bluuebunny/crossref_metadata_2025 huggingface dataset:
A Pain in the Neck in Pregnancy: Cervical Spinal Tuberculosis
Authors: Casper Gabrielle R. , Heath Peter , Garland Suzanne M.
Published: February 2008

Summary: This paper describes a case of spinal tuberculosis diagnosed at 29 weeks' gestation in a primigravid Indian woman. The report illustrates the primary problems in suspecting disease, recognizing the diverse clinical presentations and initiating investigations to confirm the diagnosis. In most cases, M. tuberculosis, once recognized and appropriately treated, should result in an excellent prognosis.
HIV Infection Presenting as Chronic Postpartum Perineal Sepsis*
Authors: Dwyer Peter L. , Carey Marcus P. , McLeish Andrew
Published: February 2008

EDITORIAL COMMENT: Readers are referred to the paper ‘Practising Obstetrics and Gynaecology in Areas with a High Prevalence of HIV Infection’ DAA Verkuyl. Lancet 1995; 346: 293–296. This paper presents an enormous experience on HIV infection as it may be seen by the obstetrician and gynaecologist and includes experience similar to that reported in the following case report.
Cervico‐isthmic Pregnancy with Placenta Percreta Ending in a Livebirth
Authors: J. Souter Dereck , B. Roberts Alistair , Stables Simon
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication not because of a morbid interest in placenta percreta, irrespective of whether the fetus is above the placenta or below it, as it usually is in cases of cervical pregnancy, but because this rare condition provides the most serious obstetric complication of all requiring massive resuscitation and expert surgery. We have commented before that when Caesarean section is performed in these cases it is wise to have a competent gynaecological oncologist scrubbed‐up assisting as he will rightly become the senior surgeon if the operation proves difficult. In the Editor's experience, it is probably wise to electively open the bladder to facilitate removal of the friable lower uterine segment and cervix in these women. As shown by this case, bilateral internal iliac ligation does not guarantee haemostasis ‐ blood coagulation failure often occurs during surgery in the more difficult cases and should be anticipated.

Previous Editorial Comments on placenta praevia accreta/cervical pregnancy are:

Woolcott RJ, Nicholl M, Gibson JS. A Case of Placenta Percreta Presenting in the First Trimester of Pregnancy. Aust NZ J Obstet Gynaecol 1987; 27:258.

Altintas A, Ozgunen FT, Doran S, Doran F. Placenta Percreta Invading the Urinary Bladder. Aust NZJ Obstet Gynaecol 1991; 31:371.

Sanders RR. Placenta Praevia Percreta Invading the Urinary Bladder. Aust NZ J Obstet Gynaecol 1992; 32:375.

Author's response to editorial comment:

We did have a gynaecological oncologist (Mr John Wittaker) assisting who performed the internal iliac artery ligation as well as 2 consultant anaesthetists (Drs E Hughes and G Crooks). The blood loss was phenomenal; we measured 14 litres of blood loss and estimated there was another 3 on the table and floor. We had planned for a significant degree of blood loss but the actual amount caught all of the team by surprise.

We attempted to aspirate the vault haematoma as there were recurrent febrile episodes which did not respond rapidly to antibiotics in the postoperative period. We presumed the 2 × 2 cm collection was either a separate haematoma or inflammatory mass.
Thyrotoxicosis in Pregnancy Presenting as Pancytopenia
Authors: Ladwig P. , Coles R. , Fischer E. , Spurrett B.
Published: February 2008

EDITORIAL COMMENT: In spite of its rarity we accepted this case report for presentation to remind readers of the dire complications that can occur in a woman with thyrotoxicosis that has escaped recognition. It is a reminder that thyroid function should be tested in patients who present with severe medical emergencies of uncertain aetiology.

Summary: Delay in diagnosis of thyroid disease can result in morbidity and mortality. Thyroid disorders are not uncommon in the reproductive age group and therefore in pregnancy; recognition of both the common and the more unusual manifestations will optimize outcome.
Risk Factors for Meconium‐Aspiration Syndrome
Authors: Urbaniak Krzysztof J. , McCowan Lesley M.E. , Townend Kevin M.
Published: February 2008

Summary: The aim of this retrospective study was to identify risk factors for meconium‐aspiration syndrome, and to identify antenatal and intrapartum risk factors which might be preventable. We analyzed maternal and neonatal records of the 210 infants who had meconium‐stained liquor and who also developed respiratory distress necessitating admission to the Special Care or Intensive Care Baby Units at National Women's Hospital, Auckland in 1992. Meconium‐aspiration syndrome occurred in 6.6% of meconium exposed babies and in 1.3% of total births. Severe meconium‐aspiration syndrome developed in 18 infants, moderate in 48, mild in 60 and transient respiratory distress in 84. An association was found between meconium aspiration syndrome and primiparity (p=0.0001) and Pacific Island ethnicity (p=0.0002). An association was also found between the severity of meconium aspiration and low umbilical artery pH (p=0.0002). Thick meconium and an abnormal cardiotocograph were more common in severe meconium‐aspiration syndrome. All deaths and long‐term morbidity occurred in babies with abnormal cardiotocographs or in unmonitored infants. Preventable antenatal and intrapartum factors were not identified in this study.
Mild Cervical Atypia: A Management Dilemma
Authors: Lim Fang‐Kan , Razvi Khalil , Ling Yee‐Kiang , Chong Angela , Tham Kok‐Fun , Arulkumaran S.
Published: February 2008

EDITORIAL COMMENT: This paper examines those patients with atypia on cervical cytology and their management. The findings reported in this study from Singapore are similar to those in Victoria (Victoria Cervical Cytology Registry, Statistical Report 1994). Of the 117 patients with atypia on cytology, 25% had a histologically proven C1N lesion. In Victoria 949 cases of atypia/HPV were found on cytology in 1994, with 28% having a colposcopy/histology finding of CIN. In Singapore 18% were found to have high‐grade lesions, compared to 13% in Victoria. The policy in Australia when atypica/HPV is reported on cervical cytology is to repeat the smear in 6 months and to refer for colposcopy only if the abnormality persists. This paper argues against such an approach. Our readers should appraise the arguments put forward by the authors.

Summary: This study examined 117 patients with mild cervical atypia or atypical squamous cells of uncertain significance; it was found that 25% had histologically proven CIN lesions by colposcopically‐directed punch biopsy or cone biopsy, 18% were found to have at least CIN 2 lesions and there was 1 case of invasive cancer. These data strongly support the recommendation of early colposcopic referral in patients with mild cervical atypia.
Abdominal Hysterectomy. Complications, Hospital Stay and Cost
Authors: Carrette Michael
Published: February 2008

EDITORIAL COMMENT: This series is small but personal, and the point made is important. As all consultant gynaecologists must surely know, private noninsured patients are usually good candidates for shortened hospital stay, when there are no complications such as ileus, wound haematoma, urinary infection or unexpected pain. Such women have shown that discharge on the third day, early by Australian but certainly not by North American standards, is a satisfactory regimen when all goes well, as it usually does. Readers are referred to MacKenzie ‘s (5) recent paper of 768 cases of nonradical total abdominal hysterectomies where from 1982 to 1994 the average number of nights in hospital fell from 8 to 5 ‐ this study suggested that ‘very early discharge is acceptable and preferable for many women, provided that domestic arrangements had been made in advance of admission’. See also Editorial Comment regarding Laparoscopic Minilaparotomy Hysterectomy. Wood C, Maher P. Aust NZ J Obstet Gynaecol 1995; 35: 204–205.
The Use of Intraoperative Ultrasound in the Management of a Perforated Uterus with Retained Products of Conception
Authors: Kohlenberg Christopher F. , Casper Gabrielle R.
Published: February 2008

Summary: The benefits of non‐invasive, correctly‐directed instrumentation coupled with an ability to predict complete evacuation of the uterus can make intraoperative ultrasound an important addition in the continued and improved care of women with a perforated uterus and retained products of conception. Two such cases are reported.
Free Fatty Acids and Gestational Diabetes Mellitus
Authors: Meyer B. , Calvert D. , Moses R.
Published: February 2008

Summary: Dyslipidaemia is a common finding in the syndrome of gestational diabetes mellitus (GDM). Free fatty acids (FFA) can cause insulin resistance and have a toxic effect on beta cell function. GDM is a syndrome due to insulin resistance and the purpose of this study was to examine FFA levels in pregnancy. For this purpose samples were taken from 44 consecutive women with GDM and 36 consecutive controls. The women with GDM had similar levels of insulin, triglycerides and total cholesterol to the controls but a significant elevation in FFA; 0.70 (0.33) mmol/L versus 0.29 (0.12) mmol/L (p<0.0001). A raised level of FFA may be responsible for the insulin resistance of GDM and may assist in the diagnosis.
A Randomized Trial of 2 Regimens for the Administration of Vaginal Prostaglandins (gemeprost) for the Induction of Midtrimester Abortion
Authors: Armatage R.J. , Luckas M.J.M.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because second trimester abortion is a sad necessity. The mean gestation in the series was 16 weeks and figure 4 shows the distribution of maturity at abortion. It seems proper to analyze the induction‐abortion interval, side‐effects and amount of gemeprost required and their cost. However it seems to the editorial committee that these studies should focus more on the need for surgical evacuation, immediate and late, and the presence of complications such as haemorrhage. It would be even better if follow‐up data of outcome in future pregnancies could be provided. It may not be statistically significant but it seems preferable to be in a group in which 64% require surgical evacuation than in one in which 78% require surgical evacuation. We require more data from a bigger series.

Summary: The most frequently used method for second trimester termination of pregnancy is administration of gemeprost (16, 16‐dimethyl‐trans A‐prostaglandin E. methyl ester) as a vaginal pessary. This provides a safe and effective method for achieving abortion. The current prescribing advice is to insert the pessaries into the posterior vaginal fornix every 3 hours. This study compares this to a 6‐hourly regimen. The median abortion interval in the 6‐hour group was shorter than the 3‐hour group (15 versus 16 hours respectively) but the cumulative abortion rates were similar (98% in the 3‐hour group and 91.8% in the 6‐hour group). The 6‐hour group required a significantly lower total dose of gemeprost to induce abortion. There was no difference in the rates of side‐effects in the 2 groups but those receiving pessaries every 6 hours required less analgesia. This study finds no advantage in giving gemeprost every 3 hours.
Antepartum and Postpartum Complications of Twin‐Twin Transfusion
Authors: Cincotta Robert , Oldham Jacqui , Sampson Amanda
Published: February 2008

Summary: Twin‐twin transfusion is a condition that was previously associated with close to a 100% perinatal mortality. Recent reports suggest that a survival rate of about 60% can be achieved with serial amniocentesis and modern neonatal care. However, it is now apparent that the survivors of this condition have multisystem complications that can result in neonatal mortality and long‐term morbidity. Fourteen cases of twin‐twin transfusion were examined to determine the antenatal findings that may predict the postnatal outcomes of these infants. The overall survival was 61% (17 of 28). The mean gestation at diagnosis was 23.0 weeks (range 18–34 weeks) and the mean gestation at delivery was 29.0 weeks (range 23–37 weeks). The mean number of amniocenteses was 2.9 and the average total volume of amniotic fluid removed was 6,114 mL. Different patterns of complications were seen in the donor and recipient twins. Hypertrophic cardiomyopathy affected 9 of the recipient twins. Anuria/oliguria was found in 4 of the donor twins and none of the recipients. Periventricular leukomalacia was found in 8 twins and 7 also had mild ventriculomegaly; of the surviving 17 twins, 5 had either periventricular leukomalacia, mild ventriculomegaly or both. Amniotic fluid leakage and perforation of the intervening membrane subsequent to serial amniocentesis were seen in 5 cases. Severe intrauterine growth retardation and abnormal cardiotocographs were a common feature. These complications directly resulted in neonatal mortality and long‐term morbidity in the survivors. Not all complications were detected antenatally and the severity was not able to be anticipated.
Monoamniotic Twin Pregnancy and Cord Entanglement: A Clinical Dilemma
Authors: Ritossa Martin , O'Loughlin John
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication because it makes the point that even accurate antenatal ultrasonographic diagnosis of monochorionic twin pregnancy with cord entanglement still leave dilemmas of management concerning testing for fetal welfare and decisions regarding timing and method of delivery. It may be of anecdotal interest to readers, as it is to the editor, that the 2 most complicated examples of cord entanglement in such pregnancies known to him both resulted in 2 living infants born vaginally. Figure 1 shows braided umbilical cords of the pregnancy published by Golan A, Amit A, Baram A, David MP. Aust NZ J Obstet Gynaecol 1982; 22:165–167. Figure 2, courtesy of Dr Michael Somerville, shows the placenta and knotted cords from a patient delivered at 39 weeks' gestation at the Mercy Hospital for Women, Melbourne, in 1994. In this pregnancy ultrasonography at 19 weeks and 32 weeks' gestation failed to detect either the monochorionic nature of the pregnancy or the knotted cords. Both of these cords were individually knotted and then entangled with additional pseudoknots, fibrotic segments at the points of crossing and with adhesions between the coils. It is extraordinary that both of these rare specimens shows what appears to our consultant pathologist to be chorioangiomas of the placenta that were not mentioned in the pathology reports of either specimen. At the Mercy Maternity Hospital, Melbourne, in the 16 years 1979–1994 there were 82,530 deliveries, 1,138 twin pregnancies and 4 cases of monoamniotic pregnancies with cord entanglement ± knotting, none of which were diagnosed antenatally. The first in 1981 resulted in delivery at 37 weeks of malformed infants, 1 stillborn, 1 neonatal death; the second in 1992 resulted in 2 intrauterine fetal deaths at 27 weeks with true knots in each cord; in the third, Caesarean section was performed at 30 weeks because of premature rupture of the membranes and both infants survived although the cords were knotted together; the fourth case is that shown in figure 2. This case reported by Drs Ritossa and O'Loughlin really is unusual and their discussion of the literature is comprehensive.

Summary: Monoamniotic twin pregnancies are rare, but are associated with a high risk of perinatal death. The major complications are due to cord entanglement and twin twin transfusion. We were recently faced with the clinical problem of a monoamniotic twin pregnancy complicated by cord entanglement. Fortunately the outcome was favourable with the survival of both twins after delivery by elective Caesarean section at 32 weeks' gestation. Our case as well as some of the controversies in the management of this unpredictable condition are presented. Most authors seem to prefer abdominal delivery upon reaching fetal lung maturity in the case of known monoamniotic twins although this management is not validated by the available studies. Hospital admission for fetal monitoring upon discovery of a cord entanglement at a viable gestation is also advocated.
A13‐Year Cytogenetic Study of Spontaneous Abortion: Clinical Applications of Testing
Authors: Ford Judith H. , Wilkin Helen Z. , Thomas Philip , McCarthy Christina
Published: February 2008

Summary: Chromosome analysis was performed on 1,543 specimens of first trimester miscarriage received between 1982 and 1994. Comparisons with earlier studies show that some findings are absolutely consistent between different years and populations, but some major differences are also found. The results are considered in the light of several recent genetic, environmental and physiological studies. Trisomy 16, and probably trisomy 22, is entirely dependent on maternal age; other trisomies show both maternal age and other environmental or genetic effects. Monosomy X and mosaic aneuploidy arise postzygotically by chromosome loss, a normal control mechanism. Some trisomy, dipaternal triploidy and tetraploidy probably occur because of pre‐ or postovulatory ‘overripeness’ either due to transient or chronic maternal conditions or delayed fertilization. Unbalanced structural abnormalities, most apparently of de novo origin, are markedly increased compared to earlier studies and are possibly due to paternal environmental exposures. It is concluded that when considering histories of abortion, studies of the chromosomes of the aborted products are much more informative and cost‐effective than studies of parental bloods. Where available, studies of products should be undertaken for preference, but only by experienced and committed laboratories.
Fibronectin as a Predictor of Preeclampsia: A Pilot Study
Authors: Jones I. , Cowley D. , Andersen M. , Vacca A. , Voroteliak V.
Published: February 2008

The measurement of serum fibronectin levels in women carrying a singleton pregnancy at between 25–30 weeks' gestation has allowed the separation of those women who will remain normotensive from those who develop preeclampsia in this pilot study. The fibronectin assays were performed using nephelometry. It is recognized that some severe cases of preeclampsia will have already declared themselves clinically by 28 weeks' gestation, but if a screening test is to be limited by cost to a single test event, then this pilot study suggests the 28‐week gestation time to be the most suitable. Further studies are being undertaken to test this hypothesis and to adequately assess the test's reliability, predictability and its cost‐effectiveness.
Serum Ferritin Levels in Normal and HIV‐1 Infected Pregnant Women
Authors: Phuapradit Winit , Taeepanichskul Surasak , Jetsawangsri Thavat , Chaturachinda Kamheang , Khupulsup Kalayanee , Kunakorn Mungkol
Published: February 2008

Between May, 1994 and May, 1995 serum ferritin concentrations were measured in 74 pregnant women who were HIV‐1 positive (17 with CD4 cell counts below 200 cells/uL) and in 148 HIV‐1 negative pregnant controls in first trimester of gestation to determine if a high level of serum ferritin is present in pregnant women with HIV‐1 infection. Comparisons were made between groups stratified by CD4 cell counts. Pregnant women with HIV‐1 infection had 92% higher mean serum ferritin levels (112.8 versus 58.8 ug/L, p<0.005) compared to controls, whereas the mean maternal age, parity, gestational age, haemoglobin levels and body mass index at entry into the study did not differ significantly between the control and HIV‐1 infection groups. The serum ferritin levels inversely correlated with the percentage of CD4 lymphocytes, CD4 cell counts and the CD4/CD8 ratio. This study suggests that serum ferritin levels can also be used as an immunological marker in HIV‐1 infected pregnant women.
Operative Laparoscopic Management of Adnexal Cysts: Initial Experience at the Royal Women's Hospital 1991–1994
Authors: Parker Jim , Bethune Michael , Lau Phillips , Permezel Michael , Tan Jeffrey , Byrne Donald
Published: February 2008

The introduction of operative laparoscopic surgery for benign adnexal cysts had led to shorter postoperative hospitalization (mean stay of 2.0 days) in association with a low rate of major complications (1.6%). A planned laparoscopic approach was successful in 95.2% (179/188) of patients. The majority of women were premenopausal (93.6%) and the most common procedure performed was an ovarian cystectomy (73.5% of cysts). Three ovarian cysts that were thought to be benign by preoperative and intraoperative assessment were subsequently found to be ovarian tumours of low malignant potential after histological examination. Operative laparoscopy has become the preferred mode of treatment for benign adnexal cysts at the Royal Women's Hospital. It confers a wide range of benefits to patients, reduces health‐care costs and appears to be a safe and effective treatment modality.
Small Cell Carcinoma of the Cervix of Neuroendocrine Origin Causing Obstructed Labour
Authors: Perrin Lewis , Bell John , Ward Bruce
Published: February 2008

Small cell carcinoma of the cervix complicating pregnancy is rare, only 4 cases having been reported. This is the first case in which the tumour is reported as causing obstructed labour.
Unexpected Ovarian Malignancy Diagnosed After Laparoscopie Surgery
Authors: Yuen Pong Mo , Leung Tse Ngong
Published: February 2008

The main concerns for laparoscopic management of ovarian masses are unexpected malignancy and the spillage of the cyst content. Careful preoperative evaluation is important in proper patient selection. We report a case of unexpected ovarian malignancy managed by operative laparoscopy in a 29‐year‐old woman. The role of ultrasonographic and laparoscopic assessment and their limitations are discussed. The potential role of intraoperative laparoscopic ultrasonographic assessment of the ovarian masses is proposed.
Maternal Lean Body Mass and Birth‐Weight
Authors: Mongelli Max
Published: February 2008

Summary: Maternal lean body mass at booking was estimated according to a formula employing the body mass index and maternal age in a sample of 511 women who booked in the first trimester of pregnancy. The significance of this parameter in comparison with established predictors of birth‐weight such as maternal weight, height, smoking, parity, gestational age and sex of the infant was examined using bivariate correlations and multiple regression analysis. Maternal lean body mass was found to be the most important determinant of birth‐weight for gestation percentile. Cigarette smoking had a negative effect on birth‐weight which was independent of maternal physique. The effect of maternal size on birth‐weight is largely mediated through constitutional and genetic factors rather than nutrition.
False Negative Cytogenetic Results Following Amniocentesis
Authors: Fraser Simon , Drew John H. , Fraser Christina
Published: February 2008

We report 2 cases where prenatal cytogenetic studies following amniocentesis yielded false negative results. Both mothers requested termination of pregnancy but were reassured by the normal chromosome analysis and therefore continued their pregnancies. When cytogenetic studies were repeated in the neonatal period, they demonstrated chromosomal abnormalities, which were confirmed when the initial specimens from amniocentesis were reviewed. Because of our findings, we suggest that if prenatal chromosome analysis is reported as normal, where there is a high index of suspicion of a chromosome abnormality, the result should be questioned and neonatal chromosome analysis undertaken.
Paclitaxel (Taxol*) as Salvage Therapy for Relapsed Ovarian Cancer
Authors: Planner R. S. , Allen D. G. , Brand A. H. , Grant P. T. , Toner G. C. , Sykes P. H. H.
Published: February 2008

Thirty‐two patients with epithelial ovarian cancer received paclitaxel 175 mg/m2, by 3‐hour infusion, in this prospective phase 2 study. All patients had relapsed or progressed after initial cisplatin/cyclophosphamide therapy. Thirteen patients received paclitaxel as second line therapy, 14 as third line therapy and 5 as fourth line therapy. One patient was excluded from efficacy analysis, due to a severe anaphylactic reaction to the first cycle of paclitaxel therapy. Of the 31 evaluable patients, complete remission was observed in 3 patients (9.7%) and partial remission in 11 patients (35.5%), with a total response rate of 45.2%. The median survival from diagnosis for the 31 evaluable patients was 32.5 months and the median survival following therapy with paclitaxel was 12.2 months (range 4–27 months). The 3 patients who achieved a complete response remain alive, at greater than 20 months, since commencing paclitaxel. Twelve patients (38.7%) who achieved a partial response, or had stable disease, had a median survival, after paclitaxel treatment, of greater than 18 months. This study confirms the activity of paclitaxel in relapsed ovarian cancer and demonstrates a prolonged survival benefit in greater than one third of this group of patients.
Peritoneal Surgery in the Treatment of Endometriosis‐Excision or Thermal Ablation?
Authors: Wood C. , Maher P.
Published: February 2008

Summary: Twenty patients with Stage 2 to 4 endometriosis were referred to an Endometriosis Clinic with an average of 3.4 previous medical and surgical treatments. All were treated by peritoneal excision. Follow‐up was for 9–36 months and 14 had a further laparoscope Seventeen of 20 patients are free of symptoms. In 1 patient recurrence occurred in a separate site and in 2 there were lesions close to the original lesion in the pouch of Douglas and bladder wall. In addition, I of the 14 patients having further laparoscopy had mild adhesions. The satisfactory results of the study suggest that a controlled trial comparing peritoneal excision and thermal ablation is worthwhile. There are considerable theoretical advantages in using peritoneal excision rather than peritoneal thermal ablation.
Underutilization of Laparoscopic Oophorectomy
Authors: Wood Carl , Maher Peter , O'Callaghan David , Hailey David , Downing Bruce
Published: February 2008

The objective of this study was to compare the use and effectiveness of laparoscopic and laparotomy oophorectomy in 3 hospitals in Melbourne. A retrospective analysis was made of medical records of 140 patients having laparoscopic or laparotomy oophorectomy in the Mercy Hospital for Women (41), Monash Medical Centre (37), and Cliveden Hill Private Hospital (62).

Both public hospitals used the laparoscopic procedure, 12% and 22% respectively, less often than the private hospital, 94%. The average number of hospital days for procedures completed by laparoscopy was 1.3 and for laparotomy 6.9. Fourteen percent of laparoscopic procedures were converted to laparotomy. Adjusting for this the average hospital stay was 1.6 days for procedures started laparoscopically.

Assuming 1,000 oophorectomies are performed each year in Australia of which 80% could be performed laparoscopically, there may be cost savings to health care providers of over $1.5 million. Laparoscopic oophorectomy is a safe, effective and cost‐efficient method of removing the ovary and gynaecologists should be encouraged to learn and perform this procedure.
Cardiopulmonary Arrest in Pregnancy: Successful Resuscitation of Mother and Infant Following Immediate Caesarean Section in Labour Ward
Authors: Parker Jim , Balis Nicholas , Chester Stephen , Adey Douglas
Published: February 2008

EDITORIAL COMMENT: This case will interest readers because it shows a frightening complication of epidural analgesia in association with hypotensive therapy. This technically was a case of postmortem Caesarean section and indicates that a favourable outcome for mother and baby is possible if intervention is prompt. Follow‐up of the infant is indicated in such cases because the literature indicates that the prognosis of surviving babies born under these circumstances is unfavourable.

Summary: Our patient experienced cardiopulmonary arrest secondary to profound hypotension and was unable to be resuscitated with external cardiac massage and assisted ventilation. This case demonstrates the need for continued vigilance by medical and nursing staff when epidural anaesthesia is being established. Resuscitation equipment should be available in the labour ward as cardiopulmonary resuscitation and immediate Caesarean section can be life‐saving in the event of a cardiopulmonary arrest.
Changes in Risk Factors for Hypoxic‐ischaemic Seizures in Term Infants
Authors: Gunn Alistair J. , Gunn Tania R.
Published: February 2008

Summary: Term infants with seizures and evidence of perinatal asphyxia were prospectively identified in 1 city and 2 time periods: 1978–1981 and 1991. Infants with multiple congenital abnormalities, hypocalcaemia or infection were excluded. Although there was little change in the overall incidence of neonatal seizures between 1978–1981 (1.9 per 1,000) and 1991 (1.78 per 1,000, N.S.) there was a marked reduction in small for dates infants with seizures: 8 of 19 infants in 1978–1981 compared to none of 16 in 1991 (p<0.005). In contrast, infants ≥41 weeks continued to show a markedly increased risk for asphyxia (relative risk 4.48,95% CI: 1.7–12.3). The mechanism of this improved outcome for small for gestational age infants is unknown, but speculatively may be due to improved obstetric monitoring techniques allowing early identification of compromised infants.
Mendelson Syndrome in the Labour Ward
Authors: Boyle R.K.
Published: February 2008

EDITORIAL COMMENT: We accepted this case report for publication to remind readers that the Mendelson gastric aspiration syndrome, although uncommon (almost rare), is a formidable complication that can occur in labour. Because the condition is a significant cause of maternal death and severe morbidity in labour, it is accepted practice that once active labour has commenced no solid food should be given. This is not a simple answer to the problem since progress in labour is very often unpredictable. Furthermore, acid regurgitation or vomiting can occur in a woman who has not taken oral fluids or puree‐type foods in labour. The Editorial Committee reviewed midwifery practice in 2 delivery suites in a Melbourne teaching hospital and learned that approximately 10% of women in labour eat solid foods. Many of these women vomit when labour becomes established. If labour persists for longer than 12 hours, intravenous fluids and calories should be administered. A regimen to combat high acidity of the stomach contents should also be considered. Nonetheless the potential risk remains. Readers will profit from the advice discussed in this paper.

Summary: A case history is reported to caution against the recommendation that a nonparticulate diet be permitted in labour unless participants are not candidates for regional analgesia. A woman was admitted to Intensive Care with Mendelson syndrome. She had been given a meal in early labour, delivered vaginally with epidural analgesia then aspirated stomach contents. Oral intake during labour may continue to be a risk factor for pulmonary aspiration.
Ovarian Hyperstimulation Syndrome
Authors: Tassone Meredith , Kuhn Raphael , Talbot J. Mackenzie
Published: February 2008

Summary: A case of severe ovarian hyperstimulation syndrome (OHSS) prompted us to review our experience of the condition, and to critically evaluate its clinical associations and treatment. Severe OHSS complicated 1.8% of gamete intra‐Fallopian transfer (GIFT) cycles, but none of the ovulation induction and artifical insemination by husband (OI/AIH) cycles. It is difficult to establish whether the higher pregnancy rate observed with OHSS was attributable to pregnancy increasing the risk of OHSS, or if it was the development of OHSS which increased the likelihood of pregnancy. Monitoring serum oestradiol levels and ultrasonographic evaluation of growing follicles may be helpful in identifying women at risk. Strategies for reducing the risk of developing severe OHSS were considered.
Massive Ovarian Oedema: 3 Cases and Clinical Considerations
Authors: Fernando Sujatha S.E. , Guibani‐Bousfield Elizabeth , Wong Felix W.S.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication although a case of massive ovarian oedema was recently reported in this journal (A) because the condition must be less rare than previously considered. The editor and subcommittee have not experienced a case between them yet consider that we should all be aware of the condition since conservative therapy without oophorectomy seems advocated, although seldom practised ‐figure 1 indeed shows an ovary that few would conserve although the other ovary should be inspected for tumour or unusual mobility warranting surgical intervention.

Summary: Three cases (2 of which presented with torsion) of massive ovarian oedema occurring in young women, clinically suspected to be a neoplasm, are presented. Microscopic examination of each showed diffuse interstitial oedema and multiple cysts, some surrounded by luteinized cells. As the patients are young, we advocate conservative management with sparing of reproductive capacity, although that is not what happened with any of our 3 patients.
The Relationship Between Gestational Age and the Incidence of Classical Caesarean Section
Authors: Bethune Michael , Permezel Michael
Published: February 2008

Summary: Improved neonatal survival has led to a rise in the number of Caesarean sections being performed in the presence of extreme prematurity. Many of these operations require an incision in the upper uterine segment with consequent ramifications for the management of any subsequent pregnancy. In this analysis of obstetric patients in a tertiary referral institution over a 9‐year period, there was an overall Caesarean section rate of 18%. A classical incision was performed in 1% of all Caesarean sections, but at 24 weeks' gestation, 20% of Caesarean sections were ‘classicaľ. This frequency decreased to less than 5% at 30 weeks and less than 1% from 34 weeks' gestation. Most women having a classical Caesarean section at term had either a transverse lie or a major degree of placenta praevia.
Changing Outcome for Infants of Birth‐weight 500‐999g Born Outside Level 3 Centres in Victoria
Authors: Doyle Lex W. , Bowman Ellen , Callanan Catherine , Carse Elizabeth , Charlton Margaret P. , Drew John , Ford Geoffrey , Fraser Simon , Halliday Jane , Hayes Marie , Kelly Elaine , McDougall Peter , Rickards Anne , Watkins Andrew , Woods Heather , Yu Victor
Published: February 2008

Summary: The aim of this study of extremely low birth‐weight (ELBW, birth‐weight 500–999 g) infants born in Victoria was to determine the changes between 3 distinct eras; 1979‐80, 1985‐87, and 1991‐92, in the proportions who were born outside level 3 perinatal centres (outbom), the proportions of outborn infants who were transferred after birth to a level 3 neonatal unit, the survival rate for outborn infants, and sensorineural impairment and disability rates in outborn survivors. The proportion of ELBW livebirths who were outborn fell significantly over successive eras, from 30.2% (106 of 351) in 1979‐80, to 23.0% (129 of 560) in 1985‐87, and to 15.6% (67 of 429) in 1991‐92. Between 1979‐80 and 1985‐87, die proportions who were outborn fell predominantly in those of birth‐weight from 800–999 g, whereas between 1985‐87 and 1991‐92 the proportions who were outborn fell predominandy in those of birth‐weight 500–799 g. The proportions of outborn infants who were transferred after birth to a level 3 neonatal unit were similar in die 3 eras, at 49.1%, 38.0% and 41.2%, respectively. The survival rates for outborn infants were lower in each era dian for infants born in a level 3 perinatal centre. Only 1 outborn infant not transferred after birth to a level‐3 unit survived in any era. The survival rates for infants transferred after birth were similar in the first 2 eras, but rose significantly in 1991‐92 (34.6%, 36.7% and 60.7%, respectively). The rates of sensorineural impairments and disabilities in survivors fell significantly between die first 2 eras, and remained low in the last era. It is pleasing that the proportion of tiny babies who were outborn fell significantly over time, reflecting increased referral of high‐risk mothers to level 3 perinatal centres before birth. For ELBW outborn infants, survival prospects free of substantial disability are reasonable, but not as good as for those born in level 3 perinatal centres.
Patient‐Controlled Epidural Analgesia After Caesarean Section Using a Disposable Deviee
Authors: Kee Warwick D. Ngan , Ma Marlene L. , Gin Tony
Published: February 2008

Summary: We have evaluated the use of a disposable device, the Patient Controlled Epidural Infusor, for patient‐controlled epidural analgesia (PCEA) using pethidine, for pain relief in the first 24 hours after elective Caesarean section. Patients using the Patient Controlled Epidural Infusor (n = 20) were compared with a control group (n = 20) who received PCEA using a standard electronic device. Efficacy, as assessed by visual analogue scores, was comparable to that achieved in the control group. Patient and nursing satisfaction was high and similar to that in die control group. There was a low incidence of side‐effects with both devices. Patients using the disposable device used less pethidine than patients using the electronic device (median (interquartile range) 181 (100–275) mg versus 238 (213–375) mg; p = 0.035). Use of this disposable device is an acceptable alternative to more expensive and bulkier electronic devices for PCEA after Caesarean section.
Graft Versus Host Disease Following Intrauterine and Exchange Transfusions for Rhesus Haemolytic Disease
Authors: Harte Glenn , Payton Diane , Carmody Frank , O'Regan Peter , Thong Y. H.
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication because it seems to link graft versus host disease with intrauterine transfusions. Since the association of transfusion with graft versus host disease is exceedingly rare it would seem to the editorial subcommittee that it is reasonable to support the recommendation of the authors that irradiated blood should be used for intrauterine transfusions but as far as we can see the case for doing so for transfusions after birth is yet to be sustained. It seems important to study the fetal maturity at the time of intrauterine transfusions that are known to have been associated with graft versus host disease, the occurrence of which is presumably related to immune tolerance of the fetus to the transfused blood products. Our paediatrician reviewer informed us that at the Royal Women's Hospital, Melbourne, blood for fetal transfusions has always been irradiated since the early 1980s when intravascular transfusions were commenced. However, at this institution they do not irradiate blood for transfusions to infants after birth either for exchange transfusions, when the dose of lymphocytes transfused must be enormous, or for simple transfusions, with a reduced dose of lymphocytes.

Reply to Editorial Comment: The comments by the paediatrician reviewer are noted.

However the decision not to irradiate blood for transfusions to a neonate, be it for an exchange transfusion or a top up transfusion is contrary to current accepted practice.

Indeed, the “dose of lymphocytes must be enormous”. Because of this, the British Blood Transfusion Task Force (A) and the American Association of Blood Banks (B) state that the indications for irradiation of blood are ABSOLUTE for the following:

Intrauterine and all subsequent transfusions and neonatal exchange transfusions.

Premature/very low birth‐weight infants (<1,500 g).

It would therefore seem prudent to follow the British and AABB Standards.

A. Guidelines on Gamma irradiation of blood components for the prevention of transfusion‐associated graft versus host disease. B.C.S.H. Blood Transfusion Task Force, Transfusion Medicinef 1996; 6: 261–271.

B. AABB Standards for Blood Bank and Transfusion Services 16th.
Comparative Study of Intravaginal Misoprostol with Gemeprost as an Abortifaeient in Second Trimester Missed Abortion
Authors: Eng Ng Siew , Guan Ang Chin
Published: February 2008

Summary: This prospective, randomized study compared the efficacy of intravaginal misoprostol (Cytotec) and gemeprost (Cervagem) as an abortifaeient for intrauterine deaths in second trimester pregnancy. Side‐effects, complications and the cost‐effectiveness associated with each drug were assessed. 21 out of 25 patients (84%) in the misoprostol group aborted whereas only 17 out of 25 patients (68%) in die gemeprost group aborted within 24 hours after the initiation of therapy. In the misoprostol group, the abortion rate was influenced by the gestational age with 100% abortion rate for those >17 weeks' gestation compared to 67% for those with a gestational age of 13–16 weeks. Side‐effects were rare in either group and no major complications were reported in either group. Misoprostol was definitely more cost‐effective compared to gemeprost as the mean cost of inducing an abortion using misoprostol was RM 1.08 whereas that of gemeprost was RM 105. We thus concluded that misoprostol was at least as effective as gemeprost as an abortifacient for intrauterine death in second trimester pregnancy. Moreover, it was less costly, with very few side‐effects.
Studies of Postnatal Diabetes Mellitus in Women Who Had Gestational Diabetes
Authors: Beischer Norman A. , Wein Peter , Sheedy Mary T. , Sc B App , Dargaville Richard
Published: February 2008

Summary: This study investigated the prevalence of undiagnosed diabetes in women in the reproductive age group in a Victorian population by analysis of the results of glucose tolerance testing in 57,563 pregnancies. Gestational diabetes (GD) was diagnosed in 4,243 pregnancies and in 2,957 (69.7%) of these, postnatal glucose tolerance testing was performed. Diabetes mellitus was diagnosed within 26 weeks of delivery in 59 women, 55 of whom were diagnosed by the postnatal glucose tolerance test (GTT). There were 4 women with GD who developed diabetic ketosis during pregnancy (3) or within 12 weeks of delivery (1). By consideration of the results of the antenatal and postnatal GTTs, it was deduced that 53% (31 of 59) of the women with diabetes diagnosed after delivery may have had unrecognized prepregnancy diabetes. Consideration of the entire glucose‐tolerance tested population led to the conclusion that approximately 1 in 1,031 women in the reproductive age group in our community have unrecognized prepregnancy diabetes mellitus.
Training, Skills and Approach to High‐risk Obstetrics in Rural GP Obstetricians
Authors: Watts Richard W. , Marley John E. , Beilby Justin J. , MacKinnon Richard P.G. , Doughty Susan
Published: February 2008

Summary: One hundred and sixty seven (82%) of the 204 practising South Australian rural GP obstetricians responded to a questionnaire on training, skills and approach to high‐risk obstetrics. The mean length of training was 8.5 months; 78% of GP obstetricians held a diploma. There was a mean of 13 years experience and 22 deliveries per year. However, 26.3% of practitioners had stopped obstetrics in the previous 12 months and cited indemnity insurance and lifestyle factors as the main reason for stopping. The GPs practised a wide range of skills; forceps (96%), Caesarean section (42%) and had good access to epidural services (83.6%), blood transfusions (91%) and specialist advice. High‐risk obstetrics such as twin pregnancy, fetal growth retardation, insulin‐dependent diabetes and preterm labour, are avoided by most rural GP obstetricians. The mean visual analogue comfort score for providing obstetric care was 7.46 (2.16) and correlated with length of training (p=0.008) and number of deliveries per year (p=0.02). Health authorities must continue to support and encourage country GP obstetricians to provide this essential service to rural women.
Transvaginal Sonography of the Endometrium in South Indian Postmenopausal Women
Authors: Kekre Aruna N. , Jose Ruby , Seshadri Lakshmi
Published: February 2008

EDITORIAL COMMENT: We accepted this paper because it has a simple important message, namely that postmenopausal women with an endometrial thickness ≤4 mm will not have an endometrial cancer; they are likely to have endometrial atrophy. A vaginal ultrasound examination to measure endometrial thickness is a noninvasive investigation. There are about 100 papers on this subject in the world literature at present, and it appears that this investigation will adequately exclude endometrial malignancy in postmenopausal women. This is especially useful in older, unfit or frail women. However, if bleeding is heavy or persists it would still be recommended that hysteroscopy and/or curettage be performed.

Summary: Endometrial carcinoma is not commonly seen in India as in the West. Nevertheless, the diagnosis has to be entertained in women presenting with postmenopausal bleeding. The aim of the study was to compare die transvaginal sonographically‐measured endometrial thickness with the histopathological diagnosis in postmenopausal women. Eighty postmenopausal women were studied prospectively. All of them underwent transvaginal sonography followed by eidier an office dilatation and curettage and/or a hysterectomy. Eight women had endometrial carcinoma and their mean endometrial thickness was 12.6±5 mm (mean ± SD). Taking 4 mm endometrial thickness as cut off the sensitivity of transvaginal scan to detect endometrial pathology was 97%, specificity 98%, positive predictive value 97% and negative predictive value 94%. Hence, we conclude that measurement of endometrial thickness by transvaginal scan is a good screening test in postmenopausal women for differentiating endometrial pathology from those who do not have an endometrial lesion.
Use of Corticosteroids by Australian Obstetricians—A Survey of Clinical Practice
Authors: Quinlivan Julie A. , Evans Sharon F. , Dunlop Sarah A. , Beazley Lyn D. , Newnham John P.
Published: February 2008

Summary: All Fellows, Members and trainees of the Royal Australian College of Obstetricians and Gynaecologists resident in Australia (n = 1,281) received a questionnaire relating to their practice of prescribing antenatal corticosteroids. 833 (65%) responded. The key findings were that 97% of Australian obstetricians prescribe antenatal corticosteroids in the classical setting of uncomplicated early preterm labour and 85% prescribe repeated courses in those cases in which the risk of preterm birth persists or recurs; 50% of obstetricians prescribe this agent weekly in cases with persisting risk of preterm birth. Some of the prescribing practices were found to be related to the number of years since obtaining specialist qualification. In view of the widespread clinical use of repeated doses of corticosteroids revealed in this present survey, it is clear that further research is warranted to determine the possible benefits and hazards of repeated exposures of the developing fetus to this therapy.