bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative AIDS Testing
Authors: O'Connor Terence W.
Published: February 2008

EDITORIAL COMMENT: This paper was presented by Dr O'Connor at the conference on Individual Testing and Review, Centre for Law and Medicine, Bond University School of Law, June 16,1991. It had great impact on the audience and the editor who therefore asked Dr O'Connor to allow us to publish it as delivered. The calculated risk of death from AIDS for surgeons of about 1 in 70 should alarm readers. The risk will be greater if the prevalence of HIV seropositivity increases to the levels now reported from other countries e.g. in Thailand about 6% of subjects with sexually transmitted diseases and more than 15% of prostitutes are seropositive; the seropositivity rate among recruits in the Thai army rose from 2% to 6% between June and December, 1990.
Severe Rhesus Isoimmunization Detected by Cardiotocography Performed for Diminished Fetal Movements
Authors: Shelley‐Jones David , Beischer Norman , de Crespigny Lachlan , Chew Franklin
Published: February 2008

Summary: Two cases of rhesus isoimmunization are presented in which the fetus was much more severely affected than anticipated and where a sinusoidal pattern found on cardiotocography, performed because of absent fetal movements, resulted in appropriate and successful management.
Premenstrual Syndrome and Spironolactone
Authors: Burnet R. B. , Radden H. S. , Easterbrook E. G. , McKinnon R. A.
Published: February 2008

Summary: A double blind placebo controlled randomized cross over study was conducted to assess the response to spironolactone by patients suffering from ‘Premenstrual Syndrome’. Somatic and neurophyschiatric symptoms were self‐assessed daily and a total score was calculated for each symptom for the 14 days prior to menstruation. No significant difference was noted for the symptoms assessed on or off spironolactone. The levels of oestradiol, progesterone and prolactin showed no changes from the first to the second half of the cycle.

In those patients who did respond to spironolactone, a significant difference in androgen levels from the follicular to the luteal phase of the cycle prior to treatment was demonstrated. Significant differences in androgen levels from the follicular to the luteal phase of the menstrual cycle may therefore be an important determinant in predicting those patients with premenstrual syndrome likely to respond to spironolactone therapy.
Puberty Menorrhagia Due to Bernard Soulier Syndrome and its Successful Treatment by ‘OvraP Hormonal Tablets
Authors: SharmaJ J. B. , Buckshee K. , Sharma S.
Published: February 2008

EDITORIAL COMMENT: Prostaglandin synthetase inhibitors, antifibrinolytic agents, oral contraceptives and the release of progestogen from a levonorgestrel‐releasing intrauterine contraceptive device (IUD) have all been shown to be effective in the treatment of idiopathic menorrhagia; a recent study found the progestogen‐releasing IUD to be the most effective of these methods1 We accepted this case report to inform readers that severe anaemia from pubertal menorrhagia due to a haemorrhagic disorder can be successfully treated with oral contraceptive tablets. This is a message to be remembered for the rare patient with life‐threatening menorrhagia and a coagulation disorder whose general medical condition may preclude surgery ‐ the simple contraceptive pill may control the problem.
Placenta Percreta Invading the Urinary Bladder
Authors: Altintas Aytekin , Özgünen Fatma Tuncay , Doran Saban , Doran Figen
Published: February 2008

EDITORIAL COMMENT: Placenta praevia percreta is the most fearsome surgical complication of pregnancy. The incidence is steadily increasing as Caesarean section rates escalate, since in the majority of cases the patient has had a previous lower segment Caesarean section. This case report was accepted for publication to indicate to readers that elective cystostomy can facilitate hysterectomy in these cases. Successive triennial reports of maternal mortality in Australia have made the point that in cases of placenta praevia accreta the decision to perform hysterectomy should not be delayed. When the diagnosis is obvious after the abdomen has been opened the baby should be delivered by classical Caesarean section and, after rapid closure of the upper segment incision, hysterectomy should be commenced with the placenta undisturbed. It is best to begin the hysterectomy before attempted removal of the morbidly adherent placenta results in massive bleeding, which is often associated with disseminated intravascular coagulopathy. When adhesions to the bladder are dense it can be helpful, as the authors report in this case, to electively open the bladder to facilitate hysterectomy. In this case haematuria was an important warning that hysterectomy would be necessary and it was a brave decision to deliver this woman vaginally since the diagnosis of placenta percreta was as certain as it is ever likely to be before an attempt is made to deliver the placenta. Three of the 86 maternal deaths which occurred in Australia during the 1985–1987 triennium were due to haemorrhage from placenta praevia accreta.

Summary: The case of a woman with a placenta percreta invading the urinary bladder treated by hysterectomy and partial bladder resection is presented. It is emphasized that if physicians in an emergency clinic are aware of this rare condition, preoperative diagnosis can be made and surgical intervention may be accomplished under ideal conditions.
Pelvic Pain Complicating LHRH Analogue Treatment of Fibroids
Authors: Chipato Tsungai , Healy David L. , Vollenhoven Beverley , Buckler Helen M.
Published: February 2008

Summary: We present these 3 cases to alert others to the possibility of severe pain with rapid shrinkage of fibroids occurring during LHRH analogue treatment. We suggest management of such events should not be surgical except for vaginal excision of prolapsed fibroid Polyps.
The Association of Maternal and Socioeconomic Characteristics in Metropolitan Adelaide with Medical, Obstetric and Labour Complications and Pregnancy Outcomes
Authors: Jonas Oswald , Roder David , Chan Annabelle
Published: February 2008

EDITORIAL COMMENT:The use of residential area as a marker of socioeconomic status in Australia has been taken up by social scientists and public health researchers. There is inevitably some misclassification which is more likely for couples with young children. Another comment provided by our reviewer is that validation studies have shown that there is marked underreporting of antenatal complications in private patients. This is obviously true since the clinic patient has her complete antenatal record available for coding and classification, whereas the private patient's history includes only what the doctor remembers when he completes the record; how many readers ensure that all abnormalities recorded on their private patient's antenatal card are transferred to the hospital history after delivery? Another consideration is that disorders detected only by screening (gestational diabetes) will only be found if the test is performed and the result recorded in the patient's history. Differences between public and private hospitals or between public and private patients may therefore account for or contribute to some of the outcome differences in tables 1 and 2.

SummaryMultiple regression analysis was used to measure associations of maternal age, race, gravidity, marital status and socioeconomic status with medical problems and pregnancy outcomes. The study population comprised all singleton births to residents of metropolitan Adelaide (in South Australia) during 1988 that were included in the State's perinatal statistics collection. The results indicate that in metropolitan Adelaide, low socioeconomic status is related to a higher risk profile of mothers and babies. It also highlights that there is a strong association of divorce and separation with medical problems and an adverse pregnancy outcome. Poorer outcomes are also seen in never married women, teenage women, older women, non‐Caucasian women and primigravid women. These poorer outcomes in older women and primigravidas include higher risks of low birth‐weight and prematurity of their babies. The study also demonstrates that groups that are less likely to have choice of obstetric care, eg. teenage women, non‐Caucasian women, and women of low socioeconomic status, have a lower odds of obstetric intervention as characterized by nonspontaneous labour and elective Caesarean section.
Born Before Arrival ‐ Uncovering the Hazards
Authors: King P. A. , Duthie S. J. , To W. K. , Ma H. K.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it examines the socioeconomic problems of mothers who deliver before arrival in hospital. The findings are important and though they may apply to communities other than Hong Kong, they are unlikely to apply to women who are admitted to metropolitan hospitals in Australia. There is remarkably little literature on birth before arrival in hospital (BBA) when one considers how many mothers‐to‐be, and their husbands, show much anxiety about the possibility of delivery before reaching hospital (A). There are different definitions used for birth before arrival that are relevant to an understanding of this paper. Weir's paper from Melbourne considered only booked patients, and the incidence of BBA's in his study was only 0.14% (1 in 695 confinements) ‐ these labours were usually precipitate (71%) and 51% occurred in the woman's first or second pregnancy; 65% were avoidable had the woman attempted to reach the hospital at the onset of labour (A). In this series from Hong Kong there were 78 (40%) unbooked patients and the main causes of the BBA's were ‘social deprivation and young maternal age’, although table 2 shows that fast labour accounted for 78 cases. The situation remains quite different in Australia: during the triennium 1987–1989 there were 15,216 women who delivered at the Mercy Hospital for Women, Melbourne, including 36 BBA's of booked patients (0.2%); none resulted in perinatal deaths although 23 of the 36 mothers had first or second degree lacerations of the perineum. During these 3 years there was only 1 nonbooked patient admitted after delivery, who had delivered anywhere else but in another hospital. The Discussion in this paper will interest readers, as the authors explain how the superior health‐care facilities available in Hong Kong should be directed to cater for those women destined to deliver their babies in an inappropriate setting.

Summary In a retrospective case controlled study the demographic background and outcome of 193 mothers whose babies were born before arrival at hospital was compared to that of a control group who delivered within the maternity units of 2 teaching hospitals in Hong Kong. Mothers who delivered before arrival at hospital were significantly more likely to be single, to have received no antenatal care, to have an unplanned pregnancy, low family income and to come from a socially disadvantaged group such as Vietnamese refugees and illegal immigrants from China. Lacerations to the genital tract, postnatal anaemia and blood transfusions were more common in the study group. Results of cervical cytology and rubella status were available in significantly fewer of these mothers. They were more likely to be ambivalent about contraception and less likely to attend the postnatal clinic. The perinatal mortality and morbidity was significantly increased.
Prelabour Rupture of the Membranes at Term and Unfavourable Cervix; a Randomized Placebo‐controlled Trial on Early Intervention with Intravaginal Prostaglandin E2 Gel
Authors: Chung Tony , Rogers Michael S. , Gordon Helen , Chang Allan
Published: February 2008

Summary Fifty nine women with prelabour rupture of membranes, unfavourable cervix and no evidence of infection or fetal distress were randomized formally to receive prostaglandin E2 (3mg) gel or sterile K‐Y Jelly intravaginally.

Conservative expectant management was followed for the next 24 hours. The subsequent management of the labour followed departmental protocol. The women who received prostaglandin went into labour sooner and were delivered earlier but the duration of labour was not significantly different. There were no significant differences in other clinical outcomes. There was 1 case of uterine rupture in the prostaglandin group. We conclude that early intervention with prostaglandin E2 gel intravaginally confers no advantage compared with conservative management except for earlier confinement in this group of patients.
Autologous Blood Donation for Elective Gynaecological Surgery
Authors: Phuapradit Winit , Souppataratan Suratsawadee , Chaturachinda Kamheang , Chiewsilp Pimol
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because Australian women also are concerned about the possibility of a blood transfusion resulting in them developing the acquired immune deficiency syndrome. The ease and success of this programme of autologous blood donation should encourage us to emulate our colleagues in Thailand and develop increasing use of this method in Australia. In this series 20% of patients (438 of2,160) scheduled for elective gynaecological surgery enrolled in the programme and 10% of these 438 received an autologous blood transfusion. The authors did not tell us the proportion of autologous to homologous blood transfusions in their institution. In the United States of America the target is for autologous transfusion to be 5–10% of all blood transfusions. Dr Gordon White, Director of Red Cross Blood Bank, informed the editor that in the State of Victoria less than 2% of all blood donations are for the purpose of autologous transfusion. However, there is increasing interest in the method and the rate of autologous blood donation has increased 40–60% in each of the last 2 years.

Summary The utilization and effectiveness of a hospital autologous blood donation programme for elective gynaecological surgery at Ramathibodi Hospital during April 1,1988 ‐ March 31,1991 were analyzed. A total of 438 patients or 98% of eligible patients were enrolled into the programme. Each patient gave 1 unit of blood within 14 days of undergoing gynaecological surgery. The untoward effects observed in the programme were higher than those found in the regular donors. However, these were very mild. Nearly 90% of the participants used no homologous blood during their hospitalization, 8% used only their autologous blood, while 2% used additional homologous transfusion. The released autologous components were subsequently administered to other recipients. The patients' acceptance was excellent. Autologous blood donation is a safe, inexpensive and feasible procedure for transfusion treatment in elective gynaecological surgery especially in developing countries.
A Study of Women Who Appear to Default from Management of an Abnormal Pap Smear
Authors: MD Heather Mitchell , Hoy Julie , BSc Meredith Temple‐Smith , Quinn Michael
Published: February 2008

EDITORIAL COMMENT: Most readers of the journal will have patients who have had minor abnormalities in a Pap smear and who have passed the statutory time for repetition of cervical cytology. Is the expense of a central register of abnormal pap smears worthwhile? ‐ do the reminder letters to practitioners result in diagnosis of significant pathology when the defaulters are rounded up? (i.e. what proportion have CIN III or worse). This paper caused the reviewer to ponder that it may be better to spend our dwindling resources on encouraging never‐smeared women over the age of 30 to attend for cytology, especially those over 50 years of age ‐ should general practitioners seek to enrol these women from their practices rather than be worried about defaulters who have had a previous smear indicative of dysplasia? How many general hospitals have a policy of performing cervical cytology on all adult female patients in their medical and surgical wards? ‐ surely it would be a simple administrative matter to do this as the women were admitted to hospital. Our reviewer also made the comment, suggested by the authors in their penultimate sentence, that patients referred to a dysplasia clinic should be returned to their general practitioner for continued follow‐up after initial assessment and treatment.

Summary A study of nonattendance at a Dysplasia Clinic found that 20% of women who had an appointment in 1988 failed to attend the clinic during the next 18 months. Most of the nonattendance was among women who had previously been assessed at the Dysplasia Clinic. Only 6% of the nonattending women had cytological/histological evidence of CIN which remained untreated. If all women who did not default from attendance at the Dysplasia Clinic were correctly managed, then 1% of all women who have appointments made for the Dysplasia Clinic were potentially receiving inadequate management for lesions considered to have a precancerous potential. A questionnaire to the women who failed to attend these appointments identified pregnancy and seeking management elsewhere as the most commonly stated reasons for the nonattendance.
Management of the Psychosocial Aspects of Infertility1
Authors: R. Daniels Ken
Published: February 2008

Summary There is a growing recognition of the place and importance of psychosocial factors in the infertility field. Counsellors, social workers, psychologists and others who work with the psychosocial dimensions are of relatively recent origin and as a consequence it is not uncommon for there to be confusion, sometimes conflict and often uncertainty between them and the more established health professionals. Knowledge, understanding and appreciation of the contributions of the staff involved is essential if the referral process is to be beneficial for the patients and less frustrating for the staff.

Against this backdrop, the paper will seek to clarify some of the factors associated with recognizing and responding to the psychosocial aspects of infertility, highlight some points concerning teamwork between doctors and workers in the psychosocial field, and finally present a list of indicators which might be used as a guide in determining when to make a referral for psychosocial assistance.
The Effect of Obesity on the Outcome of Successful Surgery for Genuine Stress Incontinence
Authors: Brieger Geoffrey , Korda Andrew
Published: February 2008

Summary In a study of 190 patients with genuine stress incontinence, 91 patients were of normal weight, 66 overweight and 33 obese as determined by their Body Mass Index at the time of operation which was either a colposuspension (143) or a silastic sling insertion (47). Body mass index was found to significantly alter the outcome.
Early Growth Retardation in the First Trimester: Is it Characteristic of the Chromosomally Abnormal Fetus?
Authors: Leelapatana Piboon , Garrett W. J. , Warren P. S.
Published: February 2008

Summary: There have been recent reports on a small number of cases which suggest that the detection of early growth retardation might allow recognition of the chromosomally abnormal fetus in the first trimester of pregnancy. To amplify these observations, the crown‐rump length (CRL) measurements between the 64th and 86th day of menstrual age were determined in (a) 500 control high risk patients in whom a normal karyotype was subsequently demonstrated by chorionic villus sampling (CVS) and (b) 25 chromosomally abnormal fetuses. The data indicate that early growth retardation, as expressed by a small CRL measurement, is not a special characteristic of the chromosomally abnormal fetus in the first trimester of pregnancy. The CRL measurement is therefore not a useful marker or screening test at that time, except perhaps for triploidy. The well documented growth retardation with trisomy 21 and trisomy 18 which has been observed in the second trimester does not begin until after the 12th week of menstrual age.
Why Deliver in the Supine Position?
Authors: Allahbadia Gautam N. , Vaidya Pratibha R.
Published: February 2008

Summary: This study was conducted at the Lokmanya Tilak Municipal General Hospital, Bombay, India during the year 1990. The aim was to compare the routinely used supine position versus ambulation in the first stage and squatting position during the second stage of labour. Our study was comprised of 200 patients both primigravidas and multigravidas; 100 were kept in the supine position throughout labour and 100 were kept ambulatory in the first stage and adopted the squatting position during the second stage. The study showed a shortening of both stages of labour in the squatting group but the incidence of complications was less in the control group. It was concluded that without proper birthing chairs which can give excellent perineal support, the usual supine position is preferable in our setup.
Antepartum Cardiotocographic Surveillance of Patients with Diminished Fetal Movements
Authors: Chew Franklin T. K. , Beischer Norman A.
Published: February 2008

Summary: Over a 9‐year period, 2,601 women had antenatal cardiotocography (CTG) performed after reporting diminished fetal movements. This series represented 5.6% of the total hospital population and 16.1% of those having antenatal CTG performed.

The perinatal mortality rate (0.8%) and major fetal malformation rate (2.2%) were lower than in the hospital population (1.1% and 4.5% respectively).

The incidence of abnormal CTG tracings was lower in the 1,390 women with diminished movements alone (6.4%) compared with the 1,211 who had additional antenatal complications (10.2%, p<0.001).

Likewise the incidences of critical fetal reserve CTG and perinatal mortality were significantly lower in the group without additional complications (0.3% and 0.5%) compared with those with additional complications (1.7% and 1.2% respectively).

The 24 patients with critical fetal reserve CTG were promptly delivered (19 by Caesarean section) with favourable results in 19, cerebral palsy in 1, and 4 perinatal deaths ‐ 2 of these deaths resulted from intrauterine hypoxia (table 3, Cases 12 and 15).

There were 17 perinatal deaths in cases where the CTG was satisfactory (13) or showed reduced reserve (4); 9 of these were unavoidable as a result of major malformations or other lethal conditions. The other 8 deaths resulted from hypoxia, including 4 in pregnancies at or beyond 37 weeks' gestation (table 3, Cases 6–9), illustrating that delivery is warranted in women with diminished fetal movements when conditions are favourable even when the CTG is satisfactory.

Cardiotocography is useful in the management of patients with diminished fetal movements.
Telephone Fetal Heart Rate Monitoring in South Australia
Authors: Green Roslyn C. , MacLennan Alastair H.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication to remind readers again (A) that fetal cardiotocographs can be transmitted, over the telephone for interpretation by an expert. As the authors say this paper is not intended to argue the merits of cardiotocography or its indications. However we wish to comment on the authors' statement that gestational diabetes and hypertension are questionable indications for cardiotocography. These 2 conditions are classically associated with intrauterine death and in the case of gestational diabetes there may be no clinical warning such as the presence of fetal growth retardation, deaths in this condition being precisely similar to those that occur in women with insulin‐dependant prepregnancy diabetes mellitus (B). These are the very conditions in which cardiotocography may show the features of impending fetal death and hence indicate immediate delivery.

A. Moore KH, Sill R. Domiciliary fetal monitoring in a district maternity unit. Aust NZ J Obstet Gynaecol 1990; 30: 36–40.

B. White BM, Beischer NA. Perinatal mortality in the infants of diabetic women. Aust NZ J Obstet Gynaecol 1990; 30: 323–326.

Summary: A pilot trial was conducted to assess the technical feasibility of long range fetal heart monitoring by telephone in an Australian setting. The indications for such monitoring and patient ability and attitude towards self‐monitoring was also assessed. One hundred and fifty seven tracings were received from 57 women using a simple doppler device to transmit fetal heart sounds to the central hospital fetal monitor. Thirty three of the patients were in country hospitals and 24 were at home. Gestation ranged from 26 to 42 weeks' gestation. Eighty six percent of the country hospital tracings and 94% of the home tracings were easily interpretable. The large majority of tracings were normal and appeared to encourage conservative management by the attendants. Two tracings were abnormal and these influenced early delivery in both cases. Nearly all women using the monitor at home found the procedure easy and reassuring. Tracings from country hospitals were initiated usually after an acute antenatal complication, whereas the indications for home‐monitoring were prompted by longer‐term, medium‐risk factors. Home‐monitoring may reduce the inconvenience and expense of inpatient or outpatient care and country hospitals without electronic fetal monitors may benefit from such a service. The selection of patients who might benefit from such technology remains controversial and warrants a prospective randomized controlled trial.
The Use of Clearplan Home Ovulation Detection Kits in Unexplained and Male Factor Infertility
Authors: Leader Leo R. , Russell Teresa , Stenning Barbara
Published: February 2008

Summary: One hundred and five couples with unexplained infertility and 43 couples whose infertility was thought to be due to reduced sperm motility were recruited. The median duration of infertility was 36 months (range 12–168). Couples were randomly allocated to either using Clearplan home ovulation detection kits for 3 cycles or were advised about the optimal time during their menstrual cycle to achieve a pregnancy. The clinical details of the 2 groups were similar. In couples with unexplained infertility over the study period 10 (20.4%) in the Clearplan group and 9 (16%) in the control group conceived with 58% of pregnancies occurring in the first cycle. In couples with reduced sperm motility, the results were disappointing with only 2 (8%) pregnancies in the Clearplan group and 2 (11.1%) in the controls. Assisted reproduction technology may not be justified as the first line of management in patients with unexplained infertility.
Organization and Early Results of a Shared Antenatal Care Programme
Authors: Ratten G. J. , McDonald L.
Published: February 2008

EDITORIAL COMMENT: For the purposes of comparison of perinatal mortality rates with other papers discussing shared care/birth centre care, it should be noted that 2 of the 5 perinatal deaths in the 780 women who completed shared care (tables 4 and 5), and 2 of the deaths in the 185 women who were removed from the shared care programme (tables 6 and 7) were associated with birth‐weight less than 500 g, the criterion for inclusion of perinatal deaths for statistical purposes in the State of Victoria. With these cases excluded the perinatal mortality rate for the entire series of 962 women was 7.2 per 1,000 births; the rate was 3.9 per 1,000 in the 778 women who remained in the shared care programme, and 20.6 per 1,000 births in the 184 women who were removed from the programme.

Summary: The organization and function of a public hospital based shared antenatal care programme is described. The programme has proved to be popular with pregnant women and local practitioners and currently 24% of public antenatal patients attending the hospital are cared for in this way.

The study presents the results of management of 1,000 consecutive low risk patients whose antenatal care was shared between hospital doctors at the Royal Women's Hospital, Melbourne and local practitioners. Two hundred and twenty patients did not complete the programme because of social factors, medical diseases or pregnancy complications. The 780 patients who did complete the programme had a lower Caesarean section rate than the overall hospital population (8.3% compared with 18.5%) and a lower perinatal mortality rate (6.4 compared with 20.5 per 1,000 births).

It is essential that patients are carefully assessed at their hospital booking visit before embarking on such a programme. Equally, careful assessment by local practitioners is important as abnormalities such as essential hypertension may be overlooked at the initial hospital assessment or may arise between the hospital visits.
Gestational Diabetes in Twin Pregnancy: Prevalence and Long‐term Implications*
Authors: Wein Peter , Warwick Michael M. , Beischer Norman A.
Published: February 2008

Summary: During the period 1971–1991 at the Mercy Hospital for Women, gestational diabetes (GDM) was diagnosed in 3,447 of 61,914 tested singleton pregnancies (5.6%) and 59 of 798 tested twin pregnancies (7.4%, p = 0.025). A difference was apparent in the period 1971–1980, when the prevalences of GDM in singleton and twin pregnancies were 3.0% and 5.6% respectively (p = 0.012), but not in the period 1981–1991 when the corresponding prevalences were 7.4% and 8.4% (p = 0.36). Of the 59 patients in whom a diagnosis of GDM in a twin pregnancy was made, 27 attended the follow‐up programme. These patients were matched to a control group of 27 patients who had GDM in a singleton pregnancy with similar characteristics for known risk factors for the development of permanent diabetes mellitus. On WHO criteria diabetes mellitus occurred in 5 (18.5%) of the subjects and 2 (7.4%) of the controls (p = 0.21).

The difference in prevalence of GDM in twin and singleton pregnancies is less now that the overall prevalence of the disease has more than doubled (1971–1980 versus 1981–1991). Although the increased rate of permanent diabetes mellitus after twin pregnancy is not statistically significant, it would seem wise to make a special effort to enrol these women in the follow‐up programme.
Antihypertensive Drug Effects on Placental Flow Velocity Waveforms in Pregnant Women with Severe Hypertension
Authors: Duggan Paul M. , McCowan Lesley M. E. , Stewart Alistair W.
Published: February 2008

Summary: Doppler studies of the uterine and umbilical arteries were performed in 24 acutely hypertensive pregnant women. Women were divided into 2 groups: Group 1 (diastolic blood pressure (DBP)>110 mm Hg) received placebo (n = 6) or 10 mg oral nifedipine (n = 9); Group 2 (DBP ≥ 110 mm Hg) received 10 mg oral nifedipine (n = 5) or 10 mg intravenous hydralazine (n = 4). Treatment allocations were random within groups and the investigator and patient were blind to the treatments. Baseline flow velocity waveforms (FVW) and posttreatment FVW's at 30, 60 and 120 minutes were recorded. There was no significant difference between baseline and posttreatment FVW indices within or between groups. Placebo was as effective as nifedipine in lowering blood pressure over 2 hours of study. There were no significant adverse effects of treatment.
Uterine Perforation Associated with Endometrial Ablation
Authors: Itzkowic David , Beale Mark
Published: February 2008

Summary: Three cases of uterine perforation associated with endometrial ablation are presented. Possible predisposing factors in 2 cases were previous Caesarean section and difficulty in cervical dilatation. Adequate training for gynaecologists in hysteroscopy is essential before undertaking any type of operative hysteroscopy.
Laparoscopic Salpingostomy with Electrocautery in the Management of Tubal Pregnancy
Authors: Wang Iris Y. , Peat Brian , Fraser Ian S.
Published: February 2008

Summary: From August, 1990 to May, 1991, all cases of tubal pregnancy presenting to King George V Hospital for Mothers and Infants were considered for laparoscopic salpingostomy. This procedure involved opening the affected Fallopian tube with diathermy, removal of ectopic tissue via the laparoscope, achieving haemostasis and leaving the tubal incision to heal by secondary intention. The procedure was undertaken in 35 patients and was successfully performed in 31 patients with an average operating time of 66.4 minutes (± 20.1 minutes). Average hospital stay was 2.1 days (± 1.3). This paper examines the technique and results of the initial learning curve for laparoscopic salpingostomy and finds that with knowledge of potential hazards and care in surgery, this operation can be safely carried out in a selected group of patients.
Endometrial Cancer: Trends in Incidence and Survival: A Preventable Disease?
Authors: Kneale B.L.G. , Giles G.G.
Published: February 2008

Summary: Endometrial cancer is the commonest gynaecological cancer. Its relative increase in incidence over recent decades has been generally associated with a reduction in mortality. Evidence is presented to show a considerable variation in incidence worldwide; Australia, like England and Wales, has a comparatively low incidence. The incidence is highest in parts of the United States where it has shown an annual fall of nearly 3% between 1973 and 1987. The influence of hysterectomy, oral contraception and hormone replacement therapy at the menopause are discussed relative to incidence and prevention of the disease. Obesity and its prevention are also shown to have an influence on incidence and its ethnic variation worldwide. Despite a minor improvement in survival in FIGO published figures, the recent COSA‐UK‐NZ ‘high risk’ trial highlights the importance to the patient of closely monitored clinical trials.
Placenta Praevia: Does Uterine Activity Cause Bleeding?
Authors: Magann Everett F. , Johnson Constance A. , Gookin Kathy S. , Roberts William E. , Martin Rick W. , Morrison John C.
Published: February 2008

EDITORIAL COMMENT": We accepted this paper for publication since it attempts to evaluate whether uterine contractions or ‘taking‐up’ of the lower uterine segment initiate placental separation and haemorrhage in women with central placenta praevia. Obstetric practice in the USA is often different from that in Australia; certainly it is not our custom to manage women at home when central placenta praevia complicated by haemorrhage has occurred after the second trimester! The use of tocolysis for preterm labour in women with placenta praevia with or without haemorrhage is another regimen employed in this series that will interest readers.

Summary: Twenty‐two women >24 weeks' gestation with a central placenta praevia were monitored to determine if an increase in uterine activity precedes bleeding in patients with central praevias. Monitoring of all subjects began at 26.3 ±4.4 weeks and continued until 37 weeks (or delivery if preterm).

All subjects had at least one haemorrhage, 7 women had 2, and 4 subjects had 3 episodes of bleeding. Only 3 patients delivered at term while the remainder (86%) delivered preterm. The gestational age at first episode of bleeding was 29.1 ±3.6 weeks and at delivery was 34.3 ±3.3 weeks. Nine women (41%) had an increase in uterine activity above baseline the day of or the day preceding the first haemorrhage. The increase in uterine activity was not statistically significant when compared to the 6 days prior to bleeding when all 22 patients were considered.
Transmission of Human Papillomaviruses from Mother to Child
Authors: Fredericks; B. D. , Balkin A. , Daniel H. W. , Schonrock:. J. , Ward B. , Frazer I. H.
Published: February 2008

Summary: Exfoliated cervical epithelial cells from women 6 weeks postpartum were analyzed for human papillomavirus (HPV) DNA using the polymerase chain reaction, and results were compared with those from buccal mucosal smears from their babies. Eleven mothers had genital genotypes of HPV in their cervical smears, and the children of 8 of these had HPV of the same genotype in buccal mucosal cell samples. Nineteen mothers had no HPV DNA detected in their cervical smears, and 1 of the buccal mucosal cell samples from their children was positive for HPV DNA (p< 0.0001). Contamination of a child's mouth with ‘genital’ HPV from a mother's cervix appears to occur commonly at birth or in the perinatal period, and to persist for at least 6 weeks. This observation has implications for the epidemiology and management of HPV associated cancer and precancerous conditions in the cervix and the mouth.
Pregnancy Hazards Associated with Low Maternal Body Mass Indices
Authors: Cattanach S. , Morrison J. , Andersen M. J. , Williams G. M. , Sheahan T.
Published: February 2008

EDITORIAL COMMENT": There are few obstetric hospitals that have computerized their clinical data such that maternal weight and obstetric results can be compared. The Mater Mothers' Hospital in Brisbane is one such institution. This paper seems to establish that the lower socioeconomic, light‐weight woman is at greater risk of producing a lightweight or very light‐weight infant and also is at increased risk of delivering a premature infant using the old definition of less than 2,500 g. Light‐weight mothers also had an increased incidence of pregnancy anaemia, infants with low Apgar score and an increased perinatal mortality rate. Interestingly in some populations the light‐weight woman is also at increased risk of gestational diabetes (El‐Shafei AMet al. Incidence and Severity of Gestational Diabetes in Bahrain and Australia. Aust NZ J Obstet Gynaecol 1989; 29:204–208). We agree with the authors that more data is required about low maternal weight, and low weight gain in pregnancy, and the associated obstetric results.

Summary: Analysis of the obstetric records of 41,955 public patients with singleton pregnancies at the Mater Misericordiae Mothers' Hospital, South Brisbane, showed a significant association (increased odds ratio) between Low Maximum Pregnancy Maternal Body Mass Index (Quetelets Index 20–24.6 and maternal anaemia, the use of intravenous tocolysis, low birth‐weight (< 1,500 g and < 2,500 g), low Apgar score (< 7 at 5 minutes) and perinatal mortality.

Parturients with a Very Low Body Mass Index (Quetelets Index < 20) had even greater odds ratios in respect of the above obstetric hazards.

Both the Low and Very Low Body Mass Index cohorts had significantly reduced risks of having hypertension (both essential and preeclamptic) or having their labours induced or augmented.

The results are presented as odds ratios with confidence limits after controlling for the potentially confounding covariables of maternal age, parity, smoking habits and gestational age.
Chlamydia Trachomatis Infections in Female Tertiary Students
Authors: Dhupelia Dilip K. H. , King Linda G.
Published: February 2008

EDITORIAL COMMENT": We accepted this paper for publication since it reports the highest prevalence of chlamydial infection we have heard of in an Australian population. These findings are alarming and need to be confirmed by others before it will be agreed that a screening test for Chlamydia trachomatis should be performed at the time of routine pelvic examination in sexually active women, whether symptomatic or not. These findings are in contrast to the 1% prevalence reported in asymptomatic antenatal patients. We need further studies of the prevalence of this infection in both high risk groups (women attending for infertility treatment or termination of pregnancy) and in women having routine pelvic examination for the Papanicolaou smear test. Let us hope HIV infection will never sweep through our population like this. Regardless of moral considerations a life‐long unshared partnership looks a better proposition than ever before.

Summary: Chlamydial infection of the endocervix was identified in 19.8% of 258 University students undergoing pelvic examination in a Student Services Health Clinic. The majority of consultations were for routine Papanicolaou smear. Chlamydial infection was present in 50% (12 of 24) of the women who had clinical evidence of mucopurulent cervicitis.
Submucous Fibroids: Clinical Profile and Hysteroscopic Management
Authors: Itzkowic David
Published: February 2008

EDITORIAL COMMENTS: This paper was accepted for publication because it reports a further use of the hysteroscope other than endometrial ablation. Some of the cases clearly involved more than pedunculated polyps lying free in the uterine cavity; the technique included removal of intramural fibromyomas. It is too soon to judge the impact this new technology will have on avoidance of hysterectomy in women with menorrhagia and/or pain. The hysteroscopist reviewer made the comment that, in his view, laparoscopy should be performed by a second operator when intramural fibromyomas are resected during hysteroscopy, to avoid perforation of the uterus and thermal damage to pelvic structures. The laparoscopist at these procedures sometimes sees the uterine wall become inverted as the subjacent fibromyoma is resected, a fact that should be drawn to the attention of the hysteroscopist! The author's response to this editorial comment is the paragraph of the discussion section of this paper printed in italics.

Summary: Fifty submucous fibroids were removed by hysteroscopic resection from 37 patients with abnormal uterine bleeding. Thirty‐seven fibroids were completely resected and 13 incompletely resected. Nine patients also had rollerball endometrial ablations. The average follow‐up period was 14 months (4 to 51 months) in 33 patients available for follow‐up. All of these patients had cure of their symptoms, 3 after repeat operations. The 1 immediate complication was a postoperative infection. A normal uterine cavity was found in 13 of 14 patients examined by office hysteroscopy at follow‐up.
The Residual Adnexa Syndrome
Authors: Ng Peng H. , Hewson Alan D.
Published: February 2008

Summary: The clinical profile of a group of 208 women who presented with residual adnexal disease subsequent to hysterectomy was studied retrospectively; 121 patients had the uterus removed vaginally and 87 per abdomen. The majority of the patients had the hysterectomy at less than 40 years of age, with a mean and median age of 33 years, and more than 60% presented with adnexal symptoms and signs within 5 years of hysterectomy. A detailed analysis of the symptoms and signs and pathology of the removed uterus in both groups was similar although as expected there was an associated finding of prolapse in a significant number of those treated by vaginal hysterectomy. There were significant delays both in the definitive diagnosis of subsequent residual adnexal disease and definitive treatment. The pathological changes in the removed residual adnexa were varied, but with a high incidence of inflammatory changes involving both the tube and ovary. This was particularly evident in those patients in whom the uterus had been removed by the vaginal route, suggesting that this may be related to the usual fixation or approximation of the conserved tube to the vaginal vault at the time of vaginal hysterectomy.
The Efficacy of the Pipelle Endometrial Biopsy in Detecting Endometrial Carcinoma
Authors: Ferry J. , Farnsworth A. , Webster M. , Wren B.
Published: February 2008

Summary: The purpose of this study was to determine the efficacy rate of the Pipelle endometrial biopsy sampler (Pipelle de Cornier) (1) in detecting endometrial carcinoma, and to analyze the tumour variables that may influence the success rate.

Thirty seven women with known endometrial carcinoma were tested preoperatively; there were 25 correct diagnoses (67%), the remaining 12 cases (33%) failed to demonstrate the correct diagnosis: 4 showed ‘atypical epithelium’, 2 showed ‘atypical hyperplasia’, 3 showed ‘nonspecific epithelium’ and the remaining 3 showed ‘necrotic hyalinized material.

All cases were analyzed with respect to several tumour parameters, including the degree of differentiation, tumour volume, depth of invasion, and the extent to which the tumour filled the endometrial cavity. Poor results were obtained in well differentiated, low volume, and minimally invasive tumours, i.e. most early tumours, precluding its use as a screening tool.

A positive biopsy can save patients the time, cost, and inconvenience of a dilatation and curettage. However, in the light of these findings, a nonspecific finding should be interpreted with caution.
Menstrual Blood Loss Measurement with Gynaeseal
Authors: Gleeson N. , Devitt M. , Buggy F. , Bonnar J.
Published: February 2008

Summary: The diagnosis of menorrhagia is usually based on the subjective complaint of heavy menstrual bleeding, although up to 50% of women describing menorrhagia have measured menstrual loss within normal limits. Treatment is usually started without first establishing an objective diagnosis, because menstrual blood loss measurement is not widely available to clinicians. Current laboratory methods of measuring menstrual loss involve extraction of menses from sanitary wear. Many women find collection of sanitary wear unacceptable and laboratory staff find the menstrual extraction procedure unpleasant and time‐consuming. We investigated the use of Gynaeseal, a vaginally placed latex menstrual seal, in women with normal menstrual loss (n = 10) and menorrhagia (n = 12) with regard to its suitability for the measurement of menstrual loss and efficacy as alternative sanitary protection. Twenty‐one of the 22 women found the device easy to insert, but 16 found it messy to remove. All of the 6 couples having coitus found the device caused no discomfort. All women with menorrhagia and 4 of 12 women with normal menstrual losses were dissatisfied with the menstrual seal provided by gynaeseal. Gynaeseal does not contain menstrual blood efficiently in women with menorrhagia and is therefore unsuitable for the measurement of menstrual blood loss.
A Prospective Randomized Study Comparing the Clinical Effects of a Norethisterone and a Levonorgestrel Containing Low Dose Oestrogen Oral Contraceptive Pills
Authors: Anstee Pamela , Kovacs Gabor T.
Published: February 2008

Summary: The two types of low dose oral contraceptives one containing levonorgestrel the other containing norethisterone have been compared in a randomized prospective study. We have found that cycle control was much poorer with the norethisterone pill and would therefore recommend that if the norethisterone‐containing pill needs to be prescribed then either the 1 mg or the ‘synphasic’ preparation should be considered.
Determinants of Birth‐weight in Women with Established and Gestational Diabetes
Authors: Cundy Tim , Gamble Greg , Manuel Alice , Townend Kevin , Roberts Alistair
Published: February 2008

Summary: Increased birth‐weight (macrosomia) can complicate the diabetic pregnancy, but many factors other than hyperglycaemia can influence birth‐weight, in particular maternal obesity. In a mixed population (European, Maori and Pacific Islander) with a high prevalence of glucose intolerance and obesity we have examined the relative impact of various maternal factors on birth‐weight in women with both established and gestational diabetes. Mean birth‐weight was significantly greater in women with established or gestational diabetes than in controls (p < 0.0001), but was similar in women with gestational and established diabetes, despite glycaemic control being significantly poorer (p < 0.0001) in the latter. Birth‐weight closely paralleled prepregnancy body mass index rather than glycaemic control, but in Maori women it was lower than expected, probably because of their high prevalence of smoking. Daily cigarette consumption was negatively correlated with birth‐weight (p<0.01) despite the smokers having significantly poorer glycaemic control (p<0.001). The most significant variables influencing birth‐weight in the diabetic pregnancy were gestational age at delivery, prepregnancy body mass index, maternal height, estimated weight gain during pregnancy, the presence of hypertension and cigarette smoking (the latter 2 having negative effects on birth‐weight). Glycaemic control in the last half of pregnancy was not significant in this analysis. We conclude that within the limits of glycaemic control which we obtained, birth‐weight was largely determined by maternal factors other than hyperglycaemia. Birth‐weight thus has severe limitations as an outcome measure of the diabetic pregnancy.