bluuebunny/crossref_metadata_2025 huggingface dataset:
The Amniotic Fluid Embolism Syndrome: 10 Years' Experience at a Major Teaching Hospital
Authors: Burrows A. , Khoo S.K.
Published: February 2008

EDITORIAL COMMENT: Study of causes of maternal deaths and hence prevention of maternal mortality and morbidity requires a high autopsy rate of mothers who die. This is especially true for deaths from amniotic fluid embolism as the clinical signs can be confused with those occurring with pulmonary thromboembolism, Mendelson acid‐aspiration syndrome and rupture of the uterus. In the present study the 2 deaths from amniotic fluid embolism gave a death rate oj'33 7 per 100,000 births whereas in Australia the death rate from amniotic fluid embolism in the 27 years 1964–1990 was 0.90 per 100,000 confinements (table 1A).

It may be noted that in the last 18 reported years of statistics from Australia the overall rate of direct maternal deaths has fallen from 23.9 to 6J per 100,000 confinements whereas the comparable figures for amniotic fluid embolism were a fall from 1.43 to 0.63 per 100,000. It is of interest that in the 18 years 1973–1990, amniotic fluid infusion accounted for relatively more direct maternal deaths (10%; 27 of 277) than in the previous 9 years (6%; 31 of 518). In comparison with amniotic fluid embolism there has been a marked reduction in the numbers of maternal deaths and of the death rates from abortion + sepsis (101 to 9), obstructed labour (24 to 2), placenta praevia (21 to 6), abruptio placentae (24 to 9), pulmonary thromboembolism (110 to 43) and preeclampsia/eclampsia (73 to 41). The cause of amniotic fluid embolism remains an enigma even when only those cases with an autopsy‐proven diagnosis are considered. The careful analysis of clinical findings in this series of 9 cases, 7 based upon clinical diagnoses alone, do not support the widely held belief that precipitating factors for amniotic fluid embolism are overactivity of the uterus, multiparity and misuse of oxytocic drugs. It should be noted that in 7 of the 9 women in this study the symptoms and/or signs of amniotic fluid embolism first occurred during or subsequent to Caesarean section or hysterotomy.

Summary: A review of the syndrome of amniotic fluid embolism (AFE) was carried out over a 10 year period, 1984–1993, at the Royal Women's Hospital, Brisbane. There were 9 patients with AFE, of whom 2 died – this gave an incidence of fatal AFE of 3.37 per 100,000 pregnancies at the hospital, in comparison with an incidence of 1.03 per 100,000 pregnancies over a 27‐year period in Australia. The study revealed no identifiable risk factors in the characteristics of the patient or her baby, labour and delivery. Three of the patients did not undergo labour and in 4 of the 6 who did, the duration was less than 12 hours. The AFE syndrome could present before, during or after delivery; the common features were shock and respiratory distress, with coagulopathy occurring in 5 patients. Current views of predisposing factors, pathogenesis, diagnosis and management are discussed.
Fetal Fibronectin in the Cervicovaginal Fluid of Women with Threatened Preterm Labour as a Predictor of Delivery Before 34 Weeks' Gestation
Authors: Parker Jim , Bell Robin , Brennecke Shaun
Published: February 2008

Summary: Fetal fibronectin (fFN) is an extracellular matrix protein found at the junction between fetal and maternal tissue. It has been hypothesized that fFN is released into cervicovaginal fluid prior to the onset of preterm labour and during episodes of threatened preterm labour (TPL). In the present study fFN was present in the cervicovaginal fluid of 31% (11/36) of patients with TPL. The presence of fFN was found to be predictive of delivery prior to 34 weeks' gestation in 36 patients presenting with TPL and intact membranes (sensitivity 100%, specificity 81%). Eleven patients had a positive fFN assay and 5 delivered before 34 weeks (positive predictive value (PPV) 46%). Twenty‐five patients had a negative fFN result and none were delivered before 34 weeks (negative predictive value (NPV) 100%). Patients presenting with TPL who are fFN positive would be ideal candidates for intervention trials of tocolytics. It may be possible to delay or avoid immediate tocolysis and interhospital transfer in patients with a negative fFN immunoassay.
Intrapartum Detection of a Maerosomie Fetus: Clinieal Versus 8 Sonographic Models
Authors: Chauhan Suneet P. , Cowan Bryan D. , Magann Everett F. , Bradford T. Hal , Roberts William E. , Morrison John C.
Published: February 2008

Summary: The purpose of this study was to determine whether clinical or sonographic models have 1) the highest accuracy in differentiating newborns with birth‐weights ≥ 4,000 g (macrosomia) versus ≤ 3,999 g, and 2) among macrosomics which method of predicting birth‐weight has the lowest percentage error. Prospectively, 602 consecutive parturients at term had a clinical estimate of birth‐weight followed by sonographic measurement of fetal parts. The sonographic prediction of birth‐weight was derived using 8 different models that utilize either 1 measurement or a combination of 2 to 4 parameters. The incidence of macrosomia was 11.1% (67 of 602). Analysis of ROC curves indicated that clinical predictions (w = 0.85) were significantly better than 4 of the 8 sonographic models. The mean standardized absolute error among maerosomie newborns is significantly lower when predictions are derived clinically (99 ± 70 g/kg) than using 1 or 2 fetal parts. Sonographic assessment of birth‐weight is not significantly more accurate in the detection of a maerosomie fetus than clinical predictions.
Sexuality in Nigerian Pregnant Women: Perceptions and Practice
Authors: Adinma J. I. B.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it undoubtedly will interest readers and hopefully encourage a similar report on Australian women. We could do with more data on the subject. We can understand that sexual activity can be ‘painful’ or ‘gratifying’, that it ‘may help to keep the husband around’ but need enlightenment on how the activity is ‘functional’ (table 3 and text). Our interpretation of the data provided is that the term means ‘fulfilment of marital obligations’.

Summary: The sexual behaviour and beliefs of 440 pregnant women from South‐eastern Nigeria were investigated. The mean frequency of sexual intercourse during pregnancy (1.5 times per week) was less than that before pregnancy (2.3 times per week). The husband was the main initiator of sexual activity (41.6%), while the wife only rarely did so (2.7%). 44.3% of the respondents believed that sexual intercourse during pregnancy widens the vagina and facilitates labour; 34.8% that it improves fetal well‐being; 30.2% that it caused abortion in early pregnancy while 21.1% had no knowledge of any repercussions of sexual intercourse in pregnancy.

Coitus during pregnancy was always painful in 22.7% of the respondents; was always gratifying in 46.1%; was functional in 49.3% and helped to keep the husband around, also in 49.3% of the respondents.

The majority of the respondents (83.4%) considered that coitus should not be stopped during pregnancy. Whereas 19.3% of the respondents believed that sexual frequency should be increased during pregnancy, 73.9% considered otherwise, and 63.6% actually felt it should be reduced.

Findings from this study suggest a ‘mixed‐feeling’ effect with a tilt towards a positive attitude to sexuality in pregnancy. Restriction should not be imposed on sexual activity during a normal pregnancy to enhance marital harmony.
Insulin‐Dependent Diabetes Mellitus Presenting as Diabetic Ketoacidosis in Pregnancy
Authors: Ko Gary T. C. , Chow C. C. , Li C. Y. , Yeung Vincent T. F. , Cockram Clive S.
Published: February 2008

Summary: We report the cases of 2 pregnant women who developed diabetic ketoacidosis (DKA) in the third trimester as the first presentation of diabetes mellitus; both cases were associated with intrauterine fetal death.
Blood Loss in Termination of Early Pregnancy with Mifepristone and Gemeprost
Authors: Prasad R. N. V. , Choolani M. , Ratnam S. S.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it provides further evidence that the combination of an antiprogestogen and prostaglandin provides a medical termination of pregnancy with the median blood loss being approximately 90 mL and the median number days of bleeding 4. The amount of bleeding is comparable to a heavy period of normal duration albeit there being the risk that bleeding can be excessive. The antiprogestogen mifepristone is not available in Australia

Summary: The combination of an antiprogestogen with prostaglandin has been shown to be an effective alternative to surgical procedures for pregnancy termination in the first 49 days of amenorrhoea and has been available in France since late 1988. Mifepristone when used alone caused poor efficacy with unacceptable vaginal bleeding. The addition of a prostaglandin analogue (sulprostone, gemeprost) produced acceptable efficacy with less bleeding. The present study provides a quantitative assessment of blood loss in a sample of 20 women undergoing medical termination of early pregnancy (amenorrhoea ± 49 days). Vaginal bleeding occurred between days 3 and 15 of commencing therapy. The median number of days of bleeding was 4 with a median blood loss of 91.5 mL. The mean blood loss was 136.8 mL (± SD 159.2) but this did not adversely affect the hemoglobin level in the volunteers. Most patients describe the experience as that similar to a heavy period and viewed the procedure positively especially since they are spared the anaesthetic risks and hospitalization attendant with surgical abortion. Caution is still however advised as there may be the occasional subject with excessive haemorrhage (as in this study where one woman bled a total of 761.4 mL) and close supervision by a physician is essential.
Fibroid Arising in a Mullerian Duct Remnant and Presenting as a Pelvic Mass in a Patient with Vaginal Agenesis: An Unusual Finding
Authors: Baker James , Buttini Melissa
Published: February 2008

EDITORIAL COMMENT: We accepted this case because of its anecdotal interest and also to stress the message that a pelvic mass in a woman with known Mullerian tract anomalies merits an intravenous pyelogram to check on the presence and positions of kidneys and ureters before laparotomy is performed to remove the tumour. The histology report of the tumour gave the reviewer a moment of anxiety when ‘the duct‐like structure lined by tubal epithelium’ was described!

Authors reply: The authors were well aware of the risk of pelvic kidney being involved. Unfortunately an adequate IVP was unable to be obtained in this particular centre. We improvised by identifying 2 kidneys in normal position by ultrasound scan.

Summary: We report a case of vaginal agenesis associated with a large fibroid arising from a Müllerian duct remnant. Vaginal agenesis is rare and infrequently encountered by gynaecologists. Its association with a pelvic mass is even more uncommon, and a medline search by the authors has failed to uncover another reported case. We provide the clinical details of this case and discuss the differential diagnoses.
Vulval Lymphangioma: The Cause Still a Mystery?
Authors: Begum Aziz Aliya , Parvez Shahid , Hassan Sheema , Setna Faridon
Published: February 2008

Summary: Lymphangioma should be considered in the differential diagnosis of multiple warty lesions involving the vulva and treatment by wide local excision should be accompanied by frozen section assessment of the deep and lateral margins to reduce the recurrence rate.
The Use of Cervicography in the Follow‐up of Cervical Intraepithelial Neoplasia Treated by CO2 Laser
Authors: Allen D. G. , Ashton P. , Wintle M. , Conway C. , Planner R. S.
Published: February 2008

Summary: After treatment for cervical intraepithelial neoplasia (CIN) the follow‐up of patients would be simplified if colposcopy could be safely omitted. A study of 50 patients was performed to determine the feasibility of such an approach. Cervical cytology, cervicography and colposcopy, with or without biopsy, was performed in each patient. From the results the following criteria for colposcopy were adopted: (a) patients thought to have CIN on cytology or cervicography, (b) inadequate cervicography picture (vagina covering cervix or poor quality photograph), (c) high‐risk factors present (immunosuppression, after cone biopsy, postmenopausal). In this study the number of colposcopies would have been reduced from 50 to 11 if these criteria were adopted. Cervical cytology combined with cervicography is a reasonable alternative to colposcopy and we feel this is a technique worth pursuing for the follow‐up of patients treated for CIN.
Indications for Blood Transfusion in Pregnancy With Sickle Cell Disease
Authors: El‐Shafei Affaf M. , Dhaliwal Jagjeevan Kaur , Sandhu Amarjeet Kaur , Al‐Sharqi Mona Rashid
Published: February 2008

EDITORIAL COMMENT": These authors have previously reported the importance of sickle cell anaemia as a cause of maternal mortality in Bahrain (A). We have accepted this paper for publication although sickle cell anaemia is rare in Australia so that our readers can see the lesson learnt from this very large experience of 571 cases, namely that prophylactic blood transfusion is not indicated unless the haemoglobin value falls below 6 g/dL. We presume that all of these patients would require blood to be cross‐matched and available at delivery in case of postpartum haemorrhage.

Summary: In order to assess the value of prophylactic blood transfusion in the management of pregnant patients with sickle cell disease, a study was conducted on 571 sickle cell disease pregnancies. These patients were divided into 2 groups, one with prophylactic transfusion and the other with restricted transfusion. In spite of the reduction in the incidence of blood transfusion the rate of preterm labour, intrauterine growth retardation, perinatal mortality and maternal mortality were similar in both groups.

A restricted blood transfusion policy can be safely followed without compromising fetal or maternal well‐being with an additional benefit of reducing the incidence of transfusion related crises and other complications.
Invasive Cervical Cancer in Pregnancy
Authors: Allen David G. , Planner Robert S. , Tang Peter T. M. , Scurry James P. , Weerasir Tilak
Published: February 2008

EDITORIAL COMMENT": Readers are advised to give this paper careful attention. It reports a large experience of treatment of invasive carcinoma of the cervix during pregnancy and within 1 year of confinement. The authors emphasize the importance of performing a Papanicolaou cervical smear on all pregnant patients and their results show that adequate investigation including cone biopsy of the cervix is possible during pregnancy and that in the vast majority of women, treatment of the disease is possible without compromise to fetal or maternal life or health. To appreciate this paper the tables must be studied closely. It is interesting that the incidence of the disease was only 1 in 4,419 pregnancies, especially when 11 of the 22 cases had microinvasive disease with a depth of invasion of 3 mm or less. The recommended method of delivery in women with microinvasive squamous carcinoma of the cervix who have had cone biopsy during pregnancy is still not clear‐cut. Certainly vaginal delivery is possible in these women as was shown in 4 patients in this series. Further follow‐up is required to confirm the safety of this finesse.

Summary: Cervical cancer is the commonest malignancy which complicates pregnancy, but the management remains controversial. We reviewed our patients in an attempt to identify the best management options which resulted in long‐term survival for the mother and a live baby. The total number of pregnancies managed between January, 1981 and March, 1995 was obtained from the hospital records, and patients with invasive cervical cancer diagnosed during pregnancy or within 12 months of delivery were identified. The case records were reviewed. Between January, 1981 and March, 1995 there were 22 cases of cervical cancer diagnosed either during pregnancy or within 12 months postpartum. This gave an incidence of cervical cancer associated with pregnancy of 1 in 3,817 pregnancies or 0.26 per 1,000 pregnancies. Eleven patients had microinvasive disease. Nine were treated by cone biopsy and 2 by radical hysterectomy. Nine patients had Stage IB and 1 had Stage 2A disease and all were treated with radical hysterectomy. One patient had Stage 3B disease and was treated witfi radiotherapy and chemotherapy followed by simple hysterectomy. Fourteen patients delivered vaginally. Twenty of the 22 patients were delivered of live babies which survived. The patients have been followed from 1 month to 13 years with only 1 recurrence, and all 22 remain alive. We conclude that all pregnant women should have a Pap smear performed antenatally. Cone biopsy can be safely performed in pregnancy and may be adequate treatment for microinvasive squamous cell carcinomas. Treatment, including the timing of delivery, must be individualized, with the patient playing an important decisionmaking role.
A Rare Cause of an Acute Abdomen in Late Pregnancy
Authors: Simpson Ian , Ng Alfred , Griffin Chris
Published: February 2008

Summary: A case is presented where spontaneous rupture of a uterine arteriovenous malformation into the peritoneal cavity presented as an acute abdomen with fetal distress in late pregnancy. This is thought to be the first reported case of its type.
Combined Chemotherapy in the Medical Management of Tlibal Pregnancy
Authors: Anandakumar C. , Choolani M. A. , Adaikan P. G. , Wong Y. C. , Gopal M. , Marshall B. , Ratnam S. S.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because the regimen for medical management of tubal pregnancy by the systemic route with such small doses of methotrexate and prostaglandin seems much simpler than laparoscopic injection into the tubal pregnancy. The authors have been cautious with the management of these patients keeping them in hospital for a week after therapy. If this period of hospitalization is necessary then it distracts from the value of the method. It is difficult to see why hospitalization is more necessary in patients treated systemically than those reported by other authors where the methotrexate was introduced into the gestation sac under ultrasound control.

Summary: The medical management of early unruptured tubal ectopic pregnancies is gaining acceptance internationally as an alternative to surgical procedures. This method has been shown to be effective and safe in properly selected cases and with adequate supervision. Most of the work however has been done using either methotrexate or prostaglandins. The present study aimed to evaluate the efficacy of a combined therapeutic regimen. The efficacy was noted to be at least as good but with fewer side‐effects. The treatment was effective in 18 out of 19 cases of tubal pregnancies (94.7%). One patient complained of a gastritis which resolved with antacids. One patient experienced abdominal cramps and transient hypotension probably as a profound vagal response during tubal abortion. The median time to resolution varied directly with the initial serum beta HCG level at diagnosis. All patients who responded to die therapy described the experience as painless and viewed die treatment positively as it spared diem the need for surgery and its attendant anaestiietic risks. However, we strongly recommend caution and close supervision and to keep the patient in the hospital at least for the first week of dierapy.
A Randomized Comparison of the 3 Papanicolaou Smear Collection Methods
Authors: Kavak Zehra N. , Eren Funda , Pekin Sakip , Kiillu Sevgi
Published: February 2008

Summary: The purpose of this study was to compare the effectiveness of 3 cervical smear sampling devices for obtaining acceptable yields of endocervical cells in Papanicolaou smears. In a randomized, controlled clinical trial, we collected 346 smears over a 6‐month period, 110 with the Cervex brush, 125 with the cotton swab plus Ayre spatula and 111 with the Cytobrush plus Ayre spatula. The Cytopathology Laboratory, blinded to the Papanicolaou smear method, screened the smears using the Bethesda system guidelines. Statistical analyses were performed using the Pearson X2 and analysis of variance tests. There was an increased detection of endocervical cells in the Cytobrush plus Ayre spatula and the Cervex brush methods, compared with the cotton swab plus Ayre spatula group (p=2.39 × 10‐6, p=4.49 × 10‐7 respectively). There was no statistically significant difference between the Cytobrush‐spatula and Cervex brush groups (p=0.0779). We concluded that the Cytobrush‐Ayre spatula and the Cervex brush sampling methods were equally effective in obtaining endocervical cells in Papanicolaou smears.
Absence of Fetal Corpus Callosum Associated with Intrapartum Cardiotocographic Nonreacthity
Authors: Cincotta Robert , Brennecke Shaun
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it shows an interesting association between a cerebral malformation and abnormal cardio‐tocography. Chew and colleagues have previously reported that in series of patients with evidence of critical fetal reserve detected by antenatal cardiotocography the incidence of major fetal malformations ranged from 10–12%, a figure very similar to the major malformation rate of infants of women with prepregnancy diabetes delivered at the Mercy Hospital for Women 1971–1994 (47 of 392). These authors have recommended that when time permits ultrasonographic assessment of a fetus should be performed to seek evidence of major malformations when there is evidence of severe fetal compromise on antenatal cardiotocography. Nonetheless, most infants are not malformed when this type of cardiotocograph is seen, and it is also true that many infants with a major malformation may not show an abnormal cardiotocograph. This can also apply to cases with defects as severe as anencephalus. The association between a major cerebral abnormality and an abnormal cardiotocograph seen in this case is of interest but cannot be implied universally to the interpretation of abnormal cardiotocographs apart from suggesting the need to exclude malformation with ultrasonography.

Authors'reply to editorial comment:

Given the currently vexatious medicolegal climate in which obstetric care and paediatric neurological outcomes feature prominently, it is worthwhile to have on record a case such as this. Specifically, an implication of this report is that, whether or not there is any demonstrable anatomical cerebral abnormality, it remains possible that an abnormal intrapartum cardiotocograph may reflect abnormal paediatric neurological function which Caesarean delivery would not influence. Other means of assessing fetal well‐being in addition to cardiotocography are required to distinguish those cases that may benefit from interventional delivery from those that would not.
Incarcerated Procidentia: A Rare Complication of Carcinoma Cervix
Authors: Kriplani Alka , Relan Supriya , Kumar Lalit , Biswal B. M. , Rath G. K.
Published: February 2008

EDITORIAL COMMENT: The word incarcerated is defined as imprisoned; in pregnancy an incarcerated uterus is one imprisoned in the pelvis usually as a result of retroversion with presentation caused by acute retention of urine due to obstruction of the urethra. Irreducible is a more appropriate term to apply to a procidentia than incarcerated in our opinion. Rarely a procidentia is truly irreducible although a longstanding prolapse with ulceration and oedema may at first seem to be irreducible until the enterocele is progressively replaced ‐ the inexperienced practitioner may fail to replace such a prolapse if an attempt is made to reduce the anterior wall first. The anterior vaginal wall prolapses first followed by the cervix then enterocele and rectocele, and correction requires the same technique in reverse; i.e. the posterior aspect of the mass must be reduced first to correct the enterocele before the cervix and cystocele can be replaced into the vagina as is performed prior to preparation for surgery or rarely, insertion of a pessary when surgery is refused by either the patient or the anaesthetist. The editor has seen only one woman with an irreducible procidentia and in this case it had been present for many years and was extremely keratinized. We accepted the present case for publication because of its rare anecdotal interest and the excuse it provided for reminding readers how to replace a huge prolapse. It may be noted that the term procidentia means prolapse (Latin procedure: to fall forward) but it is often used as being indicative of third degree or massive prolapse. It would have been of interest to know the renal function in this woman. The case also illustrates how radiation can shrink a tumour and allow subsequent revision of treatment options when the woman does not abscond.

Summary: A rare case of a huge carcinoma of the cervix leading to sudden uterovaginal prolapse and incarcerated procidentia, in a postmenopausal woman is presented. The woman presented as an emergency with severe distress. The problem was successfully managed by reducing the uterovaginal prolapse under deep sedation and starting radiotherapy as an emergency procedure at the same sitting. The role of immediate radiotherapy in the management of such an emergency situation is discussed.
How Do New Zealand Gynaecologists Treat Menorrhagia?
Authors: Farquhar Cynthia M. , Kimble Rebecca M.N.
Published: February 2008

Summary: The objectives of this study were to establish the criteria and technique that New Zealand gynaecologists use for endometrial sampling for women with menorrhagia, and to establish the preferred medical therapy for menorrhagia. A postal survey of all practising gynaecologists in New Zealand was undertaken. Questions were asked regarding which women with menorrhagia should have an endometrial biopsy, what sampling method they used, and their first, second and third line medical treatments. There were 68 replies (48% response rate). There was no general agreement on the mean age at which women with menorrhagia should have an endometrial sample. Forty‐six percent preferred hysteroscopy to sample the endometrium, and 41% preferred a pipelle suction curette. The most favoured first‐line choice used to treat menorrhagia was luteal phase progestogens (54%). The most‐favoured second choice was the nonsteroidal antiinflammatory drugs (NSAIDs), and the most favoured third choice was danazol. The results from this study suggest that protocols need to be developed in order to prevent women with menorrhagia from being inappropriately investigated or suboptimally treated. It is possible that the high hysterectomy rate in New Zealand could be reduced if gynaecologists were to use more effective treatment earlier in the clinical presentation of menorrhagia.
Removal of Fibromyomas by Laparoscopic Surgery After Preoperative GnRH Analogue ‐ An Alternative to Abdominal Hysterectomy or Myomectomy
Authors: Wood C. , Maher P.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it reports a reasonably large experience of dealing with symptomatic fibromyomas of considerable size in women who wished to avoid or reduce the risk of hysterectomy. It should be noted that the fibromyomas in these women were unsuitable for the technique of ‘myolysis ‘reported previously by the authors. Readers interested in this subject are referred to a recent publication of patients treated in Italy where a randomized trial concluded that laparoscopic myomectomy in comparison with laparotomy myomectomy has benefits of a shorter recovery time and less postoperative pain {A). In this series of 40 patients the authors excluded those with more than 4 fibromyomas requiring removal and those with the largest fibromyoma exceeding 6 cm in mean diameter (A). Mais V and colleagues. Laparoscopic versus abdominal myomectomy: A prospective, randomized trial to evaluate benefits in early outcome. Am J Obstet Gynecol 1996; 174: 654–658. It is of interest that in this series ‘to reduce the risk of short‐term myoma recurrence, no patient underwent medical treatment for ovarian suppression before the operation.

Summary: Nineteen patients with fibromyomas who had been recommended to have a hysterectomy or abdominal myomectomy were referred as they wished to avoid a hysterectomy (14) or laparotomy incision for a myomectomy (5). Following administration of the GnRH analogue goserelin, laparoscopic surgery was performed on all these patients. Hysterectomy was avoided in all but 1 of the 14 patients and laparotomy myomectomy was avoided in 4 of the 5 patients recommended to have these procedures. The combination of a GnRH analogue and laparoscopic‐based surgery may be an acceptable alternative to both laparotomy myomectomy and hysterectomy in women with fibromyomas requiring surgery.
Impaired Glucose Tolerance in Pregnancy ‐ Is It of Consequence?
Authors: Tan Y.Y. , Yeo G.S.H.
Published: February 2008

Summary: This study was done to determine if impaired glucose tolerance in pregnancy was associated with increased maternal and neonatal morbidity and if so, whether the increased morbidity was due to the confounding factors of increased maternal age and maternal obesity. It was a retrospective analysis to compare 944 women with impaired glucose tolerance (IGT) in pregnancy with 10,065 women without abnormal glucose tolerance. The incidence of impaired glucose tolerance in pregnancy was 8.6% in this study. Even when maternal age and obesity were excluded, the IGT group had significantly higher risks of labour induction (relative risk, RR, 1.15); Caesarean section (RR: overall 1.43, elective 1.72, emergency 1.31); Caesarean section for dystocia/no progress (RR 1.60); macrosomia (RR 1.69,1.76,1.61 for birth‐weight =97th, 95th, 90th percentiles respectively) and shoulder dystocia (RR 2.84) when compared to the nondiabetics (NDM). The risks of hypertensive disease (RR 1.22) and Caesarean section for fetal distress/thick meconium‐stained liquor (RR 1.53) were also higher in the IGT group but these increases were not statistically significant when maternal age and obesity were excluded. There was no significant difference in the rates of low Apgar scores at 1 and 5 minutes between the 2 groups.
Failed Homebirths: Reasons for Transfer to Hospital and Maternal/Neonatal Outcome
Authors: Ngenda N. , Khoo S.K.
Published: February 2008

Summary: A review of patients who had been transferred to the Royal Women's Hospital, Brisbane after a failed homebirth was undertaken over a period of 5′/2 years. There were 27 patients identified. The most common reason for transfer was failed progress in labour, although 4 patients were transferred after delivery. Despite the resistance of these patients to medical intervention, the study found that 63% of patients required assistance at delivery, by vacuum extraction, forceps or Caesarean section. The morbidity suffered by the babies was significant (8 were admitted to special and intensive care nursery) but long‐term sequelae cannot be determined because of early discharge against medical advice and refusal to be followed‐up in some instances.
Postcoital Contraception: Who Uses the ‘Morning After Pill’?
Authors: Pyett Priscilla M.
Published: February 2008

Summary: Postcoital contraception (PCC) is a safe and effective method of avoiding unwanted pregnancy after an occurrence of unprotected sex. It nevertheless represents an absence or failure of preventive strategies. Women engaging in unprotected sex may have been exposed to risks of sexually transmissible diseases (STDs) including HIV/AIDS. Family planning service providers have expressed concern at the number of women using this emergency measure as a form of contraception, sometimes repeatedly, but little is known about the sort of women they are and the context in which unprotected sex has occurred. This paper reports the sociodemographic characteristics of women requiring PCC in the two clinical sites of Family Planning Victoria. A self‐administered questionnaire was completed by 206 women who required PCC during a 3‐month period. The women were aged 14–43 years with an average age of 23 years. Over half the women had used PCC previously and more than a quarter of these women had used it more than twice before. Most of the women had had sex with a regular boyfriend, husband or partner at their own or their partner's home. The main reasons given for needing PCC were nonuse of condoms, condom breakage and missing an oral contraceptive pill.
Pregnancy and Active Wegener Granulomatosis
Authors: Parnham Alan P. , Thatcher Geoffrey N.
Published: February 2008

EDITORIAL COMMENT: We accepted this case report not only because readers could encounter a patient with Wegener granulomatosis, but also because the use of cyclophosphamide from 22 weeks gestation did not harm the fetus. We have asked the authors to provide readers with a 100–200 word summary of the aetiology, clinical features and complications of Wegener granulomatosis.

Author's response: Wegener granulomatosis is a systemic necrotizing granulomatous vasculitis of unknown aetiology with a predilection for the kidney and upper respiratory tract, especially the nose and sinuses. It classically causes acute renal failure, epistaxis, and pulmonary haemorrhage. It can however affect any organ and untreated has an 82% 1‐year mortality. It can occur at any age but is more common in elderly patients. It is very strongly associated with cytoplasmic antineutrophil cytoplasmic antibody (cANCA) which is directed against a serine proteinase 3 antigen and can be used to follow the course of the disease. Unless the patient has very localized disease, treatment always involves cyclophosphamide and high dose steroids ± plasmapheresis to obtain remission. This would then be followed by a prolonged course of azathioprine and steroid treatment.
Intrauterine Retention of Fetal Bone
Authors: Chan Norman S.T.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication although the February issue of our Journal contained a similar case (Bellingham FR. Endometrial bone formation. Aust NZ J Obstet Gynaecol 1996; 36: 109–110) because this paper gives a very careful complete review of the literature on the subject and discusses the pathology of ectopic bone formation within the uterus.

Summary: A case of secondary infertility, dysmenorrhoea and menorrhagia due to retained fetal bone is presented. Retained fetal bones should be considered in all patients with infertility, dysfunctional uterine bleeding, dysmenorrhoea or other symptoms dating from a pregnancy or pregnancy termination. Ultrasound is an excellent modality for evaluating these patients. Ultrasound is also very useful for the follow‐up of patients after surgical removal of the bony fragments. Some bony fragments may be embedded in the endometrium or myometrium and may not be identified at curettage. Hysteroscopy is valuable in both establishing the diagnosis and the removal of bony fragments. A crucial aspect of the procedure involves re‐introduction of the hysteroscope to document that the cavity is clear after attempts at bone removal are complete. After removal of bony fragments, restoration of fertility and improvement of symptoms are expected.
Struma Ovarii Presenting as Acute Pseudo‐Meigs Syndome with an Elevated CA125 Level
Authors: Bethune Michael , Quinn Michael , Rome Robert
Published: February 2008

Summary: A 62‐year‐old woman presented with acute hydrothoraces and ascites. The CA 125 level was greatly elevated and pelvic ultrasound revealed an adnexal mass with solid and cystic components. At surgery a benign pure struma ovarii was diagnosed and following removal of the tumour the patient had immediate and complete resolution of her symptoms. This is the first report of struma ovarii causing both pseudo‐Meigs syndrome and a marked elevation of CA 125.
The Effect of Intraumbilical Oxytocin on the Third Stage of Labour
Authors: Özcan Tülin , Sahin Güler , Senöz Selim
Published: February 2008

The umbilical vein administration of oxytocin in saline was compared with umbilical vein saline alone and the traditional management of the third stage of labour. Seventy‐two women were randomized to 3 groups. Group 1 received intraumbilical 20 IU of oxytocin diluted to 40 mL with saline. Group 2 received intraumbilical vein 40 mL of saline while subjects in group 3 were managed according to the standard protocol without any intraumbilical injection. No significant differences were found in terms of the length of the third stage, the blood loss in the third stage and postpartum haematocrit differences among the 3 groups. The administration of diluted oxytocin or saline do not seem to have any superiority to the traditional management of the third stage of labour.
Sharing Antenatal Care: Client Satisfaction and Use of the ‘Patient‐held Record’
Authors: Webster J. , Forbes K. , Foster S. , Thomas I. , Griffin A. , Timms H.
Published: February 2008

Two hundred women (148 shared care patients and 52 clinic patients) completed a questionnaire about care received during pregnancy and the use of a patient‐held record. Women receiving shared care reported higher levels of satisfaction with their care than clinic patients (p<0.0001). Thirty‐six percent of the women in shared care forgot to take their record to an appointment on at least 1 occasion. During the pregnancy, over half of the respondents in both groups made contact with the hospital for reasons other than for their regular visit. For both groups, convenience was the most frequently reported reason for choosing their model of care. Other important issues for shared care patients were that the service was more personal and more information was provided. Among clinic patients, safety and quality of care were identified as important. Problems involved with the patient holding the only complete pregnancy record are discussed.
National Trends in Gynaecological Endoscopic Surgery
Authors: Molloy David , Crosdale Sue
Published: February 2008

Endoscopic or minimal access surgery promises less postoperative pain and decreased hospitalization. It is also a more reliable diagnostic tool than some conventional diagnostic procedures. The Medicare database was analyzed over 4 sequential financial years (1991–1992 to 1994–1995) to assess trends in utilization of endoscopic procedures in the private sector. Hysteroscopy is slowly replacing dilatation and curettage as a diagnostic procedure. Endometrial ablations are decreasing. A higher proportion of adnexal procedures and ectopic pregnancies are being managed endoscopically. Laparoscopically‐assisted hysterectomies are slowly increasing. However data from the last 2 financial years suggests that the trend to endoscopic procedures is stalling with laparotomy still being extensively used. This may indicate an increased need for education and workshops by responsible organizations to extend the potential benefits of endoscopic surgery to more patients.
Combination of Vaginal Ultrasonography and Pipelle Sampling in the Diagnosis of Endometrial Disease
Authors: Kayak Zehra , Ceyhan Nejat , Pekin Sakip
Published: February 2008

In this article, we aimed to investigate the value of Pipelle endometrial sampling with and without sonographic measurement of endometrial thickness in the diagnosis of endometrial disease. We studied prospectively 78 patients scheduled for dilatation and curettage in order to evaluate abnormal uterine bleeding. Sonographic measurement of the endometrial thickness and endometrial sampling with the Pipelle were performed before the curettage. The accuracy of ultrasonography and the Pipelle sampling was measured against the final diagnosis. In 68 cases (87.1%), the endometrial histological results of curettage agreed with those of the Pipelle sampling. Pipelle endometrial sampling had a sensitivity of 73% and a specificity of 100% for endometrial disease. The use of ultrasonography increased the sensitivity of the Pipelle aspiration from 73% to 90%.
Inappropriate ADH Secretion Due to Immature Ovarian Teratoma
Authors: Lam S.K. , Cheung L.P.
Published: February 2008

Inappropriate antidiuretic hormone secretion syndrome (IADHS) is usually associated with postoperative pain, stress, chest infection, drugs or carcinoma. It is rarely found in patients with gynaecological malignancy. IADHS was found in a 17‐year‐old girl with an immature ovarian teratoma. Hyponatraemia was persistent and did not respond to fluid restriction therapy before the operation. The plasma sodium level however returned to normal after the removal of the tumour. This is the first reported case of IADHS due to an immature ovarian teratoma or germ cell tumour.
Long‐Term Satisfaction with Sheares Vaginoplasty for Congenital Absence of the Vagina
Authors: Fliegner John R.
Published: February 2008

Although a number of surgical and nonsurgical techniques have been described for the formation of a neovagina in cases of congenital absence, there are few reports on long‐term results, and especially coital function. At the Royal Women's Hospital, Melbourne, the modified Sheares technique has been used almost exclusively in cases of vaginal agenesis since 1972. This paper analyses the clinical details and surgical problems encountered, and assesses the long‐term sexual satisfaction of the procedure. In 23 patients who were sexually active, satisfactory intercourse was occurring in 18, (78%), 3 patients had serious psychological problems and 1 was lost to follow up.
Uterine Tumour Resembling an Ovarian Sex‐Cord Tumour Presenting with Spontaneous Haemoperitoneum in Pregnancy
Authors: Vagno Giovanni Di , Cormio Gennaro , Leonardo Resta MD  , Colucci Giuseppe A. , Provenzano Luigi , Selvaggi Luigi
Published: February 2008

EDITORIAL COMMENT: We accepted this case report for publication because of its rare anecdotal interest and amazingly different prognoses for mother and child. Who ever heard of a huge uterine sarcoma, masquerading as red degeneration of a fibromyoma, rupturing spontaneously in a mother doomed with undiagnosed metastatic disease and with the infant born in good condition at Caesarean hysterectomy? The results of serial ultrasonography in this woman are unusual and may provide a clue for the management of such cases.
Adenocarcinoma in Situ of the Uterine Cervix Progressing to Invasive Adenocarcinoma
Authors: Hocking Glenn R. , Hayman John A. , Östör Andrew G.
Published: February 2008

Summary: This report documents a case of adenocarcinoma in situ (AIS) of the cervix progressing to invasive adenocarcinoma. The patient, who was 32‐years‐old at the time of diagnosis of AIS, was followed with negative smears for 7 years after conization when a smear showed malignant glandular cells. A repeat conization demonstrated well differentiated papillary adenocarcinoma. The patient remains well 8 years after radical hysterectomy and lymph node dissection. The clinicopathological features of this case and a brief review of the literature are presented.
From Delivery Suite to Laboratory: Optimizing Returns from Placental Examination in Medico‐legal Defence
Authors: Khong T.Y.
Published: February 2008

Summary: While examinations of the placenta may reveal significant lesions that are helpful in a medico‐legal context, its value may be diminished by a lack of attention to detail in the period between delivery of the baby and receipt of the placenta in the pathology department. These fall generally into 2 groups: initial description and handling of the placenta and lack of relevant clinical information. This communication describes some of these pitfalls. By observing these details, the onus then falls on the pathologist to provide a meaningful assessment of the placenta.
Outcomes of Induced Labour
Authors: Robson Stephen , Pridmore Brian , Dodd Jodie
Published: February 2008

EDITORIAL COMMENT: This observational study makes the valuable point that the outcomes of labour and delivery where labour was induced for nonmedical indications, were comparable for the outcomes of spontaneous labour. As the authors point out this challenges the premise of the RACOG Obstetric Indicator which suggests that induction of labour for ‘nondefined’ indications should be kept to a minimum. This implies that labour can properly be induced for ‘social’ indications without concern for increasing the rate of birth complications. However, as the authors point out, this conclusion requires further testing in a prospective study where the state of the cervix is evaluated.

Summary: We report a review of maternal and neonatal outcomes of labour in 1,405 pregnancies managed during a 12‐month period. This included all singleton pregnancies of greater than 20 weeks' gestation, excluding women antenatally assigned for Caesarean delivery. Labour was induced in 313 cases (22.3%), and records were available for review in 311 of these. We classified the indications for induction according to the Australian Council of Healthcare Standards (ACHS) / RACOG list of ‘defined’ indications in Obstetric Clinical Indicator number 1. In 165 cases (53.7%) labour was induced for defined indications. There was no significant difference in the rates of instrumental vaginal delivery, Caesarean delivery or adverse neonatal outcome (admission to neonatal nursery in the first 24 hours of life; 5 minute Apgar score of <7) between women who laboured spontaneously and those induced for ‘nondefined’ indications. However, labours induced for ‘defined’ indications had a significantly increased rate of these outcomes.
The Role of Ureaplasma urealytkum in Adverse Pregnancy Outcome
Authors: Knox Christine L. , Cave Donald G. , Farrell David J. , Eastment Henry T. , Timms Peter
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it gives important information about the frequency of colonization of the lower and upper genital tract of pregnant women with Ureaplasma urealyticum. Although the authors discuss adverse pregnancy outcome they did not mention perinatal mortality or morbidity due to infection with Ureaplasma urealyticum although they note that there were 4 of the 16 preterm deliveries where there was evidence of chorioamnionitis. We have previously published a paper from the Toowoomba Base Hospital group on Ureaplasma urealyticum chorioamnionitis associated with 2 perinatal deaths and 1 case of severe chorioamnionitis where the infant survived (A). We refer readers to the Editorial Comment that accompanied this paper.

Summary: We investigated Ureaplasma urealyticum genital tract colonization rates in an Australian population to determine whether colonization was associated with adverse pregnancy outcome. Women attending an antenatal clinic were evaluated for lower genital tract colonization at their first antenatal visit (162 women) and at 28 weeks' gestation (120 women). Placentas from 92 women were cultured. U. urealyticum was the predominant isolate from the lower (57.4%) and upper (17.4%) genital tract in this population of pregnant women. U. urealyticum was a persistent colonizer during mid‐trimester of pregnancy (in 88% of women colonized) whereas M. hominis, G. vaginalis, and Group B streptococcus were present as transient flora of the lower genital tract. Lower genital tract colonization during pregnancy was not directly associated with adverse pregnancy outcome. However preterm delivery in afebrile, asymptomatic women, could possibly be associated with chorioamnionitis (4 of 16 preterm births). Screening of women with a history of preterm birth may prevent upper genital tract infections and preterm delivery.