bluuebunny/crossref_metadata_2025 huggingface dataset:
Postnatal Depression: A South Australian Prospective Survey
Authors: Stamp Georgina E. , Crowther Caroline A.
Published: February 2008

Summary: The purpose of this study was to determine the prevalence of postnatal depression (PND) and to assess self‐esteem in the early postnatal period and at 6 weeks postpartum and PND at 6 months postpartum.

Women giving birth to term babies over a 6‐month period, completed an Edinburgh postnatal depression scale (EPDS) and a Rosenberg self‐esteem scale in hospital, at 6 weeks postpartum and an EPDS only at 6 months postpartum. A total of 235 women participated in the study of which 222 (95%) returned their questionnaire at 6 weeks postpartum and 192 (82%) at 6 months postpartum. Characteristics of the women and their pregnancy outcome are presented.

The EPDS identified a depressed mood in 9% of women in hospital and at 6 weeks postpartum (95% CI 5.3%‐12.8%). At 6 months this had increased to 10% (95% CI 7.8%‐12.2%). Postnatal depression was significantly correlated with low self‐esteem in hospital and at 6 weeks postpartum.
Analysis of Results of Answers to Journal Questionnaire of Readers' Preferences
Authors: Beischer Editorial Committee: Norman , Ratten Graeme , Evans James , Zacharin Robert
Published: February 2008

The response rate to the questionnaire circulated in the August, 1993 issue of the Journal was 13.3% with completed questionnaires being received from 527 subscribers. This compared favourably with the response rate to the previous questionnaire of slightly less than 10% (1).
An Update On Ovarian Cancer Screening
Authors: Carter Jonathan
Published: February 2008

EDITORIAL COMMENT: The overall perspective for screening for cancer in women seems to be that the need for screening for cervical cancer is well‐established and is relatively efficient although increasing emphasis is required to enrol the over 50's less than 50% of whom are currently regularly examined in VictoriaA. The cytological screening examination for cervical cancer also detects approximately 40% of cases of endometrial cancer; the examiner also has the opportunity to inspect the vagina and vulva for clinical evidence of pathology. The screening for breast cancer by mammography is a major initiative in Australia supported by the various State governments and holds high prospects for improvement in the early detection of this most important of female cancers. There is no doubt that women with an identified family risk of ovarian cancer warrant regular screening, or in some cases prophylactic oophorectomy, but it seems to the Editorial Subcommittee that the case is not proven by the data so far available that sophisticated screening of the general population for ovarian cancer is cost‐effective. It would be interesting to compare whether colonoscopy every 3 to 5 years in the over 40 age group has higher priority than annual transvaginal ultrasound and colour Doppler examination combined with CA 125 screening for ovarian cancer as suggested in this paper. Governments will, when funds are available, respond to the case made for the detection of the most common identifiable curable cancers. Carcinoma of the ovary remains, in spite of its importance, the Cinderella in terms of prospects for early detection of invasive lesions.

(A) 57% screened in the last 3 years for the 50–59 year age group and 33% for the 60–69 year age group (Heather Mitchell, Medical Director, Victorian Cervical Cytology Registry, statement to the Editor).
Recent Negative Cytology Prior to Histologically Confirmed Carcinoma in Situ of the Cervix
Authors: Mitchell Heather , Higgins Vicky
Published: February 2008

Summary: Women with histologically confirmed carcinoma in situ of the cervix were studied within the records of the Victorian Cervical Cytology Registry. The prevalence of histologically confirmed carcinoma in situ during 1992 was 2.67 per 1,000 women screened. Thirty per cent (401 of 1,327) of the women with carcinoma in situ had negative cervical cytology reported during the 2 years prior to the diagnosis of carcinoma in situ and at least 49% (648 of 1,327) had negative cytology during the preceding 5 years. Adenocarcinoma in situ comprised 3.4% of all cases; these women were significantly older and more likely to have had a recent negative smear report than women with squamous carcinoma in situ. Fifty‐five per cent of the women with squamous carcinoma in situ had HPV reported on the biopsy compared with only 27% of the women with adenocarcinoma in situ. Ten per cent of the women with carcinoma in situ had a past history of cytological or histological abnormality; this proportion did not vary by type of carcinoma in situ. This relatively high proportion of negative cytology in close proximity to a diagnosis of carcinoma in situ is to be expected if there is active treatment of lesser lesions and frequent screening of members of the community.
Premature Ovarian Failure and Ovarian Dysgenesis Associated with Balanced and Unbalanced X‐6 Translocations, Respectively: Implications for the Investigation of Ovarian Failure
Authors: Center J.R. , McElduff A. , Roberts C.G.
Published: February 2008

Summary: This study reports the effect of an inherited (X;6) translocation which has not previously been described. The proband was intellectually delayed and had ovarian dysgenesis. Karyotyping revealed an unbalanced karyotype: 46, X, der(X)t{X;6)(q22; p11.2). Her mother was shown to be a carrier of an apparently balanced translocation between the X chromosome and chromosome 6: 46, X, t(X;6)(q22;p11.2). This finding in the mother raises to 7 the number of cases reported which involve a break within the X chromosome ‘critical region’, at band Xq22, without causing ovarian dysgenesis, although it was associated with premature ovarian failure. These cases aim to highlight to clinical specialists the range of gonadal and other phenotypic anomalies (apart from those associated with Turner syndrome) which can occur due to partial deletions of the X chromosome. These findings have implications for the investigation of both ovarian dysgenesis and premature ovarian failure.
Office Falloposcopy; a Tertiary Level Assessment for Planning the Management of Infertile Women
Authors: Dunphy Bruce , Pattinson H. Anthony
Published: February 2008

Summary: Thirty‐nine women underwent Falloposcopic examination utilizing the linear eversion catheter. Indications for examination included bilateral and unilateral proximal and distal tubal occlusive disease, assessing the residual Fallopian tube after salpingectomy for ectopic pregnancy, and unexplained infertility. Seventy‐three Fallopian tubes were available for examination, of which 72 (98.6%) were successfully cannulated. Sixty‐eight ampullas were successfully visualized (94.4%). The mean duration of the examination was 24.7 minutes. Where proximal tubal disease was not suspected, 30.3% of oviducts were found to have a proximal lesion and 57.5% were found to have distal intratubal disease. Management was changed in 24 women (61.5%) on the basis of Falloposcopic information. These data demonstrate the clinical value of Falloposcopy.
The Use of Syntocinon in the Management of Excessive Fluid Absorption During Endometrial Ablation
Authors: Shelley‐Jones David C. , Garry Ray , Mooney Paul , Kumar Chandra M. , Kokri Manmohan
Published: February 2008

Summary: Five cases of intravenous oxytocin use during endometrial laser ablations complicated by excessive fluid absorption are reported. In each of the 5 cases it was possible to measure the rate of fluid absorption before and after the administration of this medication. There was a marked reduction in fluid absorption in 4 of the 5 cases, although the small number in the study did not allow statistical significance to be reached. The clinical benefit observed supports earlier work at this institution which suggests that oxytocic agents may be of value in cases of excessive fluid absorption through their action in contracting the myometrium and thereby compressing myometrial veins.
Intrahepatic Cholestasis of Pregnancy, Worsening After Dexamethasone
Authors: Kretowicz Ewa , Mclntyre H. David
Published: February 2008

Summary: We present a case of intrahepatic cholestasis of pregnancy (ICP) treated with dexamethasone. Rapid elevation in transaminases was observed, beyond levels usually reported in this condition. The world literature is reviewed, with particular reference to a recently suggested treatment protocol using dexamethasone.
Eczema Herpeticum in Pregnancy Successfully Treated with Acyclovir
Authors: Garland Suzanne M. , Hill Penelope J.
Published: February 2008

Summary: A woman with eczema herpeticum due to herpes simplex virus type 1 presented at 35 weeks' gestation and was successfully treated with intravenous acyclovir, with subsequent vaginal delivery of a healthy female infant.
The Role of Transvaginal Sonography in the Diagnosis of Placenta Praevia
Authors: Tan Niap H. , Abu Marlik , Woo Jean L.S. , Tahir Hashim M.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it confirms that vaginal probe ultrasonography is safe if performed carefully in women who have had antepartum bleeding and who are likely to have a placenta praevia Our understanding of the data presented here is that vaginal probe ultrasonography is more accurate than transabdominal ultrasonography in diagnosis of lesser degrees of placenta praevia. This is important now that it has become accepted practice to manage women with placenta praevia at home especially if there has been no major episode of bleeding. Vaginal probe ultrasonography is also useful to avoid misdiagnosis of placenta praevia and unnecessary hospitalization of such patients: this seems very likely to occur if praevia is diagnosed when transabdominal ultrasound shows the placental edge to be within 5 cm of the internal os. Readers are referred to the article by Rosen DMB and Peek MJ “Do women with placenta praevia without antepartum haemorrhage require hospitalization?‘ Aust NZ J Obstet Gynaecol 1994; 34: 2: 130) and the Editorial Comment which accompanied this paper. There are 2 remaining important questions about the antenatal management of a patient with placenta praevia where conservative management is an option. The first is when is it safe to allow the woman home when she has had an episode of haemorrhage, and the second is when should hospitalization be recommended in the absence of haemorrhage when there is a major degree of placenta praevia? One of the main points in this paper is that many days hospitalization could be saved by using transvaginal ultrasound for the diagnosis of placenta praevia. However, this argument seems based on the assumption that women were hospitalized unnecessarily because of misdiagnosis of placenta praevia, which is quite a different argument.

Summary: Transvaginal sonography was performed in 70 patients diagnosed to have placenta praevia by transabdominal sonography. The diagnosis was confirmed either by digital examination in theatre at term or operative finding at delivery. Forty‐nine cases (70%) were correctly diagnosed to have placenta praevia by both modes of sonography. Transvaginal sonography ruled out placenta praevia in 12 cases (17%) thought to be placenta praevia by transabdominal ultrasound. Both transabdominal and transvaginal sonography demonstrated ‘placental migration’ in 4 cases (6%) which were no longer praevia at delivery. Five patients (7%) were erroneously believed to have placenta praevia by both sonographic techniques. Overall, the diagnostic accuracy of transvaginal sonography was 92.8% compared with 75.7% for transabdominal sonography. None of the subjects experienced any exacerbation of bleeding or other complications. The results suggest that transvaginal sonographic localization of the placenta is safe and superior to the transabdominal route.
Vaginal and Speculum Examination in Medical Curricula
Authors: Abraham Suzanne
Published: February 2008

EDITORIAL COMMENT: We hope that this paper will receive close attention from all our readers especially those who as professional teachers or full‐time clinicians instruct medical students or midwives in performing vaginal examination, either bimanual or with a speculum, either at an outpatient clinic or in the labour ward. It seems to the reviewers of this paper that there is an urgent need to improve our teaching experience concerning vaginal and speculum examination, and the first step is to realize how inadequate our teaching is at present. The suitability of the outpatient clinic for instruction of students would be enhanced if time was put aside specifically for the purpose of instructing the students rather than expecting the consultant to cope with a busy workload and also the problem of student teaching. It would also seem that the more detailed and prolonged the teaching vaginal examination is, the more necessary it becomes for the supervisor to gain formal consent from the patient, which is an increasingly sensitive issue in teaching hospitals in Australia. It is the Editor's opinion that teaching bimanual vaginal examination when the patient is anaesthetised is a very suitable procedure, but should only be practised when the woman realizes that the student is a member of the medical team looking after her, and that there is only 1 student in the team, and that she can choose not to consent to the teaching examination.

Summary: Medical students' perception of their own psychomotor skills and attitudes to different methods of teaching the gynaecological examination were studied. Students rated their physical skills poorly, only 7% feeling confident they could detect an abnormality and only 14% considering their ability to perform a Pap smear was good or very good. They rated their doctor/patient skills better, 55% considering they are good at conducting an examination with sensitivity and 67% at explaining to their patient what they were doing and why. Students' first preference for instruction was to examine patients in the Outpatient Clinic under the supervision of a doctor, a method experienced by most students on one occasion. The next preferred method was for students to work with 2 trained gynaecological assistants, acting as patient and instructor, with discussion of feelings and feedback (see Subjects and Methods). The option of student volunteers was a least favoured method but was cited as first preference by 5 % of students. Over 25 % of the female students considered volunteering for vaginal examination a ‘possibility’ if they were examined by a student of the same sex. Over 25% of males would ‘possibly’ volunteer for rectal examination only if the same sex was present. The comments by the students offer help in the future planning of teaching vaginal examination.
OCCASIONAL REVIEW: Education and Hysterectomy
Authors: Santow Gigi
Published: February 2008

Summary: A small Canberra survey provided the opportunity to investigate the observation that tertiary education is associated with lower hysterectomy rates. Despite the sample's being small and unrepresentative of either the Australian or even the Canberra population, it was possible to replicate a simple version of a national model of hysterectomy. Tertiary education remained strongly predictive of a low rate of hysterectomy. Additionally, the study showed, first, that tertiary‐educated women were less likely than others to be told that they needed a hysterectomy in the first place. Secondly, they were less likely to accept such advice: hysterectomy was undergone by only 1 of 5 of the better educated women to whom it had been suggested, but by 4 of 5 of the less educated.
OCCASIONAL REVIEW: Vulvar Cancer: The Cinderella of Gynaecological Oncology
Authors: Giles Graham G. , Kneale Barry L.G.
Published: February 2008

EDITORIAL COMMENT; We have accepted this paper for publication because it gives a good overview of the current situation in Victoria regarding the epidemiology and management of vulvar cancer. There are some problems that still need to be resolved especially the need to divide the cases into those that are associated with intraepithelial carcinoma of the vulva and those that present in the traditional manner of the older woman with a macroscopically apparent lesion, at least if you look carefully, which is not always as easy as it sounds! It may be that it is confusing to consider the 2 groups together.

Summary: Cancer of the vulva is a rare malignancy that increases progressively with age. The age‐standardized incidence averages between 1 and 2 per 100,000 women in Western countries. The majority (80–90%) are squamous cell carcinomas, melanoma and adenocarcinoma each accounting for about 5% of cases. Internationally, the incidence of vulvar cancer varies more than 30‐fold, the highest rates being seen in populations of Portuguese South America. In many populations the incidence appears to be stable but there is some evidence that the incidence of in situ carcinoma is increasing in the United States of America. Epidemiological studies have identified sexual factors, particularly human papilloma virus (HPV) infection, as increasing risk. Smoking also increases risk by interacting synergistically with HPV infection and genital warts. The aetiologies of vulvar intraepithelial neoplasia (VIN)3/in situ disease and invasive cancer appear to differ. VIN does not automatically progress to invasive cancer and is strongly associated with HPV infection. Many older women with invasive vulvar cancer do not have evidence of HPV and do not smoke. More research is needed on the cause of vulvar carcinoma in this group. Treatment has become more conservative over the years and this has reduced morbidity and probably mortality. Although FIGO data do not show much by way of improvement in survival, data from population‐based cancer registries have shown definite increases in survival (5‐year survival proportions in excess of 80%, when age and Stage have been taken into account). Improvement is particularly related to the preponderance of early stage disease.
Endoscopic Minilaparotomy
Authors: Maher Peter J. , Wood E. Carl , HilP David J.
Published: February 2008

EDITORIAL COMMENT: This and the following paper described further modifications of laparoscopic techniques for gynaecological surgery. It has always been standard teaching at laparotomy to mobilize endometriotic ovaries adherent to the broad ligament and other peritoneal structures by blunt dissection with the finger pressed against the back of the uterus and broad ligament. Experience has shown that this is much safer than dissection in situ and less likely to cause haemorrhage or damage to other structures such as rectum and ureter. To the nonlaparoscopist writer of this comment it appears that this minilaparotomy technique retains this classical method of mobilization of the ovaries and possibly it is not only quicker but safer than dissection via the laparoscope!

Summary: In a preliminary study the principles of standard gynaecological surgery, new operative laparoscopic techniques and mechanical elevation of the abdominal wall are combined. These early results indicate an advantage to both patient and hospitals from this approach. Further studies are required to verify our impressions that minilaparotomy combined with no insufflation laparoendoscopy will open up the concept of operative laparoscopic surgery to most gynaecologists.
OCCASIONAL REVIEW: Spontaneous Uterine Perforation as a Serious Complication of Pyometra in Elderly Females
Authors: Sawabe Motoji , Takubo Kaiyo , Esaki Yukiyoshi , Hatano Nobuhiko , Noro Toshio , Nokubi Mitsuhiro
Published: February 2008

EDITORIAL COMMENT: We accepted this case report for publication to inform readers that pyometra is an entity in itself with a significance apart from that of underlying pathology such as carcinoma of the cervix or endometrium. The authors' takeaway message seems to be that a pyometra needs treatment by cervical dilatation in addition to that of associated complications including peritonitis and septicaemia as a result of perforation of the uterus.

Summary: Spontaneous uterine perforation of pyometra is closely related to physiological uterine involution and requires a correct diagnosis, rapid surgical intervention and administration of antibiotics.
Continuous Combined Piperazine Oestrone Sulphate and Medroxyprogesterone Acetate Hormone Replacement Therapy ‐ A Study of Bleeding Pattern, Endometrial Response, Serum Lipid and Bone Density Changes
Authors: Nand S.L. , Webster M.A. , Wren B.G.
Published: February 2008

Summary: This pilot study was conducted to establish the optimum oral dosage of medroxyprogesterone acetate (Provera) given daily in combination with a fixed dose of piperazine oestrone sulphate (Ogen), as hormone replacement therapy. A group of 32 nonhysterectomized, symptomatic menopausal women were randomly allocated to receive piperazine oestrone sulphate 1.25 mg daily and medroxyprogesterone acetate 2.5 mg, 5 mg or 10 mg daily for a 2‐year period. This was an open study and the patients were reviewed at 3‐monthIy intervals for 2 years. Vaginal bleeding was reported by 58% of patients after the first 3 months of treatment. There was a gradual decline in the reported incidence of bleeding over the following 6 months particularly by women in the 5 mg and 10 mg Provera group. Only 10% of patients were still recording slight bleeding in the 10 mg group at 12 months. By 24 months all the women in the 5 mg and 10 mg Provera groups had ceased bleeding. There were 2 patients in the 2.5 mg Provera group with persistent proliferative endometrium at 24 months. All the remaining patients had atrophic endometrium. There was no significant difference in serum lipid changes between the 3 groups, but there was an overall reduction in total cholesterol, triglycerides and low density lipoprotein cholesterol in all women. There was no significant difference in bone mineral density changes between the groups over the 2‐year period. Endometrial protection with increased incidence of amenorrhoea, without significant adverse effects, was seen with the use of 5 mg and 10 mg of provera.
First Trimester Antigen Typing of Fetal Red Cells Using a Flow Cytometric Technique
Authors: Forsyth C. , Nelson M. , Popp H. , Peat B. , Boogert A. , Gibson J.
Published: February 2008

EDITORIAL COMMENT: The use of fetal red cell antigen typing using chorionic villus sampling is appropriate when the partner is heterozygous only if termination of an at risk fetus is planned as in the case reported here. Determination of the fetal red cell antigen (usually rhesus D typing) by this method when early therapeutic intervention may be required is offset by the 50% risk of chorionic villus sampling causing fetomaternal haemorrhage and promotion of antibody formation by the mother.
Falciparum Malaria in Pregnancy
Authors: Jose Ruby , Kekre Aruna N. , George Susan Shanti , Seshadri Lakshmi
Published: February 2008

EDITORIAL COMMENT We accepted this paper to remind readers to warn their patients about the problems of malaria prophylaxis, especially during pregnancy. The final sentence is repeated as a summary Women who are pregnant or planning pregnancy are advised to avoid travel to high‐risk areas, since prophylaxis is inadequate. See also ‘Failure of chloroquine malaria prophylaxis in pregnancy’ Mola G L, Wanganapi A. Aust NZ J Obstet Gynaecol 1987; 27: 24–26.
Insertion of a Permanent Electrode for Intractable Detrusor Instability
Authors: Brieger Geoffrey , Ditton John , Korda Andrew
Published: February 2008

EDITORIAL COMMENT: We accepted this case report for publication because of the miseries or urinary incontinence in elderly women, and because this problem is so common. Any method of cure or control merits consideration. Also urinary incontinence is often the reason why women with their intellectual facilities apparently intact become institutionalized. The woman portrayed in this report was made of stern stuff So too were her medical attendants, since urinary incontinence resulting from a motor vehicle accident (details of injuries not provided) would be treated by conservative means alone by many practitioners, including the writer of this comment, who would have prescribed the vaginal application of dienoestrol cream, which improves symptoms in many women with urinary incontinence and renders other therapies unnecessary in some (A). In less than 2 years this woman was investigated and treated with urodynamic study x 4, drug regimens x 5 and surgical procedures x 4. The takeaway message is that her urinary incontinence was controlled.

(A) Beischer N A, Grant FT. Management of gynaecological disorders in older women. Update in Geriatric Medicine. Part 2. Merck Sharp and Dohme University Program for General Practitioners pl‐12.
Goserelin Reduction of Uterine Fibroids Prior to Vaginal Hysterectomy
Authors: Eizenberg David H.
Published: February 2008

EDITORIAL COMMENT: This paper is provocative and we accepted it for publication so that interested readers, as well as the editorial subcommittee, could be provoked! Our reviewer reminded us that ‘one swallow does not a summer make’ and also that the GNRH agonist did not seem to reduce the size of the fibroids greatly. Not every gynaecologist would tackle such a uterus vaginally (for what it is worth the editor certainly would not). Stovall and colleagues have reported again on the problem of having treated 90 women with uterine size of 14–18 weeks and 60 with uterine size greater than 18 weeks' gestational size. Patients in both groups were randomized to either immediate hysterectomy or 2 months of preoperative gonadotrophin‐releasing hormone agonist. The results were favourable and more or less support the views expressed in this case report. The reference is given for interested readers, but please note that vaginal hysterectomy was attempted only ‘iftheuterus wasmobileand s 14 weeks'gestational size on bimanual examination’. (Stovall TG, Sumit RL, Washburn SA, Ling FW. Gonadotrophin‐releasing hormone agonist use before hysterectomy. Am J Obstet Gynecol 1994; 170: 6: 1744–1751. Response from author to editorial comment: I am happy with your editorial comment except that the GNRH agonist did reduce the size of the fibroids by 50% (volume). If you look at the ultrasound size and convert this to volume and compare the pathology specimen, you will note that the volume has reduced from approximately 280 ml to 125 ml. This agrees with references 7 to 9 where a volume reduction of approximately 50% was obtained.

Summary: A case utilising GNRH agonist to reduce the bulk of uterine fibroids to allow vaginal hysterectomy is presented.
The Beneficial Use of Risk Scoring in a Remote and High‐Risk Pregnant Population
Authors: Humphrey Michael D
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because obstetric practice in this region of Australia is important and readers will be interested to see the results of an audit performed by the author and assessed with the scoring system that is described. It is well known that scrutiny improves performance though how this is achieved is often not clear. Readers will not be surprised that there was a higher perinatal mortality rate in the unscoredpatients which, according to our interpretation of the data presented, included all of the nonbooked patients. However the reduction in perinatal mortality, both in the Cairns Base Hospital and in the patients born outside Cairns over the time reviewed, is impressive. It is of interest to note that the perinatal mortality rate in the babies born outside the Cairns Base Hospital, where the scoring system was not practised, fell from 10.5 per 1,000 singleton births in 1991 to 5J per 1,000 in 1993, although this reduction does not quite reach statistical significance.

Summary: The Peninsula and Torres Strait Health Region in Far North Queensland is a large and remote region with a high incidence of at‐risk pregnancies and few experienced caregivers to provide antenatal care. Pregnancy Risk Scoring was trialled as a means of best allocating meagre resources. All 3,679 women with singleton pregnancies who gave birth at Cairns Base Hospital were studied over a 30‐month period, during which time the Hospital and Regional perinatal mortality rates fell by more than 50%. Risk scoring was applied to 2,875 of these pregnancies. Preterm birth, the birth of low birth‐weight babies, and birth intervention were less likely to occur in those women with a low‐risk score, with the lower likelihood of preterm birth reaching clear statistical signficance. Where pregnancy care resources are scarce and large numbers of high‐risk pregnant women are scattered throughout a remote area it would appear that risk scoring assists positively with decisions about the best use of resources.
High Long‐Term Cure Rate Justifies Routine Treatment of Cervical Intraepithelial Neoplasia Grade I
Authors: Tay Sun‐Kuie , Yong Tze‐Tein
Published: February 2008

Summary: The long‐term clearance of cervical intraepithelial neoplasia (CIN) Grade 1 after one treatment was studied retrospectively in 105 patients. Treatment was by CO2 laser vaporization (74 patients), cone biopsy (8), loop electroexcision (LEEP) (7), electrodiathermy (1) and hysterectomy (2); 79 of the 92 treated patients (85.9%) had normal cervical cytology and colposcopy on a mean follow‐up period of 36.7 months (95% confidence interval between 33.1‐40.4 months). Life table analysis showed that the probability of the cervix remaining disease free was 81% at 72 months of follow‐up.

Of the 13 patients with a cervical abnormality after the initial treatment, 4 had persistent CIN 1,3 persistent human papillomavirus (HPV) infection, 2 recurrent CIN 1 and 4 had recurrent HPV infection. In contrast, of the 13 untreated patients with CIN 1,7 (53.8%) continued to demonstrate an abnormality on the cervix after a mean follow‐up period of 27.5 months (95% confidence interval between 18.8 and 36.3 months). No significant perioperative morbidity was recorded in the treated patients.

The results of this study suggest that CIN 1 can be effectively eradicated in more than 80% of women with 1 treatment alone. The treatment should be considered for all these patients to spare them the psychological and emotional trauma of having to face repeated abnormal cervical cytology on follow up.
Laparoscopic Adnexal Surgery During Pregnancy: A Case of Heterotopic Tubal Pregnancy Treated by Laparoscopic Salpingectomy
Authors: Parker Jim , Watkins William , Robinson Hugh , Byrne Donald
Published: February 2008

EDITORIAL COMMENT: Although we have reported a similar case recently (Bowditch, table 1) we accepted this case for publication because it also reviews the literature concerning laparoscopic surgery during pregnancy. We need more data before concluding that laparoscopy is less likely to result in spontaneous abortion than laparotomy, which certainly has an appreciable risk of this complication when performed before 16 weeks' gestation.
Early Incisional Hernia Following Laparoscopic Surgery
Authors: Yuen Pong Mo
Published: February 2008

Summary: Incisional hernia following laparoscopic surgery is seldom reported unless further complication arises and the presentation is usually late. A case of early incisional hernia following a laparoscopic ovarian cystectomy was reported. The hernia occurred through a 10/11 mm trocar port 3 days after the operation. Awareness of this clinical problem, its relationship to the site of abdominal entry, possible enlargement of the fascial defect during operation and hence the need of meticulous closure of the fascia when a large trocar is used will avoid such occurrence.
Cushing Syndrome in Pregnancy Secondary to an Adrenal Cortical Adenoma
Authors: MacGibbon A. L. , Brieger G. M.
Published: February 2008

EDITORIAL COMMENT: We accepted this case report for publication because of the lesson that diagnosis of severe gestational diabetes indicates the need for consideration of an underlying cause other than hormones from the fetoplacental unit. In the other case of Cushing syndrome published in our journal (Kriplani and colleagues. Aust NZ J Obstet Gynaecol 1993; 33:428‐430) the woman had had diabetes requiring insulin for 3 years and investigations at 10 weeks' gestation were suggestive of pituitary‐dependent Cushing syndrome.

Summary: Cushing syndrome in pregnancy is rare. This is explained by the syndrome's association with amenorrhoea, oligomenorrhoea, infertility and abortions. Cushing syndrome commonly presents with hypertension, weight gain, diabetes, striae or truncal obesity, all of which can be consistent with pregnancy in women without Cushing syndrome. We describe a case of Cushing syndrome in pregnancy secondary to an adrenal cortical tumour which was discovered after an abnormal glucose tolerance test. The woman developed classical features of Cushing syndrome including gestational diabetes and hypertension and was managed successfully to term after a unilateral adrenalectomy at 23 weeks. The case is reported not only because of its rarity but also because the diagnosis was made after a routine screening test for gestational diabetes. Early diagnosis and treatment of adrenal adenoma causing Cushing syndrome in pregnancy reduces maternal and fetal morbidity and mortality.
Second Trimester Colour Doppler Imaging of the Uterine Artery: Reproducibility of the Resistance Index
Authors: Yan Y.L. , Tan Y.Y. , Chang T.C. , Yeo G.S.H.
Published: February 2008

Summary: Second trimester assessment of uterine blood flow has been advocated as a predictor of subsequent adverse perinatal outcome. The reproducibility of uterine artery resistance index, as assessed using colour Doppler imaging, was investigated. Two observers, both of whom were experienced in colour Doppler assessment of uterine artery flow velocity waveforms, performed the measurements. One‐way analysis of variance was used to evaluate intraobserver variability and the limits of agreement method was used to determine the 95% prediction interval for interobserver differences. The intraobserver standard deviation was small for both observers. The limits of agreement for interobserver differences were wide (‐ 0.24, 0.16), similar in magnitude to those reported by other workers who assessed the uterine vessel using continuous wave Doppler. The poor reproducibility of the resistance index suggests that second trimester Doppler assessment of uterine artery flow velocity waveforms may be better described using other semiquantitative methods such as the presence or absence of a diastolic notch.
Shoulder Dystocia Report of 2 cases and review of the literature
Authors: Nand S.L.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication since everyone who practises obstetrics can profit from a revision of this information. Although shoulder dystocia is often not predictable, the editorial subcommittee, after a discussion of this article, agreed to advise readers that in their opinion there are 3 clinical warnings to be heeded. Firstly, there is the mother who has a past history of shoulder dystocia on 1 or more occasions and who appears to have an unusually large fetus; if Caesarean section is decided against, the delivery should be conducted in a suitable position (lithotomy) by suitable personnel (experienced medical practitioner plus assistant), with suitable conditions (episiotomy and analgesia/anaesthesia). Secondly, consider the possibility of shoulder dystocia when mid‐forceps delivery is performed when the fetal head arrests in the occipitoposterior or occipitolateral position, especially in an obese multipara where fetal size cannot be assessed. Thirdly, shoulder dystocia should be anticipated when a fetal head which is on view in the occipitoanterior position at the height of a contraction, recedes to the midpelvis and rotates to the occipitolateral position after the contraction and the mother's voluntary expulsive efforts cease‐ the ‘suitable conditions’ enumerated above should now be implemented. Many of these cases are associated with failure of anterior rotation of the shoulder when labour commenced with an occipitoposterior position. There are also those where the anterior shoulder has arrested above the pubic symphysis and these are the most difficult ones to deal with. Occipitoposterior positions continue to provide most of the problems encountered during labour (see previous comments on Shoulder Dystocia: Risk factors, prevention, association with macrosomia etc. Aust NZ J Obstet Gynaecol 1988; 28:107, 1989; 29:129 and 1990; 30:319).

Summary: Shoulder dystocia, or impacted shoulders is an infrequently encountered obstetric emergency. Despite various risk factors identified by investigators, the occurrence of shoulder dystocia is difficult to predict. Two cases of severe shoulder dystocia managed personally by the author are presented. These cases illustrate some of the important issues regarding prediction of shoulder dystocia and the need to begin a series of well‐tested manoeuvres immediately, to successfully deliver the baby.
Obstetric Experience of Female Medical Practitioners as Patients
Authors: Evans Susan
Published: February 2008

Summary: The objective was to investigate the obstetric experience of South Australian medical practitioners, and in addition, to assess whether the reported increase in adverse pregnancy outcomes among medical practitioners in America occurs in South Australia. A population‐based postal survey of the entire registered female medical population of South Australia was carried out. Comparison was made with randomly selected individually matched pregnant South Australian control women. No significant increase in any complications was found when compared with a case‐controlled group matched for age, parity, year of delivery, and social class. There was a strongly significant increase in their interest in pregnant women and empathy with the difficulties of pregnancy after their own deliveries. The reported increase in complications in American women may be due to the working conditions of those studied. Further assessment of obstetric outcome should consider the individual women's working conditions, including stress. The South Australian group in general reported more difficulties with the postpartum period than the pregnancy itself, and this is the area where more research, and practical assistance should be concentrated.
The Effect of Dance Training on Menstrual Function in Collegiate Dancing Students
Authors: To W W K. , Wong M.W.N. , Chan K.M.
Published: February 2008

Summary: A total of 98 dancing students from a collegiate school of dancing were studied through interview using a highly structured questionnaire to elicit details of the duration and intensity of dance training, menstrual patterns and musculoskeletal injuries sustained during training; 70 (72%) of these dancing students were eumenorrhoeic, while 15 (15.4%) had oligomenorrhoea. Thirteen (13.4%) either had amenorrhoea for over 90 days at the time of the study, or were on hormonal treatment because of amenorrhoea for over 3 months in the past 1 year. Those who were amenorrhoeic had longer training hours per week when compared with eumenorrhoeic and oligomenorrhoeic students. Both oligomenorrhoeic and amenorrhoeic students had a lower body mass index (18.25 kg/m2 and 18.26 kg/m2 versus 19.45 kg/m2, p < 0.01), and a higher incidence of musculoskeletal injuries and chronic orthopaedic problems compared to eumenorrhoeic ones. Ballet students had a higher incidence of menstrual dysfunction and musculoskeletal injuries as compared to classic Chinese dance, modern dance and musical theatre dance students as well as a significantly lower average body mass index. These data suggest a proportional correlation between menstrual dysfunction and proneness to musculoskeletal injuries in training, which could be explained by a hormonal mechanism.
Adenomyosis Following Endometrial Rollerball Ablation
Authors: Yuen Pong Mo
Published: February 2008

Summary: Two cases of adenomyosis following endometrial ablation using a rollerball electrode are reported. In both patients the endometrial ablation was performed for severe menorrhagia in the absence of uterine pathology. The endometrium was not prepared. After the operation, the women had persistent light menstruation for 7 to 9 months which then became heavy. They also developed progressive dysmenorrhoea and uterine enlargement. Abdominal hysterectomy was subsequently performed and adenomyosis was confirmed on histological examination. Prior endometrial preparation with hormone therapy may reduce the risk of incomplete destruction of the endometrium and therefore reduce the risk of postablation adenomyosis.
Von Willebrand Disease: A Rare Cause of Puberty Menorrhagia
Authors: Ahuja Reena , Kriplani Alka , Choudhary V.P. , Takkar D.
Published: February 2008

EDITORIAL COMMENT: In the editor's experience pubertal menorrhagia is an uncommon condition, probably because general practitioners see most of these young women and deal with the problem without the need for specialist referral. Most cases can be managed by reassurance after confirming that the full blood examination is normal (no anaemia, thrombocytopenia or evidence of leukaemia) and that there are no symptoms of pelvic pain, vaginal discharge or pruritus. Most of these girls present with their mothers and vaginal examination has never been necessary in the editor's experience and is likely to require anaesthesia if it is. Reassurance and explanation concerning pubertal anovulatory menstruation is usually all that is required, although iron tables should be prescribed. Occasionally if the problem persists or anaemia is present, hormone therapy is indicated (low dose combined contraceptive pill or a progestogen for the last 12 days of the cycle). This article makes the useful point that when pubescent menorrhagia is severe, a coagulation screen is indicated as well as full blood examination. Also important is that hormone therapy can control menorrhagia associated with Von Willebrand disease. The editor recalls a patient many years ago who presented to the Mercy Maternity Hospital with pubertal menorrhagia in whom idiopathic thrombocytopenia was diagnosed; she had a haemoglobin value of 4 g/dL and after resuscitation was treated by splenectomy.

The discussion in this paper indicates that the articles concerning pubescent menorrhagia in journals are likely to be reporting the rare cases where bleeding is severe. We have previously reported from the same New Delhi institution a case of pubertal menorrhagia due to the Bernard Soulier syndrome (hereditary disorder with decreased platelet adhesiveness, thrombocytopenia and prolonged bleeding time) also successfully treated with oral contraceptive tabletsA.

A. Sharma JB, Buckshee K, Sharma S. Puberty menorrhagia due to Bernard Soulier syndrome and its successful treatment by ‘Ovral’ Hormonal Tablets. Aust NZ J Obstet Gynaecol 1991; 31: 369–370.

Summary: A 13‐year‐old girl with a family history of epistaxis presented with pubertal menorrhagia necessitating multiple blood transfusions. Her coagulation profile confirmed the diagnosis of Von Willebrand disease. The menorrhagia was controlled by cyclical use of oestrogen progestogen combination drugs. The important clinical implication of this case is that the patient with adolescent menorrhagia may have an underlying coagulation disorder, which can successfully be managed by hormones.
Tuberculous Uteroenteroeutaneous Fistula ‐ a Rare Post‐Caesarean Complication
Authors: Malhotra Diljot , Vasishta Kala , Srinivasan Radhika , Singh Gurpreet
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication to remind readers that tuberculosis still does occur in the female genital tract ‐ indeed it is still very common in the Indian subcontinent, especially in women with infertility. When the editor was a registrar in the 1950s, in Australia, it was routine practice to culture premenstrual curettings or menstrual fluid for the tubercle bacillus in all women investigated for infertility as well as sending tissue for histological examination. Approximately 1–2 % were positive, especially in immigrants, in those days mainly from Europe and the United Kingdom. There were 5 such cases diagnosed in 1965 at the Royal Women's Hospital, MelbourneA. Note that in the authors' nation the figure was 13% in a report published in 1979. The practice of endometrial culture for tubercle bacilli ceased in the 1970s since positive findings became exceedingly uncommon. In the 1960s, when we did our fellowship courses in Scotland, routine chest X‐ray of the postgraduate students invariably detected a number of cases of active tuberculosis in each group, mostly in students from the Indian subcontinent. Antenatal chest X‐ray was performed routinely until the late 1960s ‐ it is the only routine antenatal test which comes to mind that has been discontinued ‐ will it become necessary for it to be reintroduced? The HIV epidemic has ushered in a new wave of tuberculosis which is another reason why this case was accepted for publication. finally, although the editor has seen tuberculosis present unexpectedlyB, he has not encountered a case of active tuberculosis of the genital tract presenting during pregnancy or the puerperium!

A. Medical and Clinical Report of The Royal Women's Hospital, Melbourne 1965.

B. See Mackay EV et al. Illustrated Textbook of Gynaecology, W B Saunders, 1992, p 336, figure 22.9 ‐a case of bilateral tuboovarian abscesses due to tuberculosis in a 44‐year‐old immigrant from Scotland with infertility, who had hysterectomy and bilateral salpingo‐oophorectomy performed for chronic pelvic pain.

Summary: A case of uteroenteroeutaneous fistula which developed after lower segment Caesarean section is described. A total abdominal hysterectomy with removal of a tuboovarian mass with excision of the fistulous tract and repair of a small gut fistula were performed. The tuberculous aetiology of this fistula was established after surgery by a positive endometrial culture of acid fast bacilli and the demonstration of epithelioid granulomas in the surgical specimen. Antituberculosis therapy was started and the postoperative recovery was uneventful. The description of the nature of the fistula, its rarity and its presence in a woman with unimpaired fertility are discussed.
Angiolymphoid Hyperplasia with Eosinophilia of the Vulva
Authors: Scurry J. , Dennerstein G. , Brenan J.
Published: February 2008

Summary: Vulvar angiolymphoid hyperplasia with eosinophilia is a rare benign itchy vascular lesion that, because of its nonspecific clinical features, requires biopsy for accurate diagnosis. Surgical excision is the preferred method of treatment.
The Effects of Antenatal Steroid Use in Premature Rupture of Membranes
Authors: Tucker Lisa , Hoff Charles , Peevy Keith , Brost Brian , Holland Scherri , Calhoun Byron C.
Published: February 2008

Summary: We sought to determine if antepartum steroid treatment offers any clinical benefits to patients with premature rupture of membranes. One hundred and forty‐five maternal‐neonatal pairs were studied. Forty‐five maternal‐neonatal pairs with premature, preterm rupture of membranes received steroids during 24–35 weeks' gestation. One hundred maternal‐neonatal pairs received no antenatal steroids. The 2 groups were identical with regard to gestational age at rupture of membranes, gravity, parity, race, fetal gender, socioeconomic status, smoking, and preterm labour risk factors. Study of the data revealed that maternal chorioamnionitis was less frequent in the steroid group (p<0.001). Bronchopulmonary dysplasia (oxygen dependent at discharge at term gestational age) was less frequent in the steroid group (p<0.05). The remainder of the data revealed no statistically significant differences in preterm delivery rate, necrotizing enterocolitis, respiratory distress syndrome, intraventricular haemorrhage rate or severity of haemorrhage, hospital days, latency to delivery, or ventilator days. Antepartum steroid use in preterm rupture of membranes appears to offer clinical benefit in premature infants by lessening the rate of bronchopulmonary dysplasia in those infants receiving antepartum steroids.