bluuebunny/crossref_metadata_2025 huggingface dataset:
Review of the Management of Ectopic Pregnancy in a Major Teaching Hospital: Laparoscopic Surgical Treatment and Persistent Ectopic Pregnancy
Authors: Parker Jim , Permezel Michael , Thompson Derrick
Published: February 2008

Summary: Two hundred and three cases of ectopic pregnancy were examined to determine the current management trends at the Royal Women's Hospital during a period where laparoscopic and conservative therapies were being increasingly used. Only 25% of patients were managed by the previous method of laparotomy and salpingectomy. Ten (8.8%) of 114 cases treated by laparoscopic procedures had persistent trophoblast activity and 8 of these required further surgical or medical treatment. Seven (14.9%) of 47 cases treated by laparoscopic salpingostomy resulted in persistent ectopic pregnancy (PEP). The postoperative beta HCG profiles of 41 patients were examined to identify differences between the ‘persistent ectopic’ and ‘resolved ectopic’ groups. Postoperative serum beta HCG monitoring should be performed at day 4 and day 7 to enable the early detection of treatment failure. The risk of developing a PEP after laparoscopic salpingostomy was significantly increased (p <0.01) if the preoperative serum beta HCG was greater than 3,000 IU/L. A laparoscopic salpingectomy should be performed in cases where the preoperative beta HCG is above 3,000 IU/L and the contralateral tube appears normal.
Incidental Diagnosis of Ectopic Pregnancy with Unusual Clinical Presentation
Authors: Mittal Suneeta , Chhabra Promilla , Khanna Reena , Lali Fatima
Published: February 2008

EDITORIAL COMMENT: We accepted this paper to remind even those readers who are obstetricians and/or gynaecologists that ectopic pregnancy may elude diagnosis unless the possibility is considered in any women during her reproductive years who has abdominal pain, especially when associated with anaemia and disordered menstruation. The presence of pathology in another system can be a distracter from prompt diagnosis of ruptured ectopic pregnancy as shown by these 2 cases.
Recurrent Ectopic Pregnancy Following Repeat Sterilization
Authors: Etherington I.J. , Kerr‐Wilson R.H.J.
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication not only because of its rare anecdotal interest but to remind readers that sterilization can fail even when performed competently. That this occurred twice in the same patient is extraordinary.
A Case of Attempted IVF Surrogacy in Victoria: Breaking the Law or Breaking the Deadlock?
Authors: Leeton J. , Dawson K.
Published: February 2008

Summary: A 37‐year‐old Melbourne woman underwent an emergency hysterectomy for severe postpartum haemorrhage after a twin delivery in 1990 where the pregnancy resulted from a GIFT (gamete intra‐Fallopian transfer) procedure. Two additional embryos had been produced and stored frozen at the time of conception. She and her husband subsequently wished to receive their embryos for implantation into a surrogate to allow them to achieve their own genetic offspring.

The 1984 Infertility (Medical Procedures) Act allowed them to either donate their embryos to another infertile couple or have them discarded. Neither of these options was acceptable to this couple. IVF (in vitro fertilization) surrogacy was their only chance of obtaining their genetic offspring, but this procedure was and is currently illegal. An IVF surrogacy procedure was carried out in 1993 but the surrogate failed to conceive.
Suppression of Pituitary Gonadotropins and Ovarian Steroids in Women with Polycystic Ovarian Disease Using Intranasal Nafarelin Acetate
Authors: FRACOG Ian S. Fraser , FRACOG Robert P.S. Jansen , Sutherland Paul D. , Shearman Rodney P.
Published: February 2008

Summary: Nineteen women with polycystic ovarian disease confirmed by laparoscopy or ultrasound were treated with intranasal nafarelin in the relatively high dosage of 400 μg twice daily for 40 days to suppress pituitary and ovarian function. Changes in endocrine response were assessed by blood sampling 5 times in the first week and then 3 times weekly. Serum levels of LH, FSH and oestradiol (E2) were measured in each sample, progesterone (P), prolactin (PRL) and total testosterone (T) once weekly, and free testosterone once monthly. There were dramatic rises within 24 hours in serum levels of FSH (more than doubled), LH (more than quadrupled) and E2 (more than trebled), and steady declines thereafter. FSH fell into the pretreatment range most quickly (3–4 days), LH more slowly (4–14 days) and E2 slowest (8–14 days). Levels of FSH and E2 reached a plateau within 7–21 days, while LH continued to decline throughout the 40 days. Hence, the LH/FSH ratio declined steadily from a mean of 2.0 before therapy, reversed by day 21 and reached a mean of 0.55 by day 40. Serum E2 was only suppressed to a mean of 150 pmol/L and in 4 women only occasionally suppressed below 200 pmoI/L. There was a small rise in total and free testosterone within the first 1–2 weeks, followed by gradual suppression by day 28 of total T (from 3 to 2 nmol/L) and free T (from 120 to 50 pmol/L). In 5 individuals free T was never suppressed into the normal range. PRL remained unchanged and P remained low. This study has demonstrated that LH continues to show a progressive fall over at least 40 days in women with PCO treated with a high dose intranasal GnRH agonist, yet steroid secretion of E2 and T from ovaries and other sources often remained surprisingly high. It seems unlikely that long‐term GnRH agonist therapy on its own will have much of a role in the management of polycystic ovarian disease.
Caesarean Section Rate Reduced
Authors: Maher Chris F. , Cave Donald G. , Haran Mano V.
Published: February 2008

Summary: The Caesarean section rate in consecutive years was decreased from 20.5% to 11.1% of total public deliveries (p< 0.0001). On retrospective analysis the emergency Caesarean section rate decreased from 10.9% to 6.0% (p < 0.0001) and elective Caesarean section rate from 9.6% to 5.1% (p<0.0001) in consecutive years. Interventions which have accounted for the decrease were 3‐fold. Firstly, vaginal birth after Caesarean delivery was encouraged, secondly, the active management of labour and thirdly, extensive, regular peer review were introduced as unit policy. The decrease in the Caesarean section rate was not achieved at the expense of the fetus as judged by perinatal mortality rates and 5‐minute Apgar scores of less than 7.
Value of Cardiotoeography in Women with Antepartum Haemorrhage ‐ Is It Too Late for Caesarean Section When the Cardiotocograph Shows Ominous Features?
Authors: Manolitsas Thomas , Wein Peter , Beischer Norman A. , Sheedy Mary T. , Ratten Valerie J.
Published: February 2008

Summary: Caesarean section is thought to be indicated by an ominous antepartum cardiotocograph (CTG). However, the fear remains that infants delivered for this indication in the presence of antepartum haemorrhage, especially when premature, are destined to have severe hypoxic neurological damage. We therefore reviewed our experience of cardiotoeography in women with antepartum haemorrhage (APH) from 1989 to 1992. There were 472 women with APH who had a CTG performed. Of them, 68 had abruptio placentae and 317 had an APH of undetermined cause. For the group with abruptio placentae, the perinatal mortality rate (PMR) was 230.7 per 1,000 when the CTG was abnormal, but only 18.2 per 1,000 if the CTG was normal (odds ratio 16.2, 95% confidence interval [CI] 1.53–171.9, p = 0.02). For APH of undetermined cause, the corresponding rates were 90.9 per 1,000 and 9.8 per 1,000 (odds ratio 10.1, 95% CI 0.96–105.8, p = 0.13). There were no perinatal losses in women with APH due to placenta praevia (87 cases).

There were 6 cases of critical fetal reserve identified on a CTG in women with abruptio or APH of undetermined cause. All were delivered by Caesarean section, with 4 surviving infants, 3 with normal neurological outcome and 1 lost to follow‐up. There were 3 cases of APH resulting in an infant with cerebral palsy, all of whom had had a normal antepartum CTG. Our data suggest that cardiotoeography allows pregnancy to be safely prolonged in pregnancies complicated by abruptio placentae or APH of undetermined cause, and that Caesarean section is an appropriate form of delivery when the CTG becomes abnormal in these cases.
Spontaneous Abortion: a Medical Approach to Management
Authors: Chung T. K. H. , Cheung L. P. , Lau W. C. , Haines C. J. , Chang A. M. Z.
Published: February 2008

Summary: The conventional management of spontaneous abortion is surgical evacuation of the uterus to prevent complications which may arise from retained products of conception (POC). This procedure is not without complications and also demands operating theatre resources. The purpose of this study was to determine the efficacy of a medical approach to the management of spontaneous abortion using the prostaglandin analogue, gemeprost. From an initial 212 women presenting with spontaneous abortion, 4 groups were defined according to what they required in the way of initial management. A group of 20 women were excluded from conservative medical management at presentation because they were bleeding heavily and judged to be unsuitable. Sixty women initially required no further management other than determining that they had a complete abortion using transvaginal sonography (TVS). The 132 women were treated with the prostaglandin analogue, gemeprost. Sixty were judged to need no further management afterwards and were initially discharged. The remaining 72 women underwent evacuation of retained products of conception (ERPC) after the gemeprost treatment as medical evacuation of the uterus appeared to had been incomplete. In each of these 4 groups so defined, there was 1 case where an ERPC was required after the patients have been discharged because of complications attributable to retained POC. We therefore found that no ERPC was necessary in the management of 118 out of 212 (55.6%) women who presented with spontaneous abortion. This has important implications in patient management and economical use of hospital resources.
Laparoscopic Evaluation of Apparently Normal Infertile Women
Authors: El‐Yahia Abdulrahman W.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it confirms an important message concerning infertile couples namely that about 50% have significant pelvic pathology found at laparoscopy even when the usual initial investigations, including hysterosalpingography, are normal. The pathology found is significant not because it is anatomically gross but because this group of women with treatment have about 4 times the pregnancy rate within 12–18 months than the untreated ‘normal group’ (42% versus 12%). The authors stress that the ‘normal group’ require more sophisticated investigations which will reveal a possible cause of the infertility in about 50%. This message was reported in this journal by Leeton and Talbot (A) many years ago, their conclusion being that laparoscopy was indicated early in the investigation of the infertile couple. Nonetheless simple investigations have an excellent success rate in the ‘treatment’ of infertility and one can bring on the big guns of the modern technology (superovulation ± IVF and GIFT) too soon. It is often assumed in infertility management that a successful pregnancy is a triumph for whatever was the current therapeutic regimen, yet women who conceive with treatment often subsequently conceive readily without treatment. In the infertility clinic at the Royal Women's Hospital, Melbourne in the 1960's there were bigger harvests of pregnancies in women referred with infertility at the stage of initial referral (before any treatment) and after treatment with placebo tablets, than with ovulation induction or drug treatment of endometriosis (B). The editorial committee agree with the basic investigational survey of the infertile couple shown in table 1 of this paper, although many would recommend laparoscopy after 6 rather than 12months ‘trying’ when the listed tests are normal.

 Leeton J, Talbot JMc. A Comparative Study of Laparoscopy with Hysterosalpingography in 100 Infertility Patients. Aust NZ J Obstet Gynaecol 1973; 13: 169–171.

 J H Evans MD thesis, University of Melbourne, 1976.

Summary: Laparoscopy was used to evaluate 130 women whose basic infertility survey revealed no abnormalities. Overall 75 (57.7%) patients were found to have evidence of pelvic disease while the remainder were completely normal. Pelvic endometriosis was the most common pathology accounting for 27.7%, pelvic adhesions 20.8% and mild pelvic inflammatory disease 6.2%. Appropriate treatment of the pelvic conditions resulted in 31 (42.5%) pregnancies compared with 7 (12.3%) pregnancies in the no treatment group. The outcome of this study suggests that additional pregnancies do occur as a direct result of laparoscopic examination and subsequent therapy. We believe that laparoscopy should be performed on all women to search for a tubal or pelvic cause of infertility when all other examinations have been normal.
Transabdominal Ultrasound as an Aid to Advanced Hysteroscopic Surgery
Authors: Kohlenberg Christopher F. , Pardey John , Ellwood David A.
Published: February 2008

Summary: At the Nepean Hospital transabdominal ultrasound has been used to assist the hysteroscopic surgeon when performing complicated transcervical operations. The 2 main areas of use appear to be either to direct the surgeon within the uterus to the site of pathology or to prevent inadvertent perforation of the uterine wall. The cases vary from haematometra following endometrial ablation to Asherman syndrome and subseptate uteri.
The Incidence of Histological Chorioamnionitis in IVF/GIFT Preterm Births
Authors: Williams Heather , Jeffery Heather
Published: February 2008

EDITORIAL COMMENT: We have accepted this paper for publication to inform readers of the high prevalence of chorioamnionitis in both IVF and GIFT pregnancies, and in normal singleton pregnancies that deliver before 37 weeks' gestation. It could be advantageous to analyse the incidence of chorioamnionitis in IVF pregnancies and GIFT pregnancies separately since the women treated by GIFT have patent tubes and presumably a different past history in terms of chorioamnionitis. It is also important to know the incidence of chorioamnionitis in term singleton pregnancies and in IVF and GIFT term pregnancies before one can make deductions regarding chorioamnionitis being a cause of preterm birth. Readers are referred to the other paper in this issue of chorioamnionitis associated with Ureaplasma urealyticum.

Authors' response to editorial comment: We believe that the data presented suggests that subclinical infection/inflammation although it does not explain the 4‐fold increase in preterm births in the IVF/GIFT population may contribute to between one quarter and one third of the preterm births in both the IVF/GIFT and the control groups of less than 35 weeks gestational age. We were unable to study the incidence of chorioamnionitis in IVF/GIFT pregnancies that were not delivered prematurely but consider that from the literature and Russell's paper (8) the incidence of chorioamnionitis in term infants is less than 10% and probably less than 5 %. Accordingly chorioamnionitis is likely to be an important cause of preterm birth.

Summary: A retrospective case control study was designed to investigate the role of subclinical infection as a risk factor for the high rate of preterm deliveries in IVF/GIFT pregnancies. The cases and the controls were identified from the records of consecutive livebirths of <35 weeks' gestational age (GA), at King George V Hospital from 1987–1993. Fifty one singleton and 58 twin IVF/GIFT preterm births were matched for GA, year of birth, plurality, maternal age, parity, preclampsia and antepartum haemorrhage. As a marker of subclinical infection, the incidence of histological chorioamnionitis (HCA) in the 2 groups (as defined by the standardized, semiquantitative method of Benirschke) was compared. The matched variables did not differ significantly between the IVF/GIFT group and the control group. No significant difference in the incidence of HCA was detected between IVF/GIFT and control groups for singletons or twins. Overall 24% of IVF/GIFT and 30% of controls showed evidence of HCA, odds ratio (95% confidence intervals), 0.72 (0.40‐1.31). This study showed no evidence that the incidence of HCA, is significantly increased in IVF/GIFT preterm births compared with other matched, preterm births. Therefore, we conclude that subclinical infection/inflammation cannot explain the 4‐fold increase in preterm births in the IVF/GIFT population.
Do Women With Placenta Praevia Without Antepartum Haemorrhage Require Hospitalization?
Authors: Rosen David M. B. , Peek Michael J.
Published: February 2008

Summary: Patients with placenta praevia in the third trimester are routinely confined to hospital for fear of major haemorrhage. Whilst this is arguably necessary for those who have had an episode of antepartum haemorrhage (APH), it is uncertain whether these same management principles are valid for those with placenta praevia without antepartum haemorrhage. A retrospective study was undertaken reviewing the case records of 69 consecutive patients diagnosed with placenta praevia in the third trimester of pregnancy. The outcome of 15 who had had no episodes of bleeding were compared with those who had at least 1 antepartum bleeding episode. Patients with placenta praevia without evidence of APH spent a significantly shorter amount of time in hospital and had a significantly lower rate of emergency delivery, with a neonatal outcome as good if not better than the APH group. We conclude that outpatient management in this cohort of patients may be a safe and cost‐effective means of care, and warrants randomized prospective study.
Personal Experience of Prepregnancy Care In Women With Insulin Dependent Diabetes
Authors: Steel Judith M.
Published: February 2008

EDITORIAL COMMENT: This is an account of a unique experience by a physician who extended her care of women with insulin‐dependent diabetes to their prepregnancy and pregnancy care. Dr Judith Steel pioneered the concept of prepregnancy counselling for women with insulin‐dependent diabetes. Having enjoyed this lecture we asked Dr Steel to provide this historical account of her life's work for our readers' benefit. We know of no other prepregnancy clinic for diabetics that can claim more than a 75% attendance.
Comparison of Prostaglandin E2 Vaginal Tablet with Amniotomy and Intravenous Oxytocin for Induction of Labour
Authors: Lo L. , Ho M.W. , Leung P.
Published: February 2008

Summary: Prostaglandins have been increasingly used in obstetrical practice for cervical ripening and induction of labour. We set out to investigate the effectiveness of prostaglandin E2 (PGE2) vaginal pessaries in inducing labour in the Chinese population in Hong Kong. In the period August, 1991 to August, 1992, we recruited 206 pregnant Chinese women who required induction of labour for various obstetrical indications into the trial. The study group had induction of labour by PGE2 vaginal pessaries and the control group underwent amniotomy plus oxytocin infusion. These patients were alternately assigned either method of induction. They were further divided into primiparous and multiparous (parity 1 and 2 only) groups.

Only 101 primiparas and 99 multiparas were available in the final analysis of the trial. Various aspects of labour, delivery, maternal and fetal outcome were compared. For primiparas, the traditional combined induction was the preferred method. For multiparas, both induction methods were quite satisfactory and there was a trend toward lesser blood loss and pethidine requirement in the PGE2 users.
The Safety of Vaginal Prostaglandin F2α for the Stimulation of Labour
Authors: MacLennan Alastair Harvey , Chan Fung Yee , Eckert Kerena
Published: February 2008

Summary: In an audit of 15,102 consecutive deliveries between 1986 and 1991, 3,168 labours were induced with intravenous oxytocin and 824 with 40 mg prostaglandin F2a (PGF2α) vaginal gel. Four hundred and twenty women received PGF2α alone and 404 received PGF2α followed by oxytocin. The main aim of the study was to audit the safety of PGF201 gel to stimulate labour. There were no maternal or neonatal complications attributable to this therapy. In particular, there were no cases of uterine rupture or hyperstimulation requiring surgical or pharmacological intervention. There was little difference in the evidence for fetal distress between induction methods. Although the prostaglandin and oxytocin groups were not comparable in all respects, the results of this large retrospective study confirmed the results of smaller prospective randomized trials showing a significantly shorter labour and reduced analgesia, surgical delivery and postpartum haemorrhage rates in women treated with PGF2α alone. This is the largest reported series of PGF2α induced labours and provides evidence of its safety and is in keeping with physiological data suggesting that PGF2α is the main prostaglandin and oxytocic associated with normal progressive labour. Its apparent safety and potential to reduce both intervention in labour and postpartum complications merits greater attention.
The Evidence for Increasing Cytotoxic Dose Intensity in the Treatment of Advanced Ovarian Cancer
Authors: Hicks Fiona , Murphy Damian , MD David Dodwell
Published: February 2008

Summary: There is a body of conflicting evidence regarding the place of dose intense chemotherapy for advanced ovarian cancer. It remains unproven whether dose intensity is more important than total dose delivered, and measures of drug delivery to the tumour itself are absent or crude. There are various methods under evaluation for reducing the toxicity of chemotherapeutic drugs, thus enabling larger doses to be given. However, we must not lose sight of the fact that current treatment is palliative for the majority of women, making the quality of life an important issue. The place of dose intense cytotoxic chemotherapy, for the treatment of advanced ovarian cancer, must be evaluated in large, carefully designed, prospective trials which, if possible, should include a quality of life assessment.
Randomized Prospective Intervention Study of Human Cervical Wart Virus Infection
Authors: Ward Bruce G. , Thomas Ifor L.
Published: February 2008

Summary: Between February, 1988, and January, 1991,222 women with histologically proven cervical wart virus infection without dysplasia were randomized to be managed by 1 of 4 protocols. Group 1 acted as control, Group 2 were asked to use condoms for 6 months, Group 3 underwent local ablative therapy and Group 4 were asked to use condoms after ablative therapy. Assessment at 2 and 3 years of follow‐up showed no statistically significant superiority for treatment over observation. Defaulters from follow‐up were over 50% by the completion of the study.
Rollerball Endometrial Ablation: A Histological Study in Danazol Pretreated Patients
Authors: Farnsworth A. , Itzkowic D. , Catt M. , Thurloe J. , Laverty C.
Published: February 2008

Summary: Endomyometrial biopsies were taken from danazol pretreated patients about to undergo rollerball endometrial ablation for menorrhagia. The biopsies were taken with a loop electrode at hysteroscopy before and after 1, 2, 3 passes of a rollerball electrode over the endometrium using powers of electrocoagulation diathermy varying from 30 to 100 watts. The biopsies were then assessed histologically. Nineteen biopsies from the perceived endocervical canal, 25 posttreatment curettings and 3 hysterectomy specimens were also assessed. Biopsies taken after danazol pretreatment but before diathermy showed a thinned inactive endometrium. A histological classification of the effect of electrocoagulation diathermy on the endometrium was developed describing increasing endometrial damage. The degree of endometrial damage was directly related to the number of rolls of the ball over the endometrium and to the power of electrocoagulation diathermy. Endometrium was found in 84% of biopsies from the perceived endocervical canal and endometrium was found in curettings from 3 of 11 patients who were amenorrhoeic following ablation.
The Clinical Usefulness of 3a‐Androstanediol Glucuronide in Premenopausal Women with Hirsutism
Authors: Moses R. G. , Theile H. , Colagiuri S.
Published: February 2008

Summary: A biochemical parameter correlating with the clinical assessment of the severity of hirsutism and changing appropriately with the clinical response to treatment would be extremely useful. Preliminary reports of androstanediol glucuronide indicated that it was a peripherally‐derived androgen and had a high correlation with clinical gradings of hirsutism. More recent reports have cast doubts on this association. This paper presents an evaluation of the clinical usefulness of androstanediol in 121 consecutive premenopausal patients with hirsutism. Androstanediol had a positive correlation with the clinical grading of hirsutism (p < 0.02) and the BMI (p < 0.01) but a negative correlation with age (p<0.01). After adjustment for the effects of age and BMI there was no significant association between the degree of hirsutism and the level of androstanediol. We therefore feel that the routine measurement of androstanediol does not assist in the assessment or management of patients with hirsutism.
Nulliparous Caesarean Section in the Home of Active Management of Labour
Authors: How Keith , Foley Michael , Strange John
Published: February 2008

Summary: The world‐wide incidence of Caesarean section continues to rise with dystocia recognized as the major indication. Active management of labour has been proposed as an alternative treatment to Caesarean section for dystocia. At the National Maternity Hospital, Dublin, a recent increase in the Caesarean section rate has been observed. This retrospective review reveals this to be due to other indications.
Measurements of Blood Pressure, Oedema and Proteinuria in a Pregnant Population of New Zealand
Authors: Stone Peter , Cook David , Hutton John , Purdie Gordon , Murray Henry , Harcourt Lauren
Published: February 2008

Summary: This is the first report of the largest study of blood pressure measurement in pregnancy in a New Zealand population using standardized definitions and methodology. Over 3,800 women who delivered in an 8‐month period in the Wellington region were included in the study. Blood pressure measurement and the presence of oedema and proteinuria were recorded from booking until delivery and in the puerperium. Only 2.7% of women were unable to be contacted after delivery for details on outcomes. The results established normal ranges for blood pressure throughout pregnancy. The data show that Mood pressure greater than 140/90 until 35 weeks' gestation is outside 2 standard deviations at all gestations and justifies using these measurements as the definition of hypertension in pregnancy. The fall in blood pressure in the 2nd trimester was less than 1 mm Ffg per week in both the systolic and diastolic pressures. This fall was smaller than previously recorded in other studies. Gestational hypertension was the commonest blood pressure abnormality occurring in 15.2% of the population. This represented 69% of the pregnant women with a hypertensive disorder. The overall incidence of both gestational hypertension and preeclampsia was 18.5% which is higher than reported in other parts of the world. In this study obesity was significantly associated with hypertensive disorders in pregnancy. An arm circumference of >33 cm, one of the measurements of obesity, was found in 6.8% of the study population. Even after the effect of arm circumference was taken into account, hypertensive disorders were also more common in Pacific Island women. Ankle oedema was significantly associated with the development of both gestational hypertension and preeclampsia but the incidence of oedema was noted in only 11.9% of the subjects.
The Feasibility of Early Second Trimester Pregnancy (12 to 14 weeks) Termination with Single Intra‐Amniotic Injection of 15‐Methyl PGF2α
Authors: Prasad R.N.V. , Adaikan P.G. , Anandakumar C. , Ratnam S.S.
Published: February 2008

Summary: Prostaglandin analogues have proven to be safe and effective for second trimester pregnancy terminations when given by various routes. Of these, the intra‐amniotic (IA) route has proven to be safer, especially in women with medical disorders, as it causes the least occurrence of systemic side‐effects. Previously, blind transabdominal IA instillation of the analogue 15‐methyl PGF2a was routinely possible only after 16 weeks' gestation. With the advent of ultrasound‐guided techniques, it has now become possible to use the IA route for very early second trimester pregnancies. This study examines the use of single 1.5 mg 15‐methyl PGF2a IA injection for termination of 12–14 weeks pregnancies. Single injection resulted in successful abortion in 76.5% of women and, in the unsuccessful cases, additional prostaglandin injection resulted in successful abortion in all women within 48 hours without problems. It is therefore feasible to use ultrasound‐guided IA prostaglandin injection for successful termination of early second trimester pregnancies.
Intravaginal Misoprostol for Termination of Midtrimester Pregnancy
Authors: Lim J.M.H. , Soh E.B.S. , Raman S.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because readers will be interested to see this alternative method for termination of second‐trimester pregnancy to that reported in the preceding paper by Prasad and colleagues. We agree with the authors that trials comparing intravaginal misoprostol with other prostaglandins are required. Such a study of a prospective, randomized trial comparing the efficiency and safety of misoprostol with that of prostaglandin E* in 55 women between 12–22 weeks' gestation, has recently been reported (Jain JK, MishellDR. A comparison of intravaginal misoprostol with prostaglandin E2for termination of second‐trimester pregnancy. New Engl J Med 1994; 331:290–293). This study concluded that misoprostol was at least as effective as PGE2 and was less costly, easier to administer, and associated with fewer adverse effects.

Summary: Misoprostol seems to be a drug with many potential uses apart from the treatment of gastric and duodenal ulcers. The oral tablet appears to be effective for termination of midtrimester pregnancy when administered intravaginally. Further research should be carried out to determine its full range of action in order that the drug can be utilized to its maximum potential.
Laparoscopically‐Assisted Vaginal Hysterectomy
Authors: Calandra Claude
Published: February 2008

Summary: A series of 153 consecutive patients is presented in whom a laparoscopically‐assisted vaginal hysterectomy was planned and was performed in 147 of them (96%). Bipolar diathermy was utilized to diathermy the upper uterine pedicles above the uterine arteries. Neither the uterine arteries nor the uterosacral ligaments were ligated laparoscopically and the remainder of the hysterectomy was performed vaginally. In the other 6 patients in whom the operation was commenced laparoscopically, it was discontinued and the operation concluded vaginally in 1 patient and abdominally in the other 5 patients. The aim of using the laparoscopic technique has been to convert a potential abdominal hysterectomy into a vaginal hysterectomy. The technique and the results are discussed.
Ogilvie Syndrome with Caecal Perforation in the Post‐Caesarean Patient
Authors: Tang Peter T.M. , Collopy Brian T. , Somerville Michael
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication because it warns us again that postoperative distension can be associated with spontaneous perforation of the colon. The authors provide a detailed account of the appropriate management. Readers are referred to the previous editorial comment on Ogilvie syndrome ‘Atypical Ogilvie syndrome’. Paraskevaides E C. Aust NZ J Obstet Gynecol 1988; 28:148–149. To update the comment the case reported here is the first to occur in 112,280 confinements including 16,548 Caesarean sections at the Mercy Hospital for Women, Melbourne to August 31, 1994.
Early Severe Haemorrhage Complicating GnRH Analogue Treatment of Submucous Uterine Fibroids
Authors: Gregora Michael , Forbes Kevin , Hill Brian
Published: February 2008

EDITORIAL COMMENT; This case was accepted for publication because of the warning it carries of treatment of women with large submucous uterine fibroids by gonadotropin releasing hormone analogues. We draw readers' attention to the discussion of the cases reported by Friedman (1) where haemorrhage from submucous fibromyomas was apparently successfully managed by hysteroscopy, laparotomy and myomectomy. Mullerian mixed cell sarcomas can also present with a large polypoid mass protruding through the cervix; this condition should be considered when performing uterus‐preserving surgery in such women.

Summary: We present 1 case of early severe uterine haemorrhage as a result of GnRH analogue therapy for a submucous fibromyoma resulting in hysterectomy, to alert others of this potentially serious complication.
Contemporary Transatlantic Developments Concerning Compelled Medical Treatment of Pregnant Women
Authors: Rossiter Graham P.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper because we thought that it was important for readers to realize that, ‘belief on reasonable grounds that a procedure is in accordance with accepted medical practice and in a particular patient's best interest will not (apart from very exceptional circumstances) be a defence to an action in battery’. We consider that readers who practise obstetrics will benefit from reading the details of the cases discussed in this paper.
Smoking Cessation in Pregnancy: A Survey of the Medical and Nursing Directors of Public Antenatal Clinics in Australia
Authors: A. Walsh Raoul , Redman Selina , W. Brinsmead Maxwell , Arnold Beverly
Published: February 2008

Summary: Smoking is a major cause of adverse pregnancy outcomes. However limited data are available documenting the perceptions of care providers in this area. This mail survey undertaken in 1992‐1993 aimed to assess the smoking cessation practices of Australian public antenatal clinics. Questionnaires were returned by 140 (80%) of the 175 eligible hospitals, 83 (48%) medical directors and 108 (62%) nursing directors. Smoking advice was rated an essential activity at the first antenatal visit by 69% of responding directors. Nonetheless, only 12% of clinics indicated they offered relevant training and 4% reported written policies. Results also indicate senior staff may have suboptimal levels of awareness of smoking risks. Clinics used a narrow array of strategies to promote cessation. Almost one‐third of directors said they advised smokers to cut down rather than stop smoking completely. There is a need for antenatal clinics to implement integrated strategies for the detection and treatment of pregnant smokers including staff training and modifications to the clinics' environment. In addition, major health promotion agencies need to develop effective smoking cessation programmes designed specifically for use in antenatal clinics and to monitor their on‐going implementation.
The Biochemistry and Clinical Application of Urinary Oestriol Measurement During Late Pregnancy in the 1990's
Authors: Beischer Norman , Brown James , Wein Peter , Sheedy Mary , Stereff Marianne , Boras Mary
Published: February 2008

Summary: Part 1. The present disillusionment with oestriol measurement as a test of fetoplacental function could be explained by the use of poor methodology and inappropriate normal ranges rather than that the test has lost its usefulness. We have updated the Lever method for measuring oestriol in urine, and examined the automatic TDX system supplied by Abbott Laboratories. The precision of the methods and consistency of results between methods have been determined and normal ranges have been established for both methods. The overall accuracy of collection of 24‐hour urine specimens in a routine laboratory setting has also been calculated. The normal ranges suggested as a guide for the TDX method by Abbott were based on those derived from the original method of Brown and were found to be too low and therefore unsuitable for clinical use. This study reports appropriate lower limits of normal for both the updated Lever and the TDX methods.

Part 2. The results obtained using the updated Lever method since its introduction in 1991 have been compared with those obtained by the original Brown method during the years 1971‐1989. The new, user‐friendly Lever method of oestriol assay measurement used in 1991‐1993 gave results of equivalent clinical value to the Brown method used in 1971‐1989, although the perinatal mortality rates in the tested populations fell from 0.95% to 0.37%.

During 1971‐1989, low oestriol excretion on 1 or more occasions was associated with a 5.6‐fold increase in the perinatal mortality rate (0.66% to 3.67%), whereas in 1991‐1993, the factor was 4.4 (0.27% to 1.2%). Fetal growth retardation was identified by low oestriol excretion equally by the 2 methods, 27.8% with the Brown method and 26.5% with the new Lever method (tables 1 and 2). In the 1991‐1993 study the perinatal mortality rate of infants with growth retardation was 1.0%, and was increased by a factor of 7 if oestriol excretion was low on 1 or more occasions (from 0.4% to 2.8%); 7 of the 10 deaths of growth‐retarded infants were associated with low oestriol excretion. In our view, measurement of oestriol excretion is a practical method for identification of high‐risk pregnancies that require further surveillance (cardiotocography, ultrasonography). The new Lever method is suitable for screening purposes. Although perinatal mortality rates have fallen sharply in the past 20 years, increased risks of fetal growth retardation and perinatal death are still identified by urinary oestriol measurement.
Screening for the Small Fetus: A Study of the Relative Efficacies of Ultrasound Biometry and Symphysiofundal Height
Authors: Harding Kate , Evans Sharon , Newnham John
Published: February 2008

Summary: In this study 3 different methods of screening for birth‐weight <10th percentile in pregnancy were evaluated both indivually and in combination; 1,135 women with singleton pregnancies were studied. Measurements of symphysiofundal height by tape measure, and amniotic fluid index and fetal abdominal circumference by ultrasound imaging, were made at 18, 24, 28, 34 and 38 weeks. At none of these gestational ages did amniotic fluid index perform well as a screening test for birth‐weight <10th percentile. Combining the tests, using symphysiofundal height to select a group at high risk who then had a fetal abdominal circumference measurement, reduced the false positive rate but significantly decreased the percentage of infants diagnosed. The results of this study confirm that the most appropriate antenatal diagnostic test for birth‐weight < 10th percentile is ultrasound measurement of fetal abdominal circumference. Selecting pregnancies at risk by clinical measurement of symphysiofundal height will provide a lower false positive rate than a policy of performing ultrasound on all pregnancies during the third trimester, but will also reduce the sensitivity.
Maternal Serum Screening and Routine 18‐week Ultrasound in the Detection of all Chromosomal Abnormalities
Authors: Scott Fergus , Boogert Anthenius , Smart Stuart , Anderson John
Published: February 2008

Summary: Over a 15‐month period, maternal serum screening (alpha fetoprotein, oestriol, chorionic gonadotrophin) and ultrasound were evaluated in the detection of all chromosomal abnormalities. Of the 981 screened, there were 8 chromosomally abnormal pregnancies. Six of these were considered to be at increased risk on serum screening, all of which were detected. Of the remaining 2, one was detected by ultrasound and the other resulted in a liveborn baby with trisomy 21. The positive and negative predictive values for serum screening for all chromosomal abnormalities was 7.8% and 99.9% respectively. The sensitivity and specificity were 87.5% and 91.5% respectively. Serum screening is useful in the detection of many chromosomal abnormalities, not just Down syndrome. The combination of maternal serum screening and ultrasound has a high negative predictive value and is valuable in providing reassurance of no underlying chromosomal abnormality. With a positive predictive value of 7.8% a chromosomal abnormality will be found once in every 13 amniocenteses performed.
Maternal Methadone Dosage and Neonatal Withdrawal*
Authors: Malpas T.J. , Darlow B.A. , Lennox R. , Horwood L.J.
Published: February 2008

Summary: The aim of this study was to assess the influence of maternal methadone dosage on the severity of neonatal withdrawal. The charts of 67 drug‐abusing mothers and their 70 infants were examined to determine documented patterns of drug usage and the severity of neonatal withdrawal. Of these, 40 women were on a methadone programme. There was a strong relationship between maternal methadone dose at delivery and severity of neonatal withdrawal as assessed by the Neonatal Abstinence Score, length of stay and duration of treatment. Children whose mothers received methadone had mean peak symptom scores greater than 10 whereas the group receiving no methadone had mean scores of less than 4 (p < 0.001). These effects tended to increase with increasing doses of methadone. Length of stay and duration of neonatal treatment showed highly statistically significant increases (p< 0.001) with increasing methadone dose. Maternal methadone dose appears to be strongly related to the severity of neonatal withdrawal.
A Prospective Study of the Microbiological Environment of the Genitourinary Tract in Hong Kong Chinese Women During Pregnancy
Authors: Yim So‐Fan , Lyon Donald J. , Chung Tony K.H. , Haines Christopher J.
Published: February 2008

EDITORIAL COMMENT: There seems no doubt that Chinese women have a low incidence of premature delivery (less than 37 weeks) although the 5% quoted in this paper is similar to the 5.9% for Victoria in 1992 (3,874 of 65,252 confinements). Drew and Chan have confirmed the lower incidence of prematurity in Chinese women living in Hong Kong and in Melbourne than in non‐Chinese women living in MelbourneA. The Chinese women in this study had a remarkably low incidence of group B streptococcal isolation (0.8%) and a very high rate of detection of Candida (30.2%). It is of interest that the authors did not treat women with tests positive for Candida. Sexual practices could understandably influence the vaginal microbiological environment. Recently we reported on the frequency of anal intercourse and other sex practices in pregnancy in a small series from South AustraliaB. Also recently the Editor was privileged to visit a number of maternity hospitals in the Jiansu province in China. When discussing premature rupture of the membranes and prematurity we were told, repeatedly (via our interpreter), that in China it was customary to abstain totally from intercourse during pregnancy even in the absence of complications such as bleeding, ruptured membranes or evidence of infection in one or other partner. Should we disbelieve what we are told when the information seems unexpected? We need more information regarding sexual activity (frequency and route) and associated complications such as premature rupture of the membranes and otherwise uncomplicated spontaneous premature labour, so that we can advise our patients appropriately.

A. Drew JH, Chan DP. Incidence of prematurity and low birth‐weight in an immigrant Chinese population. Aust NZ J Obstet Gynaecol 1989; 29: 303‐305.

B. Barclay LM, McDonald P, O'Loughlin JA. Sexuality and Pregnancy. An Interview Study. Aust NZ J Obstet Gynaecol 1994; 34: 1‐7.
A Cohort Study Comparing the Detection of HPV DNA from Women Who Stop and Continue to Smoke
Authors: Fairley Christopher K. , Tabrizi Sepehr N. , Gourlay Steven G. , Chen Shujun , Borg Anthony , Garland Suzanne M.
Published: February 2008

Summary: The objective of this study was to compare the detection of human papillomavirus (HPV) DNA in women who stopped smoking, and those who continued to smoke. Women entering a smoking cessation programme had tampon specimens collected and analyzed for HPV DNA using polymerase chain reaction (PCR) (LI consensus primers). Women with HPV DNA in their initial specimens had follow‐up specimens collected 1 year later. The stored initial specimens were reanalyzed in the same experiment with the follow‐up specimen. In addition, Hybrid Capture and quantitative PCR were used to determine if the change in HPV DNA over the year of follow‐up was greater in either group. Of 197 women who were recruited into the study, 57 (29%) were positive for HPV DNA. Second specimens were obtained from 49 of these 57 women. Of these 49 women, 13 had stopped smoking and 36 continued to smoke. The detection of HPV DNA in follow‐up specimens was not significantly different in the women who stopped smoking (54%) compared to those who continued to smoke (50%, p = 0.81). Furthermore, the change in the amount of HPV DNA during follow‐up was not different in women who stopped smoking compared to women who continued to smoke (p>0.25). This study suggests that smoking cessation does not affect the detection of genital HPV DNA. On the basis of these findings it is likely that smoking does not increase the risk of invasive cervical cancer by prolonging the detection of HPV DNA.
Remarkable Lubricating Capabilities of Amniotic Surfactant
Authors: Hills Brian A.
Published: February 2008

Summary: Surface‐active phospholipid (SAPL) extracted from amniotic fluid or elutriated from the chorioamnionic sacs of placentas recovered from normal full term deliveries has been shown to be a remarkable lubricant. Coefficients of kinetic and static friction were reduced to 0.009 by SAPL from amniotic fluid and 0.011 for a membrane extract, even under high load (3 kg/cm2), compared with 0.04 for the best nonbiological boundary lubricants. The antiwear properties were equally remarkable, giving a mean scar diameter under extreme pressure of only 0.76mm for amniotic SAPL and 1.00 mm for membrane extract compared with 0.85‐0.95 mm for aqueous lubricants commercially available.

These results support the hypothesis that premature rupture (PROM) is less likely to occur if movement between the fetus and the amnion or between the decidual surface of the uterus and the chorion is well lubricated.
The Treatment of Recurrent Pelvie Lymphocysts with Marsupialization and Functioning Omental Flap
Authors: Perrm Lewis C. , Goh Judith , Crandon Alex J.
Published: February 2008

Summary: A new treatment for recurrent pelvic lymphocysts is reviewed. Nine women with recurrent symptomatic lymphocyst were treated by marsupialization of the lymphocyst to the peritoneal cavity and functioning omental flap. The omental flap was dissected off the greater curve of the stomach maintaining its blood supply from the appropriate gastroepiploic vessels. The flap functioned by absorbing the lymph that previously accumulated in the lymphocyst. The efficacy of treatment was accessed both clinically and with diagnostic imaging. The pelvic lymphocysts were successfully treated in all 9 cases. There was no significant morbidity and the average hospital stay was 7 days. Marsupialization of pelvic lymphocysts combined with an omental flap is effective, not associated with increased morbidity and has a very low recurrence rate.