bluuebunny/crossref_metadata_2025 huggingface dataset:
Abnormal Uterine Bleeding and Cancer of the Genital Tract
Authors: Alien D. G. , Coney J. F. , Marsden D. E.
Published: February 2008

EDITORIAL COMMENT: This paper makes the point that dilatation and curettage need not be routinely performed in women under the age of 40 years with menor‐rhagia to exclude carcinoma of the endometrium. This point is worth making since many such operations are done for this indication. However, dilatation and curettage may be indicated in women under the age of 40 when excessive menstrual bleeding is causing anaemia, is associated with pain, or palpable gynaecological pathology. Presumably there were a number of patients in this study with menor‐rhagia, aged less than 40 years, in whom atypical hyperplasia of the endometrium was diagnosed as a result of dilatation and curettage and/or hysterectomy. The patients with menorrhagia included 195 with endometrial hyperplasia and 86 with endometrial polyps — one would imagine that a number of these women, even some under the age of 40, had their proper further management determined by knowledge of their endometrial histology!

Summary: All patients in Tasmania admitted to hospital for investigation of abnormal uterine bleeding in 1987 and 1988 were studied. A total of 4,318 patients were investigated. Four of 539 (0.7%) patients with intermenstrual or postcoital bleeding and 31 of 538 (5.8%) patients with postmenopausal bleeding were found to have endometrial cancer. Of the 3,241 patients investigated for ‘heavy’ periods (menorrhagia) there was no case of endometrial cancer. The detection rate of endometrial cancer on dilatation and curettage before the menopause is extremely low. Patients presenting with menorrhagia should not be treated surgically in the first instance unless an obvious organic cause is present.
Acute and Subacute Polyhydramnios in Singleton Pregnancies
Authors: Desmedt Els , Henry Olivia A. , Steinberg Lionel H. , Beischer Norman A.
Published: February 2008

Summary: Over a 10‐year period when 51,022 singleton infants were delivered, 19 pregnancies (1 in 2,685) were complicated by acute polyhydramnios, 17 (1 in 3,000) by subacute polyhydramnios and 501 (1 in 102) by chronic polyhydramnios. The incidence of major congenital malformations in singleton pregnancies associated with acute polyhydramnios was 63% and the perinatal mortality rate was 74%. When subacute polyhydramnios occurred in singleton pregnancies, the incidence of major congenital malformations was 65%, similar to acute polyhydramnios, but the perinatal mortality rate was only 35%. The comparable figures for chronic polyhydramnios in singleton pregnancies were a major malformation incidence of 14% and perinatal mortality rate of 10%. The type of onset of polyhydramnios, acute, subacute or chronic is therefore the most important indicator of prognosis. In patients with gross polyhydramnios, acute renal failure must be specifically excluded.
Caudal Analgesia by the Obstetrician
Authors: Dennerstein Graeme
Published: February 2008

EDITORIAL COMMENT: Not many obstetricians in Australia perform ‘their own’ caudal blocks in patients requiring forceps delivery or manual removal of the placenta. This paper indicates that the practice is safe when training is appropriate and expertise is maintained by regular use of the technique.

Summary: The results of 670 consecutive caudal blocks performed by the author for operative obstetrics over 20 years is reported. There was no morbidity attributable to the technique. Satisfactory analgesia was not achieved in 83 patients and obesity was not a major cause of failure. The causes of these failures are discussed. It is recommended that caudal analgesia continues to be used for operative vaginal obstetrics.
Cancer of the Uterine Cervix and Screening of Aboriginal Women
Authors: Guest Charles , Mitchell Heather , Plant Aileen
Published: February 2008

Summary: Carcinoma of the cervix has not been widely reported as an important health problem for Aboriginal women. From four sources, we have studied cervical cancer death rates, abnormalities detected by cervical cytology screening, and the proportion of women who had been screened. First, from the Northern Territory for the years 1979–1983, we present a relative risk of 6.3 (95% confidence interval, 3.0–11.6) for cervical cancer deaths in Aboriginal women compared with all Australian women. Second, the screening and disease rates in Aboriginal women were profiled within a large laboratory in Victoria. Since 1984, a fourfold increase in the number of smears taken at Aboriginal health services is apparent. In women attending these services, a high rate of significantly abnormal smears is evident. Third, to study the extent of screening, we interviewed Aboriginal women in a Victorian country setting and fourth, we examined a random sample of medical records from an Aboriginal Health Service. The proportion screened at least once rose from 5/47 (11%) among women whose most recent consultation with the Health Service was during the years 1974–1980 to 51/170 (31%) women who attended from 1981–1987 (p<0.01). Aboriginal communities may interpret these trends favourably as they encourage their women to be screened regularly to reduce cervical cancer mortality.
Long‐Term Radiographic Follow‐up of the Sella Turcica in Hyperprolaetinaemic Women
Authors: Rasmussen Carsten , Larsson Sven‐Göran , Bergh Torbjörn
Published: February 2008

Summary: Seventy‐three hyperprolactinaemic women were followed up with radiographic examinations (lateral and posteroanterior coned down views) of the sella turcica for 5 to 13 years during which time all but one had received treatment with bromocriptine. Progression of the sellar asymmetry occurred in 25 women (7 during pregnancy), 14 had regression of their changes in the pituitary fossa while 34 did not show any changes in the configuration of the sella turcica. Prolactin levels in serum, duration of bromocriptine therapy or sellar configuration could not predict later radiographic progressive or regressive changes of the sella turcica. The clinical course was benign in the majority of the women with signs of prolactin‐producing adenomas. The risk of serious tumour enlargement seems to be very small. We were not able to demonstrate any parameter which could predict the growth or shrinkage of the tumour. Routinely repeated radiographic sellar examinations are unnecessary in the vast majority of hyperprolactinaemic women.
Hypertension Due to Renal Artery Stenosis in Pregnancy — the use of Angioplasty
Authors: Pollock C.A. , Gallery E.D.M. , Gyory A.Z.
Published: February 2008

Summary: The use of transluminal percutaneous renal angioplasty for severe hypertension in the second trimester of pregnancy has not previously been reported. We describe its use in a 19‐year‐old female. The procedure resulted in a significant improvement in blood pressure control and allowed the pregnancy to proceed to term, resulting in the delivery of a normal female baby on the 90th percentile for weight. No morbidity to mother or fetus was observed as a result of diagnostic or therapeutic procedures. We conclude that pregnancy should not preclude making the diagnosis of renovascular hypertension as angioplasty may be a useful therapeutic option.
A Case of Multiple (5) Ectopic Pregnancies, Ultimately Resulting in a Twin Pregnancy After in Vitro Fertilization and Embryo Transfer
Authors: Kovacs Gabor T. , Shekleton Paul , Hurley Victor , Leoni Maria
Published: February 2008

Summary: The history of a woman with anovulation, tubal disease and 5 ectopic pregnancies is presented. She finally succeeded in having a family by conceiving twins in her eighth attempt at in vitro fertilization.

‘Tis a lesson you should heed’: Try, try, try again. If at first, you don't succeed, Try, try, try again.

Try and Try Again William Edward Hickson (1803–1870)
Differentiation of Monochorionic and Dichorionic Twin Placentas by Antenatal Ultrasonic Evaluation
Authors: Cheung A. , Wan M. , Collins R.J.
Published: February 2008

EDITORIAL COMMENT: Any lead that promises improved results in twin pregnancy warrants scrutiny since the condition accounts for more than 10% of perinatal deaths (78 of 677 in Victoria in 1987). Twins are monozygotic or identical in about 1 in 4 cases in Caucasian populations and about 1 in 2 in Asian populations (15 of the 31 consecutive cases in this series from Hong Kong). Differences in incidences of spontaneous twin pregnancies in different populations is accounted for by differences in rates of dizygotic twinning, monozygonic twinning apparently having a similar incidence (about 1 in 300 pregnancies) in all populations. This study shows that ultrasound is reasonably accurate at identification of dichorionic from monochorionic twins (70% of monozygotic twins) by assessment of the thickness of the septum between the 2 gestational sacs. The higher perinatal mortality rate in monozygotic compared to dizygotic twins is mainly due to complications that occur exclusively in the monochorionic variety (twin to twin transfusion and its various complications, acute polyhydramnios) but there is also an increased incidence of fetal growth retardation (about 25 %). This paper discusses the advantages of knowing if twins are monochorionic from the point of view of antenatal management. In the editor's opinion the principles of management of all twin pregnancies are: I) The patient should be encouraged to have extra rest at home, whether she believes it to be necessary or not, from 20 weeks' gestation until delivery. 2) Extra surveillance (more frequent testing) for anaemia and preeclampsia. 3) Ultrasonographic assessment of fetal growth every 3–4 weeks from 20 weeks. 4) Weekly cardiotocography from 30 weeks' gestation, especially if the twins are thought to be monochorionic, or if polyhydramnios is present, in order to detect severe fetal compromise (twin to twin transfusion, fetal growth retardation of 1 or both fetuses). Recognition of the rare monoamniotic twin pregnancy alters management only at delivery, the time at which the astute clinician makes the diagnosis by noting that there is only one amniotic sac, since the 25% incidence of cord entanglement or knotting indicates immediate delivery of the second twin if this condition is diagnosed antenatally by ultrasound, elective Caesarean section at 37 weeks' gestation has many advocates.

ABSTRACT The prenatal identification of various types of placentation is important for the antenatal management of twin pregnancies. Such classification can be achieved with the use of ultrasound examination. In 32 cases of twin pregnancy the intervening septum was classified as either a thick (dichorionic) or thin (monochorionic) type. Macroscopic and microscopic examination of the placenta after delivery confirmed the ultrasound diagnosis in 24 of the 30 cases, an accuracy of 80%.
Intrauterine Surgery Using Electrocautery
Authors: Hill David J. , Maher Peter
Published: February 2008

EDITORIAL COMMENT: This is a preliminary report. The authors informed the editor that they have treated 40 patients with this method. We will await the results of follow‐up and details of case selection. Endometrial ablation has been reported recently from several centres but authors have stressed that the procedure was not an alternative to hysterectomy except when the patient refused hysterectomy or was too ill for general anaesthesia (e.g. menorrhagia associated with coagulopathy due to neoplasia)—caution has been expressed because of the possibility that subsequent development of endometrial carcinoma may present late if cervical stenosis prevents tell‐tale vaginal bleeding; there is also the possibility of infection, or haematometra if endometrial ablation is incomplete. Many women would prefer to avoid hysterectomy when indicated by benign disease, but the operation has a relatively low mortality and morbidity, and endometrial ablation must be shown to do better. Is the retained cervix of coital value?—this has not, in the editor's opinion, been properly evaluated in follow‐up of premenopausal women having hysterectomy without oophorectomy. The answer to this question is relevant when counselling the patient about conservative methods of treatment aimed at avoiding hysterectomy.

ABSTRACT A procedure is described which may considerably reduce the number of hysterectomies performed for abnormal uterine bleeding due to benign conditions.
Vaginal Cones for the Treatment of Genuine Stress Incontinence
Authors: Wilson P Don , Borland Margaret
Published: February 2008

EDITORIAL COMMENT: This paper provides further evidence of the value of pelvic floor exercises as a viable alternative to surgery in the treatment of genuine stress incontinence. Many women will not have the motivation to continue with pelvic floor exercising over a prolonged period of time but the fact that over 40% are significantly improved up to 2 years later makes this a worthwhile treatment modality. Surgery for stress incontinence will never be 100% effective or without complications, so it is important that women with stress incontinence be given the option of conservative treatment in the first instance. Vaginal cones are one method of strengthening the pelvic floor and have a timesaving advantage for the busy General Practitioner or Gynaecologist.

ABSTRACT The value of vaginal cones for genuine stress incontinence was assessed in 34 women with this condition. Subjective and objective assessments were made before and after 6 weeks of treatment using urinary diaries, perineometry, ‘home’ pad test and cone weights with and without voluntary pelvic floor contraction. There was a subjective improvement in 23 of the 34 women (68%) after 6 weeks of cone use with 16 (47%) deciding that no additional treatment other than cone therapy was required at this time. Statistical analyses showed that there were significant improvements in the objective indices. There were no side‐effects observed with cone use. When followed up 12–24 (mean 15.8) months from the start of the study, 14 women (41%) were still improved with either cone or pelvic floor exercises. Vaginal cones would seem to be a simple and practical means of improving both pelvic floor strength and genuine stress incontinence.
Unusual Gynaecological Presentations of Donovanosis Pseudoelephantiasis and Carcinoma of the Cervix
Authors: Leung Y. C. , McCartney A. J.
Published: February 2008

Summary: We report 2 unusual gynaecological manifestations of Donovanosis in young tribal aborgines. The first patient presented for medical attention after haemorrhaging from a large pedunculated lesion arising from the left labium minus and majus. This lesion was subsequently confirmed as pseudoelephantiasis resulting from long‐standing Donovanosis of the vulva. The second patient, with initial findings consistent with a diagnosis of advanced cervical malignancy, was referred to the oncology service of a tertiary referral centre. Because of her age and race a differential diagnosis of Donovanosis was considered and subsequently confirmed on special staining (Warthin‐Starry) of biopsy specimens. No evidence of malignancy was found in these specimens.
The Use of Corium Porcine Graft For a Malignant Enterovaginal Fistula
Authors: Jobling T. W. , Barrett G. S.
Published: February 2008

Summary: Palliative treatment of an enterovaginal fistula secondary to adenocarcinoma of the rectum in a 65‐year‐old woman with intraperitoneal corium porcine graft is reported. The patient had previously had a total colectomy for ulcerative colitis followed by excision of the rectal stump, mucosal proctectomy and ileostomy.
The Clinical Value of Clearplan Home Ovulation Detection Kits in Infertility Practice
Authors: Leader Leo R. , Russell Teresa , Clifford Katy , Stenning Barbara
Published: February 2008

Summary: : A home ovulation testing kit, Clearplan, that detects the urinary luteinizing hormone (LH) surge was used by 32 patients on a donor insemination programme for 50 cycles to indicate when to first attend the clinic for a serum LH test to determine ovulation. Using Clearplan significantly reduced the number of clinic attendances (4.06 ± 1.5) compared to the preceding control cycle (7.06 ± 2.0 p< 0.001). One serum LH peak was missed using Clearplan. Ovulation was predicted within 2 days of the serum LH surge in 77% of cycles. Home ovulation determination has the potential to reduce the stress and cost of fertility programmes.
Positive Chlamydial Serology and its Effect on Factors Influencing Outcome of IVF Treatment
Authors: Driscoll G. L. , Dodd J. , Tyler J. P. P. , Howard B. , Lamont B. , Coles R.
Published: February 2008

Summary: : A retrospective study of 98 IVF treatment cycles from 49 couples has assessed the relationship between presence of antibodies to Chlamydia trachomatis and success with respect to fertilization, cleavage and pregnancy rate, both at nidation and term. No effect of prior infection on IVF outcome was noted.
Repeat Sterilization Reversal
Authors: Wood Carl
Published: February 2008

Summary: : Thirteen women had repeat sterilization reversal using microsurgery either because of failed IVF or personal preference for microsurgery. Six pregnancies occurred in 5 women resulting in 5 livebirths and 1 miscarriage. Pregnancy occurred in all 3 patients having isthmic anastomosis in the second sterilization reversal.

Preliminary hysteroscopic tubal cannulation would have excluded operation on 2 patients who had tubal blockage extending several centimetres proximal to the site of the first anastomosis.
Borderline Epithelial Ovarian Tumours
Authors: Ayhan Ali , Akarin Rahime , Develioglu Osman , Yarali Hakan , Kücükali Türkan , Bilgin Filiz
Published: February 2008

EDITORIAL COMMENT: : We accepted this series of cases of ovarian tumours of borderline malignancy because the series is quite large and will interest readers. Stage 3 borderline ovarian lesions should be dealt with by the type of radical surgery reserved for frankly invasive ovarian cancer. The place of chemotherapy where the metastatic disease is histologically borderline in nature is still unclear although many would advocate its use. However when there is no evidence of spread beyond the ovary and the histology confirmed by an expert places the tumour in the borderline malignancy group, then no further therapy is indicated, even when the ovarian tumour is large. Alkylating agents used for chemotherapy have approximately a 10% long‐term incidence of leukaemia and subsequent risk of death. There seems to be little point in having a classification of borderline malignancy if the patient is to be subjected to radical treatment in any case, even though the authors make the exception of the premenopausal patient who may wish to conceive. Proper staging at operation is important but it is also essential that the pathologist is an expert. In the Editors' experience there is usually only one or two such senior pathologists in any major city and usually pathologists are wise enough to make sure their local expert reviews the sections of all such cases. In this series a large proportion of the patients received radical surgery and chemotherapy as for ovarian carcinoma; although the results were exemplary, especially if one excludes the patient with the Stage 3 lesion, we consider that the treatment of Stage la ovarian borderline tumours does not require the use of adjuvant chemotherapy.

Summary: : Twenty‐four patients with borderline epithelial ovarian tumours treated in the Department of Obstetrics and Gynaecology of Hacettepe University during the last 12 years were evaluated with regard to histopathology, therapeutic modalities employed and outcome. No mortality was encountered among the 23 patients with Stage 1 disease, regardless of the surgical mode of treatment or adjuvant therapy.

The related literature was reviewed briefly to help enlighten the controversial issue of borderline ovarian tumours.
Pseudomyxoma Peritonei ‐ Experience from a Tertiary Referral Centre
Authors: Carter Jonathan , Moradi Mark M. , Elg Steven , Byers Lowell , Adcock Leon A. , Carson Linda F. , Prem Konald A. , Twiggs Leo B
Published: February 2008

Summary: : Pseudomyxoma peritonei is a clinical diagnosis of massive abdominal swelling by a gelatinous material, produced usually from an ovarian or appendiceal primary. It is a rare entity that is usually histologically benign but behaves clinically in a malignant fashion with recurrent growth, although not demonstrating histological stromal invasion. The disease remains localized to the peritoneal cavity and the clinical course is one of repeated episodes of intestinal obstruction caused by extrinsic compression that seem only to be relieved by surgical debulking. Variable responses have been obtained with adjuvant chemo‐, radio‐ and immunotherapy, but these isolated responses are unable to be reproduced and so there is no accepted adjuvant treatment for this disease.
Determinants of Maternal Mortality in the Developing World
Authors: Stokoe Usha
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it considers the contribution of socioeconomic and cultural factors to maternal mortality in developing countries. These issues are relevant to much of the world's population and so should interest readers. There is also a useful bibliography of papers for those who wish to explore the subject further. It is of interest to reflect that the original prime aims of antenatal care (prevention of anaemia and preeclampsia), that still need to be introduced in some developing countries, are now pursued with less vigour than in the past in so‐called developed countries. there were 83,402 confinements and 7 maternal deaths in hospital, and 14 other pregnancy‐related deaths within I year of delivery. In the Tibur Anbessa (Black Lion) Teaching Hospital in Addis A baba, during the 6 years 1980–1985, there were 22,404 livebirths and 216 maternal deaths in hospital‐. These maternal mortality rates differ by a factor of 120 (0.08 per 1,000 versus 9.6 per 1,000). A recent ‘Newsletter of Worldwide Activity in Maternal Health’ slates that ‘mothers are not dropped from heaven, they are born as undervalued, neglected girls and grow as exploited, uneducated children’ ‐ this publication lists in its ‘fact File’ that ‘In Africa, 1 in every 25 girls reaching menarche will die as a result of pregnancy or childbirth’ and that ‘In South Asia, women face a lifetime risk of maternal mortality of 1 in 38’.

Although teaching hospital statistics do not present the national maternal mortality rates, they are useful for purposes of comparison, being readily available, and the contrast is stark: At the Mercy Maternity Hospital, Melbourne, during the 18 years 1971–1988.
HELLP Syndrome: an Often Unrecognized Complication of Preeclampsia
Authors: Lim B.H. , Barry C.L. , Brown G.H.
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication to remind readers that the HELLP Syndrome does exist and can be present in patients who do not exhibit hypertension or marked generalized oedema; it tends to occur when preeclampsia is treated conservatively. When diagnosed, prompt delivery is indicated, after commencement of the preferred drug regimen for treatment of severe preeclampsia, but Caesarean section is not necessarily the preferred route of delivery, as illustrated by the following case, courtesy of Dr Ian Maclsaac, seen 2 days after the editor read this paper.

A 29‐year‐old primigravida presented with severe pain and tenderness under the right costal margin, at 35.5 weeks' gestation, after a normal antenatal course; she had proteinuria (urine 1/10 solid on boiling), BP120/70, platelet count 44× 109/I and elevated serum enzymes levels (aspartate aminotransferase 364 (0–31 μ/l), alanine aminotransferase 513 (0–31 μ/l); there was no haemolysis and the coagulation profile was otherwise normal. Two days later labour was induced by amniotomy and oxytocin infusion because the epigastric pain, thrombocytopenia, proteinuria and abnormal liver function tests had persisted; 8 hours after induction a 2,860 g infant was born normally in good condition. Two days later the platelet count had fallen to 19×109/l, and microscopic haematuria was present; the patient was given a 6‐unit platelet transfusion; 2 days later the platelet count was 122× 109/l and there were no further problems with mother or baby.

Readers may debate whether this is a genuine case of HELLP syndrome without evidence of intravascular haemolysis or abnormal coagulation profile apart from thrombocytopenia. However, this case does undoubtedly endorse the author's message that patients with preeclampsia treated conservatively, and all those with epigastric pain associated with proteinuria, should have coagulation profile, full blood examination and tests of liver function performed, in addition to renal function tests and assessment of fetal well‐being by cardiotocography.

Summary: We describe a case of preeclampsia with the HELLP (Haemolysis, Elevated Liver enzymes, Low Platelets) syndrome and highlight the delayed diagnosis due to its nonspecific presentation. This syndrome is associated with significant maternal and perinatal mortality and morbidity and we discuss the importance of early recognition of the condition, aggressive management and a multidisciplinary approach.
The Embryo Comes of Age: The First Decade of the Fertility Society of Australia
Authors: Johnston Ian , Jones Warren , Saunders Douglas
Published: February 2008

‘The Commission recommends an initial limit of 10 years, after which the embryo may not be kept alive.’
Presacral Neurectomy ‐ A Reappraisal
Authors: FHegner John R. H. , Umstad Mark P.
Published: February 2008

Summary: Between April 1984 and April 1990, 20 patients with a mean age of 27.9 years underwent presacral neurectomy at The Royal Women's Hospital, Melbourne, Australia. Overall, 11 of the 19 patients (58%) assessable for follow‐up were totally cured of pain and 8 (42%) were partially cured. The most common indication for presacral neurectomy was secondary dysmenorrhoea, usually in association with endometriosis or pelvic adhesions. In 4 patients with uterine dysmenorrhoea not associated with pelvic pathology the operation produced a complete cure. The general consensus of gynaecological opinion is that presacral neurectomy should still be reserved for a limited number of carefully selected patients in whom other methods of treatment have been exhausted. It is imperative that a prior psychological assessment should be undertaken whenever a functional component is suspected. Whilst pain of uterine origin may be cured by presacral neurectomy, lateral pelvic pain of adnexal origin requires ovarian sympathectomy.
Primary Adenocarcinoma of the Uterine Cervix: Changing Clinical Profile
Authors: Kushtagi Pralhad , Rao Kuntal
Published: February 2008

EDITORIAL COMMENT: The authors of this paper agreed to present their data concerning the changing incidence of primary adenocarcinoma of the cervix in an Indian centre as a summarized report. The interval of follow‐up (6 moths) is short but the numbers of patients studied are large. There has been an increase in the number and percentage of cervical adenocarcinomas; in this series follow‐up at 6 months suggests that prognosis is worse in women with adenocarcinoma compared to those with squamous cell carcinoma of the cervix.
A Comparative Study of X‐Ray Pelvimetry and CT Pelvimetry
Authors: Raman S. , Samuel D. , Suresh K.
Published: February 2008

EDITORIAL COMMENT: This paper compares conventional X‐ray pelvimetry with CT pelvimetry and the authors conclude that the latter is preferable due to the lower radiation dose, patient comfort and shorter time of examination; surprisingly they commented that the 2 procedures had no significant difference in cost.

Ultrasonography has virtually replaced radiography in obstetric practice The exception is X‐ray pelvimetry which is still performed in many centres in the management of breech delivery at term, and in patients in whom a trial of vaginal delivery is planned after previous Caesarean section although the latter indication is not accepted in many centres (e.g. Dublin). In our mixed Australian community, moderate to severe pelvic contraction, even predominantly of the pelvic outlet (and hence especially relevant to breech delivery) is a reasonably common finding.

Not all radiologists will agree with the conclusions in this paper. Our reviewers pointed out that the actual radiation doses were not measured but were quoted from references, those for conventional pelvimetry being 1962 and 1963 references. It should be noted that with modern X‐ray technique the radiation dose has been considerably reduced and ‘the radiation dose from CT pelvimetry including the 2 scout films and one axial slice using a reduced MAS is comparable to conventional pelvimetry including 2 films, the erect lateral film and the tube shift film for the transverse diameters but excluding the outlet view!’

Our reviewers believe that both methods of pelvimetry are comparable and require meticulous technique; they agreed that there was no significant interobserver variability reporting the pelvimetries in this study. The take away message seems to be that there is still a place for pelvimetry in obstetric practice and CT pelvimetry is likely to become more popular. We agree with the practice of postpartum pelvimetry to avoid fetal irradiation and provide information for management of subsequent pregnancies in nulliparas who were delivered by Caesarean section or difficult forceps delivery.

Summary: In this study 24 patients who had conventional erect lateral X‐ray pelvimetry had a CT pelvimetry done after delivery to complete the pelvimetry views. The erect lateral pelvimetry was read independently by a Consultant Radiologist, Consultant Obstetrician and a Medical Officer training in Obstetrics and Gynaecology. Using CT pelvimetry as the ‘gold standard’ (as the error of measurement was known with the machine used) the 3 readings were compared. There was no statistical difference in the values suggesting that X‐ray pelvimetry is comparable to CT pelvimetry. However CT pelvimetry is preferred, if available, because of the lower dose of radiation involved, more comfort for the patient and shorter time in performing the procedure. Measurements done are easily read directly from the CT console.
Pelvimetry — a Squatter's View
Authors: Gudgeon C. W. , Jarrett J.
Published: February 2008

EDITORIAL COMMENT: These days there is much talk at antenatal classes and in delivery rooms of the options available to women regarding the position at delivery. Many who give advice antenatally lack delivery room experience, and many who give delivery room advice do not receive the blame for delivery difficulties. Comfort of the patient during the process of birth is important. It is also important for the accoucheur to perform his/her task in a satisfactory manner avoiding unnecessary perineal damage (episiotomy or extension thereof) or fetal hypoxia or injury due to difficulty with delivery of the shoulders.

We agree with our radiologist reviewer that the bituberous diameter is difficult to measure with accuracy, and that the available AP of the outlet is a more important measurement to predict the outcome of labour. The Editor may be a square but he has not yet delivered a woman while she was in a squatting position ‐ he has often been! This paper provides some evidence that the squatting position does not improve the dimensions of the pelvic outlet during delivery.

Summary: Patients were X‐rayed in supine and squatting positions in order to measure any increase in pelvic outlet diameters. An increase of less than 2% was found. Previous estimates of 20–30% increases in pelvic outlet area were not duplicated.
The Development of Infertility Treatment in Australia1
Authors: Cox Lloyd W.
Published: February 2008

Summary: The development of fertility clinics in Australia began in Sydney at the Women's Hospital, Crown Street, in 1938 with Alan Grant. Clinics in other cities followed: Melbourne (1940), Adelaide (1946), Brisbane (1948), Perth (1949) and Hobart (1967).

At first, the work was confined to clinical investigation and tubal surgery. In the early 1960's the university departments of Obstetrics and Gynaecology appointed scientists and developed endocrinology enabling investigation of anovulation and leading to ovarian stimulation with gonadotrophin and clomiphene. Male infertility had been investigated, but although there was occasional use of fresh semen donations, it was not until 1972 that sperm banks were set up, the first being in Adelaide.

In 1979 the first IVF baby was born in Melbourne, and clinics in other cities had success over the next 3 years. Microsurgery had by then been introduced for tubal reconstruction.

The high standing of Australian clinics has been due to the pioneers who were careful investigators, considerate doctors, and enthusiastic teachers; and later, to the close cooperation between clinicians and scientists and the sharing of new advances both informally and at scientific meetings.
The Current Status of IVF Surrogacy in Australia
Authors: Leeton John
Published: February 2008

EDITORIAL COMMENT: A surrogate according to Chambers Twentieth Century Dictionary is ‘a deputy, in the place of, a person who fills the role of another in one's emotional life (as a mother, a father)’ but in the reproductive sense as used in obstetric practice is a woman who bears a baby for another woman. Usually, the surrogate mother has her ovum fertilized by artificial insemination with sperm from the recipient's husband or, much less frequently, the baby will have been conceived by in vitro fertilization of the recipient's ovum with her husband's sperm before embryo transfer to the surrogate mother. This paper explains that few couples request surrogacy which illustrates why all such cases should be centralized to a special clinic where the required technical and counselling expertise is available. Surrogacy, like homebirths, makes interesting news for the general population and so receives disproportionate publicity. The punch line of this paper is that ‘surrogacy is not the optimal management for failed infertility treatment’.
Oral Ketoconazole and Miconazole Vaginal Pessary Treatment for Vaginal Candidosis
Authors: Sharma J. B. , Buckshee K. , Gulati N.
Published: February 2008

EDITORIAL COMMENT: Ketoconazole (Nizoral) is available in Australia but is normally not indicated as first line therapy for candidiasis, largely because of the risk of hepatic damage (occasionally fatal) and because it is relatively expensive. The approved indications are for systemic or deep mycoses where other forms of therapy have failed, or recalcitrant cases of superficial mycoses which fail to respond to local therapy. The duration of the topical treatment in this study was longer than commonly used in Australia; miconazole pessaries (100 mg) were administered for 14 days whereas the usual regimen is to use 100 mg pessaries once daily for 7 days, or 200 mg pessaries once daily for 3 days.

Since colonization of the bowel by Candida is a well known factor in recurrent candidiasis it is not surprising that use of a systemic and local agent concurrently was more effective than either therapy alone. We consider that the result obtained with local treatment (78% cure, 12% recurrence) would generally be regarded as quite acceptable in clinical practice. This study shows that topical or systemic antifungal agents are quite effective at eradicating Candida albicans with an enhanced effect if both modes of administration are used concurrently.

Paul Drink water, Director of Pharmacy, Mercy Hospital for Women

Summary: This prospective study was carried out on 250 patients having clinical and mycological evidence of vaginal candidosis. One hundred patients received ketoconazole orally (400 mg/day for 5 days), another 100 patients received miconazole vaginal pessary treatment (one 100 mg tablet locally for 14 days), while the other 50 patients received combination therapy of oral ketoconazole and miconazole vaginal tablets. Although all 3 regimens were significantly effective in relieving patients symptoms and physical signs, the combination therapy gave the best results. There was 98% symptomatic relief with the combination therapy in contrast to 82% and 78% in the oral ketocanozole and vagina] miconazole groups respectively (p < 0.001). Mycological cure rates were also significantly higher in the combination therapy group (94% versus 80% and 76%). The relapse rate was least in the combination group 2% versus 8% and 12%. The combination therapy is recommended for the best results in vaginal candidosis.
Position and Mobility of the Urethrovesical Junction in Continent and in Stress Incontinent Women Before and After Successful Surgery
Authors: Carey Marcus P. , Dwyer Peter L.
Published: February 2008

EDITORIAL COMMENT: This paper has a nice discussion regarding the anatomical supports of the upper urethra and how the position of the urethrovesical junction influences urinary continence during acute episodes of raised intraabdominal pressure. Because of the importance of urinary incontinence in the female the urethrovesical junction has been the site of a wider range of surgical manoeuvres than any other part of the genitourinary tract. This paper will not settle the debate but it reexamines the theories and will interest many readers. The principles of the Burch and Stamey operations are also discussed and explanation provided of why surgery may fail to cure stress incontinence of urine.

Summary: The position of the urethrovesical junction and its movement with straining was assessed using lateral chain cystourethrography in 9 continent women and 27 women with genuine stress incontinence before and after continence surgery. The women with genuine stress incontinence had a significantly lower urethrovesical junction related to the symphysis pubis which descended more with straining than the continent women. Surgery was successful in 25 of the 27 women. Following both successful Burch colposuspension and Stamey operation the urethrovesical junction was significantly higher, closer to the symphysis and less mobile. The position of the urethrovesical junction was significantly higher following the Burch colposuspension than Stamey operation and was similar to the continent control group. Overelevation of the urethrovesical junction can be avoided at the time of Burch colposuspension by not tying the suspension sutures with excessive tension but leaving a free space of 2–4 cm between the vaginal wall below and the iliopectineal ligament above.

The posterior urethrovesical angle was similar in continent and incontinent women but was significantly narrower following successful surgery.
Teenage Pregnancy in South Australia, 1986–1988
Authors: Zhang Baoping , Chan Annabelle
Published: February 2008

EDITORIAL COMMENT: Readers please note that this paper on teenage pregnancy has the unique quality of coming from the only Australian State in which it is a statutory requirement to notify all cases of termination of pregnancy. The authors have therefore been able to provide important information regarding the characteristics of pregnant teenagers and the changing incidence of abortion as well as the obstetric results in continuing pregnancies. These data allow deductions concerning teenage behaviour resulting in pregnancy. The results identify subgroups of our population who require special counselling and care. Hopefully the Council members of the Royal Australian College of Obstetricians and Gynaecologists will use their influence to encourage alt State Parliaments to introduce legislation requiring notification of all cases of termination of pregnancy. We need the facts to identify the high risk groups, so that available resources can be appropriately directed.

Summary: Teenage pregnancies accounted for 6.0% of confinements and 24.8% of legal abortions in South Australia in 1986–1988. The teenage pregnancy rate has declined by 28.5% since the early 1970s, associated with a 52.6% decline in the confinement rate. The abortion rate rose in the 1970s but fell slightly in the 1980s; nearly half the teenage pregnancies now end in legal abortion: abortion was a more likely pregnancy outcome for younger teenagers and for teenagers resident in metropolitan areas. Compared with women confined in their twenties, confined teenagers were more likely to be single, primigravid and Aboriginal, to have few antenatal visits and to have a medical or obstetric complication during their pregnancy. They were less likely to have an induction of labour or an elective Caesarean section. They had higher frequencies of preterm deliveries (8.9%) and low birth‐weight babies (9.3%). The youngest teenagers had the most risk factors and the worst outcomes. In the small group of Aboriginal teenagers aged 16 years and under, about a third of the babies were low birth‐weight or premature and one in 12 babies was a perinatal death. Comparison of singleton pregnancies of teenagers with women in their twenties all of whom were single, Caucasian and primigravid, with 7 or more antenatal visits, showed similarity in outcomes. This suggests that being teenage is not in itself a risk factor. Continued support and extension of teenage counselling and antenatal care services is essential.
First Antenatal Visit Haematocrit and Pregnancy Induced Hypertension
Authors: Goh Judith TW
Published: February 2008

EDITORIAL COMMENT: Women with severe preeclampsia often have a reduced circulatory blood volume and increased haematocrit. It was a nice idea to see if the booking haematocrit value was predictive of subsequent preeclampsia/severe preeclampsia. The answer in this study was negative but this should not be the end of the enquiry. It may be worth seeking such an associated/predictive test (with the possibility of prevention or amelioration of preeclampsia by rest, dietary measures and/or aspirin) at a later time in pregnancy since preeclampsia and its presumed provoking placental poison is not likely to be operative early in pregnancy. Alternatively further analysis of booking haematocrit values could be useful if the study group included a group of women who went on to develop early‐onset (before 3 7 weeks) severe preeclampsia ‐ such a study would require large numbers to recruit sufficient patients with severe preeclampsia

Our reviewer when commenting on current views on the aetiology of preeclampsia stated that the ‘uteroplacental bed, primed by genetic factors and disturbed by immunological reactions, produces a biochemical defect (an imbalance between the placental production of the prostaglandins (prostacyclin and thromboxane ‐ the production of which is affected by aspirin)) which lead to placental ischaemia. Placental ischaemia in turn leads to release of uterine renin and an increase in angiotensin activity. These effects trigger reduction in plasma volume, increased coagulability and a vicious cycle of deteriorating organ function’. This thesis provided by our reviewer assumes that the low blood volume inpatients with severe preeclampsia does not antedate pregnancy.

Summary: First antenatal visit haematocrit values during the first and second trimesters were retrospectively collected from 546 nulliparas with singleton pregnancies. The results were analysed for correlation with development of pregnancy induced hypertension (PIH) later in pregnancy. It was found that women with higher haematocrit values, especially over 0.40, had an increased risk of developing PIH. However, there appeared to be no absolute level of haematocrit which had sufficient discriminative value to be useful in clinical practice.
Study of Lupus Anticoagulant in Pregnant Women with Recurrent Abortion
Authors: Das Indira , Vasishta Kala , Dash Sumitra
Published: February 2008

EDITORIAL COMMENT: The management of patients with recurrent fetal loss is controversial but it is generally agreed that the presence of lupus anticoagulant (LA) should be tested for in these women. There are 2 reports of the treatment of groups of patients with LA and/or anticardiolipin antibodies (ACA) with high‐dose prednisone and/or low dose aspirin (1,2). However, although raised levels of LA or ACA have a predictive value for recurrent abortion, as well as thrombosis and thrombocytopenia, there is conflicting evidence about whether high‐dose immunosuppression (± plasmapheresis) is necessary in order to improve fetal survival (3). Our physician reviewer treats pregnant women who are LA or ACA positive with prednisolone 45–50 mg per day until the test is negative, and also antiplatelet therapy is given (aspirin 100 mg per day and dipyridamole 100 mg QID). Treatment with prednisolone and aspirin can lead to successful pregnancies in these women but with a high incidence of preeclampsia and fetal growth retardation (2). These patients require careful fetal surveillance, and preterm delivery is often necessary.

Summary: The relation between lupus anticoagulant (LA) and repeated abortions was evaluated in a case‐controlled study of 50 women with 3 or more unexplained spontaneous abortions compared with 50 control subjects who had 2 or more normal pregnancies and no previous spontaneous abortion or fetal deaths. LA was detected in 5 of 50 cases (10%, 95% confidence limits 1.69% to 18.31%) but in none of the 50 controls. There was an indication that missed abortions may be more frequent in LA positive women. The women who had recurrent abortions but were LA negative had prolonged prothrombin time values (though within normal range) compared to the control group. LA being a treatable cause of idiopathic recurrent abortion should be sought for in women with unexplained fetal losses.
Survivors of Extreme Prematurity — Outcome at 8 Years of Age
Authors: Kitchen W. H. , Doyle L. W. , Rickards A. L. , Ford G. , Kelly E. , Callanan C.
Published: February 2008

Summary: Of 149 infants liveborn in a large maternity hospital in 1980 to 1982 and delivered between 24 and 29 completed weeks of gestation inclusive, 91 (61%) survived; 88 (97%) survivors were assessed at 8 years' corrected age; 77% of children were not disabled; disability was mild in 13%, moderate in 2% and severe in 4% of children. Although survival decreased with decreasing gestation, disability in survivors did not increase. An earlier assessment of the same children at approximately 2 years of age had been unduly pessimistic particularly for those born ≤26 weeks' gestation. The only other reports in the literature on outcome by gestation have all assessed the children in early childhood, and estimates of severe disability rates from these studies will probably also be too pessimistic. Since the rate of severe disabilities in infants of borderline viability is not much higher than in more mature infants the obstetrician should mainly consider survival chances for the fetus, and not be overly concerned with long‐term neurological outcome, when making clinical decisions.
Current Problems in Health Care ‐ Government Criteria in Resource Allocation Today and in the Future
Authors: Herron Senator John
Published: February 2008

EDITORIAL COMMENT: This paper was presented by Senator Herron at the conference on ‘Individual Testing and Review’, Centre for Law and Medicine, Bond University School of Law, June 16,1991. The editor considered that many readers might be interested in this overview of Australia's Health Care system and its development by a general surgeon who is also a politician.