bluuebunny/crossref_metadata_2025 huggingface dataset:
Group B Streptococcus and Pregnancy
Authors: Vigneswaran Rasiah , O'Loughlin John A. , McDonald Helen M.
Published: February 2008

EDITORIAL COMMENT: We have accepted this paper for publication as an Editorial because it is an overview of the experience from a centre with a longstanding interest in routine screening for Group B streptococcus in pregnancy. The fact remains that universal screening for Group B streptococcus during pregnancy is not routinely performed in many major hospitals in Australia although it is widely advocated. It may be noted that in Victoria in 1992 there were only 2 perinatal deaths considered to have resulted from Group B streptococcal infectionA; the extent to which this low mortality rate is related to antenatal screening and intrapartum treatment is not known.
Routine Voluntary Antenatal Anti‐HIV Screening in Bangkok, Thailand
Authors: Phuapradit Winit , Chaturachinda Kamheang , Saropala Nopadol , Chittacharoen Apichart , Sirinavin Sayompom , Kunakorn Mongkol
Published: February 2008

EDITORIAL COMMENT: Perusal of the references quoted in this communication show how the scientists in Thailand have responded to the increasing prevalence of HIV‐seropositivity in their community. Routine testing of 24,856 antenatal women detected 91 (036%) to be seropositive, anda further8 (0.03%) were found to have seroconverted when retested at 28‐32 weeks' gestation. We accepted this paper for publication to stimulate local enquiry throughout Australia as to whether or not we need to set up population audits, done anonymously, for establishment of prevalence without the possibility of patient care. We consider that this is necessary in major centres on a regular basis. As the authors note it would be difficult for others to emulate their 100% rate of informed consent for routine voluntary screening. Although the point is made that the infants of those mothers who seroconverted during pregnancy are at greatest risk of perinatal transmission, we cannot see the need for double testing for patient care in the Australian community ‐ hopefully this comment, which has been passed by our infectious diseases consultant, is correct and will stand for many years.
Evaluation of a Rapid Enzyme Immunoassay for Detection of Genital Colonization of Group B Streptococci in Pregnant Women: Own Experience and Review
Authors: Hordnes Knut , Eide Martha , Ulstein Magnar , Digranes Asbjorn , Haneberg Bjorn
Published: February 2008

EDITORIAL COMMENT: As regular readers of the Journal will know we have published a number of papers recently on the subject of screening for group B beta‐haemolytic streptococcal (GBS) colonization of the vagina in pregnancy. This is the first paper we have published on the important problem of identification in labour of women who are GBS‐carriers so that appropriate antibiotic therapy can be given to them and their infants after delivery. It shows that the current technology is inadequate to quickly and reliably identify GBS‐carrier women.

Summary: We have compared an enzyme immunoassay (ICON Strep B, Hybritech) with cultures for emonstration of genital carriage of group B streptococci (GBS) in pregnant women, and studied the relationship between vaginal and rectal carriage of this organism. Pertinent literature has also been reviewed. Two hundred pregnant women at gestational week 17 were included. Swabs from the uterine cervix were tested for GBS by ICON Strep B immunoassay and ordinary cultures on blood agar. Additional swabs from the rectum were tested by cultures. The percentage of women with GBS in cervical secretions was 13.5o7o (27/200) by cultures and 4% (8/200) by the ICON Strep B immunoassay. The overall sensitivity of the immunoassay was 7.4%, and the specificity 96.5%. In conclusion, the sensitivity of rapid enzyme immunoassays is too low for accurate screening of GBS in the genital tract of pregnant women.
Follow‐up of Patients with Gynaecological Cancer
Authors: Kerr‐Wilson R. H. J. , McCrum A.
Published: February 2008

EDITORIAL COMMENT: In the editor's private practice the follow‐up of survivors of treatment of invasive cancer is favoured by both practitioner and patient ‐ we have become friends and are dependent upon each other ‐ our annual meeting allows mutual documentation of survival and morbidity as each assesses the effects of the ageing process on the other. The brief annual meeting is surely cost‐effective in terms of mutual morale ‐ and occasionally an unsuspected local recurrence or metastasis is detected and managed effectively after referral and discussion of treatment strategies with the appropriate oncologist. Nonetheless the questions asked by the authors after their analysis of our colleagues' regimens of follow‐up require answers, although the woman's wishes for continued surveillance should be heeded.

Additional Comment by our Oncologist Reviewer: The follow‐up of the cancer patient is an essential part of the management of cancer and should follow a strict protocol. The objectives of follow‐up are:

1. Assessment and documentation of the results of therapy with regard to cure, time to relapse and survival time.

2. Early detection of recurrence and institution of further therapy when appropriate. On‐going surveillance wilt vary according to disease site, prognostic factors and family history of cancer. Routine investigation should include vaginal cytology, chest X‐ray, renal ultrasound, CT scans, mammography and tumour markers such as CA 125.

3. Quality of life assessment with regard to the early and late sequelae of cancer therapy and the appropriate therapy for these side‐effects i e. lymphoedema, psychosexual problems, bladder or bowel problems.

The value of a comprehensive follow‐up protocol is seen in many cancer clinical trials. The overall improvement in survival of patients entered into trials relates in part to early detection of recurrence and institution of salvage therapy.
The Efficacy of Hysteroscopy: A Comparison of Women Presenting With Infertility Versus Other Gynaecological Symptoms
Authors: Woolcott Robert , Petchpud Arpas
Published: February 2008

Summary: The aim of this study was to compare the relative efficacy of hysteroscopy as a management tool in the routine initial assessment of women presenting for investigation of infertility with women presenting for investigation of other general gynaecological symptoms for which it is routinely performed. The results of 400 consecutive completed hysteroscopies performed during the primary investigation of infertility are compared with 400 consecutive completed hysteroscopies undertaken in the investigation of women with other gynaecological symptoms. Abnormalities were detected in 12.3% of the 800 hysteroscopies. Significantly less of the infertility group demonstrated abnormality (8.8%) compared to the general gynaecological group (15.8%) (p = 0.0034). There was no difference in the detection rate between primary and secondary infertility. In patients undergoing the procedure for infertility, the results of the hysteroscopy led to an alteration in management in 5.8% of the entire group and in 65.7% of those in whom an abnormality was detected. In patients undergoing the procedure for general gynaecological symptoms, the results of the hysteroscopy led to an alteration in management in 14.5% of the total group and in 97.2% of those in whom an abnormality was detected (p < 0.0001). Structural abnormality correlated with the presence of histological abnormality in 97.2% of cases. In infertile women, the use of hysteroscopy is supported as part of a comprehensive assessment of female reproductive anatomy.
Acute Hypoglycaemic Coma ‐ A Rare, Potentially Lethal Form of Early Onset Sheehan Syndrome
Authors: Zuker Naftaly , Bissessor Melanie , Korber Manfred , Conrads Martin , Margolis Jack , Massel Peter , FRCP Mohamed A. K. Omar MD
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication because it mil inform readers that the rare patient with postpartum collapse, which is likely to be due to postpartum haemorrhage, may develop Sheehan syndrome and develop hypoglycaemic coma within a short time of delivery. (See also Editorial Comment Sheehan syndrome: An analysis of possible aetiologicalfactors. Aust NZ J Obstet Gynaecol 1994; 34:534–536).

Summary: This case emphasizes the importance of intensive obstetric management that is required when confronted with prolonged postpartum haemorrhage. Anticipation of the possibility of acute hypoglycaemic coma as an initial manifestation of Sheehan syndrome and prompt recognition may prevent disastrous consequences, including maternal death.
Is The Fibroid a Uterus?
Authors: Koong Denise K. , McKenna K. Mark
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication to allow readers to see the point that a morbidly adherent placenta in the cervix and/or lower uterine segment can lead to catastrophic haemorrhage whether the fetus is above the abnormally implanted placenta (most cases of placenta accreta, increta orpercreta) or below it (most cases of cervical pregnancy which can also be associated with placenta accreta, increta orpercreta). The moral of the story seems to be that conservative treatment with methotrexate or balloon tamponade requires diagnosis before damage to the cervix or lower uterine segment occurs due to attempted or actual removal of the placenta. However there are reports of cases of cervical pregnancy where very considerable haemorrhage was quickly controlled by a large Foley catheter or Sengstaken‐Blakemore tube, usually when the placenta had been removed.
Prevention of Preeclampsia with Heparin and Antiplatelet Drugs in Women with Renal Disease
Authors: North R.A. , Ferrier C. , Gamble G. , Fairley K.F. , Kincaid‐Smith P.
Published: February 2008

Summary: In a retrospective cohort study of women with renal disease in pregnancy we investigated if:

low dose aspirin reduced die prevalence of preeclampsia and improved fetal outcome compared to no anticoagulant therapy.

heparin plus low dose aspirin and/or dipyridamole reduced die prevalence of preeclampsia and improved fetal outcome compared to i. no treatment ii. low dose aspirin alone.

Women with renal disease were allocated into 3 groups according to the treatment received during their pregnancies: I. no prophylactic heparin or antiplatelet drags, n=76 II. prophylactic low‐dose aspirin 75(50–150)mg, n=27 III. prophylactic subcutaneous heparin 10,000 (5000‐12,500) IU b.d. combined witii low‐dose aspirin 50 (50–150)mg and/or dipyridamole 400 (200–400)mg, n=44. Preeclampsia and fetal outcome was analysed according to treatment group.

Preeclampsia was less common in the heparin group (2.3%) compared with 27.6% in the no treatment group [O.R. 0.06 (0.01‐0.30)] and 25.9% in the aspirin group [O.R. 0.07 (0.01‐0.38)].Women on aspirin, who developed preeclampsia, delivered later in pregnancy [35.4 (33–38.2) weeks] than preeclamptic women on no treatment [29 (22–38) weeks], p=0.04. There was a trend to reduced perinatal deatfis in the heparin + antiplatelet drug group, [2.3%; O.R., 0.17 (0.02‐1.4)] and in the aspirin group [0%, O.R., 0.13 (0.01–2.3)] compared with 11.7% perinatal deaths in the no treatment group.

Heparin widi anti‐platelet drugs may prevent preeclampsia in high risk women witfi renal disease. Further investigation in a randomized trial is indicated.
Low Dose Aspirin for the Treatment of Fetal Growth Restriction: A Randomized Controlled Trial
Authors: Newnham John P. , Godfrey Maiyellen , Walters Barry J.N. , Phillips John , Evans Sharon F.
Published: February 2008

Summary: The purpose of this study was to investigate the hypothesis that maternal administration of lOOmg aspirin each day will improve birth‐weight and other measures of neonatal size when given as a treatment to pregnancies complicated by fetal growth restriction and umbilical‐placental insufficiency. A randomized, double‐blind, placebo controlled study design was employed; 51 pregnant women were enrolled. The entry criteria were a fetal abdominal circumference <10th per centile together with an umbilical artery Doppler systolic/diastolic ratio >95th per centile between 28 and 36 weeks'gestation. Compliance was assessed by serial measurement of maternal serum thromboxane B2 levels. The mean gestational age at enrolment was 32 weeks and at delivery was 36 weeks. There were no differences between the 2 groups in gestational age at birth; birth‐weight or birth‐weight ratio; circumferences of the head, chest or abdomen; skin fold thicknesses; or neonatal morbidity. Low dose aspirin therapy did not alter Doppler systolic/diastolic ratios. After 14 days therapy, mean thromboxane B2 levels fell more than 80% from baseline values; 10.5% of women did not demonstrate biochemical confirmation of aspirin ingestion, despite verbal confirmation of compliance. We conclude that low dose aspirin therapy is not of benefit in the treatment of pregnancies complicated by fetal growth restriction and umbilical‐placental insufficiency between 28 and 36 weeks' gestation.
The Prevalence and Timing of Obstetric Ultrasound in Victoria 1991–1992: a Population‐based Study
Authors: Yates Judith M. , Lumley Judith , Dev Grad Dip Child , Bell Robin J.
Published: February 2008

Summary: A statewide study to ascertain the number of ultrasound scans received by women in pregnancy, to identify the proportion having a scan at 16 to 20 weeks' gestation, and to establish where the scan at 16 to 20 weeks was performed was carried out between January, 1991 and June, 1992 in Victoria. Additional data were collected by midwives and entered on the perinatal morbidity statistics form routinely completed for all births. Of 52,319 women providing responses, 3.1% did not have a scan. Of the remaining 96.9% who had a scan, 73.5% were scanned at 16 to 20 weeks'gestation. Predictors of not having a scan were maternal birthplace and higher parity: previous perinatal death(s), and attendance at nonteaching hospitals predicted the opposite. Predictors of being scanned were location of hospital (country), maternal birthplace, higher parity and maternal age (< 20 years). Substantial differences in frequency and timing were found between hospitals attended. Factors associated with the pattern of scanning are not readily explicable in terms of risk of malformations or women's choices.
The Effect of Work Activity in Pregnancy on the Risk of Severe Preeclampsia
Authors: Spinillo Arsenio , Capuzzo Ezio , Colonna Laura , Piazzi Gaia , Nicola Sabrina , Baltaro Federica
Published: February 2008

Summary: The aim of this study was to evaluate the impact of type of employment and level of physical activity at work on the risk of severe preeclampsia. For this purpose, we carried out a case control study of 160 nulliparous pregnant women with severe preeclampsia and 320 normotensive nulliparous controls who received prenatal care from members of one medical staff. The type of employment and the level of physical activity sustained at work were ascertained at birth through an interview based on a standard questionnaire. The degree of physical activity at work was assessed by a 4‐level activity score based on type of work, physical intensity, posture at work, and weekly working hours. In logistic regression analysis, after adjustment for potential confounders (maternal age, time of stopping work, prepregnancy body mass index, social status of the partner, history of previous abortion, and prepregnancy smoking status), clerical workers had a significantly lower risk of severe preeclampsia than women who were unemployed at the beginning of pregnancy (OR 0.53, 95% CI 0.30, 0.96). In multivariate analysis, there was a significant linear trend relating the degree of physical activity at work, to the risk of preeclampsia (likelihood chi‐square = 9.38, 3 df, p = 0.002). We then restricted the analysis to women who had ever worked in pregnancy (n = 339) also adjusting for confounders, and found that clerical workers were still at significantly lower risk of severe preeclampsia dian women not formally employed (OR 0.2,95% CI 0.08,0.49). In addition, moderate/high physical activity at work was associated with a 2‐fold increase in the risk of severe preeclampsia compared to mild activity (OR 2.08, 95% CI 1.11,3.88). We conclude that moderate to high physical activity at work seems to increase the risk of severe preeclampsia.
Efficacy of Bupivacaine Delivered by Wound Catheter for Post‐Caesarean Section Analgesia
Authors: Mecklem David W. J. , Humphrey Michael D. , Hicks Ross W.
Published: February 2008

Summary: A prospective, randomized, double‐blind trial was conducted to assess contribution to postoperative analgesia of intermittent instillation of 0.25% bupivacaine beneath the rectus sheath in 70 women delivered by lower uterine segment Caesarean section. The operations were performed via a Pfannenstiel incision under spinal anaesthesia. Background intravenous narcotic analgesia was provided with a patient controlled analgesia system (PCAS) using a standard morphine regimen.

Overall (44 hr) mean morphine consumption was significantly greater in the placebo (saline) group compared to the treatment group (84.2 mg versus 63.3 mg. Two tailed t test p<0.001). The most significant intergroup differences in narcotic use were found in the first 4 hours and between 24 and 36 hours after commencing PCAS (Two tailed t test p=0.014 and 0.003 respectively).

Subjective pain scores were assessed with a 10 cm visual analogue scale (VAS). The mean peak VAS score was greater in controls (5.37) than the treatment group (4.25) between 18 and 24 hours postoperatively (Mann‐Whitney U=424, p=0.027). There were no intergroup differences in pain scores for any other time period. The overall incidence of nausea was lower in the treatment group compared to the control group (Chi squared with Yates' correction p=0.046) and a lower degree of sedation was seen in those receiving bupivacaine between 4 and 8 hours after commencing PCAS (Mann‐Whitney U=427, p=0.028). No differences in other narcotic related side‐effects (vomiting and pruritus) were shown between groups.

Regular instillation of 0.25% bupivacaine beneath the rectus sheath of women delivered by Caesarean section reduces their morphine requirements by 25% in the 44 hours after operation, with an associated reduction in both nausea and early sedation.
Terminations of Pregnancy for Exposure to Oral Retinoids in South Australia, 1985–1993
Authors: Chan Annabelle , Keane Rosemary J. , Hanna Marshall , Abbott Malcolm
Published: February 2008

Summary: The oral retinoids, isotretinoin and etretinate, are highly teratogenic drugs which have been available in Australia since 1985 because of their unique effectiveness in severe cystic acne, psoriasis and other keratinization disorders. Only dermatologists can prescribe them, but in spite of strict guidelines by the manufacturers and the College of Dermatologists, exposed pregnancies have occurred. We attempted to determine the circumstances of exposure to these drugs for the 18 pregnancies terminated in South Australia in 1985–1993, using questionnaires to medical practitioners who notified the terminations under legislation. The main reason for their occurrence was the lack of compliance with the use of effective contraception by the women. In South Australia, some prescriptions of oral retinoids by unauthorized doctors have been dispensed during this period. Using statistics on prescriptions dispensed, an estimate was made of 1 termination of pregnancy for 319 courses of treatment for women with isotretinoin. Extension of guidelines for prescription and more detailed counselling in relation to the use of contraception are recommended. It is also suggested that doctors intending to recommend terminations obtain consent to discuss exposure with the dermatologists concerned, who may not be aware of the exposed pregnancy.
Treatment of Preterm Cervical Dilatation with Glyceryl Trinitrate, a Nitric Oxide Donor
Authors: Rowlands Shelley , Trudinger Brian , Visva‐Lingam Shan
Published: February 2008

EDITORIAL COMMENT: This paper reports very impressive results of treatment of cervical dilatation with glyceryl trinitrate in what seems to be a very high‐risk group of 10 women. The details provided of Case 1, table 1, suggest that glyceryl trinitrate patch therapy may be considered as an alternative to cervical ligation, at least in selected patients where insertion of a cervical stitch has contraindications (haemorrhage, uterine contractions, possibility of infection). It is early days yet, but the editorial committee wish to endorse the authors' conclusion that ‘the data presented here supports the need to perform randomized placebo‐controlled trials so that the role of glyceryl trinitrate, if any, and safety of its use can be established’. Should such trails include prophylactic use of this regimen in women without cervical dilatation when there is a past history of recurrent mid‐trimester fetal loss from premature labour ± premature rupture of the membranes? These women are significant contributors to the 35–40% of all perinatal deaths that occur associated with delivery between 20 and 28 weeks' gestation.

Summary: We report an observational study on the use of transdermal glyceryl trinitrate as a treatment to delay delivery of women presenting in pregnancy with dilatation of the cervix. Ten women found to have cervical dilatation more than 2 cm (range 2 to 8 cm) at gestations between 16 and 32 weeks were studied. These women were treated with 50 mg glyceryl trinitrate patches. The mean prolongation of gestation from the time of admission was 46.2 days (range 1 to 130 days). There was 1 stillbirth in a 22.6‐week fetus and 1 neonatal death secondary to prematurity. Vaginal delivery occurred in all but 3 cases. All babies were of size appropriate for gestational age at delivery. The only reported maternal side‐effect was headache. No adverse fetal effects were noted. We conclude that glyceryl trinitrate may provide an effective and safe method of tocolysis, well suited for long‐term use. The purpose of reporting this study is to highlight the mounting accumulation of data on glyceryl trinitrate and reinforce the need to evaluate its use in randomized controlled trials.
What's in a Name ‐ Is the Pregnant Woman a Mother? Is the Fetus a Baby?
Authors: de Crespigny Lachlan
Published: February 2008

EDITORIAL COMMENT: We published this paper because we believe the author has a point. It is of interest that it was made by an ultrasonologist because the woman and her partner bonding with the ‘fetus'at the 18–20 week examination can have a difficult time when an unexpected malformation is detected. The editor doubts if a woman in late pregnancy should have her unborn child referred to as a fetus; her attachment is far more intimate than that, and she may take offence e.g. would you say, is your fetus moving normally? To widen the discussion we remind readers of the arguments on the correct spelling of the word fetus and the embryologists distinction between the words embryo (earliest stages of development, before the fourth month of pregnancy) and fetus (young animal in the womb after its parts are distinctly formed).
An Audit of Hysterectomies in Young Women at the Queen Victoria Hospital, 1984–1994
Authors: Hanson J. , Khong T.Y.
Published: February 2008

Summary: A retrospective audit of hysterectomies in young women (age 30 years and under) was conducted. Forty‐one hysterectomies, representing 4% of all hysterectomies at the hospital, were performed in women of this age group. The main clinical indications were abnormal uterine bleeding (44%), pelvic pain (20%) and endometriosis (15%). None were performed for invasive malignant conditions. Most women had some prior therapy for their symptoms. Thirty‐seven of the operations were total abdominal hysterectomies and 4 women had a unilateral oophorectomy. Complications were found in 17 women. Causal pathology, though not always what was predicted clinically or on the basis of operative findings, was identified. Further studies would be worthwhile to document the experiences from other institutions and to provide long‐term follow‐up.
Phaeochromocytoma in Pregnancy
Authors: Lau Phillips , Permezel Michael , Dawson Peter , Chester Steven , Collier Neil , Forbes Ian
Published: February 2008

Summary: The Royal Women's Hospital, Melbourne, is a tertiary referral hospital with over 7,000 deliveries per year. We report 3 cases of phaeochromocytoma in pregnancy at the hospital in the 20‐year period since 1976. The first case was unsuspected and resulted in a maternal death. The subsequent 2 cases were diagnosed antenatally with successful outcomes for both mother and baby. The 3 cases demonstrate the importance of an early antenatal diagnosis and the special management problems of phaeochromocytoma in pregnancy. The diagnosis of phaeochromocytoma should be considered in any pregnant woman with severe hypertension, particularly if presenting before 20 weeks' gestation, labile, or associated with sweating, palpitations or headaches.
Macrofolliculoid Granulosa Cell Tumour Mistaken for a Polycystic Ovary at Ultrasound Scan
Authors: Fox Robert , Draycott Tim
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication because it carries the important clinical message that an oestrogen‐producing tumour should be considered in patients with anovulation especially when the classical features of polycystic ovarian disease are not present and when the alleged polycystic ovary was defined to be present on one side only. In these patients an oestrogen assay by showing markedly elevated levels is a useful screening test for oestrogen secreting tumours of the ovary or adrenal gland.
Eclampsia in Kuwait 1981–1993
Authors: Makhseed Ma'asoumah , Musin Vijaya Manav
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it provides interesting data concerning the incidence and clinical results obtained in 101 cases of eclampsia in 167,080 confinements in Kuwait. The vicissitudes of the Gulf war influenced the data gathering during this series but the results warrant comparison with those from an Australian teaching hospital shown in table A from 113,909 consecutive confinements. It should be noted that the overall similarity in results (apart from maternal mortality) is as remarkable as the dissimilarity in the methods used to treat women with preeclampsia and eclampsia in these 2 centres. The incidence of eclampsia was the same in Australia as Kuwait (5.6 versus 6 per 10,000 confinements). Nulliparas comprised 72% and 73% of the series respectively although it should be noted that in the Australian series nulliparas comprised 42% of the total obstetric population in comparison with 23% in Kuwait. The associations with multiple pregnancy (4.7% versus 5%) and diabetes (3.1% versus 2%) were similar as was the perinatal mortality rate (10.9% versus 9.3%), but not the maternal mortality rate (6.3% versus 1%) or the Caesarean section rate (25% versus 49%). We concur with most of the authors' conclusions but cannot agree that, in 1996, we can label eclampsia as a ‘preventable condition’.

Summary: The aim of this study is to investigate the maternal and fetal outcome and the risk factors for developing eclampsia in Kuwait. The study includes all patients with eclampsia observed at the Maternity Hospital, Kuwait during the period from 1981 to 1993. It revealed that the risk factors predisposing to eclampsia were primiparity, a maternal age below 30 years, multiple pregnancy and the presence of preeclampsia. The pregnancy outcome in terms of the stillbirth rate, neonatal death rate and low birth‐weight babies was significantly higher in mothers with eclampsia than in noneclamptic mothers. The operative delivery and maternal mortality rates were also significantly higher in these patients.
A Review of Eclampsia in Melbourne: 1978–1992
Authors: Cincotta Robert , Ross Andrew
Published: February 2008

Summary: A retrospective review of all cases of eclampsia diagnosed at 3 obstetric teaching hospitals in Melbourne from January, 1978 to December, 1992 was undertaken. Ninety cases were identified; there were 5 maternal deaths and 17 perinatal deaths. Severe maternal morbidity such as pulmonary oedema, acute renal failure or HELLP syndrome was found in 26%. Significant maternal thrombocytopenia (<100 × 109/L) was found in 50% and 35% had abnormal maternal liver function tests. Forty six women received magnesium sulphate for treatment of eclampsia and of these 3 had further seizures compared to 4 of 18 who received phenytoin (odds ratio 0.24 (0.04‐1.52) X2, p=0.09). Eclampsia remains a significant complication of pregnancy with high maternal and perinatal mortality and morbidity. Results of this study show a trend that is in agreement with recent randomized controlled trials which demonstrate a reduced incidence of seizures and maternal and fetal complications with tbe use of magnesium sulphate. The results of these recent trials suggest that magnesium sulphate should be the drug of choice in the prevention and treatment of eclampsia.
The Effect of Epidural Bupivacaine on the Fetal Electrocardiogram
Authors: Phillips Kevin , Umstad Mark P. , Donnelly John G. , Cameron Alan D.
Published: February 2008

Summary: Fetal electrocardiogram waveform analysis was used to assess the effect of epidural bupivacaine on the fetal myocardial conducting system by evaluating its effect on the PR interval, RR interval, T/QRS ratio and the PR‐RR correlation coefficient. There were no significant changes in either the PR interval or the PR‐RR correlation coefficient. There was a significant increase in the fetal heart rate and a significant fall in the T/QRS ratio. Epidural bupivacaine does not alter fetal myocardial conduction as measured by the PR interval and it does not induce ischaemic cardiac changes as assessed by the T/QRS ratio.
Fearing the Worst ‐ Why Do Pregnant Women Feel ‘At Risk’?
Authors: Searle Judith
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it explores the association of antenatal patients' anxieties about their own welfare and that of their fetus in terms of the antenatal investigations that are performed during pregnancy. It is noteworthy that women who were told the results of their tests were 8 times more likely than those not told the results to perceive that antenatal screening tests were helpful which is a message that probably all readers can profit from. It is also important to learn that routine antenatal screening tests were regarded by the patients as being the most effective factor in reducing the level of fear and anxiety experienced throughout pregnancy. Those who are responsible for antenatal classes will be interested to read that only a very small percentage of women identified them as being effective in the reduction of anxiety. The editorial committee of the Journal will be pleased to receive a paper such as this exploring the value of antenatal classes as perceived by women and their partners. At present the information on this subject is mainly anecdotal.

Summary: Whilst pregnancy and childbirth are generally regarded as a joyful and exciting time in a woman's life they are also filled with fear, uncertainty, a feeling of being ‘at risk’ and anxieties about what the pregnancy and future may hold. In a society where the perinatal and maternal mortality and morbidity rates are low, where do these fears and uncertainties arise from? Why do pregnant women fear the worst? What are the implications of this?

A cross‐sectional and qualitative study of 376 postnatal women in a major public teaching hospital in Melbourne was undertaken in 1995 to explore women's beliefs and fears about pregnancy and birthing outcomes, through their perceptions and use of routine antenatal screening tests. Through women's perceptions about the value of, and expectations of, routine antenatal screening tests, and their fears during pregnancy, the author explores the ‘notion of risk’ as perceived by these women.
Perinatal Infection with listeria Monocytogenes
Authors: Craig Simon , Permezel Michael , Doyle Lex , Mildenhall Lindsay , Garland Suzanne
Published: February 2008

Summary: Listeria monocytogenes has been increasingly recognized as a cause of intrauterine sepsis with associated perinatal wastage. The condition is mostly acquired through dietary intake and appropriate advice should be given to all pregnant women. The most common presentations in pregnancy include premature labour, an influenza‐like illness and reduced fetal movements.

In this report, we present a series of 24 cases of perinatal listeria infection presenting to either our obstetric or neonatal units and confirmed by the microbiology department of the hospital. In particular, we wish to highlight 3 cases in which antenatal diagnosis and aggressive therapy was associated with a successful outcome. Amongst the remaining 21 cases in which an antenatal diagnosis was not made, there were 5 perinatal deaths and 1 mid‐trimester loss at 18 weeks.

Clinicians must maintain a high index of suspicion for listeria, particularly in gravid patients who present with fever in the setting of a persistent ‘flu‐like’ illness and premature labour. Once suspected, appropriate specimens for listeria culture should include blood, cervical swabs and midstream urine. Empirical antibiotic therapy with amoxicillin should be instituted while waiting for culture results in patients with possible Listeria monocytogenes sepsis.
Antenatal Human Parvovirus B19 Infection and Nonimmune Hydrops Fetalis Presenting as Severe Preeclampsia
Authors: Choong Shawn , Meagher Simon
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication since the authors believe it is the first report of hydrops fetalis due to parvovirus infection apparently causing severe preeclampsia. This is similar to the ‘maternal preeclampsia syndrome’ classically described with fetal and placental hydrops due to maternal rhesus isoimmunization (A), and which also can occur with fetal and placental hydrops due to fetal alpha thalassaemia major. The authors indicate that treatment of fetal anaemia could possibly result in resolution of the signs of preeclampsia in such cases. Indeed the members of the editorial subcommittee have already heard, on the Australian academic grapevine, of surviving infants treated in utero for anaemia caused by parvovirus and erythroblastosis due to maternal rheus isoimmunization respectively, in 2 mothers with signs of severe preeclampsia.

(A) Scott JS. Pregnancy toxaemia associated with Hydrops foetalis, Hydatidiform mole and Hydramnios. J Obstet Gynaecol Br Emp 1958; 65:689–701. William Blair‐Bell Memorial Lecture delivered at the Royal College of Obstetricians and Gynaecologists on May 30, 1958.
Complete Inversion of the Uterus During Caesarean Section: A Case Report
Authors: Kriplani Alka , Relan Supriya , Roy Kallol Kumar , Mittal Suneeta , Buckshee K.
Published: February 2008

A case of complete inversion of the uterus through the uterine incision at the time of Caesarean section is presented. The possible aetiological factors were a short cord and fundal insertion of the placenta. Disappearance of the lower segment incision and the raw appearance of the endometrial surface of a completely inverted uterus posed a diagnostic dilemma. Prompt understanding and immediate repositioning by a simple technique prevented any further complications. This rare complication of Caesarean section and its easy principles of management are described for the benefit of an unwary obstetrician.
Is Laparoscopically‐assisted Vaginal Hysterectomy Associated with Low Operative Morbidity?
Authors: Yuen Pong Mo , Rogers Michael S.
Published: February 2008

Seventy‐one consecutive patients undergoing laparoscopically‐assisted vaginal hysterectomy were prospectively evaluated with particular emphasis on the operative morbidity. Bipolar desiccation was the mainstay for haemostasis. Fibroids accounted for two‐thirds of the uterine pathology and the average uterine weight was 238.0 g (SD 134.6). Mean operating time was 126.3 minutes (SD 36.9) and decreased with experience despite the progressive increase in uterine weight. The mean blood loss was 432 mL (SD 288) with a mean haemoglobin change of 2.3 g/dL (SD 1.5). Intraoperative complications occurred in 5 patients (7.0%), 2 with inferior epigastric artery injuries and 3 serosal bladder injuries. Postoperative complications occurred in 45 patients (63.4%). Febrile morbidity was the major complication and occurred some 50% of patients, 45% of whom had no underlying cause identified. Vault haematoma was the second most common complication and occurred in 31.0%. The mean hospital stay was 5.4 days (SD 2.7) and the readmission rate was 10%. Our results of laparoscopically‐assisted vaginal hysterectomy did not conform with the benefits of reduced blood loss, shorter hospital stay and reduced postoperative complications reported in the literature. The true complication rate of laparoscopically‐assisted vaginal hysterectomy should be carefully assessed before this can be considered as the approach of choice to hysterectomy.
Genital Prolapse: A Legacy of the West?
Authors: Brieger G.M. , Yip S.K. , Fung Y.M. , Chung T.
Published: February 2008

A retrospective study was undertaken to determine if there has been a change in the incidence of genital prolapse and urinary stress incontinence in Chinese women in Hong Kong. The medical records of 2,312 consecutive patients admitted for major gynaecological surgery for benign conditions in 5 out of 7 major public teaching hospitals in Hong Kong for the calendar year of 1993 were reviewed by way of an audit of all gynaecological operations performed in these hospitals. A total of 578 cases (25%) were identified as having genital prolapse and or urinary problems.
Hysterectomy, Massive Transfusion and Packing to Control Haemorrhage from Pelvic Veins in the Course of Bilateral Oophorectomy
Authors: Edwards William R.
Published: February 2008

The patient required bilateral salpingooophorectomy for pain caused by the late effects of pelvic infection. Division of adhesions was followed by torrential bleeding from the gluteal tributaries of the right internal iliac vein aggravated by the partial retraction of those veins into the subgluteal region. Measures to control the bleeding and the late complications are described.
Massive Ovarian Oedema: A Nonneoplastic Adnexal Mass Mistaken for a Neoplasm
Authors: Turan Cem , Ugur Mustafa , Mungan Tamer , Taner Dilara , Aydogdu Tugrul , Cobanoglu Omer
Published: February 2008

Massive ovarian oedema (MOO) is an unusual clinical entity occurring in teenage girls and young women, and is thought to result from periodic and intermittent torsion of the ovarian pedicle. It is usually mistaken for an ovarian neoplasm and treated by oophorectomy. A case that underwent more radical surgery than is necessary is presented.
Obstetric Profiles and Pregnancy Outcomes of Immigrant Women in New South Wales, 1990–1992
Authors: Ma Janet , Bauman Adrian
Published: February 2008

Summary: This study examined the obstetric profiles and pregnancy outcomes of immigrant women in New South Wales (NSW). The source of data was the NSW Midwives Data Collection. The characteristics of 64,922 immigrant women were compared with 189,357 Australian‐born non‐Aboriginal women who delivered babies between 1990–1992 in NSW. The study demonstrated that immigrant women were older, generally had less private health insurance coverage and fewer teenage pregnancies. Immigrant women showed lower rates of essential hypertension, but higher rates of hepatitis B and gestational diabetes. While induced labour was conducted less frequently among immigrant women, episiotomy, instrumental delivery and Caesarean section were performed more frequently among this group. The incidence of postpartum complications was higher among immigrant women. Differences were assessed among women from European, Asian, Middle Eastern, American, New Zealand/Oceania and African backgrounds. For example, the higher rates of hepatitis B, gestational diabetes, episiotomy, instrumental delivery, Caesarean section, postpartum haemorrhage, third degree tear and puerperal infection among Asian‐born women were of concern. By contrast, pregnancies among Middle Eastern‐born women were associated with fewer complications in spite of their high parity and high percentage of teenage pregnancies. Infants of immigrant mothers were more likely to be resuscitated and/or admitted to special care nursery/neonatal intensive care unit. These findings in immigrant women in NSW suggested the need for culturally appropriate obstetric services, clinical practice reviews, and the greater involvement of general practitioners in obstetric care.
Low Aboriginal Birth‐weight‐Prematurity or Intrauterine Growth Restriction?
Authors: Humphrey Michael D.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it explores the important question of whether low birth‐weight in infants of Aboriginal mothers is due to prematurity or fetal growth‐retardation. This paper reviews the previous literature, provides some interesting new information, and shows that a prospective study with verification of fetal maturity is required to resolve the problem. Readers will realize the difficulties that exist in compilation of prospective data with sufficient numbers of cases to answer this question.

Summary: Two thousand, nine hundred and twenty‐eight consecutive singleton public births at Cairns Base Hospital were studied retrospectively. Contrary to popular clinical belief, there was no statistically significant difference in the birth‐weights, corrected for gestational age between Aboriginal babies and Caucasian babies. There was a highly significant excess of preterm Aboriginal births, when compared with Caucasian births. This study suggests that any attempt to reduce the high incidence of low birth‐weight births in Aboriginal people should be directed at reducing the incidence of preterm birth, rather than the supposed high incidence of intrauterine growth restriction.
Fetal Growth and Perinatal Outcome of Pregnancies Continuing After Threatened Abortion
Authors: Das A. G. , Gopalan S. , Dhahwal L. K.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it provides some useful information on the outcome of a small series of women with threatened abortion who were followed carefully with serial ultrasonographic estimations. Although the results were excellent in comparison with the control series it should be noted that patients were excluded if delivery occurred before 28 weeks' gestation. This is an important point because threatened miscarriage may result in an increased incidence of premature births between 20–28 weeks' gestation and an increased incidence of fetal malformations in those pregnancies that terminate before 28 weeks. Nonetheless it is important to be able to reassure women who have had a threat to abort that if the pregnancy continues past 28 weeks there is no increased incidence of either major fetal malformations or perinatal deaths. A higher incidence of placenta praevia in patients with threatened miscarriage could also be hidden in a series excluding all those patients delivered before 28 weeks if those with placenta praevia were to deliver before this time. Other studies have also shown that pregnancies complicated by threatened abortion which proceed beyond 28 weeks' gestation have no significant increase in the incidence of prematurity, fetal growth retardation or major fetal malformations.

(A) Evans JH, Beischer NA. The prognosis of threatened abortion. Med J Aust 1970; 2: 165–168.

Summary: The present study was conducted with the aim to find out the effect of threatened abortion in the current pregnancy on the subsequent perinatal outcome and follow the growth pattern of the fetuses of such complicated pregnancies. The study group consisted of 55 women with threatened abortion and 55 women with normal pregnancies formed the control group. Most of the patients presented at 6–12 weeks' gestation. The fetal growth was monitored by both clinical as well as ultrasound (USG) parameters. The mean growth rates were almost identical throughout gestation. The mean values of each parameter of the study group were found lying within 95% confidence limit values of their control group. The apparent increased incidence of low lying placenta in early pregnancy probably contributed to threatened abortion. There was no significant difference in preterm delivery, low birth‐weight and overall perinatal outcome.
Postoperative Symptoms Following LLETZ or Radical Cervical Diathermy with Fulgaration: A Randomized Double‐Blinded Prospective Study
Authors: Healey Martin , Warton Bruce , Taylor Nancy
Published: February 2008

Fifty‐five patients were randomized in a double‐blinded manner to large loop excision of the transformation zone (LLETZ) (29 patients) or radical cervical diathermy with fulgaration (RCDF) (26 patients) for treatment of cervical intraepithelial neoplasia (CIN). Patients completed a 2‐month diary of symptoms and completed a 10‐week postoperative questionnaire. White vaginal discharge lasted 7.3 (4.6) days (SD) for RCDF compared to 3.4 (1.6) days (SD) for LLETZ. There was no significant difference in any other symptoms on analysis This appears to be the first report clearly assessing the length and severity of postoperative symptoms following LLETZ or RCDF. There is no reason on length and severity of postoperative symptoms to choose 1 of these 2 treatment methods over the other.
Uterine Rupture During Labour in a Primigravida
Authors: Chin Michael M.S. , Harvey James A. , Duffy Brian L.
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication because it will interest readers. Certainly the woman had a haemoperitoneum and signs indistinguishable from a case of rupture of the uterus although technically this is not a rupture because the tear did not extend through the uterine wall to the endometrial cavity. The editor saw a patient some 38 years ago who had a haemoperitoneum and who came to laparotomy on 2 occasions where it appeared that the bleeding had come from a tear in the peritoneum between the uterosacral ligaments. This patient died during her third laparotomy. There is also literature describing tears in the peritoneum over the uterosacral ligaments as a cause of chronic pelvic pain. The editorial committee find it feasible that a patient in labour can develop a tear in the peritoneum and superficial myometrium in her posterior uterine wall which if it involved vessels could cause a life‐threatening haemoperitoneum. Of course similar tears occur due to trauma such as a motor‐car accident when the woman is wearing a seat belt which can localize trauma to the uterus.

Summary: Uterine rupture ie extremely rare in the absence of any of the commonly recognized risk factors. We describe here a case of incomplete uterine rupture in a woman in her first pregnancy who had no previous instrumentation to the genital tract. Her only significant history was that of 2 episodes of minor antepartum haemorrhage occurring prior to induction of labour with artificial rupture of membranes and intravenous oxytocin. The rupture was manifested by 450 mL blood in the peritoneal cavity when an emergency Caesarean section was performed for persistent fetal bradycardia.