival were evaluated. The overall incidences of pelvic and paraaortie lymph node involvement were 24.1% and 8.0%, respectively. The overall 5‐year survival rate was 83.8%. The 5‐year survival of patients subjected to both pelvic and paraaortie lymphadenectomy was found to be 84.6%; the figure was 80.9% for patients subjected to only pelvic lymphadenectomy. No statistical difference in survival was found between patients with and without paraaortie lymphadenectomy.
Vaginal Perforation due to Jet Ski Accident
Authors: Wein Peter , Thompson Derrick J.
Published: February 2008

Summary: A case of full thickness vaginal perforation into the peritoneal cavity resulting from a jet‐skiing accident is presented. Attention is drawn to the previously reported cases of similar injuries due to high speed water sports, and the need for adequate protective clothing in all people undertaking such sports.
Symphysiotomy for the Trapped Aftercoming Parts of the Breech: A Review of the Literature and a Plea for Its Use
Authors: Menticoglou Savas M.
Published: February 2008

EDITORIAL COMMENT: This is a scholarly clinical essay and we commend it to readers even if they feel symphysiotomy is not an option in their armamentarium — it will at the very least provide an excellent revision of the possible mechanisms of difficult breech extraction. This paper is a masterpiece with the right amount of repetition to make its central point.

Summary: The most dreaded complication of vaginal breech delivery is entrapment of the aftercoming head. When this is due to disproportion, persistent attempts at vaginal extraction are likely to result in a dead or damaged baby. A largely unknown solution in this desperate predicament is to surgically enlarge the pelvis by means of a symphysiotomy. A review of the literature shows that symphysiotomy performed to free the trapped aftercoming head will save at least 80% of babies if the procedure is performed without delay. Every obstetrician should be prepared to perform a symphysiotomy if the aftercoming head is trapped.
Domiciliary Fetal Monitoring in a District Maternity Unit
Authors: Moore Kate H. , Sill Richard
Published: February 2008

Summary: Domiciliary Fetal Monitoring is a new technique which allows fetal heart rate monitoring from within a patient's home. The 30 minute cardiotocograph is transmitted by telephone, to a central labour ward computer, within 45 seconds. Of 522 domiciliary cardiotocographs performed on 100 consecutive patients, 356 (68%) were performed for suspected intrauterine growth retardation or reduced fetal movements. Thirty one (5.9%) recordings were abnormal; a repeat cardiotocograph in hospital was abnormal in 9 cases (1.3%); all such patients were delivered within 7 days. The induction rate for the study group was increased by a factor of 3.2 with respect to all hospital confinements; 49% of infants were small for gestational age (<10th percentile). Caesarean section and forceps delivery rates were the same for both groups. No stillbirths occurred in the study group. After the introduction of domiciliary monitoring, the number and duration of hospital admissions for fetal surveillance were reduced by 29% and 52% respectively.
Gentian Violet — Is It Safe?
Authors: Drinkwater Paul
Published: February 2008

EDITORIAL COMMENT: Yet another old friend seems to have become a potential enemy. Because of the evidence reviewed in this report, many paediatricians no longer prescribe gentian violet for infants with evidence of candidial infection of buccal mucosa or buttocks. Whether or not the gynaecologist should discontinue the practice of using a single application of gentian violet (1/2%aqueous) at the time of diagnosis of severe thrush infection of the vagina, while the speculum remains in position, is uncertain; although immediate relief of itch and discomfort is guaranteed, a dose of a specific antifungal preparation, perhaps one of the single‐dose treatments (isoconazole pessaries 2 × 300mg or clotrimazole pessaries 500mg), could be used in the same manner.
Correlation of Umbilical Cord Whole Blood Viscosity and the Presence of Fetal Distress at Birth: A Mathematical Modelling Study
Authors: Umapathysivam K. , Haskard K. A. , Meffin E. , Jones W. R.
Published: February 2008

Summary: This study was designed to investigate the relationship between umbilical cord blood viscosity and clinical parameters such as maternal parity, maternal smoking, mode of delivery, sex of infant and the incidence of fetal distress at birth using mathematical modelling.

The results demonstrated vaginal delivery, male infants, infants of primigravidas and low cord whole blood viscosity at a high shear rate were co‐variables and were associated with an increased incidence of fetal distress and low Apgar scores.
An Investigation of the Maternal Antecedents of Perinatal Mortality in 2 Large Teaching Hospitals
Authors: Forbes Kevin L. , King James F.
Published: February 2008

EDITORIAL COMMENT: We wish to endorse the conclusions in this paper, namely that perinatal deaths should be classified by antecedent clinical parameters, since strategies of prevention are then more likely to be enunciated and evaluated. Spontaneous preterm labour, fetal malformations and intrauterine growth retardation are well recognised as the 3 main causes of perinatal mortality. However, the view expressed in this paper that unexplained intrauterine death is an important category, worthy of special attention, requires emphasis, even although such deaths occur in only 1 in 1,000 pregnancies (la). We consider that for inclusion in this group there should be a maturity (36 or more weeks' gestation) or birth‐weight limit (≥ 2,500 g), since prenatal investigation is more likely to reap a reward if there is focus upon salvageable infants.

Ia. Beischer N A, DeGaris C N, Unexplained Intrauterine Death near Term. Aust NZ J Obstet Gynaecol 1986; 26: 99–101.

Summary: Perinatal mortality reviews are a form of quality assurance, and the classification of perinatal mortality would be most useful if it assisted in strategies for prevention. Whilst the value of clinicopathological (autopsy) and separate neonatal classifications is recognized, the Whitfield classification, modified for Australian conditions and applied to 393 cases, clearly identified the major obstetric problems leading to perinatal death, and may therefore contribute to continuing improvement in prenatal care.
Hysteroscopic Adhesiolysis
Authors: Finikiotis George
Published: February 2008

EDITORIAL COMMENT: These cases suggest that hysteroscopic adhesiolysis resulted in restoration of menstruation (Cases 1 and 3) and a normal shaped uterine cavity (Cases 1–3) albeit at the price of uterine perforations (Case 3). Pregnancies after treatment of intrauterine adhesions have a high risk of complications including placenta accreta (Case 3). Elsewhere the author has reported a high incidence of abnormal cornual ostia in patients with infertility but also in women having elective sterilization and presumably normal fertility (Aust NZ J Obstet Gynaecol 1989; 29: 4:425–427). It seems that hysteroscopy offers greater precision than other methods in assessment of the intrauterine anatomy but we require much more information to interpret the significance of intrauterine adhesions seen at hysteroscopy in infertile patients.
Is Genital Human Papillomavirus Infection Always Sexually Transmitted?
Authors: Sun‐Kuie Tay , Tew‐Hongw Ho , Soo‐Kim Lim‐Tan
Published: February 2008

Summary: The occurrence of genital human papillomavirus (HPV) infection was studied prospectively by colposcopy and histology in 43 virginal and 162 sexually active women attending a colposcopy clinic. The study also included 111 husbands of the latter group. By colposcopic criteria, the prevalence of HPV infection was 51.1% in the virginal and 69.1% in the sexually active women. The prevalence was 77.1% among men whose wives had HPV infection compared to 13.3% among men whose wives did not have the infection (p<0.01). There was a strong association in genital HPV infection between husbands and wives as expected from a sexually transmissable disease. However, the high prevalence of the infection among the virginal women indicated that transmission of HPV by nonsexual modes was common. Genital HPV infection is ubiquitous and in women is not exclusively a venereal disease.