bluuebunny/crossref_metadata_2025 huggingface dataset:
Cephalhaematoma
Authors: Tan K. L.
Published: February 2008

A study of babies with cephalhaematoma of moderate or large size (more than 7 cm. in diameter) was conducted over a 12‐month period in the Kandang Kerbau Hospital, Singapore. There were 74 infants with such a complication among the 36,427 who were born alive during this period, giving an incidence of 2.03 per thousand. Primiparity, assisted delivery and high birth weight were associated with a higher incidence of the condition. Significant degrees of anaemia and jaundice were only rarely present. Resolution was usually complete by the end of 4 weeks, beyond which if resolution was not complete, calcification usually occurred.
Rhesus Incompatibility – An Assessment of the Hazards of Amniocentesis, and the Effect of Liquor Volumes on Amniocentesis Prediction
Authors: Free Keith , McDonnell Brian
Published: February 2008

The complications of 185 amniocenteses have been analysed. The failure rate of the procedure was 11.3%. Spontaneous rupture of the membranes and premature labour occurred in 2.2%. In 33% of patients fetal cells were found in the liquor and feto‐maternal haemorrhage occurred in 38%.

The presence of fetal cells in the maternal circulation was followed by an increase in maternal sensitisation in 4 of 16 patients. Intra‐uterine fetal death can occur from feto‐maternal haemorrhage.

A suprapubic approach for amniocentesis decreases the incidence of feto‐maternal transfusion. Placental localization is essential to avoid feto‐maternal transfusion. In 25 patients differences in liquor volume had no effect on the accuracy of amniocentesis prediction.
The Effect of Pregnancy on the Sensitivity of the Rabbit Liver to Diethyl Nitrosamine
Authors: Texler K. C. , Roman W. , Irving Elizabeth A.
Published: February 2008

By the analysis of various serum constituents it is concluded that the liver of a pregnant rabbit is considerably more sensitive to acute toxic injury than that of a non‐pregnant rabbit.
The Value of Plasma Oxytocinase in the Assessment of Fetal‐Placental Function
Authors: Blunt Alan
Published: February 2008

Summary: Preliminary results in the study of plasma 1‐cystine aminopeptidase levels as a test of fetal‐placental function are reported. A significant correlation has been obtained between plasma 1‐cystine aminopeptidase and the total 24‐hour urinary oestrogen excretion. It is concluded that serial determinations of plasma 1‐cystine aminopeptidase levels are of value in assessing fetal‐placental function.
Bacterial Endocarditis in Pregnancy
Authors: Ward Humphry , C. Hickman R.
Published: February 2008

: Five cases of bacterial endocarditis associated with pregnancy are described. Despite modern therapy, the seriousness of the condition prevails. Emergency valve replacement during the acute stage of the disease is now possible.
Haematological Data and Milk Iron in Malaysian Women
Authors: Loh T. T. , Sinnathuray T. A.
Published: February 2008

Breast milk iron concentrations from Malaysian women taken on the second postpartum day were comparable with those reported from Finland. The present study did not find any correlation between the total iron‐binding capacity (TIBC) of milk whey, presumed to be rich in lactoferrin, and the whole milk iron concentrations. On the average, about 30% of the whey iron‐binding proteins were saturated with iron. Again, the correlation between the milk iron values and plasma iron or plasma TIBC is not statistically proven. There were no significant differences in the haemoglobin, haematocrit, reticulocyte count, plasma iron and whey TIBC obtained from Malaysian parturient women of the 3 major ethnic groups, viz. Chinese, Malays and Indians. However, the plasma TIBC was significantly lower in Malay women and the milk iron content lower in Chinese women.
Gynaecological Survey in a Metropolitan Area of Melbourne
Authors: Wood Carl
Published: February 2008

Summary: A survey of the emotional and physical health of 990 women in a suburb of Melbourne was carried out. The data related to the reproductive period are presented. Evidence was found that the age of menarche was declining. Nine per cent of women menstruated beyond the age of 55 and there was a tendency for the late onset of the menarche to be followed by early menopause. Menstrual symptoms were very common (51.5%) and their frequency did not vary between the age of 20 to 50. Menstrual symptoms were more frequent in the presence of psychiatric illness and psychoneurotic symptoms. Smoking and medication were more common in patients with menstrual symptoms. One in 3 women between the age of 25 to 29 was taking the contraceptive pill, and single women used it almost as frequently as married women. Both depression and neurotic symptoms were commoner among pill users.
The Development of the Lower Uterine Segment
Authors: Morrison John
Published: February 2008

Summary: The change in position between the lower placental border and the internal cervical os has been measured serially by compound ultrasonic scanning at different stages of gestation in a group of patients with a relatively low insertion of the placenta. These measurements, in conjunction with the clinical estimation as to whether or not placenta praevia was present at delivery, have been used to calculate the normal pattern of development of the lower uterine segment during pregnancy. Factors which apparently interfere with this pattern of development and the value of this knowledge in relation to placental localisation is presented.
Combined Intra‐Uterine and Extra‐Uterine Pregnancy in Two Patients Treated With Human Pituitary Gonadotrophins
Authors: Robertson Struan , Grant Alan
Published: February 2008

Summary: Two cases of combined intra‐uterine and extra‐uterine pregnancy in patients receiving treatment with human pituitary gonadotrophin for stimulation of ovulation are described. One patient subsequently delivered a healthy child, whereas the other miscarried before diagnosis of the extra‐uterine pregnancy was made.
Triplet Pregnancy
Authors: Dawood M. Yusoff
Published: February 2008

Summary: Five triplet pregnancies are described. None of these terminated prematurely. The perinatal mortality was 33%, while the sex ratio was 150:100. There was one set of conjoined twins. The literature on triplet pregnancy is reviewed and the incidence, aetiology, diagnosis, complications and management are discussed.
The Value of the Amniotic Fluid Lecithin: Sphingomyelin Ratio in the Management of High Risk Pregnancy
Authors: Yared L. E. , McGeary H. M. , Gaffney T. J.
Published: February 2008

Summary: The amniotic fluid lecithin: sphingomyelin ratio was used to assess fetal maturity in the management of 62 high risk pregnancies. Correlation between the ratio and the onset of respiratory distress syndrome was good in 58 of the 62 cases (93%). In 7 patients delivered with an immature‐type ratio, one baby died in utero, 4 babies developed respiratory distress syndrome and of these 2 died from hyaline membrane disease.

The value of the test in the management of high risk pregnancies is discussed.
Carcinoembryonic Antigen in Cancer of the Female Reproductive System: Its Detection in Serum by a Microradioimmunoassay*
Authors: Khoo S. K. , Mackay E. V.
Published: February 2008

Summary: Carcinoembryonic antigen (CEA) is demonstrable in whole serum of patients with cancers of the female reproductive system. Positive results, taken arbitrarily as levels of CEA exceeding 5 ng./ml., were obtained in 60% of such patients; the highest incidence of positive results was present in patients with ovarian and breast cancer (73% and 70%). By comparison, none of 73 patients with benign gynaecological conditions such as cervicitis and dysfunctional uterine bleeding, and only 4% of unselected blood donors, had a positive result. The incidence of high levels of CEA (values of 10 ng./ml. or more) was lower in patients with cancer of the reproductive system (56 of 171) than in those with cancer of the digestive system (96 of 138). There was no difference in incidence of positive results for patients with adenocarcinoma and with squamous cell carcinoma of the female genital organs. In general, a higher incidence of positive results and higher levels of CEA were present in patients with extensive or meta‐static disease, but positive results were found even in those with pre‐invasive lesions (carcinoma in situ and severe dysplasia).
A Comparison of Serial Cephalometry and Maternal Urinary Oestrogen Excretion in Assessing Fetal Prognosis
Authors: Varma Thankam R.
Published: February 2008

Summary: Serial ultrasonic cephalometry and maternal 24‐hour urinary oestrogen assays were performed on 400 patients who were considered on clinical grounds to be at risk of having a small‐for‐dates fetus. It was found that serial cephalometry was a better indicator of fetal well‐being than urinary oestrogen assays. Serial cephalometry enabled dysmaturity to be predicted in 90% of patients, compared with 70% by serial oestrogen assays. The false positive and false negative diagnoses using serial cephalometry were 12% and 10%, respectively, compared with 22% and 30%, using oestrogen assays. It was also noted that serial cephalometry was significantly better than oestrogen assays in predicting perinatal asphyxia.
Serum Progesterone in Normal Pregnancy. Studies in an Asian Population
Authors: Teoh Eng Soon , Dawood M. Yusoff , Ratnam S. S. , Ambrose Anselm , Das N. P.
Published: February 2008

Summary: Progesterone was measured in 232 normal pregnancy sera by a competitive protein binding assay. The mean serum progesterone concentration increased gradually from 15.1 ng./ml. at 6 weeks of gestation to 22.5 ng./ml. at 8 weeks, dipped slightly to 18.8 ng./ml. at the ninth week and then rose steeply during the second and third trimesters to reach 180.5 ng./ml. at term. There was a 5.5‐fold difference between the lowest and highest concentrations of serum progesterone for any period of gestation. In 5 patients investigated for diurnal changes there were small, random fluctuations in the serum concentration. The mean umbilical venous serum progesterone concentration in 10 babies was 4.5 times higher than the corresponding maternal venous concentration.
Immunological Aspects of Female Infertility
Authors: Jones W. R.
Published: February 2008

Summary: Results in 377 couples indicate that the sperm immobilization test provides a reliable means of detecting significant humoral anti‐sperm activity in infertile patients. Occlusion therapy in patients with sperm antibodies has proved disappointing when compared with the natural reproductive pattern in untreated patients.

A continuing prospective study indicates a lower subsequent fertility rate, and a markedly higher abortion rate, in women with sperm antibodies compared with those without them. Notwithstanding this, patients with infertility of 3 or more years' duration achieved a subsequent pregnancy rate of 27%, even in the presence of sperm antibodies. The nature and significance of sperm iso‐immuniza‐tion requires much further elucidation.
Massive Haemoperitoneum Due to Spontaneous Rupture of a Uterine Varix
Authors: Picker R. H. , Saunders D. M. , Coppleson J. V. M.
Published: February 2008

Summary: A case is presented of massive haemoperitoneum resulting from spontaneous rupture of a uterine varix in late pregnancy. A review of the literature indicates that this is associated with a high maternal and fetal mortality. The condition warrants special attention so that the diagnosis is not made too late.
Comparison Between Plasma and Urinary Oestrogen Measurements in Predicting Fetal Risk
Authors: Aickin D. R. , Smith M. A. , Brown J. B.
Published: February 2008

Summary: A fluorimetric method for measuring total oestrogens in late pregnancy plasma is described and data on its precision, sensitivity, accuracy and specificity is presented. One worker can complete 24 analyses in a day.

A total of 311 parallel estimations of total oestrogens in plasma and urine were performed in 119 initially normal pregnancies to define the normal ranges. A further 454 parallel estimations were performed in 166 patients with pregnancy abnormalities likely to be associated with increased fetal risk. The incidences of low oestrogen values in the initially normal group of patients were 21% for plasma and 17% for urine; the corresponding incidences in the abnormal group were 42% for plasma and 28% for urine. The correlation coefficient between the plasma and urine values was 0.71 in the ‘normal’ group and 0.58 in the abnormal group. These correlations were highly significant but did not allow one value to be calculated from the other with any accuracy. Throughout the study, plasma and urine oestrogen assays did not give synonymous information and it was concluded that it would be dangerous to establish plasma oestrogen measurements as a test of fetal welfare merely on the basis that urine measurements were useful.

Plasma oestrogen assays gave the same assessment of fetal risk in 226 pregnancies and opposite assessments in 59. In the 59 pregnancies, the plasma values were correct in predicting fetal risk as often as the urine values. In the total 285 pregnancies, all indices of fetal risk except the passage of meconium during labour were increased when the plasma or urine values were low and the levels of significance of these correlations were the same for plasma as for urine. There was no evidence that one assay was superior to the other in any pregnancy complication including renal disease, or that changes in plasma values gave a more immediate indication of a rapidly deteriorating fetal environment than urine. It was concluded that plasma and urine oestrogen assays give equally valid information in the assessment of fetal risk, that they could well be used as complementary tests and that because of ease of collection and avoidance of time delay, plasma assays could replace urine assays as soon as rapid fully automated assay methods are developed for plasma comparable to those now available for urine.
Oral Prostaglandin E2in Induction of Labour
Authors: Ratnam S. S. , Khew K. S. , Chen Christopher , Lim T. C.
Published: February 2008

Summary: In a randomised study of 207 patients, labour was induced with oral prostaglandin E2in 107 and intravenous oxytocin (Syntocinon) in the remainder, half in each group with medication alone, the other half with fore‐water amniotomy as well. Prostaglandin and oxytocin were found to be more effective when preceded by amniotomy. Once labour was established, the time taken to achieve vaginal delivery was the same with either drug, as also the number of successful vaginal deliveries. There were 6 failed inductions, but no statistical significance in the percentage differences between PGE2 and oxytocin could be found. The two perinatal deaths which occurred could not be attributed to either drug. Oral PGE2is therefore as effective as intravenous oxytocin with no observed hypertonus and little side‐effects.
Amniotic Fluid Thromboplastic Activity as an Index of Fetal Maturity — Preliminary Report
Authors: Hastwell Gary B.
Published: February 2008

Summary: Based on the thromboplastic activity of amniotic fluid, a bedside test has been evaluated, whereby an amniotic fluid sample is added to a sample of the patient's blood and the accelerated clotting time (ACT) observed.

In 11 patients (27 samples) studied serially in the last trimester, there was a decrease in ACT and, hence, an increase in thromboplastic activity, with increase in maturity.

In a random series of 94 samples from 74 patients, an ACT of greater than 110 seconds usually indicated that the fetus was premature.

Although the number of infants with respiratory distress was small, the ACT gave useful confirmatory information to the lecithin/sphingomyelin (L/S) ratio which was studied in parallel.
Results of Fetal Transfusion Royal Hospital for Women, Sydney 1964‐73
Authors: Bosch E. G. , Fisher C. C. , Stevens L. H.
Published: February 2008

Summary: Despite a marked decrease in the overall incidence of rhesus iso‐immunization, the number of very severe cases referred to this hospital, many of whom require fetal transfusion, is almost unchanged. Fetal transfusion had a success rate of 26% in the years 1964‐68, but currently the success rate is 57%. This improvement is due to 2 factors, the survival of more fetuses who showed signs of hydrops fetalis and a greatly improved survival rate of babies born alive. The procedure is not hazardous for the mother and should be offered to all severely affected infants.
Metastatic Choriocarcinoma of the Gum
Authors: Dawood M. Yusoff , Ratnam S. S.
Published: February 2008

Summary: A case of metastatic choriocarcinoma of the right upper alveolar margin occurring 20 months after total abdominal hysterectomy for a molar pregnancy is presented. Profuse tumour haemorrhage necessitated ligation of the right external carotid artery. The tumour regressed completely with chemotherapy, but subsequently a pulmonary metastasis required lung resection after chemotherapy had failed.
Blood Pressure Changes Following Smoking in Pregnancy
Authors: Biggs John S. G.
Published: February 2008

Summary: The smoking of 1 or 2 cigarettes in late pregnancy causes a significant rise in blood pressure in most patients. The usefulness of a device for the repeated measurement and recording of blood pressure is demonstrated.
The Effects of Hypoglycaemia and Hyperglycaemia on Pregnancy Outcome
Authors: Abell David A. , Beischer Norman A.
Published: February 2008

Summary: A 50 g 3‐hour oral glucose tolerance test was performed on 5,000 consecutive patients during the third trimester of pregnancy. An increased incidence of complicated pregnancy outcome was seen when there was hypoglycaemia and hyperglycaemia (fifth and ninety‐fifth percentiles respectively for plasma glucose levels). Hypoglycaemia had a significant association with subnormal urinary oestriol excretion (P<0.05), fetal and placental growth retardation (P<0.001), and increased perinatal mortality (P<0.05). When there was hyperglycaemia, placental growth was stimulated (P<0.01) and perinatal mortality was increased (P<0.001). When urinary oestriol excretion was persistently subnormal and glucose tolerance was normal the perinatal mortality rate was 2.0%, whereas in the presence of hypoglycaemia this was 12.7% (P<0.001) and when there was hyperglycaemia the rate was 12.8% (P<0.001). Therapeutic measures applied to the patient who is hypoglycaemic, especially when there is subnormal oestriol excretion, require investigation and may enable reduction of perinatal mortality and morbidity.
Fetal Growth Patterns in Normal Malaysian Pregnancies
Authors: Yusof K. , Sinnathuray T. A.
Published: February 2008

Summary: The birth weights of normal singleton Chinese, Malay and Indian babies, born between March, 1968 and December, 1971 at the University Hospital in Kuala Lumpur have been studied. The gestational age of these newborn babies was between 36 and 43 weeks. For each gestation, the arithmetical mean birth weights, standard deviations, standard errors, and the 10th, 50th and 90th per‐centiles were calculated. The mean birth weight of the Chinese babies at 40 weeks' maturity was 3,233 g; the Malay and Indian babies were lighter by 119 g and 200 g, respectively. The pattern of intrauterine fetal growth showed differences between the 3 community groups.
Cushing's Syndrome and Pregnancy
Authors: Anderson Kenneth J. , Walters William A. W.
Published: February 2008

Summary: The literature on Cushing's syndrome associated with pregnancy is reviewed, and the first case to be reported of pituitary‐dependent adrenal hyper‐plasia treated by pituitary irradiation during pregnancy is described. Vaginal delivery at term resulted in a normal female infant. The interpretation of plasma cortisol levels after pituitary irradiation is discussed and, in particular, the effect of the latter on diurnal variation of cortisol levels and dexamethasone suppression.
Artificial Donor Insemination
Authors: Leeton John , Backwell June
Published: February 2008

Summary: This paper discusses the indication, need, and methodology for artificial donor insemination in Australia by describing the management of 111 referred couples over a 15‐month period. Insemination was carried out with either deep frozen or fresh semen in 97 women. Using deep frozen sperm insemination, 2 pregnancies were achieved in 19 women, with a mean of 9.5 cycles per pregnancy. With fresh semen, 42 pregnancies were obtained, with a mean of 2.8 cycles per pregnancy. In both programmes the insemination was carried out only once each month in 80% of cycles and was timed to coincide with the temperature dip preceding the rise in the basal temperature chart. The majority of pregnancies occurred when insemination was performed on the day of this dip. All babies conceived 2 to 3 days before this dip were female and all babies conceived after the dip were male. Two spontaneous abortions, one tubal pregnancy, one set of twins, and one case of mild hypospadias occurred. The overall attitude of the husband and wife to each other, to the pregnancy, and to the baby was excellent.
Utilization of A Mass Screening Programme for Cervical Cancer in N.S.W.
Authors: Pacey N. F. , Westgarth L.
Published: February 2008

Summary: An analysis is made of the impact of the mass screening programme for cervical cancer conducted by the N.S.W. Department of Health in the 13‐year period 1962–1974.

It is being used efficiently in the younger age groups. This reflects a good acceptance and understanding of the service by the participating doctors, satisfactory communication with their patients, and adequate opportunity to perform the test.

The principal and continuing problem is the lack of adequate coverage in older age groups in whom the risk of invasive cancer and death from the disease is highest. It is suggested that this problem be approached by increasing the opportunity for such women to have a smear under circumstances that similar women have found acceptable elsewhere, rather than trying to achieve a similar result by public education programmes within the existing pattern of medical care.
The Effect of Maternal Smoking on Cord Blood Erythroeytes
Authors: Harrison K. L. , McKenna H.
Published: February 2008

Summary: A matched controlled study of cord blood erythrocyte parameters has been carried out on infants of smoking and non‐smoking mothers. A highly significant (P < .001) increase in mean corpuscular volume in the infants of smoking mothers was observed which did not appear to be related to the number of cigarettes used. There was no significant change in the red cell count, but haemoglobin concentration and mean corpuscular haemoglobin showed a similar increase. Growth retardation has been observed in the infants of smoking mothers and a possible mechanism for this is postulated.
Ovulation Induction With Bromocriptine (CB154) in Patients With Hyperprolactinaemia
Authors: Pepperell R. J. , McBain J. C. , Healy D. L.
Published: February 2008

Summary: Bromocriptine was effective in inducing ovulation in 95% of 44 anovulatory subjects with hyperprolactinaemia and 73% conceived. Most subjects ovulated during treatment with bromocriptine in a dose of 5 mg/day, however 8 required 10 mg/day, 3 required 15 mg/day and 2 required 40 mg/day. Half of the subjects showed follicular maturation only or deficient corpus luteum function as their initial ovarian response. Increase in the dose of bromocriptine administered was not always necessary to improve this response to that of normal ovulation. At the time of conception the serum prolactin level had been suppressed to normal in all but one subject and in the majority was less than 10 ng/ml.

Three subjects who did not conceive during treatment with bromocriptine alone were also treated with thyroxine, although their thyroid function was normal. Two of these subjects conceived and the third had cycles of ovarian response of follicular maturation only or ovulation with deficient corpus luteum function having previously had no ovarian response when treated with bromocriptine alone.
Cervical Ligation: A Review of 242 Pregnancies
Authors: Kuhn R. J. P. , Pepperell R. J.
Published: February 2008

Summary: Two hundred and forty‐two pregnancies complicated by cervical incompetence requiring cervical ligation were reviewed. Analysis of the outcome of these pregnancies enabled conclusions to be drawn about the suture technique employed, the management of these pregnancies after premature rupture of the membranes, the effectiveness of chemoprophylaxis, and fetal salvage rates after prophylactic or therapeutic cervical ligation.
Prognostic Value of Plasma Oestradiol‐17β and Human Placental Lactogen in High‐risk Pregnancies
Authors: Chew Peter , Salmon J. A. , Ratnam S. S.
Published: February 2008

Summary: Serial estimations of plasma oestradiol‐17(E2) and human placental lactogen (HPL) were made in 58 high‐risk pregnancies. In pregnancies complicated by marked hypertension, intrauterine growth retardation, and intra‐uterine death, plasma E2 did not reflect fetal well‐being accurately, unlike HPL which was accurate in predicting fetal outcome. In diabetic pregnancy, plasma E2 and HPL levels were similar to those found in normal pregnancy.
Leiomyomatosis Peritonealis Disseminata
Authors: O'Sullivan Brendan T.
Published: February 2008

Summary: A case of leiomyomatosis peritonealis disseminata in a 34‐year‐old para 3 is presented.
Emergency Obstetric Calls in the Wimmera
Authors: Miller E. T.
Published: February 2008

Summary: This paper analyses emergency obstetric calls in the Wimmera Plains over the 10‐year period, 1967–1976. There were 120 calls and 39 of these were managed at the local hospitals. In a district of this type there is a place for a visiting obstetric emergency service.
Laparoscopic Tubal Occlusion with Silicone Rubber Bands
Authors: Kumarasamy Thampu , Hurt W. Glenn , Dunn Leo J.
Published: February 2008

Summary: Application of the silastic ring to the Fallopian tubes through the laparoscope seems to be a simple, safe and acceptable method of tubal sterilization. The technique and results in 337 patients are described. In the majority of cases, the procedure was effected in the outpatient department under local anaesthesia. Transsection of the tube (with or without bleeding), tearing of the mesosalpinx, and avulsion of the tube at the uterotubal junction were the most common complications; with experience and adherence to the proper technique of ring application, the above can be minimized. The pregnancy rate following this procedure seems to be acceptable, but long‐term follow‐up is necessary for definitive conclusions.
Duffy Haemolytic Disease of the Newborn
Authors: Lee W. H. , Jones W. R. , Blake G. P.
Published: February 2008

Summary: case is reported of mild haemolytic disease of the newborn due to anti‐Fya (Duffy). This brings to 19 the number of cases of Duffy haemolytic disease recorded in the English literature.
Effects of Danazol on Pituitary Gonadotrophins in Post‐Menopausal Women
Authors: Fraser Ian S. , Thorburn Geoffrey D.
Published: February 2008

Summary: Multiple sampling was carried out in 4 postmenopausal women for measurement of LH and FSH before and at the end of a 1‐week treatment period with Danazol (400 mg daily). A small but significant depression of FSH was found in 3 of 4 subjects, while a significant depression of LH was only seen in 1 subject. In view of the very modest gonadotrophin suppression demonstrated in these women it is possible that Danazol also exerts its profound and sometimes rapid effects through inhibition of positive oestrogen feedback and by direct actions on the ovaries and endometrium.
Single Dose Extra‐Amniotic Prostaglandin Gel for Midtrimester Termination of Pregnancy
Authors: Quinn M. A. , Shekleton P. A. , Wein R. , Kloss M.
Published: February 2008

Summary: The efficacy of a single dose of prostaglandin F2α gel instilled into the extra‐amniotic space to induce termination of pregnancy in the second trimester has been assessed and compared with intra‐amniotic prostaglandin F2α and with an extra‐amniotic infusion of prostaglandin F2α combined with intravenous oxytocin. There was no significant difference between the methods in time taken to abortion, incidence of retained placenta, need for blood transfusion, or rate of sepsis. Single dose extra‐amniotic prostaglandin gel is recommended as a safe, effective, and convenient method of midtrimester termination of pregnancy.
Review: The Mechanism of Action of Danazol, a Novel Steroid Derivative
Authors: Jenkin Graham
Published: February 2008

Summary: Danazol is being increasingly used for the treatment of a wide range of disorders, many of which appear to bear little relation to the condition for which the drug was originally marketed – endometriosis. It has been claimed that this drug acts by means of its antigonadotrophic effects on the pituitary; however, a review of the literature reveals that its efficacy in suppressing normal endometrial growth and in causing atrophy of deposits of endometrium cannot be explained solely on this basis. Recent information indicates that, besides acting at the pituitary level, a major mechanism of action may be by a direct inhibitory effect on target tissues. It is suggested that such a mechanism would more readily account for the diverse effects of this drug in the treatment of many disorders, all of which appear to be associated with an imbalanced sensitivity of target organs to steroid hormones. A greater understanding of its mechanism of action could lead to an even wider application of this novel drug.
The Ultrasonic Diagnosis of Cervical Ectopic Pregnancy
Authors: Pridmore B. R. , Lees R. F. , Ward B. G.
Published: February 2008

Summary: Two patients with cervical pregnancy who had ultrasonic scans performed before operation are reported. The ultrasonic features of this condition are presented.
Mortality and Morbidity of Fetal Growth Retardation
Authors: Dobson P. C. , Abell D. A. , Beischer N. A.
Published: February 2008

Summary: This study reports the fetal outcome in 500 pregnancies when the baby weighed less than the 10th centile for gestational age at birth, compared with that in a series of 500 pregnancies where there was a normal weight for gestation. Fetal growth retardation (0‐9th centile) had a significant positive association with perinatal mortality (5.2% versus 1.2%, P > 0.001) and low oestriol excretion (42.4% versus 15%, P > 0.001), but not with major fetal malformations or fetal asphyxia. In the study group, 20 of the 26 perinatal deaths were associated with subnormal oestriol excretion. When severe fetal growth retardation was considered (less than the 5th centile), the associations with perinatal mortality (19%) and subnormal oestriol excretion (63%) were stronger and a significant correlation with major malformations emerged (17%, P > 0.001). Detection of subnormal oestriol excretion allows identification and appropriate treatment of severe fetal growth retardation which should improve survival and neurological development in these infants. This study confirms that birth‐weight below the 10th centile is an appropriate definition of fetal growth retardation in terms of perinatal mortality and morbidity.
A Case of Premature Labour Due to Campylobacter jejuni Infection
Authors: Miller R. C. , Guard R. W.
Published: February 2008

Summary: A case history is described in which premature labour was thought to have been caused by chorioamnionitis secondary to infection with Campylobacter jejuni. The pathogenicity of this organism in the perinatal period and in pregnancy is discussed.

Campylobacter species are known to cause abortion and stillbirth in cattle and sheep. The present case report supports previous evidence that Campylobacter jejuni can cause infection in utero and perinatally in man, leading to abortion and preterm labour. Sporadic accounts of case histories similar to the present have appeared in the literature, but the incidence and epidemiology of this infection in obstetric patients is still unclear.
Primary Hyperparathyroidism in Pregnancy
Authors: Kirby C. A. , Read M. D.
Published: February 2008

Summary: A case is presented of maternal primary hyperparathyroidism diagnosed antenatally. This rare complication of pregnancy is associated with a very high neonatal complication rate when undiagnosed before delivery. The diagnosis and management of the condition are discussed and the literature is reviewed.
The Outcome of Twin Pregnancies in Dunedin 1968–1978
Authors: Clarkson John E. , Buckfield Patricia M. , Herbison G. Peter
Published: February 2008

Summary: Of 14,473 pregnancies in Dunedin City between 1968 and 1978, 1.07% were twin (1 in 93.4 pregnancies). Perinatal mortality has decreased over this period for both twins and singletons. To examine the hypothesis that the tendency for twins to be preterm and small for gestational age explained their increased mortality and morbidity, groups of twins and singletons of like birth‐weight and gestational age were compared. No significant differences were found, suggesting that birth‐weight and gestational age are the major determinants of outcome, and that a twin should fare no worse than a singleton of similar birth‐weight and gestational age.
The Utilization of Prenatal Cytogenetic Diagnosis in Western Australia
Authors: Mulcahy Marie T. , Michael C. A.
Published: February 2008

Prenatal cytogenetic diagnostic services for the whole of Western Australia are undertaken by 1 central department in Perth. The records of this unit have been used to calculate the utilization rates of amniocentesis by women aged 35 years or older at the estimated date of confinement for the 5‐year period 1977–1981. During this time there were 5076 livebirths to mothers aged 35 years or more and 1,408 pregnancies in this age group were cytogenetically monitored, giving an overall utilization rate of 28%. This rate is comparable to similar rates in other developed countries. Possible directions for future expansion of the service are suggested.

Prenatal cytogenetic diagnosis requires close cooperation between clinical and laboratory personnel and access to fairly sophisticated equipment (ultrasound and tissue culture facilities). These factors, together with the degree of public awareness and acceptance of the test and its implications, all affect the utilization rates of prenatal cytogenetic diagnosis. The procedure is costly in time and expertise and is most cost effective when used in a high risk target population.
The Management of Antepartum Haemorrhage (Excluding Placenta Praevia)
Authors: Pagano Ross , Adey F. Douglas , Butterfield Louis J. H.
Published: February 2008

A 3‐year retrospective survey of patients presenting with an antepartum haemorrhage (APH) to The Royal Women's Hospital, Melbourne, was undertaken. Cases of placenta praevia were excluded from the series. The overall perinatal mortality (PNM) was 14.5%. There were 98 patients with accidental haemorrhage (PNM 23.4%) and 101 patients with an APH of unknown aetiology (PNM 6%). Generalized uterine tenderness and tenseness were the most consistent features associated with imminent fetal compromise and it is in this group that an early resort to Caesarean section may be beneficial. The routine use of a clotting profile was found to be of little value, especially in patients with a mild haemorrhage.
Cystyl Aminopeptidase in Maternal Serum for the Antenatal Recognition of Fetal Growth Retardation
Authors: Gopalaswamy Geetha , Balasubramaniam N. , Kanagasabapathy A. S.
Published: February 2008

An appraisal has been made of the usefulness of cystyl aminopeptidase (CAS, E.C. 3.4.11.3) activity patterns in the in utero detection of fetal growth retardation; 196 pregnancies at risk from placental insufficiency, classified into 9 aetiologic groups were considered. Absolute levels and trend of enzyme activity were studied in all cases and compared with the reference range of CAS activity established in 267 healthy pregnant subjects. Excluding multiple pregnancies, overall predictive value of CAS in defining fetal outcome in 186 ‘at risk’ pregnancies was 72%, overall sensitivity and specificity being 82% and 71% respectively; 48% of the ‘at risk’ population delivered growth retarded infants, whereas the prevalence of growth retardation as diagnosed by CAS was 54%. Out of the 89 patients who delivered growth retarded infants, 73 exhibited abnormal CAS activity patterns. In twin pregnancies, values of CAS in 73% of the total number of assays were above mean plus 2 standard deviations for the respective gestational period. CAS in maternal serum is advocated as a simple and reliable antepartum indicator of fetal growth retardation and is suitable for the detection of twin pregnancy as early as the second trimester.
The Effect of Maternal Height on the Fetal Growth of New Zealand European Singleton Infants: 35–42 weeks' Gestation
Authors: Buckfield Patricia M. , Clarkson John E. , Herbison G. Peter
Published: February 2008

Using a population of approximately 9,000 singleton deliveries collected over a 10‐year period from a defined geographical area, the effect of maternal height on birthweight, length and head circumference was examined. Each 5 cm increase in maternal height accounted for an increase of 85g, 4.1 mm, and 1.5 mm respectively in these measurements in males; and 25g, 1.1 mm and 0.5 mm in females. When maternal height adjustments were used in conjunction with birth centile charts in the diagnosis of small‐for‐gestational‐age infants, this condition was diagnosed less frequently where the mother was small, and more frequently when the mother was tall, than when the adjustment was not made. However, allowing for maternal height made no difference to the incidence of mortality or morbidity in small‐for‐gestational‐age babies.
Ultrasonic Diagnosis of Hydrops Fetalis in the Early Second Trimester
Authors: Ghosh A. , Woo J. S. K. , Liang S. T. , Ho H. C. , Wong V.
Published: February 2008

A case of fetal ascites diagnosed by ultrasonography at a gestational maturity of 16 weeks is described. Associated congenital abnormalities included asplenia, situs inversus, aneurysmal dilatation of the aorta, and fetal bradycardia. The pregnancy was terminated at 18 weeks.
Management of Fetal Complete Atrioventricular Block
Authors: Yamada Motohiro , Sakakibara Shigeki , Utsu Masaji , Chiba Yoshihide
Published: February 2008

Congenital atrioventricular block was diagnosed with B‐mode and M‐mode ultrasonography at the 30th week of gestation in a bradycardic fetus. Major anomalies were excluded and prenatal fetal well‐being was monitored with daily B‐mode and maternal perception of fetal movement to detect circulatory derangement at an early stage. Because of the sudden onset of circulatory failure, emergency Caesarean section was performed to save the otherwise normal fetus. Two days later, the infant developed ventricular fibrillation, for which surgical intervention was indicated. Pacemaking was effective in reestablishing the neonatal circulation.
Comparison of Single Dose with a 5‐day Course of Co‐trimoxazole for Asymptomatic (Covert) Bacteriuria of Pregnancy
Authors: Bailey Ross R. , Bishop Vicki , Peddie Barbara A.
Published: February 2008

Summary: Forty‐four pregnant women with covert (asymptomatic) bacteriuria proven by suprapubic bladder aspiration were randomly allocated to treatment with either a single 1.92g dose or a standard 5‐day course of co‐trimoxazole. Twenty‐one of 24 women were cured with a single dose. Seven of these 21 women were reinfected later in the pregnancy. All 20 women treated with a 5‐day course of co‐trimoxazole were cured, and 2 became reinfected later in the pregnancy. There were no side‐effects of treatment, and no detrimental effects on the outcome of pregnancy. Single dose therapy should be considered as the treatment of choice for covert bacteriuria in pregnancy.
Can Obstetricians Prevent Neonatal Intraventricular Haemorrhage?
Authors: de Crespigny Lachlan Ch. , Robinson Hugh P.
Published: February 2008

Summary: The possible influence of obstetric and early neonatal factors on the development of neonatal intraventricular haemorrhage (IVH) in very low birth‐weight infants have been studied. Caesarean section was associated with a significantly lower incidence of IVH, this reduction being largely confined to infants of 25–28 weeks' gestation. Forceps delivery did not seem to influence the rate of occurrence of IVH if one allowed for differences in gestational age between infants delivered spontaneously and those with forceps. Similarly the use of an episiotomy at the time of delivery did not seem to reduce the incidence of IVH, and a similar lack of correlation was found with the other factors examined.
The Problem Of Antenatal Diagnosis Of Microcephaly By Ultrasonography In Twin Pregnancy
Authors: Chadwick John M. , Gilmore David W. , Herbert Warwick W.
Published: February 2008

A case report is presented in which microcephaly was suspected by serial scanning in a first pregnancy and was subsequently proven. However, a diagnosis of apparent microcephaly in one of a pair of dizygotic twins in the patient's second pregnancy proved incorrect and illustrates that there are problems with genetic counselling in this condition.
Urodynamics Is it Useful for the Gynaecologist?
Authors: Glenning P. P.
Published: February 2008

Summary: The investigation of female incontinence is incomplete without the performance of a urodynamic evaluation. A diagnosis made only on a clinical history and examination is too inaccurate to allow for the proper management of the patient. In a personal series of 100 patients only 56% of those who were ultimately considered to have stress urinary incontinence were correctly diagnosed by clinical means as opposed to 97% correct using urodynamics. A urodynamic evaluation should be performed on most female patients suffering from urinary incontinence and is essential for patients who are being considered for surgery for recurrent stress incontinence. Mention is made of a group of 8 patients whose incontinence was due to a very low urethral closure pressure who responded well to phenylpropanolamine.
Management of Pregnancy Complicated by Diabetes: Experience with 232 Patients in a 4‐year Period
Authors: Plehwe W. E. , Shearman R. P. , Turtle J. R.
Published: February 2008

Summary: Two hundred and thirty two women with diabetes complicating pregnancy were seen at a metropolitan teaching hospital during a 4‐year period. Management during pregnancy in insulin dependent diabetics was directed towards strict metabolic control using conventional insulin regimens and diet. A similar programme was followed for women in whom screening revealed glucose intolerance. Control of maternal blood glucose levels, assessment of fetal maturity and modes of delivery were reviewed in an attempt to define factors which could predict optimal neonatal outcome. Patients with insulin dependent diabetes were less likely to have optimal metabolic control both during pregnancy and parturition than patients with gestational diabetes. Women with gestational, but not preexisting diabetes, demonstrated a close correlation between gestational age and parameters of fetal pulmonary maturity. A high rate of intervention to deliver infants in both groups (50%) was noted. These data indicate the need for meticulous care of women with insulin dependent diabetes during pregnancy.
Epilepsy and Pregnancy
Authors: Svigos J. M.
Published: February 2008

Summary: A retrospective study of 75 pregnant epileptic women compared with a parity, age and socioeconomic matched control group of women is presented. Deterioration of control of epilepsy during pregnancy occurred in 24% of women. Statistically significant obstetric complications noted were anaemia, premature labour, premature rupture of the membranes and postpartum haemorrhage. There was 2.5‐fold increase in the incidence of congenital anomalies in the neonates, an increase in feeding difficulties and a reduced incidence of jaundice. There was no maternal or perinatal death. Refinements in management may further reduce the maternal and fetal morbidity in epileptic women who choose to become pregnant.
A Technique for Enrichment of Motile Spermatozoa from Oligozoospermic and Asthenozoospermic Patients
Authors: Leung Peter C. S. , Hyne Ross V. , Clarke Gary N. , Johnston Ian
Published: February 2008

Summary: A system for rapid selection of normal motile spermatozoa from poor semen samples is described. Analysis of the selected samples shows that there are significant improvements in the percentage motility, velocity and morphology. The final spermatozoa suspension of 0,5 ml is sufficient for the purpose of intrauterine AIH and IVF.
Vesicovaginal Fistula and its Complications Due to Prolonged Use of Vaginal Diaphragm
Authors: Kwa Daniel M. , Malloy Terrence R.
Published: February 2008

EDITORIAL COMMENT: What a terrible penalty for neglect!

Summary: The vaginal diaphragm is currently less popular than other contraceptive methods, such as the pill, IUDs or surgical sterilization. It is however, regarded as one of the safest methods of contraception available and complications of diaphragm use are rare. This report describes a case in which a vesicovaginal fistula and genitourinary tract infections complicated the use of this contraceptive method.
Fetal Responses to Vibrotactile Stimulation, A Possible Predictor of Fetal and Neonatal Outcome
Authors: Leader Leo R. , Baillie Peter , Martin Bahia , Molteno Chris , Wynchank Sinclair
Published: February 2008

Summary: This study measured the antenatal fetal heart rate changes in response to a single vibrotactile stimulus. In a group of 11 normal patients, this resulted in a significant change in the fetal heart rate (P < 0.001). Sixty‐eight high risk patients were also tested. In the group of 25 patients whose fetuses showed no response to the stimulus, there were 4 stillbirths and 4 neonatal deaths; 23 of these 25 infants were small for gestational age (SGA) compared to only 15 of the 43 that showed a response to the stimulus.

Fetal habituation to a repeated vibrotactile stimulus was measured in a control group of 40 patients who had a normal antepartum and intrapartum course and delivered infants in an optimal condition. The same was done in a study group of 48 patients who delivered infants that were SGA. These infants were assessed at 1 year of age by the Griffiths Mental Developmental Scale (GMDS). Infants that were SGA did not differ significantly from the control group. However, infants who had a normal antenatal habituation pattern had a significantly better performance (P < 0.01) compared to infants who had an abnormal antenatal habituation pattern.
Cervical Occlusion Due to Adhesions Following Therapeutic Abortion: An Uncommon Sequel to Vacuum Curettage
Authors: Fraser Ian S.
Published: February 2008

Summary: Eleven women were referred with postabortal amenorrhoca and cyclical lower abdominal pain due to upper cervical occlusion by a thin band of fibrous adhesions. All had undergrone first trimester termination of pregnancy by vacuum curettage. Associated intrauterine adhesions were found in 2 patients. Cervical adhesions were easily breached with a uterine sound and cervical dilators, and were then visualized with a hysteroscope. All women resumed normal menstrual cycles and suffered no sequelae. This unusual, but eminently treatable, complication of vacuum curettage should be more widely appreciated.
α Thalassaemia in Pregnancy
Authors: Trent R. J. , Yakas J. , Black J. , Kronenberg H.
Published: February 2008

Summary: α thalassaemia as a cause of hypochromic, microcytic anaemia in pregnancy is described. The problems associated with accurate diagnosis of this condition and prediction of fetal outcome is now made much easier by use of recombinant DNA techniques such as gene mapping. Two Greek Cypriot families with α thalassaemia have been studied by DNA mapping. Definitive assessment of α thalassaemia genotype in these cases enabled confident genetic counselling.
Serum Sickness due to Rh(anti‐D) Immunoglobulin
Authors: Jones B. F. , Trevillian P. R. , Nanra R. S.
Published: February 2008

Summary: Considerable attention has been given recently to antepartum Rh immunoprophylaxis. We report here a case of serum sickness due to repeated administration of Rh (anti‐D) immunoglobulin.