bluuebunny/crossref_metadata_2025 huggingface dataset:
Ureteric Injury at Burch Colposuspension 4 Case Reports and Literature Review
Authors: Rosen David M.B. , Korda Andrew R. , Waugh Richard C.
Published: February 2008

Summary: The Burch colposuspension operation is an accepted and effective technique for the correction of genuine stress incontinence. It is, however, associated with a number of well‐recognized complications. Ureteric injury at the time of colposuspension is a potentially severe, if uncommon, complication of this procedure with legal ramifications for the surgeon as well as health risks for the patient. To date, only 19 cases have been described in the literature. This paper highlights 4 cases of this injury occurring amongst the patients of 1 urogynaecologist (2) and gives an incidence for its occurrence as well as discussing the aetiology and management of this complication.
A Case of Acute Colonic Pseudoobstruction in Pregnancy
Authors: Rieger Nicholas A. , Lyon William J. , Bryce Robert L. , Birrell Stephen N.
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication because it shows that acute colonic pseudoobstruction can occur during pregnancy and may be successfully managed by colonoscopy as in this patient. For readers' interest we direct them to 2 previous case reports on Ogilvie syndrome which occurred post‐Caesarean section and which were complicated by spontaneous perforation of the colon: Atypical Ogilvie syndrome. Paraskevaides EC. Aust NZ J Obstet Gynaecol 1988; 28: 148–149; Ogilvie syndrome with caecal perforation in the post‐Caesarean patient. Tang PTM, Collopy BT, Somerville M. Aust NZJ Obstet Gynaecol 1995; 35: 104–106. These papers indicate that perforation is likely to occur if the caecum is dilated to a diameter between 9–12 cm; the dilatation of the transverse colon to 18 cm in the present case is remarkable.
Vaginal Delivery After Caesarean Section: Factors Influencing Success Rates
Authors: Lovell Rosemary
Published: February 2008

In a retrospective review of 333 pregnancies in women who had 1 previous Caesarean section, 244 (73.3%) underwent a trial of scar, and 89 (26.7%) had an elective Caesarean section. In the trial of scar group 197 (80.7%) had a vaginal delivery and 47 (19.3%) required an emergency Caesarean section. The success of the trial was favourably influenced by a nonrecurring indication for the original Caesarean section, a previous vaginal delivery, and a smaller baby. Maternal morbidity was greater in the groups requiring a Caesarean section, whether elective or emergency. Those patients delivered vaginally spent significantly less time in hospital. In 2 of the 244 patients (0.8%) who underwent a trial of scar the previous lower segment scar was found at Caesarean section to have dehisced or ruptured.
Termination of Early Human Pregnancy with Either 50 mg or 200 mg Single Oral Dose of Mifepristone (RU486) in Combination with Either 0.5 mg or 1.0 mg Vaginal Gemeprost*
Authors: Prasad R.N.V. , Choolani M.
Published: February 2008

Mifepristone (RU486) is licensed for use in France at a dose of 600 mg in combination with 1.0 mg of vaginal gemeprost (a prostaglandin E1 analogue) for medical termination of early pregnancy up to 7 weeks' amenorrhoea resulting in 96% complete abortion rates. This study examines if it is possible to use lower doses of mifepristone and gemeprost to achieve similar success for women with pregnancies up to 56 days' amenorrhoea. Four groups of 25 women were scheduled to be given single oral doses of either 50 mg or 200 mg of mifepristone followed 48 hours later by insertion of a single vaginal pessary of 0.5 mg or 1.0 mg gemeprost. The lowest dose combination (i.e. 50 mg mifepristone + 0.5 mg gemeprost) was found to have unacceptable efficacy with a complete abortion rate of only 82%; the highest dose combination (i.e. 200 mg mifepristone + 1.0 mg gemeprost) resulted in a satisfactory complete abortion rate of 96% which is comparable with the rates for the recommended high 600 mg mifepristone dose (+ 1.0 mg gemeprost) in routine clinical use in France. The current study shows that efficacy can be maintained using a third of the recommended dose of mifepristone.
Complications of 174 Laparoscopic Hysterectomies
Authors: Cooper M.J.W. , Cario G. , Lam A. , Carlton M. , Vaughan G. , Hammill P.
Published: February 2008

The case records of 174 patients who underwent laparoscopic hysterectomy between September, 1992 and April, 1995 were retrospectively reviewed. The mean age of the group was 45.4 (range 17.8–68.5) years, mean weight 70.2 (50–121) kg and mean parity 2.3 (0–4). Laparoscopic hysterectomy (i.e. uterine arteries secured laparoscopically) was performed in 98 patients, laparoscopically assisted vaginal hysterectomy in 70, and laparoscopic subtotal hysterectomy in 6. Bilateral or unilateral oophorectomy were performed in 40 cases. The mean operating time was 131 (45–285) minutes and mean hospitalization 2.6 (1–11) days. Endoscopic stapling devices were used in 135 cases, biopolar diathermy in 117, sutures and ties in 84, and the harmonic scalpel in 29. The overall complication rate was 16%. Seven cases (4%) required conversion to laparotomy. These included 2 inadvertent cystotomies (1 after 2 Caesarean sections), 3 cases of dense uterovesical adhesions following previous surgery and 2 instances of excessive uterine size (>16 weeks). The mean follow‐up period was 2.2 (1–18) months. One patient had a shortened vagina requiring dilatation and another had vault granulations requiring diathermy treatment. Overall 98.3% of patients were satisfied with their surgery.
A Review of Results in a Series of 113 Laparoscopic Colposuspensions
Authors: Cooper M.J.W. , Carlo G. , Lam A. , Carlton M.
Published: February 2008

The case records of 113 women having laparoscopic retropubic colposuspensions (Burch procedure) performed for the treatment of genuine urinary stress incontinence between December, 1992 and April, 1995 were retrospectively reviewed. The mean age of the group was 49.4 (30–80) years, mean weight 72.1 (44.5–114) kg, and mean parity 2.7 (0–8). All patients had preoperative urodynamic study to confirm genuine stress incontinence (GSI). Sixteen patients (14%) had dual pathology (GSI and detrusor instability).

A transperitoneal approach was used in 93 operations and extraperitoneal in 20. The mean operating time was 108 (30–320) minutes and mean hospitalization 3.3 (1–10) days. In 13 women the operation was converted to laparotomy; 10 due to adhesions and diminished bladder mobility, 1 for inferior epigastric vessel injury, 1 for an ovarian tumour discovered incidentally at the procedure and 1 for equipment problems. Operative complications included 10 cystotomies (5 repaired laparoscopically), 2 extraperitoneal cases converted to transperitoneal, 1 inferior epigastric vessel injury, 1 vaginal tear, 1 suture through the bladder and 1 case of possible enterotomy oversewn at laparoscopy.

The mean follow‐up period was 8.4 (1–28) months. All patients were reviewed postoperatively and then contact was attempted either by telephone or in consultation. There was an overall 87% subjective success rate. Two patients felt sutures tear out at 4 and 6 months and were deemed failures; 4 felt their incontinence was improved but had ongoing stress incontinence of urine; 9 had symptoms of detrusor instability and one developed an enterocele 9 months after surgery.
Role of Endoscopy in Retrieval of Misplaced Intrauterine Device
Authors: Mittal Suneeta , Kumar Sunesh , Roy Kallol K.
Published: February 2008

We report a series of 45 patients with misplaced intrauterine devices (30 extrauterine and 15 intrauterine). Only those patients with intrauterine misplacements in whom conventional blind removal was not possible were included in the study. All of the 15 misplaced intrauterine devices could be removed hysteroscopically; 22 of the 30 extrauterine misplaced devices (73%) could be removed laparoscopically. One patient required both laparoscopy and hysteroscopy. Only 7 (15.5%) of 45 patients required laparotomy for safe removal of misplaced devices. Considerable comfort and minimal hospital stay associated with endoscopic procedures should offer these as the first line attempt to remove a misplaced intrauterine or extrauterine translocated device.
An Audit of the Women Who Died During 1994 from Cancer of the Cervix in Victoria, Australia
Authors: Mitchell Heather , Medley Gabriele , Higgins Vicky
Published: February 2008

An audit of 73 Victorian women who died from cervical cancer during 1994 is presented. Seventy per cent of the deaths occurred in women who were 50 years at the time of cancer diagnosis. Younger women had significantly better screening histories than older women, but overall only 10% of the deaths occurred among women who were adequately screened. There was no excess of deaths in rural women or in women of non‐English speaking background. Four of the 6 deaths in women who were diagnosed with cancer while <35 years of age occurred in adequately screened women. If this finding is confirmed in a larger series, it raises questions about the ability of Papanicolaou screening to control disease in this age group.
Rectosigmoid Complications of Radiotherapy in Stage 3B Carcinoma of the Cervix
Authors: Vyas Rakesh Kumar , Dixit Sanjay , Singhal Sandip , Baboo Harshad A. , Aurora Dayal C. , Venkatratnam S.
Published: February 2008

A retrospective analysis of 165 patients with Stage 3 B carcinoma of the cervix treated with radiotherapy alone was done; 120 patients were treated with a combination of external radiotherapy and intracavitary treatment while 45 patients received external radiotherapy only. Early rectosigmoid reactions were seen in 65% of cases with Grade 1, 2 and 3 reactions in 40%, 20% and 5% of cases respectively. Late rectosigmoid sequelae were observed in 25 patients (16%) with moderate complications in 5%. Severe rectal complications were seen in 2 women only. Rectosigmoid complications are the most common sequelae of pelvic irradiation and seen more in advanced stages where a greater dose is given by external radiotherapy. The role of rectal dosimetry is equivocal if proper precautions are taken during intracavitary treatment.
Abnormal Cervical Cytology Leading to the Diagnosis of a Primary Serous Adenocarcinoma of the Peritoneum
Authors: Maher Chris E , Haran Mano V. , McLaughlin John
Published: February 2008

A case is presented where abnormal cervical cytology in an asymptomatic female led to the diagnosis of a primary serous adenocarcinoma of the peritoneum. We would like to highlight the importance to the physician of a tumour diathesis on malignant cervical cytology.
Ovarian Epithelial Tumour in Gonadal Dysgenesis A Case Report and Literature Review
Authors: Lam S.K. , Yu M.Y. , To K.F. , Chan M.K.M. , Chung T.K.H.
Published: February 2008

A patient with gonadal dysgenesis was found to have a mucinous epithelial ovarian tumour on the left side and a streak gonad on the right. The preponderance of mucinous tumours (5 of 8) over other epithelial tumours in these patients is noted but the significance is not fully understood. Two models of pathogenesis (incessant ovulation and hypergonadotrophic hypogonadism) were proposed but neither satisfactorily explains the development of the tumours. Further ultrastructural, chromosomal and molecular biological study of these tumours may help to elucidate the underlying cause and pathogenesis.
Accuracy of Estimated Fetal Weight below 1,000g
Authors: Scott Fergus , Beeby Philip , Abbott Jason
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it gives useful information on the interpretation of ultrasonographic estimates of fetal weight when considering whether fetal viability is such that Caesarean section is indicated on fetal grounds as the method of delivery in a complicated pregnancy.

Summary: The Wars of formula is 1 of 3 currently recommended by the Australian Society for Ultrasound in Medicine for the routine estimation of fetal weight. However, this formula was derived using mostly large fetuses, and its accuracy in extremely low birth‐weight fetuses is not known. Using this formula, we studied 184 infants delivering within 14 days of an estimated fetal weight (EFW) <1,000 G, The mean percent error in EFW was 11.7% underestimation, with 80% of infants underestimated and 61% of estimates within 15% error. The percent error was consistent at 9.6% throughout the first 9 days, but increased to 32% after 10 days post scan (p<0.0001). There was a significant association between the accuracy of EFW and maternal height, but not with placental position, liquor volume or multiple pregnancy. EFW underestimated birth‐weight on average by 9.6% during the first week, and this error appeared to be mainly due to the formula. The error in EFW became unacceptable after 9 days and repeating the estimate before 10 days is recommended. A different formula may be more suitable for extremely low birth‐weight fetuses.
The Predictive Value of Biophysical Profiles and Doppler Veloeimetry for Fetal Acidosis in a Low Risk Population
Authors: Kent Nancy , Matthews Len , Davies Peter , Stanton Lisa
Published: February 2008

Summary: Antenatal fetal monitoring is the principal means of distinguishing the fetus requiring imminent delivery from that which is coping well in utero. The ability to detect fetal compromise, defined by fetal acidosis, in a low‐risk population was evaluated in a prospective study of 50 women undergoing a Caesarean section in the absence of labour. The sensitivity and positive predictive value of a modified biophysical profile (BPP) or Doppler veloeimetry to detect a fetus subsequently born with an umbilical artery pH of less than 7.20 was poor. The incidence of fetal acidosis in the population under study was 8%. Interpretation of antenatal fetal assessments must be tempered by the clinical features of each case. Decisions to deliver should take into account the low sensitivity of these tests in the absence of other complicating factors.
A Comparison Between Visual Estimation and Laboratory Detennination of Blood Loss During the Third Stage of Labour
Authors: Razvi K. , Chua S. , Arulkumaran S. , Ratnam S. S.
Published: February 2008

Summary: A prospective study was conducted to compare the accuracy of visual estimation of blood loss (EBL) at delivery with laboratory determination of measured blood loss (MBL). It showed that EBL tends to be clouded by the conventional teaching that blood loss at delivery is usually between 200 to 300 mL. Women with MBL up to 150 mL were overestimated and the best correlation was in women with MBL between 150 to 300 mL. There was a tendency to underestimate blood loss when the MBL was between 301 to 500 mL. Of the 9 women with a primary postpartum haemorrhage, only one was correctly diagnosed as such and 3 women were estimated to have blood losses of at least 500 mL but the measured blood losses were all lower. It was concluded that visual estimation of blood loss is inaccurate, especially at the extremes of MBL and that primary postpartum haemorrhage is not detected by visual estimation of blood loss, unless there are associated signs of haemodynamic instability.
Ergotamine Use in Pregnancy
Authors: Hosking Simon P.
Published: February 2008

EDITORIAL COMMENT: We accepted this short report for publication to warn readers that ergotamine may cause acute fetal hypoxia. Although prescribing information lists pregnancy as a contraindication, there is still a belief that ergotamine can be used in pregnancy. The mechanism of injury of the fetus is not clear‐cut. The use of ergotamine was associated with more than just the fetal brain becoming hypoxic: the cardiotocograph shows features of myocardial ischaemia as well. The fact that the infant was stillborn also suggests myocardial injury, so that isolated cerebral vasospasm seems unlikely. It is of interest that meconium was not passed. Both this case and that described in reference 4 indicate that ergotamine may cause uterine contractions as well as vasospasm.
Rectal Carcinoma In Pregnancy
Authors: Gard G.B. , Peek M.J.
Published: February 2008

Rectal carcinoma is an uncommon malignancy in pregnancy. Described below is the case report of a patient with rectal carcinoma diagnosed in pregnancy, together with a review of the current literature. When rectal carcinoma is diagnosed at greater than 20 weeks' gestation the timing and mode of delivery become the major obstetric management decisions. The approaches to these problems are outlined in this report.
Primary and Recurrent Colorectal Cancer Masquerading as Gynaecological Malignancy
Authors: Brand A. , Scurry J. , Planner R. , Leung S.
Published: February 2008

To make clinicians more aware of the phenomenon of primary and recurrent colorectal and anal carcinoma masquerading as primary gynaecological malignancy, we reviewed the records of 8 women referred to our gynaecological oncology unit with primary colorectal cancer (1), recurrent colorectal cancer (6) and primary anal cancer (1). Seven of these patients presented with abnormal vaginal bleeding or discharge. All patients had Papanicolaou smears performed; 7 were abnormal and 1 unsuitable for cytological assessment. None of the 6 patients with recurrent carcinoma had been previously treated with more than standard anterior or abdominoperineal resection; no radiotherapy had been given, and only 1 patient had received chemotherapy. These patients were treated in our gynaecological oncology unit for their recurrence by surgery and/or chemotherapy and/or irradiation. All 6 had further recurrences in the pelvis despite this aggressive therapy. Follow‐up of colorectal cancer in women should involve gynaecological history, pelvirectal examination and Pap smear at each visit. Correct diagnosis of the colorectal origin of a genital tract tumour is made on careful history, examination and biopsy. An abnormal Pap smear may be the first indication of recurrent colorectal cancer in the cervix and vagina, although most patients ultimately present with abnormal vaginal bleeding. The presence of a tumour invading both cervix and posterior vaginal wall is suggestive of spread from a colorectal tumour compared to the more common lateral spread of a cervical primary.
Intrauterine Adhesions: Hysteroscopic Lysis and Adjunctive Methods
Authors: Bellingham F. Richard
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because the author describes a sophisticated method of dealing with adhesions under ultrasound control in those patients where the adhesions are dense. It is always difficult to assess the effectiveness of therapies used in the treatment of infertility especially as most studies do not have a control series. This comment may particularly apply to patients with minor adhesions that are divided by the passage of a hysteroscope.

Summary: A series of 17 patients with significant intrauterine synechiae is presented with a demonstration of various adjunctive therapeutic measures which may be helpful. The procedure is ideally performed under ultrasound control and this is essential if the adhesions are extensive. There may be a place for postoperative use of an intrauterine contraceptive device or of hormone therapy, but these modalities are not universally accepted. However, 11 of 13 patients regained normal menstruation and 8 of the 10 desiring pregnancy achieved livebirths with these methods. Four of the latter had had severe adhesions. One patient (Case 9) was not seen after the postoperative visit (“lost to series‘) and 1 (Case 7) later had a hysterectomy for pain but the operative specimen showed a normal uterine cavity.
Undiagnosed Ectopic Pregnancy: A Retrospective Analysis of 31 ‘Missed’ Ectopic Pregnancies at a Teaching Hospital
Authors: Robson Stephen J. , O'Shea Robert T.
Published: February 2008

Summary: The management of 255 surgically proven cases of ectopic pregnancy, treated at a teaching hospital over a 5‐year period, was retrospectively reviewed to determine the proportion of cases where the diagnosis was ‘missed’ at initial presentation. Thirty‐one patients (12%) had presented and been discharged with an incorrect diagnosis, then subsequently readmitted for definitive treatment of a tubal ectopic pregnancy. In this group, the mean time from initial presentation to definitive surgery was 8 days. Ten of the 31 women with ‘missed’ ectopic pregnancies (32%) underwent salpingectomy, whereas the rate of salpingectomy in those women whose ectopic pregnancy was correctly diagnosed at first presentation was 19.5% (44 of 224). We conclude that delays in the diagnosis of ectopic pregnancy may be associated with an increased rate of salpingectomy, which may in turn reduce prospects for future fertility, a finding not previously canvassed in the literature. The factors contributing to misdiagnosis of ectopic pregnancy are discussed and compared with those reported in other studies.
Chronic Ectopic Pregnancy: A Clinical Analysis of 62 Cases
Authors: Uĝur Mustafa , Turan Cem , Vicdan Kubilay , Ekici Eyüp , Oĝuz Özlem , Gökmen Oya
Published: February 2008

Chronic ectopic pregnancy is a form of tubal pregnancy in which salient minor ruptures or abortions of an ectopic pregnancy, instead of a single episode of bleeding, incites an inflammatory response often leading to the formation of a pelvic mass. Its clinical features are often confusing, and laboratory evaluations are often misleading. Surgery for chronic ectopic pregnancy is frequently difficult since chronic inflammatory changes and adhesions distort the normal anatomy. In the present retrospective study, its incidence was found to be 20.3% (n=62) in a series of 305 ectopic pregnancies. A pelvic mass of varying sonographic appearance, mostly with a nonhomogenous echo pattern, was demonstrated in all 55 patients in whom transvaginal sonographic evaluation was performed preoperatively. Although most of the patients [91.9% (n=57)] had a positive serum beta HCG value, 5 patients had a negative test value. Laparotomy resulted in 40 salpingectomies, 19 salpingo‐oophorectomies, and 3 total abdominal hysterectomies with salpingo‐oophorec‐tomies. One patient had an incidental cystotomy and 2 an incidental colotomy. We conclude that chronic ectopic pregnancy is not rare, although little is mentioned about it as a clinical entity in the gynaecological literature. With increased awareness of its mildly symptomatic and protracted clinical course, and with proper interpretation of laboratory evaluations, a preoperative diagnosis can be made in the majority of the cases.
Iatrogenic Cardiac Tamponade During Pregnancy
Authors: Yim So‐fan , Lam Siu‐keung , Haines Christopher J.
Published: February 2008

EDITORIAL COMMENT: Reports in the literature during the past 15 years seem to have established that asymptomatic pericardial effusion is common in women with apparently normal pregnancies, especially in the third trimester. There seems to be no association with cardiac disease or preeclampsia. We accepted this case report to inform readers about the occurrence of pericardial effusion and to deliver the authors' warning that conservative management should be favoured. It is common, indeed usual, to see an accumulation of fluid in the peritoneal cavity at Caesarean section, especially when performed in labour when there is cephalopelvic disproportion. The editor has always assumed this to be a sign of obstructed labour due to transudation of fluid from peritoneum of the pelvis and bladder, perhaps due to obstructed lymphatics or increased venous pressure in compressed tissues. The members of the editorial committee remain puzzled concerning the aetiology of pericardial effusions in pregnancy. We hope to be offered a review of the problem to dispel our ignorance. The physiology of peritoneal fluid production in complicated and normal pregnancy also remains unexplained.

(A) Calvin S, Silva M, Weinslein L, Finley P, Witse M. Characterization of ascites present at cesarean section. Am J Perinatal 1991: 8: 99–102.

Summary: A 26‐year‐old primigravida who presented to us with threatened preterm labour which was suppressed successfully with sulindac, was found to have a pericardial effusion. Pericardiocentesis was performed because of evidence of right ventricular compression. However, it was complicated by inadvertant puncture of the left ventricle causing cardiac tamponade, and hypovolaemic shock shortly afterwards. An emergency pericardiotomy was performed to rescue the patient.
Antecedents to and Outcomes of Rh(D) Isoimmunization: Mater Mothers Hospital, Brisbane, 1988–1995
Authors: Portmann C. , Ludlow J. , Joyce A. , Chan F.Y.
Published: February 2008

Summary: We analyzed the antecedents and outcomes of Rh(D) isoimmunization in a local population. Forty‐two Rh(D) isoimmunized women attending Mater Mothers Hospital for antenatal care were identified through the Mater Hospital Blood Bank database; their records were reviewed for variables including sensitizing events, obstetric interventions and pregnancy outcomes. In this group, 74% of women became sensitized despite receiving anti‐D immune globulin, 17% did not receive anti‐D appropriately and the others failed to attend for treatment of bleeding in pregnancy. Antenatal sensitization was implicated in 6 women (14%) and potentially responsible for isoimmunization in another 18. Over half of the 80 viable pregnancies in this study group required some form of obstetric intervention. Thirty pregnancies required amniocentesis and 1 in 3 babies underwent either intrauterine or exchange transfusion. Three fetal deaths occurred as a result of severe disease. This study offers information highlighting circumstances in which immunoprophylaxis guidelines have failed to impart protection against Rh(D) sensitization and the consequences of such failures.
A Validation Study of Home Uterine Activity Monitoring Technology in Western Australia
Authors: Dickinson Jan E. , Godfrey Maryellen , Legge Mathew , Evans Sharon F.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it shows that there is technology available to reliably record uterine contractions and that the information can be transferred by a telecommunications system. As the authors indicate there is no consensus in the literature concerning the usefulness of home monitoring in the prevention of prematurity and whether the newer methods of biochemical monitoring will prove superior. Final judgement must be deferred until data are presented regarding testing this methodology on high and low‐risk patients in their homes including those in areas remote from hospital.

Summary: Home uterine activity monitoring has been developed as an ‘early warning’ device to detect premature uterine activity, thereby encouraging earlier referral and tocolysis of women at risk of preterm delivery. This ambulatory monitoring system, utilizing a ring‐guard tocodynamometer, was piloted in Western Australia to determine if it can reliably record and transmit antenatal uterine activity data in an Australian environment. Pregnant women were readily able to correctly apply and use the ambulatory monitoring device. The information collected was able to be transmitted using standard Australian telecommunications systems within our hospital environment. Validation studies with the ambulatory monitor and current external tocodynamometry hardware were performed. The ring‐guard tocodynamometer detected more uterine activity at gestations less than 32 weeks compared with conventional external tocodynamometers. As term approached, however, the sensitivity of the ring‐guard tocodynamometer decreased. A cross‐sectional profile of antenatal uterine activity was developed for women at low risk of delivering preterm. A gradual increase in the number, duration and amplitude of uterine contractions as pregnancy advanced was observed.
Changes Over Time in Attitudes to Treatment and Survival Rate for Extremely Preterm Infants (23–27 Weeks' Gestational Age)
Authors: Gultom E. , Doyle L.W. , Davis P. , Dharmalingam A. , Bowman E.
Published: February 2008

Summary: We determined the changes over time in attitude to treatment of very preterm infants (23–27 weeks of gestational age) born at the Royal Women's Hospital, Melbourne, and their survival rate. The subjects were consecutive Iivebirths at 23–27 weeks'gestational age born from 1983–1994, inclusive. The main outcomes measured were the proportions of Iivebirths treated intensively and survival rates to hospital discharge, both excluding lethal abnormalities. Over the 12 years of the study there were 788 Iivebirths free of lethal abnormalities born at 23–27 week's gestational age. Overall 669 (85%) were treated intensively; the proportions treated intensively rose significantly over time from 74% in 1983–1985 to 91% in 1992–1994, and with increasing gestational age, from 19% at 23 weeks to 100% at 27 weeks. Overall 439 (56%) survived their primary hospitalization; the survival rate rose significantly over time, from 43% in 1983–1985 to 70% in 1992–1994, and with increasing gestational age, from 3% at 23 weeks to 78% at 27 weeks. In 1992–1994, the survival rates were 11 % at 23 weeks, 53% at 24 weeks, 70% at 25 weeks, 81 % at 26 weeks, and 87% at 27 weeks. For infants treated intensively, the survival rate rose significantly from 53% in 1983–1985 to 76% in 1992–1994. The largest increases in survival have occurred in the 1990s, and at 24 and 25 weeks' gestational age. The proportions of very preterm infants treated intensively and their survival rates have increased over time, and have always been higher with increasing gestational age.
Trends in Stillbirths and Neonatal Deaths for Very Pre‐Term Infants (<32 weeks'Gestation) Bora in Victoria, 1986–1993
Authors: Jonas Helen A. , Lumley Judith
Published: February 2008

Summary: We have examined the trends in stillbirth rates and neonatal mortality rates of infants of 20–31 weeks' gestation born in Victoria during 1986–1993 (n=6,462), using data from the Victorian Perinatal Data Collection Unit. Seventy four percent of all infants and 83% of all liveborn infants were born in level 3 hospitals. Both stillbirth and neonatal mortality rates were lower for infants of higher gestational ages, and those born in level 3 hospitals. During 1986–1993, annual stillbirth rates remained steady, with mean values of 61.2%, 40.2%, 24.7%, 16.0%, and 11% for infants of gestational ages 20–23, 24–25, 26–27, 28–29, and 30–31 weeks, respectively. The neonatal mortality rates decreased from 76.1 to 38.6%, 423 to 17.6%, 12.9 to 6.0%, and 8.4 to 3.7% for liveborn infants of gestational ages 24–25, 26–27, 28–29, and 30–31 weeks, respectively. The time‐related falls in neonatal mortality were not due to changes in Caesarean section rates, intubation rates, or the proportions of infants born in, or transferred to, level 3 hospitals. They probably reflect continuing improvements in perinatal care.
Candida G lab rata Chorioamnionitis Following In Vitro Fertilization and Embryo Transfer
Authors: Sfameni Salvatore F. , Talbot James M. , Chow Steven L.S. , Brenton Lisa A. , Scurry James P.
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication not only because it provides, for the first time, convincing evidence that Candida glabrata can cause chorioamnionitis and premature rupture of the membranes, but for the suggestion that infection in the upper vagina and/or cervix should be considered in women having in vitro fertilization and embryo transfers (IVF‐ET). The authors suggest swab and culture to exclude infection before IVF‐ET. Since this technique could cause ascending infection an alternative would be to set up a culture from the cannula used to introduce the embryo(s) into the uterus, and commence appropriate antibiotic therapy if the culture was positive. Although previously not reported these cases illustrate that systemic treatment of Candida glabrata is indicated in women with a positive culture who have had IVF‐ET or have developed premature rupture of the membranes. In retrospect, the management in Case 1 was indeed conservative. As the authors indicate Candida glabrata is extremely resistant to all antifungal agents so the value of treatment of patients such as those reported here remains to be established.

Summary: Candida glabrata is a yeast which is considered to be a commensal of the vagina with limited pathogenicity in die immunocompetent host. We report 2 cases of severe chorioamnionitis occurring in pregnancies achieved by in vitro fertilization techniques which resulted in preterm delivery and pregnancy loss. Candida glabrata as the causative agent was probably introduced into the uterus by the cannula at the time of embryo transfer. It is recommended mat appropriate investigation of the microbial flora of the cervix be undertaken and treatment instituted prior to embryo transfer in order to prevent this complication.
Low Malignant Potential Ovarian Tumours: A Review of 175 Consecutive Cases
Authors: Buttini Melissa , Nicklin James L. , Crandon Alex
Published: February 2008

Summary: Epithelial ovarian tumours of low malignant potential (LMP) are known to have a generally good prognosis, although there is not universal agreement on all aspects of treatment. We report a series of 175 patients with LMP ovarian tumours referred to the Queensland Centre for Gynaecological Cancer between January, 1982 and December, 1993. Stage I disease accounted for 142 cases, with only 1 patient dead from disease at 293 months. Twenty nine patients in this group had conservative surgery with 1 recurrence only (in the contralateral ovary) giving a recurrence rate of 3.5%. Survival and treatment data for other stages are presented, and the current literature reviewed. It is suggested that early stage disease may be treated conservatively depending upon the patient's desire to retain reproductive capacity. While adjuvant therapy is not recommended, long‐term follow‐up is indicated. More advanced disease should be debulked to the smallest practical volume. The role of lymphadenectomy has been questioned, as survival has not been shown to be affected by treatment decisions made as a result of knowing the lymph node status. Whilst some centres give platinum‐based adjuvant therapy, the evidence that it is beneficial is not supported by any prospective randomized trials.
Progression and Regression of Low‐grade Epithelial Abnormalities of the Cervix
Authors: Furber Susan E. , Weisberg Edith , Simpson Judy M.
Published: February 2008

Summary: The records of 738 women with low‐grade cervical epithelial abnormalities were examined for changes in degree of cervical disease and lesion size, as well as sociodemographic and behavioural factors which influence the development of invasive cancer of the cervix. Survival analysis was used to determine the predictors and rates of progression and regression. The results suggest that about 80% of low‐grade epithelial abnormalities of the cervix will not progress within 2 years. The only predictors of progression were a biopsy diagnosis of CIN 1 and die size of the lesion. Predictors of regression were older age, older age at first intercourse, greater parity, fewer sexual partners, and absence of a past history of genital herpes. Although progression rates of low‐grade abnormalities of the cervix were very low, CIN 1 lesions were 2.4 times (95% CI: 1.6 to 3.7) more likely to progress than lower‐grade lesions and large lesions (>l/2 ectocervix) were 2.0 times (95% CI: 1.2 to 3.3) more likely to progress than small ones (<I/4 ectocervix).
Angiographic Transcat heter Embolization in Gynaecological Practice
Authors: Craig Simon , Permezel Michael , Thomson Ken
Published: February 2008

Summary: Intractable uterine haemorrhage, unresponsive to medical therapy or curettage, has been traditionally treated by hysterectomy and/or internal iliac artery ligation. Percutaneous angiographic localization of the bleeding vessel with subsequent embolization, may be a genuine alternative approach that enables preservation of reproductive potential with minimal morbidity. We present 3 such cases here, all subsequent to curettage in the first trimester of pregnancy, 2 after a therapeutic termination of pregnancy and the odier after an incomplete abortion.
Intermittent Auscultation for the Intrapartum Assessment of Fetal Well‐being in Western Australia
Authors: Gilles Marisa T. , Norman Margo , Dawes Vivienne , Gee Vivien , Rouse Ian , Newnham John
Published: February 2008

Summary: In May 1995, in response to a decision of die Perinatal and Infant Mortality Committee of Western Australia, a survey of Western Australian hospitals was performed to ascertain what policies were in use for the monitoring of the fetal heart rate in labour and what proportion of these hospitals had access to electronic monitoring by cardiotocography. A response was received from 96% of the surveyed hospitals. More than half the births in this State (13,950 of 25,238) were monitored in labour using intermittent auscultation as the primary test; 7.5% of Western Australian births each year occurred in hospitals in which electronic monitoring was not available. Fewer than 50% of hospitals had written protocols describing the method of auscultation of the fetal heart during labour, the indications to contact a doctor or the management of fetal distress. The protocols which did exist displayed considerable variation in the recommended frequency of intermittent auscultation. The lack of standard practice in this field probably results from uncertainties in the literature. Intermittent auscultation has not been subjected to rigorous scientific evaluation as a screening tool and guidelines documenting ideal auscultatory practices need to balance the precision of electronic monitoring and freedom from intervention. Based on this compromise and existing evidence, a protocol for intermittent auscultation in normal labour is proposed.
Peripartum Cardiomyopathy
Authors: Ladwig Petra , Fischer Eddy
Published: February 2008

EDITORIAL COMMENT": Cardiomyopathy is an important primary cause of indirect maternal deaths and in the last 3 published triennial reports on maternal deaths in Australia accounted for 2 of 11 deaths due to cardiovascular disease in the 1988‐90 triennium (total deaths 96), 3 of 14 in 1985‐87 (total deaths 86), and 2 of 14 deaths due to cardiovascular disease in the 1982‐84 triennium in which the total number of maternal deaths was 94. This paper reports 3 cases of peripartum cardiomyopathy and provides valuable information concerning diagnosis, differential diagnosis and treatment. Case 1 has the anecdotal advantage of presenting the first successful pregnancy after cardiac transplantation in Australia.

Summary: Peripartum cardiomyopathy is an uncommon condition of unknown aetiology. Diagnosis requires exclusion of other causes of congestive cardiac failure and the demonstration of global ventricular dysfunction on echocardiography. Treatment consists of diuretics, vasodilators, digoxin and anticoagulants. Prognosis is related to recovery of ventricular function. The availability of cardiac transplantation has improved the outlook for those with persistent dysfunction.
Survival and Neonatal and Neurodevelopmental Outcome of 24–29 Week Gestation Infants According to Primary Cause of Preterm Delivery
Authors: Gray Peter H. , Hurley Thomas M. , Rogers Yvonne M. , O'Callaghan Michael J. , Tudehope David I. , Burns Yvonne R. , Phty M. , Mohay Heather A.
Published: February 2008

Summary: A total of 189 infants of 24–29 weeks' gestation were born in a regional perinatal centre during a 2‐year period. They were divided into groups according to the primary cause of preterm delivery: antepartum haemorrhage (n=37, 20%), preeclampsia (n=27, 14%), preterm premature rupture of membranes (n=64, 34%), preterm labour (n=27, 14%), chorioamnionitis (n=16, 8%), other complications (n=18, 10%). The perinatal mortality rate (PMR) was 286/1,000 of whom 44% were stillbirths. The ‘other complication’ group had the highest PMR due to a large number of intrauterine deaths, with no differences in neonatal mortality between the groups. Preeclampsia was associated with an increased risk of necrotizing enterocolitis and chorioamnionitis was associated with an increased risk of periventricular haemorrhage. Follow‐up to at least 2 years was performed in 122 (97%) of survivors. Cerebral palsy occurred in 7%, while 18% had neurodevelopmental disability. No relationship was found between primary cause of preterm delivery and outcome. This information should be of value in counselling parents when preterm delivery is imminent.
Balloon Catheter with Extra‐amniotic Saline Instillation: a Method of Induction in Pregnancies at 41 or More Gestational Weeks
Authors: Fait Gideon , Grisaru Dan , Shenhav Michael , Kupfermine Michael J. , Lessing Joseph B. , Peyser M. Reuben , Jaffa Ariel
Published: February 2008

Summary: One hundred five women with a documented pregnancy of 41 weeks' gestation or more, admitted for induction of labour by balloon catheter with extra‐amniotic saline instillation, were retrospectively compared to 196 women admitted in spontaneous labour at the same gestational age, with regard to mode of delivery. The success rate of the induction group was 97.1%. The mode of delivery did not differ significantly between the 2 groups. The Caesarean section rates were 11.4% in the induction group versus 9.7% in the spontaneous group. The mode of delivery after induction of labour by balloon catheter with extra‐amniotic saline instillation and simultaneously commenced intravenous oxytocin infusion, in pregnancies of 41 weeks or more, is similar to that of spontaneous deliveries at the same gestational age.
Antenatal Screening for HPA‐la by Flow Cytometry
Authors: Lavu E.K. , Nelson M. , Popp H.J. , Gibson J. , Kronenberg H. , Pearson H. , Child A.
Published: February 2008

Summary: regnant women who attended antenatal clinics at King George V Hospital, the Birth Centre or were referred by obstetricians from February to July. 1996 were screened for the platelet antigen HPA‐la by flow cytometry. Forty out of 2300 (1.7%) were found to be negative for this antigen. Of the 28 women followed throughout their pregnancy, none developed antibody to HPA‐la. Platelet counts performed on samples from 17 babies born to 17 of these mothers were all normal. This study proves the simplicity and rapidity of flow cytometry for platelet antigen screening. The results were comparable with the Solid Phase Red Cell Adherence (SPRCA) method and with PCR. The lack of a plentiful supply of specific antibody and the rarity of fetomaternai alloimmune thrombocytopenia (FMAIT) argue against the introduction of routine screening for maternal HPA‐la status at the present time.
Medicolegal Matters involving a Major Obstetric and Gynaecological Teaching Hospital
Authors: Ratten Graeme J.
Published: February 2008

Summary: Review of medicolegal files held by the Royal Women's Hospital. Melbourne confirms that during the last 25 years there has been a marked increase in the number of claims for compensation brought by patients who believe that the care they received was inadequate; thus 4 claims for compensation were received during the first 5 years of the study period and 29 claims in the last 5 years. Complaints about service provision resulted in a claim for compensation in 29.7% of cases in which the dissatisfied client was represented by a legal firm and in 6.25% of cases where the initial approach was made through the Health Services Commission. One half of all claims for compensation were received in response to perceived complications of birth, surgery or treatment of a premature baby.
The Levonorgestrel‐Releasing Intrauterine Device: A Wider Role Than Contraception
Authors: Coleman Matthew , McCowan Lesley , Farquhar Cynthia
Published: February 2008

Summary: The Levonorgestrel‐releasing intrauterine device (LNG IUD) provides excellent contraception; it may reduce the rate of pelvic inflammatory disease (PID) and ectopic pregnancy compared to other ‘modern’ copper releasing IUDs; it can safely be used in the puerperium for breast‐feeding mothers, and it significantly reduces menstrual blood loss and pain. While it was developed primarily as a contraceptive, its potential role in managing heavy and painful menstruation and the symptoms of the climacteric may eventually be just as important. Amongst developed countries New Zealand and Australia have some of the highest hysterectomy rates. By the age of 50 years 1 in 4 women in New Zealand and 1 in 5 women in Australia will have had a hysterectomy (A, B). In New Zealand 90% of these are performed for heavy menstrual bleeding and fibroids (A). The LNG IUD has been shown to be effective treatment for both these conditions and its introduction to New Zealand and Australia would offer women an additional choice beyond surgery.
Saline Infusion Sonohysterosalpingography, an Underutilized Technique
Authors: de Crespigny Lachlan , Kuhn Raphael , McGinnes Dorothy
Published: February 2008

Summary: Saline infusion sonohysterography (SIS) is an important gynaecological diagnostic tool which is little used in Australia. We herein report the findings in 60 women referred for SIS, the procedure being uneventfully performed in 55. Forty‐nine of the 60 referrals were for investigation of abnormal uterine bleeding. The technique described allows examination of the uterine cavity and the Fallopian tubes. In 26 of the patients information was obtained which improved or altered the diagnosis made on B mode and colour Doppler ultrasound. Unlike hysteroscopy, SIS is always performed as an outpatient procedure, appropriate disinfection procedures are relatively simple to implement (1), and vasovagal reactions are rare. Hysteroscopy was avoided in 11 patients, there were other benefits in 4 patients, and in only 1 of 16 patients did the hysteroscopy findings differ with SIS. If diagnostic pitfalls are avoided by careful attention to detail, SIS offers a powerful new gynaecological investigative tool in the investigation of bleeding disorders (including menorrhagia, intermenstrual and postmenopausal bleeding), uncertain endometrial Findings on vaginal ultrasound, infertility, and in the investigation of congenital and acquired uterine abnormalities.
Pre and Intraoperative Diagnosis of Ovarian Tumours: How Accurate Are We?
Authors: Lim Fang‐Kan , Yeoh Chee‐Lim , Chong Siew Meng , Arulkumaran S.
Published: February 2008

Summary: In the assessment of malignant potential of ovarian tumours, frozen section has been found to be accurate in 97.1% (168 of 173) of cases. The positive predictive value of frozen section in the diagnosis of a malignant lesion was 100% (34 of 34). Errors were mainly made in the diagnosis of borderline tumours with a predictive value of 87.5% (7 of 8). The negative predictive value was 98.4% (127 of 129). Frozen section however, was less accurate in the diagnosis of specific histological type with an accuracy rate of 91.9% (159 of 173). Macroscopic features were found to be useful in the intraoperative prediction of malignant potential. Completely cystic tumours were benign in 96.4% (108 of 167) of cases. Solid/cystic tumours were malignant in 69% (27 of 38) of cases. Completely solid tumours were malignant in 56% (9 of 16) of cases. Frozen section in completely cystic tumours only marginally improved the clinical macroscopic diagnosis of malignancy. The sensitivity and specificity of ultrasound scan in the diagnosis of malignant/borderline tumours were 82% and 86% respectively. The false negative rate of 7% makes laparoscopic excision of unsuspected malignant ovarian cyst a significant possibility. The predictive value of ultrasound scan in the diagnosis of malignant ovarian tumour was 62% (26 of 42). In the preoperative assessment of malignant potential of ovarian tumours, this study shows that ultrasound scan has a high false positive and a significant false negative rate. Careful intraoperative assessment of gross features and the use of frozen section especially in those with solid/cystic and solid tumours will help achieve a high accuracy rate in the assessment of ovarian tumours.