bluuebunny/crossref_metadata_2025 huggingface dataset:
Single Dose Prophylactic Antibiotics in Caesarean Sections
Authors: Chan A.C.W. , Leung A.K.L. , Chin R.K.H. , Chang A.M. Z.
Published: February 2008

Summary: A prospective, double‐blind randomized trial was carried out at the Department of Obstetrics and Gynaecology, the Chinese University of Hong Kong, involving 4 groups of patients receiving a single intravenous dose of placebo, ampicillin, ampicillin and metronidazole, and ampicillin and sulbactam before operation. No difference in postoperative morbidity was present between the 4 groups of patients.
Colposuspension for the Treatment of Female Urinary Incontinence
Authors: Korda Andrew , Ferry James , Hunter Peter
Published: February 2008

EDITORIAL COMMENT: This paper reviews the results of a large series of patients with urinary incontinence treated by the Burch colposuspension with a few minor alterations. The operation is performed entirely from above, the vagina being suspended on either side of the bladder neck and attached to the iliopectineal ligament at the pelvic brim. It is noteworthy that only 36 of the 174 patients had pure stress incontinence as a symptom and 59 were obese. Selection of the patient who requires surgery when stress incontinence is associated with urgency and other urinary symptoms is very difficult. All of the 30 patients who remained incontinent after the operaton had urodynamic investigaton and 16 were found to have detrusor instability. It would seem that the author's results justify their willingness to operate on patients with mixed urinary symptoms. The success rate and incidence of complications in this series is consistent with other studies — however, there was a high incidence of voiding difficulties postoperatively as revealed by a mean postoperative catheter drainage time of 10 days, 5 patients requiring to go home using self‐catheterization with 2 needing this long‐term, and a postoperative incidence of detrusor instability of 10%. One reviewer believes this is due to overelevation of the bladder neck at the time of colposuspension which may be avoided by leaving the suspending sutures long at the time of surgery. The takeaway message is that patients with mixed urinary symptoms who have stress incontinence confirmed urodynamically have a good chance of being cured by surgery. It would be prudent that such patients should have a trial of medical management and pelvic floor exercises before resorting to surgery.

Summary: Between June 1, 1983 and June 30, 1988, 174 patients with stress incontinence were treated with a colposuspension operation; 144 patients were cured, 30 remained wet. Sixteen patients who remained wet had detrusor instability; 9 of these were cured by anticholinergic medications. Of 25 patients who had dual pathology 19 were cured. Seventy nine patients had urinary tract infections. Two patients had ureteric obstruction due to kinking; it is postulated that this can be an in‐fequent and sometimes unavoidable complication.
Semen Quality and In‐vitro Fertilization
Authors: Jeyendran R.S. , van der Ven H.H. , Rachagan S.P. , Perez‐Peieaz M. , Zaneveld L.J.D.
Published: February 2008

Summary: The standard sperm parameters, and a newly developed assay, the hypoosmotic swelling (HOS) test, of 208 ejaculates were correlated with in vitro fertilization (IVF) outcome to assess their predictive value of the fertilizing capacity of spermatozoa. One hundred fifty‐three (73.6%) of the ejaculates possessed spermatozoa that fertilized at least one oocyte and were considered fertile. Among the semen parameters studied, only the HOS test had a relatively high (r = 0.46, p< 0.001) association with the fertilizing capacity of the spermatozoa. This test was also able to predict the outcome of IVF more reliably than the other semen parameters studied.
Outcome of Treatment with Bromocriptine in Patients with Hyperprolactinaemia
Authors: Al‐Suleiman Dr S.A. , Najashi Dr S. , Rahman Dr J. , Rahman Dr M.S.
Published: February 2008

EDITORIAL COMMENT: The results obtained in Ms series of hyperprolac‐tinaemic women indicates the efficacy and safety of bromocriptine therapy. Not everyone would agree with the need for routine surgical excision of pituitary macroadenomas nor with the cessation of the medication at 12 to 16 days after the first missed menstruation, since microadenomas may also enlarge in pregnancy.

Summary: Results in 136 hyperprolactinaemic women who presented with infertility, amenorrhoea, menstrual irregularities and/or galactorrhoea are reported. There was radiographic evidence of pituitary microadenoma in 21 (15.4%) patients and 5 (3.7%) had macrodenoma. Four patients were taking antidepressants, 2 an‐tihypertensive drugs and 7 had taken oral contraceptives for a period of 6 months to 5 years. The remaining patients had no obvious cause for elevated prolactin levels. Patients with pituitary adenoma had a significantly higher (p<0.001) baseline serum prolactin level (182 ± 4.6 ng/ml) than those with no adenoma (59.2 ± 4.2 ng/ml). All patients in the study were treated with bromocriptine (2.5 — 10 mg) to normalize serum prolactin or to achieve a pregnancy. The patients without an adenoma required a significantly smaller dose of bromocriptine (2.5 ‐ 5.0 mg) (p<0.005) than those with an adenoma. Galactorrhoea disappeared in all 64 patients within 2–4 months of treatment, sixty‐six (71%) of the 93 patients who desired pregnancy achieved it within 3 to 8 months of bromocriptine therapy; 32 of these patients received additional treatment with clomiphene and human chorionic gonadotrophins for induction of ovulation. In the remaining 70 patients menstruation became regular and ovulation was evident in 40% of them. There was no significant difference in the pregnancy rate between the patients with or without pituitary adenoma. Similarly, presence of galactorrhoea or a high level of prolactin did not influence the pregnancy rate. No complications were observed during pregnancy related to pituitary adenomas; 8 (12%) pregnancies ended in first trimester abortion. No lethal congenital fetal abnormalities were observed in the patients treated with bromocriptine. It is concluded that hyperprolactinaemia in infertile patients with or without pituitary adenoma can be safely treated with bromocriptine with a high pregnancy rate and resumption of a normal menstrual pattern. All 5 patients with macroadenomas had excision of the tumour performed before bromocriptine therapy.
The Clinical Significance of the Serum Haptoglobin Concentration in Patients with Invasive Cervical Carcinoma
Authors: Neale Edmund J. , Wong W.S. Felix , Arumanayagam Mano , Chang M.Z. Allan
Published: February 2008

Summary: The serum haptoglobin concentration was measured by rate nephalometry in 56 patients with invasive carcinoma of the cervix, and in 24 women with no evidence of cervical pathology who served as control subjects. There was a significant difference in the mean serum haptoglobin concentration (p < 0.005) between the 2 groups of patients. However there was no significant correlation between the serum haptoglobin concentration and the clinical stage of the disease. From our data we propose that a serum haptoglobin concentration greater than 96 mg/dl is suggestive of invasive carcinoma of the cervix, and that this may be used as additional investigation in the initial assessment of such patients.
Incidence and Severity of Gestational Diabetes in Bahrain and Australia
Authors: El‐Shafei Affaf Mohammed , Bashm Yousef A. , Beischer Norman A. , Henry Olivia A. , Walstab Janet E.
Published: February 2008

Summary: The incidence and severity of gestational diabetes in a series of 5,199 predominantly Arab patients in Bahrain, and 2,643 of mixed racial origin in Australia were studied. The incidence of gestational diabetes in Bahrain (5.4%) was less than in Australia (7.2%) but the more severe degrees were 3 times more common in Bahrain (p < 0.001). The incidence of gestational diabetes was significantly increased with increasing maternal age and parity. A notable difference between the 2 populations occurred in the groups weighing less than 70 kg. Although Bahrain had a higher proportion of patients weighing less than 70 kg (64.7% versus 55.9%; p < 0.001) there was a significantly higher incidence of gestational diabetes in this group in the Australian series (13.9% versus 3.7%, p < 0.001). Postnatal testing of 165 gestational diabetics in Bahrain and 194 in Australia indicated that although the severe degrees of glucose intolerance were more likely to persist postnatally, it was impossible to predict in the individual patient the change in glucose tolerance that would occur after delivery. All gestational diabetics should therefore have a postnatal glucose tolerance test.
Cardiorespiratory Collapse and Pulmonary Oedema Due to I niravascular Absorption of Prostaglandin F2aL Administered Extraamniotically for Midtrimester Termination of Pregnancy
Authors: Wein Peter , Robertson Barbara , Ratten Graeme J.
Published: February 2008

Summary: A case of severe reaction to extraamniotically administered prostaglandin F2aL, with cardiorespiratory collapse and pulmonary oedema necessitating transfer to an intensive care unit, is presented. Attention is drawn to the profound haemodynamic effects of systemically administered prostaglandin, and the need for caution and ready availability of facilities for resuscitation when this potent substance is administered. Treatment for the effects of intravascular absorption of prostaglandin F2aL is discussed.
Intrauterine Transfusion for anti‐Duffy(Fya) Haemolytic Disease
Authors: Cook S.G. , Baker J.W. , Weaver E.W.
Published: February 2008

Summary: This paper reports what we believe to be the first case of intrauterine transfusion for severe erythroblastosis due to anti‐Duffy(Fya).
Two Cases of Partial 21 Hydroxylase Deficiency Associated with Progesterone Excess
Authors: Eden J. A.
Published: February 2008

Summary: Two cases of partial 21 hydroxylase deficiency are presented where inappropriate follicular phase progesterone secretion was documented and ultra‐sonography demonstrated a failure of the normal endometrial and uterine growth towards ovulation.
The Consequences of Intrauterine Growth Retardation: What Do We Know?
Authors: Watt Jan
Published: February 2008

Summary: This paper restricts itself to a discussion of the development of term infants born small, and presumed to have suffered fetal malnutrition. They form a subgroup of low birth weight infants, and have been sparsely studied to date. Investigations have usually failed to differentiate between the kinds of fetal undergrowth exhibited at birth, and it is clear that further understanding of the processes and consequences of early behaviour based on clear categorization of the growth retardation is needed. This together with more systematic investigation of the characteristics of the families of these infants is required before effective efforts can be made to ameliorate the potential effects of fetal malnutrition. The evidence so far suggests that the development of small for gestational age infants is susceptible to environmental intervention despite its physical origins; however we are far from understanding the aetiology and the precise consequences of this complex phenomenon.
Pregnancy Loss with Phospholipid Antibodies: Improved Outcome with Aspirin Containing Treatment
Authors: Gatenby Paul A. , Cameron Kaye , Shearman Rodney P.
Published: February 2008

Summary: The obstetric outcome in 37 patients with antiphospholipid antibodies (APAs) is described. The APAs were measured by the lupus anticoagulant assay and/or more recently anticardiolipin antibodies. There were 15 patients with SLE who without therapy had 51/58 pregnancy failures, either abortion or fetal death in utero, a failure rate of 88%. Likewise, 22 patients without definite SLE lost 69/87 pregnancies, a failure rate of 79%. After treatment the pregnancy wastage rate was 55% and 25% in the 2 groups respectively. When treatment regimens used were examined in detail the improvement with therapy was most clearly evident in the group who received low dose aspirin (75–150mg) in association with immunosup‐pression. This improvement was most apparent in the patients without definite SLE.
Serum Uric Acid Levels in Normal Pregnancy
Authors: Carter Jonathan , Child Andrew
Published: February 2008

Summary: Sixty‐four patients were assessed throughout pregnancy to determine normal serum uric acid levels (mean ± 2SD). Serum uric acid levels increased significantly from early pregnancy levels of 0.13–0.33 mmol/L to levels of 0.18–0.45 mmol/L at full‐term (p<0.005). Factors implicated in uric acid homeostasis contributing to these changes are discussed.
Patient Age and Success in a Human IVF Programme
Authors: Harrison K.L , Breen T.M. , Hennessey J.F. , Hynes M.J. , Keeping J.D. , Kilvert G.T. , DeAmbrosis P.J.W. , Molloy D.
Published: February 2008

Summary: Previous studies suggest that at around 40 years of age, pregnancy rates achieved by IVF programmes fall and pregnancy loss rates increase. The actual age at which this occurs has not been clearly delineated. This study of 2,692 patients including 94 aged 41 or over shows that satisfactory pregnancy rates can be achieved up to and including age 40. As age 40 is approached the pregnancy loss rate increases to around 40%. In the 41 years and over group the pregnancy rate was poor at 6% (6/94) and the pregnancy loss rate very discouraging at 83% (5/6).
Trends in Invasive Cancer of the Cervix Uteri in New South Wales, 1973–1982
Authors: McCredie Margaret , Coates Marylon S , Ford Joyce M
Published: February 2008

Summary: Data from the New South Wales (NSW) Central Cancer Registry comprising all new cases of, and deaths from, invasive cancer of the cervix uteri registered in persons aged 15 years and over for the 10‐year period 1973 to 1982 were examined using log‐linear regression to determine whether incidence and mortality had been changing in NSW. Allowing for the estimated fraction of women who had undergone hysterectomy, this cancer had decreased significantly in incidence (‐ 1.3% per year) as well as mortality (‐3.6%). There were no significant trends in relation to age at diagnosis, stage at diagnosis or histological type. Overall, younger age at diagnosis was associated with an earlier stage at presentation and there was no evidence for a trend towards more severe disease in young women during the 10‐year period. No evidence was found for an increasing incidence of adenocarcinoma. By 1982 the age‐standardized incidence rate was 10.4 per 100,000 (12.5 per 100,000 after adjustment for the hysterectomy fraction). Cancer of the cervix uteri was more common in Inner and Western Sydney and less common in the Northern Metropolitan region of Sydney and rural New South Wales.
Cervical Incompetence in a Pregnancy Following a Cervical Ectopic Pregnancy
Authors: Hurley Victor A. , Beischer Norman A.
Published: February 2008

Summary: A case of cervical incompetence is reported which occurred in a pregnancy which followed soon after treatment of a cervical ectopic pregnancy using a Foley catheter. Very few pregnancies following cervical pregnancy have been reported. Although this isolated case is clouded by other risk factors, cervical incompetence should be considered as a potential complication of such pregnancies.
Pyoderma Gangrenosum of the Vulva
Authors: Grant Peter , Beischer Andrew
Published: February 2008

EDITORIAL COMMENT: These 2 cases illustrate that blood dyscrasia should be considered and excluded (full blood examination) in patients presenting with unusual ulcerative lesions of the vulva because incisional biopsy may fail to provide the diagnosis and wider excision may lead to rapid deterioration in the patient's condition — if pyoderma gangrenosum is diagnosed the treatment of associated ulcera‐tion is not surgical. Serology for syphilis should also be performed in patients with unusual vulval ulcers.
Acute Appendicitis in Pregnancy
Authors: McGee Therese M.
Published: February 2008

Summary: Acute appendicitis is the commonest nongynaecological surgical problem occurring during pregnancy. Almost 10 year's experience at a large teaching hospital is supplemented with an extensive review of the literature to offer guidelines for diagnosis and management. Symptoms, signs and investigations are unhelpful in diagnosis. The overwhelming message is that because perinatal mortality rises from less than 3% in both uncomplicated appendicitis and negative laparotomy, to 20% in perforated disease, the maxim regarding acute appendicitis — if in doubt, take it out — is never more true than in pregnancy.
Effect on Pregnancy on Gallstone Formation
Authors: Sali Avni , Oats Jeremy N , Acton Christine M , Elzarka Ayman , Vitetta Luis
Published: February 2008

Summary: An ultrasound study was carried out to determine the incidence of gallstone formation during pregnancy. One hundred and thirty seven pregnant women attending antenatal clinics were studied; 70 women were primigravidas and 67 were 1 para or more. An ultrasound of the gallbladder was carried out at 20 weeks or less of gestation and a repeat of ultrasound examination was performed soon after delivery. Five women had gallstones diagnosed before pregnancy; 1 of these was a primigravida, the other 4 were para 1 or more. None of the women developed gallstones during pregnancy. This finding suggests that pregnancy is unlikely to be an important factor in gallstone formation.
Ureteric Endometriosis: 3 Case Reports and a Review of the Literature
Authors: Bradford Jennifer A. , Ireland Ernest W. , Giles Warwick B.
Published: February 2008

Summary: Endometriosis involving the ureter is a relatively rare phenomenon but at least 121 cases have been reported previously. The 3 cases presented in this report emphasize some important facets of this condition: the lack of symptoms leading to late diagnosis, the presence of severe renal damage with very localized pelvic disease, how an incomplete initial operation may lead to further major difficulties, and the failure of medical therapy to halt its progress. The potentially lethal nature of ureteric endometriosis is stressed, and the different treatment modalities for patients of different ages and parity discussed. Surgical management, either conservative or radical, is suggested as the modality of choice, and where conservative operation is undertaken very careful continuing observation of renal function is a necessity.
Combined Treatment With Gonadotrophin Releasing Hormone Agonist and Gonadotrophins In Poor Responders To Hyperstimulation For In Vitro Fertilization (IVF): Clinical and Endocrine Results
Authors: McKenna K. Mark , Foster P. , McBain J. , Martin M. , Johnston W.I.H.
Published: February 2008

EDITORIAL COMMENT: We believe that this study on gonadotrophin releasing hormone agonist requires comment for our general readers. The emphasis of this journal is on clinical papers but it would be a pity if our general readers passed by reading some of the special aspects of modern endocrinology such as discussed in this paper. The detailed regimens for administration of drugs will mainly interest en‐docrinologists, but the general reader should be aware of the application of these recently available hormones and the rationale of their use for stimulation of the ovaries so that oocytes can be collected for in vitro fertilization or intra‐Fallopian tube deposition. The authors of this paper were asked, and have provided, the necessary introduction to explain the present indications for the use of gonadotrophin releasing hormone agonist. This paper explains how difficult it has become to improve results in the treatment of infertility in those patients who do not respond to the conventional regimens — it is becoming more expensive in time and money to prise new secrets from Nature on the control of the process of ovulation and conception.

Summary: Seventy three cycles of combined gonadotrophin releasing hormone (GnRH) agonist/gonadotrophin treatment for IVF controlled ovarian hyperstimulation in previous poor responders to standard ovarian hyperstimulation therapy are reported. Oocyte numbers obtained were better than the previous average results, but were similar to the previous best response. In general more oocytes than the previous mean could be expected but low order responders were not transformed into high order responders. Pregnancies did occur in this difficult group of patients but the rate was modest. Because of a reduction in cancelled cycles, patients might reduce their total costs in time and gonadotrophin used, however this treatment is not a panacea for the true low order responder.
Ovarian Remnant Syndrome
Authors: Webb Maurice J.
Published: February 2008

Summary: Twenty‐seven patients with ovarian remnant syndrome were operated on by the author in a 7‐year period. All patients presented with pelvic pain as their major symptom. A mass was palpable in 20 patients. In 3 patients, no mass was palpable but a lesion was visible on computed tomographic scanning. In 4 patients, there was no palpable mass and scans were negative, yet an ovarian remnant was found at laparotomy. Segmental bowel resection was necessary to obtain clearance in 8 patients, and partial bladder resection was performed in 2. Previous pelvic operations (mean, 4.3) in this group of patients probably contributed to the development of this syndrome.

The ovarian remnant syndrome occurs in a patient who has previously had a bilateral salpingo‐oophorectomy. A piece of ovarian tissue remains, and this remnant often produces symptoms, usually pelvic pain and associated dyspareunia. Usually the patient has had a hysterectomy as well as bilateral salpingooophorectomy, so that the pain is often dismissed as ‘not gynaecological’ in origin (1–5).

This syndrome is not synonymous with residual ovary syndrome, in which an ovary that has previously been intentionally conserved either develops an abnormal pathological process or causes symptoms necessitating its surgical removal (6). Unfortunately, awareness of the problems caused by an ovarian remnant is not widespread, and often these patients have been to many gynaecologists, general surgeons, or even psychiatrists in an attempt to get relief from their symptoms.

It is not possible to estimate the incidence of symptomatic ovarian remnants, but certainly when an awareness of the syndrome develops, referral of patients with the problem is common (7).
Evidence Against Diathermy as a Beneficial Treatment for Human Papillomavirus Infection of the Cervix
Authors: Mitchell Heather , Medley Gabriele
Published: February 2008

EDITORIAL COMMENT: In recent years there have been numerous reports regarding human papillomavirus infection of the female genital tract and its possible association with preinvasive and invasive carcinoma of these sites (cervix, vagina, vulva). The most alarming information comes from studies of DNA hybridization techniques which indicate that a very high proportion of patients with apparently normal cervices on colposcopy and cytology harbour this virus. Many studies indicate that only a small proportion of patients who show clinical evidence of the papillomavirus have evidence of continuing infection or go on to develop intraepithelial or invasive carcinoma. The proportion of patients who spontaneously eradicate signs of the disease is not established, neither do we know why some patients cure themselves of the disease and why others do not. There is also confusion in the literature as to whether local treatment can eradicate this disease. This paper gives a very good account of the current state of knowledge about papillomavirus infection. It seems difficult to understand how diathermy to the cervix can eradicate this viral infection when many studies have shown that papillomavirus infection is usually present in the vagina and vulva when it involves the cervix, unless the cellular damage induced by the cautery enhances the patient's immune response. There is evidence in numerous reports that biopsy of papillomavirus lesions and early dysplasias of the cervix modifies the natural history of these lesions, possibly by alteration of local immune function. The present study also indicates that treatment of the cervix for papillomavirus infection alone does not affect the incidence of subsequent development of intraepithelial neoplasia. These authors have stressed the fact that further long‐term follow‐up is required of patients with evidence of papillomavirus infection.

Summary: An observational study of the influence of diathermy on the rate of subsequent cytological evidence of cervical intraepithelial neoplasia and/or human papillomavirus infection among women with a histological diagnosis of cervical human papillomavirus infection is presented. After the histological diagnosis of human papillomavirus infection, 35% (23/65) of women who were not diathermied had persistence/recurrence of cytological abnormalities compared with 30% (60/203) of the women who were diathermied at the time of the biopsy. The rate ratio for further abnormality among women who did not have a diathermy relative to those who did was not significantly different at 1.25 (95% confidence interval 0.77–2.03). This study had a power of 77% to detect a true rate ratio of 2 at the 0.05 level of significance. This data does not provide strong evidence that diathermy is appropriate management for women with cervical human papillomavirus infection without evidence of dysplasia.
Trial of Labour after Previous Caesarean Section: Obstetric Outcome
Authors: Chua S. , Arulkumaran S. , B.Sc(Hons) Piara Singh. , MD S. S. Ratnam. FRCOG FRCS(Ed)
Published: February 2008

EDITORIAL COMMENT: Recently we have accepted a number of papers on trial of scar because of the importance of avoiding unnecessary repeat Caesarean sections. This paper reports impeccable results from Singapore but readers should heed the authors' warnings regarding the need for careful assessment before and during labour, especially when augmentation with oxytocin is employed.

In this series trial of labour was permitted when the previous Caesarean was indicated for by cephalopelvic disproportion. It is not enough to monitor labour electronically in such patients — when uterine rupture occurs it can do so suddenly without warning deterioration in fetal condition — an experienced clinician should review these patients regularly during labour, especially when oxytocin augmentation is planned because of uterine dysfunction. Cephalopelvic disproportion may be unrecognized particularly if the patient is obese.

In this series the incidence of scar dehiscence was 1.4% (3 of 207) in patients who had a trial of labour; all 3 cases were associated with oxytocin augmentation of labour, and 2 of the 3 laboured for longer than 12 hours (table 6). It is also worth noting that vaginal delivery was achieved in only 2 of 14 mothers who had a trial of labour when birth‐weight was more than 4,000 g (table 5).

Note the authors takeaway message that the trial of scar finesse in their institution achieved a reduction of 2% in the overall Caesarean section rate. Note also that in this series, which has acceptable results, 90% of patients allowed a trial of scar had spontaneous onset of labour.

Summary: Of 305 patients with a previous lower segment Caesarean section scar admitted over a 28‐month period, 207 were allowed a trial of labour. A successful trial of labour was achieved in 63.3% of patients with a recurrent indication and 73.4% with a nonrecurrent indication. Of 75 patients who received oxytocin for augmentation and 22 for induction of labour, 70.5% achieved vaginal delivery. This was similar to the vaginal delivery rate in patients who did not require augmentation in induction. Three cases of scar dehiscence occurred in patients who had oxytocin, but in whom the recommended management protocol was ignored. The events that led to these 3 dehiscences is described. Analysis of birth‐weights revealed a trend towards more repeat Caesareans with increasing birth‐weight beyond 2,500g. This was especially reflected by the higher emergency Caesarean section rate in those who had a trial of labour.

A trial of labour in patients with a previous Caesarean scar is safe, and can be allowed even in patients who had the previous Caesarean for cephalopelvic disproportion, although malpresentation and obvious disproportion must be excluded. Judicious use of oxytocin for a limited period of time should help in reducing the number of repeat Caesarean sections.
Insulin‐like Growth Factor 1 as an Intra‐ovarian Hormone — an Integrated Hypothesis and Review
Authors: Eden John A. , Carter Graham D. , Jones Julia , Alaghband‐Zadeh Jamshid
Published: February 2008

Summary: Fourteen ovulatory patients undergoing diagnostic laparoscopy had at least 2 samples of clear follicular fluid (FF) collected in the late follicular phase. Dominant follicles contained significantly higher concentrations of insulin‐like growth factor‐1 (IGF1), oestradiol (E2), progesterone (P) and lower androstendione (AD) than their matched cohorts. After the luteinizing hormone (LH) surge, a significant increase in dominant FF‐IGF1 and FF‐P occurred. Log FF‐E2 and log FF‐P were correlated with both FF‐IGF1 and FF volume. Log FF‐AD was negatively correlated with FF‐volume, FF‐E2 and FF‐P (but not FF‐IGF1). The cohort concentration of FF‐IGF1 was correlated with serum IGF1. These results support the hypothesis that IGF1 has a central role in the selection of the dominant follicle.
Invasive Carcinoma of the Cervix in Young Women
Authors: Webb Maurice J. , Sheehan Terrence M.
Published: February 2008

Summary: One hundred and seventy‐six cases of cancer of the cervix in women age 35 years or less from 1959 to 1980 were compared with 65 cases occurring in the 5‐year period from 1982 to 1986. The incidence of the disease in this age group changed little over this time, increasing from 9% to 11%. However, the incidence of adenocarcinoma cell types increased from 10% in the first period to 25% in the more recent cases. A change in management resulted in increased surgical emphasis in treatment; only 24% were treated surgically in the earlier group compared to 80% in the recent group. There has not been an increase in advanced cases or mortality in those young patients in recent years.
An Alternative Regimen of Hormone Replacement Therapy to Improve Patient Compliance
Authors: Kemp John F. , Fryer Judith A. , Baber Rodney J.
Published: February 2008

EDITORIAL COMMENT: There is no doubt that the introduction of progestogen to regimens of oestrogen replacement therapy for menopausal women, because of the risk of endometrial carcinoma from unopposed oestrogenic stimulation of the endometrium, has had one very unfortunate result — many patients resent the return of menstruation and discontinue hormone therapy. Indeed having been warned about the risk of carcinoma, patients often fear that the return of bleeding heralds such a complication. This paper reports good patient compliance with a regimen aiming at 6‐monthly cycles. Annual endometrial sampling revealed no cases of carcinoma. Although this regimen warrants further study before endorsement, the authors have highlighted the need to judge regimens of hormone replacement therapy in terms of patient compliance as well as risks of endometrial hyperplasia and carcinoma.

Summary: In order to achieve the long‐term benefits from hormone replacement therapy of a markedly reduced incidence of heart disease and osteoporosis, a high degree of compliance is essential.

In an effort to obtain high compliance, it was decided to introduce a cyclic therapy of 6 months duration using conjugated oestrogens supported by a 10‐day course of progestogens.

A total of 85 patients were treated prospectively. Compliance was assessed by the number of patients continuing treatment, and endometrial response was assessed by office biopsy and cytological or histological examination.

Five patients withdrew, giving an overall compliance rate of 94%. Two have subsequently resumed therapy, thus 98% of those enrolled are currently receiving hormone replacement therapy.

No cases of endometrial carcinoma were detected during the trial period of 4 years. Two cases of mild atypical endometrial hyperplasia were detected but both were mild and reverted to secretory or inactive endometrium following progestogen therapy.

This regimen provides a viable alternative for those women who are troubled by progestogenic side‐effects and monthly withdrawal bleeding.
Fetal Head Injury Following Motor Vehicle Accident; an Unusual Case of Intrauterine Death
Authors: Ford Robert M. , Picker Richard H.
Published: February 2008

Summary: This case report documents fetal death in utero at 30 weeks' gestation due to subdural and subarachnoid haemorrhages, resulting from a motor vehicle accident in which the mother sustained ‘seat belt’ and facial injuries. There was no evidence of placental abruption. The causes of fetal deaths in utero following maternal involvement in motor vehicle accidents are discussed.
The Surgical Treatment of Tubal Polyps
Authors: Gillett Wayne R.
Published: February 2008

Summary: Three of 5 women who had resection of intramural tubal polyps as part of their infertility treatment conceived normal pregnancies within 12 months. Linear salpingotomy for the resection of polyps may have a place in the surgical management of infertility.
Liver Function in Normal Pregnancy
Authors: Carter Jonathan
Published: February 2008

Summary: Liver function tests were measured in a longitudinal study of 64 women throughout normal pregnancy. Standard liver function tests and postprandial levels of cholesterol, triglycerides, protein and albumin were measured at each visit. Serum alkaline phosphatase, cholesterol and triglyceride levels increased significantly throughout pregnancy (p< 0.001) while serum transaminases and bilirubin remained within the normal range. Total protein and albumin levels decreased significantly (p< 0.001).
Cost Effectiveness of Antenatal Hepatitis B Screening and Vaccination of Infants
Authors: Thomas I. L.
Published: February 2008

EDITORIAL COMMENT: We thought readers may appreciate definition of the terms vertical and horizontal transmission before reading this paper. To the epidemiologist vertical transmission means transmission of infection from mother to baby, at or before birth but not necessarily by the transplacental route. It is believed that babies usually become infected with hepatitis B from their carrier mother by ingestion of blood at delivery (vaginal or Caesarean). Horizontal transmission refers to all other types of cross‐infection via body fluids (saliva, blood, vaginal secretions, seminal fluid). Ingestion of infected breast milk would be an example of horizontal transmission from mother to baby. Immunization of infants born to carrier mothers reduces the risk of chronic infection (carrier status) from more than 90% to less than 10%. At birth the baby receives passive immunity by injection of hepatitis B immune globulin (HBIG) and active immunity is achieved by a course of 3 injections of hepatitis B vaccine, the first of which is given before the child leaves hospital; the second is given 6 weeks later and the third 6 months later. Prevention of carrier status in babies is thus achieved by a combination of passive and active immunity.

Summary: Over a 2‐year study period 5,858 public antenatal patients were screened with the Welcome hepatitis B surface antigen HA screening kit; 52 (0.89%) were positive (carriers) and 45 (87%) of these were identifiable as high risk patients and would have been diagnosed by selective screening; the remaining 7 (13%) would have been missed.

Using a subsample of 1,000 women, it was found that high risk factors were present in 237 (23.7%).

Restriction of screening to the high risk group cost an estimated $97 per carrier identified; universal screening cost $354 to identify each carrier. Screening only the high risk group would have missed the 7 carriers in the low risk group, which was estimated to number 4,470 patients (76.3% of the total). Estimated cost of screening the low risk group was $14,036, or $2,005 per carrier identified.

The advent of highly effective vaccines enables the almost complete prevention of vertical transmission of hepatitis B. In mid‐1988, vaccine costs in terms of hepatitis B prevention per baby were estimated to be $2,432 for vaccination of babies born to mothers in the high risk group, irrespective of maternal serology; and $9,729 for universal vaccination.

Carrier rates vary between populations. For our clinic patients, universal screening and vaccination of all babies of high risk group mothers are considered appropriate. Selective screening may be more appropriate in a low risk private practice.
Down Syndrome and Low Maternal Serum Alpha Fetoprotein
Authors: Jacobs Sue , Giles Warwick
Published: February 2008

EDITORIAL COMMENT: This paper presents the case for routine mid‐trimester (16 weeks) screening of maternal serum alpha‐fetoprotein level for the diagnosis of increased risk of Down syndrome since low values can result in identification (by amniocentesis and karotyping of fetal cells) of approximately 30% of all Down syndrome infants; women aged 37 years at the calculated date of delivery are currently offered amniocentesis because of maternal age alone (New South Wales and Victoria). It is noteworthy that the authors do not believe that present data justify introduction of routine alpha‐fetoprotein testing alone for the diagnosis of increased risk of Down syndrome.

Maternal serum alpha‐fetoprotein estimation has been performed routinely in many centres as a screening test for fetal neural tube defects especially in communities with a high prevalence of this disorder (I in 700 births in Australia; in Western Sydney the incidence is 3–5 in 1,000 births) ‐ high values allow selection of about 95% of cases of anencephaly and 75% ofspina bifida. Advocates for the introduction of a new test for universal application can usually present convincing cost‐effectiveness calculations in
Transeervieal Endometrial Resection for Abnormal Uterine Bleeding ‐ Report of 100 Cases and Review of the Literature
Authors: Maher Peter J. , Hill David J.
Published: February 2008

Summary: Many Australian women suffer from unacceptable uterine bleeding and up to 40% may undergo hysterectomy for benign conditions which may be better treated by a less radical procedure ‐ endometrial resection. The preliminary results of 100 patients treated in this way are presented.
Abdominoperineal Urethral Suspension: A Report of 20 Cases
Authors: Browne David S. , Frazer Malcolm I.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because we consider Zacharin's operation does not enjoy the popularity it deserves ‐ it is also ironical that this operation and the anatomy of the pubourethral ligament as described by Zacharin, and on which the technique is based, has been acknowledged in overseas journals (Obstet Gynecol Surv 1989; 44:833) but not our own. Zacharin uses abdominoperineal urethral suspension exclusively for patients with recurrent stress incontinence but he, unlike the authors of this paper, does not advocate its use as a primary procedure when there is uterovaginal prolapse. Most of the 335 patients Zacharin has operated on in the past 20 years for the relief of stress incontinence have had previous surgery, although there were a few without prolapse who had not (personal communication to the editor). Zacharin reported an 85% overall cure rate for his operation after long‐term follow‐up in a series of 194 women treated during the 15 years, 1965–1980 (Obstet Gynecol 1983; 62: 644–654). During the past 15 years Zacharin has been invited to perform his abdominoperineal urethral suspension procedure in university centres in the United States, Canada. Europe, the United Kingdom, Africa and Asia. The editorial board is unaware of any other Australian gynaecologist who is repeatedly asked to demonstrate a surgical procedure abroad ‐ it seems appropriate that the technique be reexamined by all gynaecologists who treat patients for stress incontinence when it recurs after primary surgery.

Summary: Twenty patients adjudged to require surgical management of genuine stress incontinence underwent the abdomino‐perineal urethral suspension procedure between May, 1989 and February, 1990. Short‐term subjective follow‐up revealed a 94% cure and improved rate in 19 patients in whom the operation was completed. There was a striking absence of postoperative voiding morbidity. We believe this somewhat neglected procedure is worthy of further objective study and comparison with the more popular methods of surgical management of genuine stress incontinence.
Maternal Smoking, Urinary Cotinine Levels and Birth‐Weight
Authors: Mathai Matthews , Skinner Alyson , Lawton Kevin , Weindling A.M.
Published: February 2008

Summary: The smoking habits of 300 consecutive pregnant women and of other members of their household were obtained by interview at 16 and 32 weeks' gestation and after delivery. Urine samples for estimation of cotinine were collected at the same times during pregnancy and on admission in labour. Both self‐reports of active maternal smoking and urinary cotinine levels were significantly associated with lighter babies but urinary cotinine correlated the better. Active maternal smoking was associated with a decrease in birth‐weight of 12 g for every cigarette smoked in a day while there was a decrease of 25 g in birth‐weight for every microgram of cotinine/mg of urinary creatinine. Passive maternal smoking was associated with a decrease of 66 g in mean birth‐weight but this decrease was not statistically significant. Self‐reports of active and passive smoking accounted for 43% of the variation in urinary cotinine levels suggesting that urinary cotinine assays can be used to assess and monitor exposure to tobacco smoke in pregnancy.
Chorion Villus Sampling — Transcervical or Transabdominal
Authors: Finikiotis George , Gower Lisa
Published: February 2008

EDITORIAL COMMENT: This study provides interesting information on the relative effectiveness of chorion villus sampling performed transcervically and transabdominally regarding obtaining a suitable specimen. The results seem to indicate that the abdominal route is preferred unless contraindicated, because of a lesser risk of infection. Although the series is not a controlled trial with alternate patients receiving transcervical or the transabdominal technique, the results seem clinically meaningful. It is important to note that the spontaneous abortion rate following chorion villus sampling by any route is less than the rate observed in normal obstetric practice when early ultrasound has not been used to exclude cases of unsuspected missed abortion. This explains the remarkably low incidence of miscarriage following chorion villus sampling. It will be interesting to see whether the low complication rate of chorion villus sampling will eventually result in the test being offered to all patients rather than those that are high risk — it should be remembered that the majority of recognizably malformed fetuses are born to patients without any risk factor. This is already the practice in some areas of the United States of America. The present state of the art is that when chorion villus sampling is indicated it is performed by the transcervical route at 8–12 weeks and by the transabdominal route at 10–12 weeks. However, the normal genetic counselling amniocentesis when liquor rather than chorion is sampled, is performed ideally at 16 weeks.

Summary: Chorion villus sampling was performed transcervically on 84 patients and transabdominally on 126 patients. Two of 4 (5%) spontaneous abortions in the transcervical group were complicated by uterine infection. Five (4%) spontaneous, abortions in the transabdominal group were uncomplicated by infection. The results support the contention that the transabdominal method may be safer and that the procedure related fetal loss rate is similar to that following amniocentesis.
Chlainydia Trachomatis — Role in Tubal Infertility
Authors: Garland Suzanne M. , Lees Maxwell I. , Skurrie Ian J.
Published: February 2008

Summary: The prevalence of humoural IgG and IgM antibodies to Chlamydia trachomatis was determined in 110 infertile women and compared to 87 healthy pregnant women without any known fertility problem. Overall antibodies to chlamydia were detected in 45% of infertile women. Antibodies were found in significantly more patients with tubal factor infertility (65%) than in women whose infertility was due to other causes (22%) (p< 0.005). These findings are consistent with the hypothesis that C. trachomatis is a major cause of tubal factor infertility.

In addition the prevalence of antibody in patients with other sexually transmitted diseases (STD), pelvic inflammatory disease and confirmed chlamydia cases were evaluated. Within this miscellaneous high risk group of patients, chlamydial antibodies were detected commonly, ranging from 19–72%.
Birth‐weight of Newborns to Chinese Women Subsequent to a Previous Abortion
Authors: Tan Tah‐Chew , Chang Allan MZ , Rogers Michael S
Published: February 2008

EDITORIAL COMMENT: It is left to the reader to tell us why birth‐weights of infants born to Chinese primiparas were significantly higher when there was a previous induced (73 g) or spontaneous abortion (110 g).

Summary: The mean birth‐weight of firstborns of women was significantly higher when there was a previous abortion. The increase was 73.5 and 119.4 g in newborns of women with an induced and a spontaneous abortion respectively. This trend of significant increased birth‐weight among firstborns of women with either a previous induced or spontaneous abortion continued for male infants, in recent migrants, and in subjects aged 20–24 and 30–34 years. Stepwise logistic regression analyses showed that a history of an induced or a spontaneous abortion increased the birth‐weight of the firstborns, while short maternal stature and female newborn were associated with decreased birth‐weight. For low birth‐weight, a previous abortion was not selected into the regression models but short maternal stature and female newborns continue to contribute to low birth‐weight. Prematurity and mean gestation were found not to be associated with previous abortion using logistic regression analyses.