bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Cervical Mucus in Human Infertility
Authors: Daunter B. , Khoo S. K.
Published: February 2008

Summary: The physiological role of cervical mucus in enhancing spermatozoal penetration at mid‐cycle has been established. However, the involvement of cervical mucus in primary infertility is still controversial. Although immunological reactions against spermatozoa in the female have been offered to account for the immobilization of spermatozoa — an observation termed ‘hostility’ of the mucus — this is not always demonstrable. In addition, there are a number of microbial antigens that are similar to spermatozoal antigens. Antibodies to these antigens are found in the serum of the majority of females and males whose infertility is considered to be immunopathological in origin. There are also naturally‐occurring antispermatozoal antibodies in both females and males that in some cases may contribute to immunological infertility. The overall spectrum of ‘hostile’ mucus reactions becomes more complex when we consider the biochemical structure of cervical mucus and its possible interaction with spermatozoa. This spermatozoa: mucus interaction may involve the transfer of spermatozoal components to ‘hostile’ mucus that should normally be transferred to the zona pellucida of the ova. In addition, there are also pH changes in some ‘hostile’ mucus that lead to spermatozoal immobilization. In contrast to the above, the cause of infertility in some cases is the inability of spermatozoa to survive in normal mid‐cycle mucus. It is evident therefore that an understanding of the complex nature of ‘hostile’ cervical mucus will lead to a more objective approach in the treatment of infertility.
Letters to the Editor
Authors: Goh T. H. , Wong W. S. Felix , Chang A.M.Z.
Published: February 2008

Trial of 16, 16 Dimethyl Trans Δ2 Prostagiandin E, Methyl Ester Vaginal Pessaries for Management of Second Trimester Fetal Death.
Outcome of Extremely Low Birth‐weight Infants in Relation to the Hospital of Birth
Authors: Kitchen William , Ford Geoffrey , Orgill Anna , Rickards Anne , Astbury Jill , Lissenden Jean , Bajuk Barbara , Yu Victor , Drew John , Campbell Neil , Roy R. Neil D.
Published: February 2008

Summary: There were 351 nveborn infants of birth‐weight 500–999 g born in the State of Victoria in the years 1979 and 1980; 89/351 (25.4%) survived to the age of 2 years: 42 (47.2%) survivors were of gestational ages of 24 to 26 weeks and 47 (52.8%) were born at 27 to 32 weeks' gestation. Survival of these extremely low birth‐weight infants was significantly better (71/245, 29%) for births in tertiary centres compared with those born elsewhere (18/106, 17%). Of the 351 livebirths, 69.8% occurred in 1 of the 3 tertiary centres.

All 89 survivors were traced; 84 (94.4%) were assessed at the age of at least 2 years by a multidisciplinary team. Three children had been fully assessed at 1 year of age and paediatric reports were available for 2 children. The quality of survival of children born in tertiary centres was significantly better than those transferred to a tertiary centre after birth; the prevalence of serious functional handicap was 72.2% (13/18) for outborn children compared with 22.5% (16/71) for those born in tertiary centres. The prevalence of serious functional handicap in the inborn survivors was lowest (9/55, 16.4%) in singleton births who had been of appropriate birth‐weight for gestation.

A review of the 18 surviving outborn infants' records indicated that 6 (33.3%) could have been transferred to a tertiary centre in utero and for the 12 infants where birth in a tertiary centre was not feasible, improvements in the early neonatal care were possible in another 7 infants.
Pregnancy Hydronephrosis — A Longitudinal Ultrasonic Evaluation
Authors: Woo J. S. K. , Wan C. W. , Ma Ho‐Kei
Published: February 2008

Summary: The progression of physiological hydronephrosis through the 3 trimesters of pregnancy was assessed by ultrasonic measurement of calyceal diameters in 56 asymptomatic patients in a longitudinal study. A grading system basing on the maximum calyceal diameter was used; 89% of the patients showed at least mild dilatation before delivery. There was a preponderance of the right side being affected. In 6 patients (10.7%), severe dilatation was demonstrable and in all of them its onset appeared to be in the second trimester. The likelihood of progression to moderate or severe dilatation when only mild dilatation is demonstrated in the second trimester is low. Furthermore, it is not common for moderate dilatation in the second trimester to progress to severe dilatation in the third trimester. These findings appear to support the mechanical theory in the genesis of pregnancy hydronephrosis. Rapid regression of calyceal dilatation is not apparent in the first 5 days after delivery.
An Unusual Set of Triplets: Twin Intrauterine Pregnancy with Singleton Extrauterine Pregnancy
Authors: Cario G. M. , Carlton M. A.
Published: February 2008

Heterotopic pregnancy (simultaneous intrauterine and extrauterine pregnancy) is an extremely rare clinical phenomenon occurring approximately 1 in 30,000 pregnancies (1) or 1 in 2,000,000 live births (2). There have been 435 cases reported in the world literature up to 1956 (3). Simultaneous viability in heterotopic pregnancy is an even rarer event occurring in only 10.6% of cases (3).
Malignant Sequelae of Molar Pregnancy in Victoria
Authors: Olesnicky G. , Long A. R. , Quinn M. A. , Pepperell R. J. , Horacek I. , Kneale B. L. G.
Published: February 2008

Summary: In a retrospective study of 455 patients with confirmed molar pregnancy, registered with the Hydatidiform Mole Register of the State of Victoria in the years 1973–1982 inclusive, treatment for persistent trophoblastic activity was necessary in 62 (13.6%) patients. The need for treatment was independent of levels of urinary chorionic gonadotrophin (UCG) excretion prior to evacuation of the molar pregnancy, age, parity or blood group. All patients achieved initial remission of UCG levels within 5 courses of treatment. Risk factors were scored retrospectively and patients responded poorly if therapy inappropriate to risk factors was given. Only 2 cases of histologically proven choriocarcinoma occurred and the only death recorded was in 1 of these patients.
Culdocentesis in Tubal Pregnancy
Authors: Mittal Sushil , Grover Vimal , Dhall Kamala , Dhall G. I. , Gupta A. N.
Published: February 2008

Summary: Culdocentesis was carried out in 92 suspected cases of ectopic pregnancy and was positive in 90%. Laparotomy confirmed the accuracy of culdocentesis in 97.5% of the cases of acute tubal rupture, 87.5% of tubal abortions and 80% of ‘intact’ tubal pregnancies.
Vault Haematoma after Vaginal Hysterectomy: An Invariable Sequel?
Authors: Kuhn Raphael J. P. , de Crespigny Lachlan Ch.
Published: February 2008

Summary: Fifty consecutive patients undergoing vaginal hysterectomy were studied prospectively by ultrasound to determine the incidence of vault haematoma and the relationship between its size and the development of postoperative pyrexia; 49 patients (98%) had a vault haematoma and 35 (70%) were febrile postoperatively. Large vault haematomas (mean diameter > 5 cm) were invariably associated with significant febrile morbidity, whilst 1 in 3 patients with a small haematoma was afebrile. Colporrhaphy did not influence the likelihood of haematoma formation.
The Care of Older Children When a Sibling is Born
Authors: Graudins Andis , Harris Michael J.
Published: February 2008

Summary: This study into the care of a child when his/her mother is hospitalized has shown that most care is given by the father and the grandparents. However, about 10% of mothers do not feel or recognize their child's need to understand why she is not at home, where she is, nor to visit her in hospital.
Histocompatibility Antigens and Intrauterine Fetal Growth Retardation
Authors: Weir P.E. , Oats J.N. , Holdsworth Rhonda , Cross R.
Published: February 2008

Summary: Maternal‐fetal antigen compatibility adversely affects fetal and placental weights in animal experiments and is associated with recurrent spontaneous abortion and preeclampsia in human reproduction. HLA A and B types of the mother, father and infant were determined in 30 pregnancies complicated by intrauterine fetal growth retardation (IUGR) and in 32 normal pregnancies. The frequency and degree of antigenic compatibility between the parents and the mothers and their infants were compared between the groups. There was no evidence that IUGR was associated with a significant degree of HLA A and B antigenic compatibility.
The Premenstrual Syndrome in Chinese
Authors: Mao K. , Chang A.
Published: February 2008

Summary: A questionnaire survey of 84 Chinese nurses was carried out to assess the presence of premenstrual syndrome. More than half of the respondents reported emotional changes and backache premenstrually. There were significant associations between nausea and breast changes, irritability and depression, body and skin changes, finally between backache and the 3 symptoms of irritability, headache and the necessity to take time off work.
Recurrent Dysgerminoma After 33 Years
Authors: Haines Ian E. , Schwarz Max A. , Sinclair Roger A. , Ostor Andrew G.
Published: February 2008

Summary: Surgery with or without radiotherapy produces a high cure rate in localized pure dysgerminoma of the ovary. Recurrence rates are low, and usually occur within 2 years. We report the case of a 58‐year‐old para 1 who developed recurrent pure dysgerminoma 33 years after initial surgery. The need for long‐term follow‐up of these patients is emphasized.
Congenital Absence of Fallopian Tube Segments
Authors: Paterson Peter J. , Chan Clement L. K.
Published: February 2008

Summary: A ease is reported in which laparotomy demonstrated that the proximal portion of the left Fallopian tube was absent and that the distal end was separated into 3 portions. There is no previous report of a congenital abnormality of this type.
A Rare Pelvic Mass: Osteosarcoma of the Body of the Uterus
Authors: Jotkowitz Max W. , Valentine Renata
Published: February 2008

Summary: A rare, enormous, unresectable, osteosarcoma of the uterus is reported. This obstructed ureters, enclosed rectum, bladder, aorta and vena cava, and metastasized to peritoneum, lungs and liver causing death of the patient by renal and pulmonary failure.
Complications of Beta‐Mimetic Therapy in Preterm Labour
Authors: Ingemarsson I. , Arulkumaran S. , Kottegoda S. R.
Published: February 2008

EDITORIAL COMMENT: This careful review of the reported complications of beta‐mimetic drugs may properly cause obstetricians to have ‘second thoughts on stopping labour’ (Anderson, 1981: 53), in many patients, especially when there is premature rupture of the membranes and the possibility of intrauterine infection.

Summary: Selective beta‐mimetic drugs are the most frequently used agents for arresting preterm labour. For this purpose these drugs have to be given in high doses for several hours and since they act on several organ systems, side‐effects, some of which are potentially dangerous, appear. These hazards, which involve chiefly the cardiovascular and metabolic areas, have been examined in the light of available experience with these drugs. This review considers the possible mechanisms for the side‐effects and offers suggestions on how the dangers in the use of beta‐mimetic drugs in preterm labour might be avoided.
Failed Induction of Labour
Authors: Arulkumaran S. , Gibb D. M. F. , TambyRaja R. L. , Heng S. H. , Ratnam S. S.
Published: February 2008

Editorial Comment: There is an important take away message in this paper–namely that 65% of nulliparas with an unfavourable cervix who had induction of labour performed by amniotomy and simultaneous oxytocic infusion came to Caesarean section, two‐thirds because of failed induction.

Summary: Over a 15‐month period 1,057 consecutive inductions of labour were performed representing a 10% induction rate; 174 (16.5%) of these patients were delivered by Caesarean section of which 74 (7.0%) were for failed induction of labour, 58 (5.5%) for fetal distress, 19 (1.8%) for cephalopelvic disproportion, 6 for malposition and 17 for other reasons. The mean cervical score at induction of labour was 5.7 and 5.5 for cephalopelvic disproportion (CPD) and malposition respectively but was 4.0 for failed induction. The mean cervical dilatation at the time of Caesarean section was 5.7 cm and 6.6 cm for CPD and malposition respectively whereas it was 3.5 cm for failed induction. Mean maximum dose of oxytocin was 19.2 milliunits per minute (mu/min) and 22.5 mu/min for CPD and malposition respectively whereas it was 24.7 mu/min for cases of failed induction. Nulliparas with a cervical score of 3 or less had a 65.4% Caesarean section rate of which more than two‐thirds were for failed induction of labour. Analysis of indications for induction of labour revealed that a fair number of inductions had debatable obstetric indications. Tailoring induction of labour to the cervical score and indication might reduce the Caesarean section rate for failed induction of labour. Rational management to ensure an adequate dose of oxytocin and sufficient time in the first stage of labour is important. Failed induction of labour may be differentiated from failure of labour progress due to CPD or malposition.
Thiamine Deficiency – A Neglected Problem of Infants and Mothers – Possible Relationships to Sudden Infant Death Syndrome
Authors: Jeffrey Heather E. , McCleary Barry V. , Hensley William J. , Read D. J. C.
Published: February 2008

Summary: i) An unexpectedly high incidence of biochemical thiamine deficiency (erythrocyte transketolase) was found in groups of mothers and infants, selected for apparent health from a westernized Caucasian community in Australia.

Deficiency was common in mothers at term but not their infants, and in apparently healthy older infants but not their mothers. These findings can be explained by preferential delivery of thiamine to the fetus, at the expense of the pregnant mother; after delivery the mother recovers, and the infant becomes depleted.

ii) The incidence of thiamine deficiency was high in ‘near‐miss' sudden infant death syndrome (SIDS) infants and their mothers, and in siblings of SIDS. The thiamine deficient infants had a high familial incidence of SIDS deaths. These ‘high risk families' might reflect poor nutrition or genetic defects of thiamine uptake and metabolism.

Since apparently thriving infants with thiamine deficiency can sometimes die unexpectedly, thiamine status deserves more attention in clinical practice and research.
Gynaecological Tuberculosis: Analysis of a Personal Series of 710 Cases
Authors: Sutherland A. M.
Published: February 2008

Summary: A study has been made of 710 patients with proved gynaecological tuberculosis investigated between January 1, 1951 and March 31, 1985. The main presenting symptoms in order of frequency were infertility, pelvic pain, excessive menstrual loss and amenorrhoea. The average age was 31 years at first attendance, only 16% of married women had been pregnant and palpable adnexal masses were found in 47%.

Seven drug programmes have been used, the best results being obtained with the current regimen employing rifampicin, ethambutol and isoniazid. Where drug treatment failed, surgery under further drug cover was successfully employed. Toxic drug reactions occurred in 114 patients.
The Diagnosis, Treatment and Complications of Cervical Intraepithelial Neoplasia – Experience at The Royal Hospital for Women, Sydney, During the Years 1972–1982
Authors: Seshadri Lashmi , Cope Ian
Published: February 2008

Summary: During the 11 years 1972–1982, 770 patients with cervical intraepithelial neoplasia III (carcinoma in situ/severe dysplasia) were treated at The Royal Hospital for Women, Sydney. Of these, 592 had primary conization (Group I) and 153 had colposcopically directed biopsy and diathermy (Group II). Carcinoma in situ was diagnosed in the remaining 25 following hysterectomy for other gynaecological indications. The recurrence rates were similar in the 2 groups, but the conization group had a complication rate of 9.6% while none of the patients in group II had any significant complications. The presenting symptoms, gravidity, cytology and histopathological diagnosis were similar in the 2 groups. The conization and subsequent hysterectomy rates have decreased over the years. However, 50% of patients are still treated in this institution by cone biopsy. More conservative treatment (biopsy and diathermy) is being performed in increasing numbers of younger patients.
Surgery and Radiotherapy in the Treatment of Primary Carcinoma of the Fallopian Tube – Report of 18 Cases
Authors: Wong W. S. Felix , Tindall V. R. , Wagstaff John , Bramwell Vivien , Crowther Derek
Published: February 2008

Summary: Eighteen cases of primary Fallopian tube carcinoma referred to Christie Hospital, Manchester over the years 1966 to 1980 are reviewed. The overall 5‐year survival rate was 14.4%. Treatment by total hysterectomy and bilateral salpingo‐oophorectomy resulted in a longer survival compared to bilateral salpingo‐oophorectomy or removal of the tumour alone. Postoperative radiotherapy did not seem to improve survival.
Ultrasound‐Guided Puncture for Gynaecological and Pelvic Lesions
Authors: de Crespigny Lachlan Ch , Robinson Hugh P. , Davoren Ruth AM , Fortune Denys W.
Published: February 2008

Summary: A series of 34 patients who underwent a total of 37 ultrasound‐guided cyst punctures and fine needle biopsies for diagnosis and treatment of pelvic lesions are reported. In all but 1 patient the lesion visualized was entered and cytological diagnosis was achieved, although 1 patient required a second attempt under general anaethesia. Seven cysts were endometriotic; these and all the remaining cysts were benign and only 4 patients developed a recurrence of the cyst following puncture. No patient in whom the ultrasound appearance suggested a benign cyst was found to have an ovarian malignancy. Three patients with malignant lesions had a total of 4 punctures or biopsies and a final patient had a fine needle biopsy of an ovary to exclude malignancy.
Gall Bladder Disease Complicating Pregnancy
Authors: Woodhouse D. R. , Haylen B.
Published: February 2008

Summary: Five cases of gall bladder disease complicating pregnancy are presented. The importance of antenatal cholecystosonography as a safe, simple, noninvasive diagnostic and screening test is stressed.
Changes in Obstetric Practice in Our Time
Authors: Ratten Graeme J.
Published: February 2008

Summary: In the years since 1939 there has been a marked change in the nature and results of obstetric practice at the Royal Women's Hospital, Melbourne.

The noteworthy changes have been a reduction in the number of maternal deaths (from 12.2 per 1,000 in the 1940's to 0.2 per 1,000 in the 1980's), especially those due to septic abortion, and an increase in the Caesarean section rate (from 2% to 14%).

The increase in the operative delivery rate has been matched by a decrease in mortality in patients thus delivered, the maternal and perinatal mortality rates changing from 5.5 and 88.9 per 1,000 to 0 and 7.6 per 1,000 respectively in the case of forceps delivery and from 24.7 and 162.5 per 1,000 to 0.15 and 10.6 per 1,000 respectively in the case of Caesarean delivery.
Family Births at the Royal Women's Hospital, Melbourne
Authors: Eggers Thomas R. , Kloss Michael , Neil John , Robinson Hugh P.
Published: February 2008

Summary: A controlled study comparing clinical aspects of birthing unit confinement with orthodox obstetric care in a major obstetric hospital is detailed. The results confirm that this centre provides an acceptable and safe alternative for those who desire such an environment.
An Evaluation of Three Ultrasound Equations for Fetal Weight Prediction
Authors: Wong Felix , Rogers Michael , Chang Allan
Published: February 2008

Summary: Ultrasound fetal weght estimation based on the equations of Shepard et al (1), Warsof et al (2) using biparietal diameter and abdominal circumference, and Campbell et al (3) using abdominal circumference, were evaluated in 92 Chinese patients in labour. Our result shows that Campbell's equation (3), based on the abdominal circumference alone provides a higher accuracy and precision in predicting fetal weight than using a combination of biparietal diameter and abdominal circumference.
Toxic Shock Syndrome Presenting to a Paediatric Service
Authors: Hughes Phillip F. , Carmichael Eleanor M. , Cull Anthony B.
Published: February 2008

Summary: A case of toxic shock syndrome occuring in a 13‐year‐old and presenting to a paediatric service is described. Some implications are discussed including an approach to menstrual protection and the question of future contraceptive needs.
The Oversized Infant. A Study of 86 Cases
Authors: Khwaja Suraiya S. , Uduman S. A. , Al‐Sibai Hisham , Facharzt  , Al‐Suleiman S. A.
Published: February 2008

Summary: The maternal factors and perinatal and neonatal outcome of 86 oversized infants (birthweight 4,500g and above) were studied. 11.6% of mothers were diabetics while 34.5% demonstrated a hyperglycaemic glucose tolerance test. A comparison of the maternal variables and perinatal and neonatal morbidity was made between the diabetic and nondiabetic group. No significant difference in maternal age ≥30 years, parity and obesity was observed in the 2 groups. Perinatal and neonatal complications were noted to be high in the study population but no significant difference in the 2 groups was noted except for a higher prevalence of hypoglycaemia in the infants born to the diabetic mothers. Oversized infants caused a high risk obstetric and paediatric situation independent of the diabetic status of the mother.
Obstetric Team Care by a Private Midwife and Obstetrician—A Pilot Trial
Authors: MacLennan Alastair H. , Rippin Chris , Tiver Jill
Published: February 2008

Summary: Autonomous obstetric care by either midwife or doctor excludes the complementary expertise of each other. However, in the present Australian hospital system midwives are usually unable to provide continuity of antepartum, intrapartum and postpartum care to the individual patient and thus are less able to accept ongoing clinical responsibilities or provide satisfactory psychological support to the patient. A pilot trial was instituted to assess the practicality of team care by an obstetrician and a midwife where the midwife, having joined with the obstetrician in the care of the patient at all antenatal visits, attended the patient on her admission to the labour ward until 1 hour after her delivery. This personalized midwifery service did not, in this trial, involve the midwife in duties or responsibilities greater than those of the normal labour ward staff but provided the patient with continuity of care and support by a midwife known to the patient throughout her labour and delivery. The midwife visited the patient twice postnatally. Sixty private patients entered the trial and 56 were attended by the midwife in labour. The mean length of attendance of the midwife in the labour ward was 6.6 hours (range 2–14 hours). The mean length of labour in the hospital was 5.2 hours. There was an apparent reduction in analgesic requirements in the trial patients compared to the concurrent rates in the hospital. All patients in the trial were very enthusiastic about the service, the words ‘confidence’ and ‘security’ recurring in their later comments. The service was well accepted by the rostered labour suite staff after an initial orientation programme. The midwife found the change from rostered to ‘on call’ duties at times inconvenient and tiring but professionally very rewarding, satisfying and worthwhile. The obstetrician noted an increase in communication between patient, midwife and doctor and felt that the system greatly facilitated and improved the obstetric care. The pilot trial suggests that team care by a private obstetrician and private midwife in the Australian hospital system is eminently feasible. Trials involving larger numbers of patients should involve full time mid‐wives working in pairs with an approximate patient load of 400 per pair.
The Prognostic Value of HCG, PAPP‐A, Oestradiol‐170 and Progesterone in Early Human Pregnancy
Authors: Yovich John L. , Willcox David L. , Grudzinskas Jurgis G. , Bolton Anthony E.
Published: February 2008

Summary: Four serum parameters were assayed weekly from the 4th to the 12th week of pregnancy and finally at 16 weeks, to assess their relative prognostic values for predicting pregnancy outcome. Of 85 pregnancies generated following treatment for infertility, 16 cases had blighted ova and subsequently aborted at a mean age of 9.9 ±0.5 weeks. Serum HCG concentrations differentiated (p < 0.005) between ongoing pregnancies and blighted ova as early as the 4th week which was often several weeks in advance of clinical abortion. PAPP‐A, oestradiol‐17/3 and progesterone did not differentiate between the 2 groups until 7 weeks (p < 0.005, p < 0.001 and p < 0.001 respectively). PAPP‐A measurements detected ongoing pregnancies at week 4 (16.5 ±5 ug/l) but HCG remains the more sensitive diagnostic test. The lower limits of oestradiol‐17/J and progesterone for ongoing pregnancies were 670 pmol/l and 37 nmol/1 respectively. The circulating concentrations of all 4 serum markers were unaffected by administration of me‐droxyprogesterone acetate from 6 to 16 weeks in both ongoing and aborting pregnancies.
The Contraceptive Diaphragm Is it an Acceptable Method in the 1980s?
Authors: Kovacs Gabor T. , Jarman Heather , Dunn Kay , Westcott Mary , Baker H. W. Gordon
Published: February 2008

Summary: A prospective study of diaphragm users at the Family Planning Association of Victoria was undertaken. Despite the women being well motivated and instructed the pregnancy rate was high (24 per 100 woman years) and the continuation rate was only 35% at 12 months. Three‐quarters of the women who became pregnant admitted that they did not use a diaphragm on every occasion. Therefore emphasis must be placed on the committed use of the diaphragm every time coitus occurs. Even so, the diaphragm does not appear to be a very safe method of contraception, and may be better suited to family spacing rather than as a method when high efficacy is required.
Disseminated Intraperitoneal Oxyuris Granulomas
Authors: Dalrymple J. C. , Hunter J. C. , Ferrier A. , Payne W.
Published: February 2008

Summary: The threadworm, enterobius (oxyuris) vermicularis, is an nematode which may inhabit the human terminal ileum, colon and appendix. Its presence in ectopic sites is uncommon. We describe a case of generalized intraperitoneal oxyuris granulomas detected as an incidental finding at laparotomy for tuboovarian abscess.
Abnormal Antepartum Cardiotocography and Major Fetal Abnormalities
Authors: Ayodeji Oladiran F. , Kuhn Raphael J.P.
Published: February 2008

Summary: A 10‐year experience of antepartum cardiotocography (8,463 pregnancies) was reviewed to examine the associations with major fetal malformations (278 cases or 3.3%). Patients with critical fetal reserve cardiotocography had a 72% Caesarean section rate (91 of 126) and major fetal malformations were present in 19% (24 of 126) of their infants. Although only 10 of the total 278 malformations (3.6%) were lethal, 6 of these 10 (60%) were associated with a critical reserve antepartum cardiotocographic pattern. As delivery by Caesarean section is usual in patients with critical fetal reserve cardiotocography, it is mandatory to perform ultrasonography to exclude identifiable lethal fetal malformations before delivery.
Amniocentesis: a Comparison of ‘Monitored’ versus ‘Blind’ Needle Insertion Technique
Authors: de Crespigny Lachlan Ch , Robinson Hugh P.
Published: February 2008

Summary: The incidence of complications following 382 ‘blind’ amniocenteses, in which ultrasound was used prior to but not during the procedures, was compared with those following 482 ‘continuously monitored’ amniocenteses. The monitored technique was associated with a reduction in the incidence of blood‐stained amniotic fluid, the number of attempts required to obtain fluid and with a fall in the number of spontaneous abortions from 9 (2.4%) to 4 (0.8%).
Hydatidiform Mole Coexisting with a Live Fetus: A Dilemma of Management
Authors: Khoo S. K. , Monks P. L. , Davies N. T.
Published: February 2008

Summary: A review of 24 patients with a molar placenta and coexisting live fetus, including 2 new cases from the Queensland Trophoblastic Disease Registry, was made. The rate of fetal abnormalities was 33%; all 8 abnormal fetuses were female and in 5 of them in whom cultures were performed the chromosomal karyotype was triploidy 69XXX. There were 3 patients in whom malignant sequelae were detected (12%). After a confident ultrasound diagnosis of a molar placenta and a coexisting live fetus, the decision on whether the pregnancy should be terminated or allowed to continue should be based on the likelihood of the fetus being abnormal. It is recommended that the chromosomal karyotype and anmiotic fluid α‐fetoprotein level be determined by amniocentesis at about 16–18 weeks. This should allow those pregnancies in whom the fetus is potentially normal to be selected for conservative management.
Perinatal Colonization of Group B Streptococcus: An Epidemiological Study in a Chinese Population
Authors: Liang S. T. , Lau S. P. , Chan S. H. , Fok T. F. , Kaneko T. Murai and Y.
Published: February 2008

Summary: An epidemiological study of perinatal colonization of group B streptococcus (GBS) was carried out prospectively in a Chinese population. One hundred and sixty‐eight mother‐infant pairs were studied. Maternal carriage rate from multiple sites was 19.0%, with an overall neonatal colonization rate of 19.6%. There was no neonatal sepsis due to GBS. No obstetrical risk factors that could influence material carriage could be identified. Neonatal colonization was associated with premature/prolonged rupture of membranes, increased duration of rupture of membranes and intrapartum pyrexia. The number of infected sites and the density of organism in each site in the infant were directly proportional to the number and density of organisms in the culture‐positive sites in the mother. Ser‐otypical study showed a complete absence of type II GBS in this population. Since the vertical transmission rate was only 37.5%, it is postulated that nosocomial spread of the organism contributed significantly towards colonization of the infants in our study population.
Total Proteins in Human Amniotic Fluid
Authors: Bala Shashi , Seth S. , Seth P. K.
Published: February 2008

Summary: The study of the biochemical constituents of amniotic fluid is essential in the diagnosis of fetal disorders which result in high concentrations of metabolites in the fetal serum, that can be detected by amniotic fluid examination. The present study is based on the estimations of total protein concentration in the amniotic fluid of normal pregnancies at different gestational weeks. The total protein concentrations, determined by the method of Lowry et al (1951), revealed a characteristic trend during different gestations, with a progressive rise from the 12th week till the 24th week, and then a gradual decline from the 30th week till the 40th week of gestation. Thus, in the third trimester, the total protein decreased with advancement of pregnancy, indicating an inverse relationship with gestational age.
Caecal Adenocarcinoma Metastatic to Ovary Inducing Increased Oestrogen Production and Postmenopausal Bleeding
Authors: Brennecke S. P. , McEvoy M. I. , Seymour A. E. , Bessell C. K. , Munday R. N.
Published: February 2008

Summary: This report describes a patient with a primary caecal adenocarcinoma metastatic to the right ovary, who presented with postmenopausal bleeding secondary to neoplastically induced excessive ovarian steroid production. Histopath‐ological, electron microscopical, tumour tissue incubation and various endocrino‐logical studies were performed to investigate the hormonal basis of this presentation. It is concluded that the elevated oestrogen levels responsible for the postmenopausal bleeding were not of direct ovarian origin, but were consequent upon nonovarian conversion of oestrogen precursors produced by tumour induced hyperplastic ovarian stromal tissue.
Maternal‐Infant Attachment: a Developmental Perspective
Authors: Mertin Peter G.
Published: February 2008

Summary: The formation of a close and satisfying maternalinfant bond is recognized as being an important contribution to the optimal psychosocial development of the child. However the relationship that develops between mother and infant is increasingly seen as an ongoing developmental process rather than a postpartum event, occurring in the first few days after birth. It is also being increasingly recognized that there are a multitude of factors during this period which affect the development of this relationship (14,15, 16, 17). The father too plays an important role at this time, and his reactions to the birth as well as the support he is able to offer his wife are determinants in the evolving maternal‐infant relationship. The view of bonding as an ongoing developmental process influenced by both ante‐ and postnatal factors, indicates some flexibility of response on the part of the mother when things do not go according to plan. For example, separation of mother and infant in the case of a premature delivery need not have an adverse effect on the development of the maternalinfant relationship provided that there is adequate support for the parents. Well trained I.C.U. staff and hospital practices that are sensitive to the needs of the parents at this time are important determinants here. It is felt that the success of the video programme, and the results of the long‐term follow‐up programme conducted at the Queen Victoria Hospital support this developmental view.
Association between Diaphragm Use and Asymptomatic Bacteriuria
Authors: Peddie Barbara A. , Bishop Vicki A. , Blake Elspeth E. , Gorrie Salah I. , Bailey Ross R. , Edwards Diana
Published: February 2008

Summary: The prevalence of asymptomatic bacteriuria was assessed in women using different contraceptive methods. Three hundred and twenty women attending a family planning centre were studied, 80 in each of the following groups: diaphragms, intrauterine contraceptive devices (IUCDs), oral contraceptives (OCs) and no contraception. The numbers with asymptomatic bacteriuria in the 4 groups were as follows: diaphragm — 12 (all E coli); IUCD — 3 (E coli; P mirabilis; S saprophyticus); OC — 5 (all E coli); no contraception — 4 (3 E coli; 1 S sapro‐phyticus). The prevalence of Gram‐negative bacteriuria in women using diaphragms was significantly higher than for women in the other groups (x2= 8.98; p<0.05). Factors such as parity, numbers of sexual partners and frequency of sexual intercourse had no apparent effect. The use of diaphragms may contribute to the risk of Gram‐negative urinary tract infections in sexually active women.
Management of Translocated and Incarcerated Intrauterine Contraceptive Devices
Authors: Mittal S. , Gupta I. , Lata P. , Mahajan U. , Gupta A. N.
Published: February 2008

Summary: Thirty‐seven consecutive patients who reported with absent or snapped strings and failed attempts at removal of intrauterine contraceptive devices (IUCD) by hooks or curette were posted for hysteroscopy/laparotomy following a plain X‐ray of the pelvis to exclude unrecognized spontaneous expulsion. Direct visualization of the endometrial cavity was invaluable in locating and removing IUCDs, particularly the embedded and fragmented ones. Translocated medicated devices were associated with dense adhesions, suggesting the need for their prompt removal. There appears to be an increased risk of translocation in lactating women.
Study of Vaginal Delivery in Patients with One Previous Lower Segment Caesarean Section
Authors: Singh T. Kishor C. , Barman S. D. , Gupta A. N.
Published: February 2008

EDITORIAL COMMENT: The incidence of scar disruption in this series of trial of Caesarean section scars was 3.5% (5 of 144) when pitocin was used for induction or augmentation of labour, and 1.3% (7 of541) when pitocin was not used. This series sounds a warning that concern with today's high Caesarean section rate must not encourage us to overreact and to use oxytocin to improve prospects for vaginal delivery when a patient elects to have a trial of Caesarean section scar.

Summary: This retrospective study evaluated the prospects of having a vaginal delivery following a lower segment Caesarean section in Nehru Hospital; 685 (52%) of 1,315 patients with a previous Caesarean section were given a trial of vaginal delivery with a success rate of 69%. Vaginal breech delivery was allowed in 14 patients without affecting the outcome of term babies and without maternal morbidity or mortality. There were 12 cases (1.7% incidence) of scar disruption of which 4 were of scar rupture. There was no maternal or fetal death as a result of these disruptions even though 3 mothers had subtotal hysterectomy. Pitocin was used in 144 (21%) patients. Of the 12 cases of scar disruption 5 patients had received pitocin. There was no favourable influence of prior vaginal delivery on the success of the trial, and 3 patients with scar disruption had already had a vaginal delivery in addition to a lower segment Caesarean section.
Oxytocin Induced Second Trimester Uterine Rupture
Authors: Dickinson Jan E. , Newnham John P. , Roberts Rae V. , Reid Stanley E.
Published: February 2008

Summary: A case of oxytocin induced rupture of an unscarred uterus during the second trimester is presented. While rupture of the uterus by oxytocic agents in the second trimester has previously been documented, this case is unusual in that fetal parts were palpable through the cervical os, delaying diagnosis and definitive management. Digital palpation of fetal parts through the cervix does not preclude the diagnosis of fetal extrusion secondary to uterine rupture.
Antenatal and Intrapartum Events Influencing Outcome in Very Low Birth‐Weight Infants
Authors: John Elizabeth , MSc David Todd FIMLS , Burnard E. D.
Published: February 2008

Summary: The influence of antenatal and intrapartum events and the route of delivery on Apgar scores and short‐term outcome was studied in 359 singleton very low birth‐weight infants who were resuscitated adequately at birth and had no lethal congenital anomalies.
Very Low Birth‐Weight (< 1,500 g) and Previous Induced Abortion: Victoria 1982–1972
Authors: PhD Judith Lumley MA MB BS
Published: February 2008

Summary: In Victoria, previous termination of pregnancy is a risk factor for giving birth to a very low birth‐weight infant (<1,500 g) — the risk of giving birth to an infant less than 1,000 g is increased more than 2.5‐fold by a prior induced abortion and more than 3.5‐fold by 2 or more prior abortions. However, more than 97% of women with a prior termination gave birth to infants weighing more than 1,500 g. Subsequent very preterm delivery appears to be a real but rare complication of induced abortion, responsible for about 9% of very low birthweight infants in 1982–1983.
Use of a Pocket Personal Computer in Obstetric Ultrasound
Authors: MRCOG Felix Wong FRCS , FRACOG Allan Chang PhD FRCOG
Published: February 2008

Summary: Obstetric ultrasound is of increasing importance in obstetric practice. The conventional ultrasound prediction of fetal weight and gestational age using various fetal parameters, like biparietal diameter, abdominal circumference, femur length etc have to rely on various different charts or tables, which are both laborious and time consuming. Three programmes in Basic language using a pocket personal computer have been developed and their application is presented in this paper.
Emergency Serum and Urine HCG Analyses with the ‘Tandem ICON’ Procedure
Authors: Tsokos Nicolas , Masters Anne M. , Boyne Peter
Published: February 2008

Summary: A comparison between new urine and serum enzyme immunoassay techniques and existing serum radioimmunoassay techniques for the detection of HCG in the diagnosis of ectopic and early intrauterine pregnancy was undertaken. Urine HCG estimations by enzyme immunoassay were not found to be adequate for the exclusion of ectopic pregnancy due to a false negative rate of 12.5% (2 of 16 patients). Serum HCG estimations by enzyme immunoassay were found to compare favourably with radioimmunoassay techniques in the detection of HCG in both ectopic and early intrauterine pregnancy.
Chemotherapy in Gynaecological Cancers — Here Today and Here Tomorrow
Authors: Hillcoat Professor Brian L.
Published: February 2008

If physicians who use drugs to treat cancer had one wish, it would be for a single drug that would cure all cancers with no toxic effects. Failing this, they would ask for the ability to pick only those patients who would respond to the drug so the other patients would not suffer toxic side‐effects unnecessarily. The article by Khoo et al in this issue addresses the second problem. Take the case of a cancer which has a 40% response rate to a drug which produces moderate nausea and vomiting in 65% of patients and marrow toxicity in 15%. Of the 6 of 10 patients who don't respond to treatment, 4 will have moderate nausea and vomiting and 1 marrow toxicity. If we could avoid treating this group, we would avoid this unproductive toxicity.
Short‐Term In Vitro Chemosensitivity Testing of Tumours of the Ovary, Cervix and Uterus, Measurement of DNA Metabolism by H Thymidine Incorporation
Authors: Khoo S. K. , Hurst T. , Webb M. J. , Mackay E. V.
Published: February 2008

Summary: A 3‐hour biochemical assay was chosen in the present prospective study to determine the in vitro chemosensitivity of tumours of the ovary, cervix and uterus. The basis of the assay was to determine the ability of a panel of cytotoxic drugs to inhibit the proliferative activity of tumour cells in culture, using 3H thymidine as a precursor of DNA synthesis. We found variability in the in vitro responses of individual tumours to the 4 drugs (cisplatin, adriamycin, melphalan, methotrexate). In ovarian cancer, cisplatin and adriamycin produced the best inhibitory effects; serous cystadenocarcinomas were most frequently inhibited by cisplatin, whilst undifferentiated carcinomas were more affected by adriamycin. Only 14% of tumours were sensitive to all 4 drugs. We found a good correlation between in vitro results and in vivo response in the medium term. For cisplatin, the predictive accuracy was 85% for ‘sensitive’ tumours and 72% for ‘resistant’ tumours. These findings should increase our confidence in the test as a new aid to planning of chemotherapeutic strategies.
Tubal Resection and Anastomosis I. Sterilization‐Reversal
Authors: FRACOG Robert P. S. Jansen FRACP
Published: February 2008

Summary: Seventy‐seven women (median age 30 years, range 21 to 43) underwent microsurgical tubal resections and anastomoses for sterilization‐reversal. All patients had a laparoscopy between 8 and 21 days postoperatively to allow early diagnosis and treatment of adherences that had formed between tube and ovary or between adnexa and uterus or bowel. Follow‐up ranged from 1 to 21 months and outcome was assessed with life‐table methods. The cumulative probability of pregnancy was 63% at 6 months from surgery, 80% at 12 months and 87% at 18 months. Empirically, average fecundability, or monthly probability of pregnancy, was 13.6%; of 70 women followed‐up and not on contraception, 59 (84.3%) have in fact conceived. The data indicate that: (1) tube‐length, at least above 4 cm, has no discernible effect on Fallopian tube function when fimbrial access to the ovary is not compromised; (2) elapsed time between sterilization and reversal is irrelevant to subsequent likelihood of pregnancy; (3) deleterious effects of endometriosis on fertility can be overcome surgically, provided precautions are taken to prevent adnexal adhesions forming; and (4) reversals of bilateral partial salpingectomies are less likely to be followed by pregnancy than are other methods of tubal interruption.
Failure of Chloroquine Malaria Prophylaxis in Pregnancy
Authors: Mola Glen L. , Wanganapi Alex
Published: February 2008

EDITORIAL COMMENT: Failure of chloroquine for malaria prophylaxis is important, if not alarming, for residents and visitors, especially pregnant women, in these areas.

Summary: Women in a hyperendemic malarious area of Papua New Guinea are supplied with weekly chloroquine chemoprophylaxis at antenatal clinics. A study of 180 women in late pregnancy failed to show any difference in Plasmodium falciparum parasite rates between regular and irregular clinic attenders. Nor was anaemia in late pregnancy associated with parasitaemia; however, grandmultiparas exhibited significantly more prevalent parasitaemia and anaemia in late pregnancy. This study reveals a need for a more detailed investigation of the effects and usefulness of chemoprophylaxis with chloroquine in areas where P. falciparum chloroquine resistance is present.
Summary of Labour and Obstetric Audit by Microcomputer
Authors: Glass Reuben , Humphrey Michael
Published: February 2008

Summary: A microcomputer is used directly by the clinician, immediately after delivering a baby, to produce a summary letter to the referring physician and for the case notes. The programme is easy to use, and accepted by a wide range of medical users. In addition to producing a summary, the information is added to the obstetric data base, which may be interrogated by a computer novice. The system is now used to produce yearly obstetric audits of the Queen Victoria Medical Centre.
Gestational Trophoblastic Disease in Port Moresby, Papua New Guinea
Authors: Sill P. R. , Aimo J. Y. , Murthy D. P.
Published: February 2008

Summary: A retrospective study was performed at Port Moresby General Hospital covering the period 1.1.81–31.3.86. There were 37 cases of hydatidiform mole, 2 of choriocarcinoma and 4 of metastasizing gestational trophoblastic disease of unknown histology. During the study period there were 35,630 deliveries in the same hospital. The incidence of hydatidiform mole was found to be 1: 963 deliveries. Among the patients with hydatidiform mole 1 death was recorded whilst in the group with choriocarcinoma and unclassified disease there were 4 deaths. Of the patients treated for hydatidiform mole 48.5% made no follow‐up visits to the hospital.
Tubal Sterilization — Its Aftermath
Authors: Paterson Peter J.
Published: February 2008

Summary: A review of the long‐term sequelae of female sterilization has been made. There is Little support for the belief that the procedure leads to an increased incidence of menstrual problems, psychological difficulties, or subsequent surgery. All presently available techniques occasionally fail. The rate is not significantly greater when mechanical methods are employed. The proportion that are ectopic, however, is greatly increased following tubal diathermy. Reversal requests per 1,000 women sterilized are numerically higher than failure rates. Success rates following reversal are far higher when mechanical techniques have been used.