bluuebunny/crossref_metadata_2025 huggingface dataset:
Intrauterine Growth Standards for Hong Kong Chinese
Authors: Woo Joseph S. K. , Li Dominic F. H. , Ma Ho‐Kei
Published: February 2008

Summary: Intrauterine growth standards for Hong Kong Chinese were derived from birth‐weight data between 28 and 42 weeks' gestation in 15,815 livebirths delivered in 1982 to 1984 at 2 maternity teaching hospitals in Hong Kong. Normal distribution of birth‐weights was noted in each of the gestational weeks studied. The mean birth‐weight was 3,237g at 40 weeks which was similar to the mean weights reported in other populations for this gestation. The trend of the median weight curve was also similar to that in other Caucasian and Asian reports. The growth pattern for males and females were similar and males were on the whole heavier than females throughout the gestational period studied. At 40 weeks, the 10th percentile weight also showed wide variations between reports, which would have important bearing on the studying of intrauterine growth retardation.

When the mean weight at term as derived from the present study was compared to a previous report on birth‐weight data in 1970–1972 in the same hospital, a significant increase in birth‐weight was observed over the 12‐year period. The importance of having up‐to‐date intrauterine weight standards for a specific population is discussed.
Oligospermic Infertility Treated by In‐Vitro Fertilization
Authors: Matson P. L. , Turner S. R. , Yovich J. M. , Tuvik A. I. , Yovichm J. L.
Published: February 2008

Summary: A series of 451 couples receiving treatment in an IVF programme were classified according to the quality of semen produced by the male partner, and were regarded as either severely oligospermic (≤5 times 106 motile spermatozoa/ ml; n = 29), moderately oligospermic (5.1 to 11.9 times 106 motile spermatozoa/ml; n = 46) or normospermic (≥12 times 106 motile spermatozoa/ml; n = 376). Despite similar insemination numbers, a significant reduction in the proportion of oocytes fertilized was seen when the normospermic group (1,314/1,815; 72%) was compared with the moderately oligospermic group (134/239; 56%) and the severely oligospermic group (57/190; 30%) and there was a progressive increase in the proportion of couples with total fertilization failure in the 3 groups (18/376, 5%; 10/46, 22% 12/29, 41%) respectively. In addition, 10 couples with severe oligospermia chose to divide the oocytes collected for insemination by the husband and a donor. The fertilization rates achieved using the husband's spermatozoa (9/31; 23%) are significantly lower than with donor (26/35; 74%), despite similar insemination densities, suggesting a functional defect in the spermatozoa of oligospermic husbands. Nonetheless, the pregnancy rates following embryo transfer were similar for all groups, suggesting that once fertilization is achieved, all embryos have the same potential to result in a successful pregnancy.
A Modified Shirodkar Surgical Closure of the Incompetent Cervix During Pregnancy
Authors: Sivanesaratnam V. , Zainal Siti Zaliha , Rachagan S. P.
Published: February 2008

Summary: A modified technique of Shirodkar cervical cerclage is described; 28 patients had 33 pregnancies with such a suture inserted after 12 weeks' gestation. An overall fetal survival of 93.9% showed a significant improvement (p < 0.001) over that obtained in the previous pregnancies without cervical stitch. The operation is safe for both mother and fetus.
The Contents of the Labour Ward Register
Authors: Quine Susan
Published: February 2008

Summary: Information recorded in the Labour Ward Register was identified for all maternity hospitals and hospitals with maternity sections in the N.S.W. Sydney Metropolitan area. This survey established that certain demographic and clinical information is consistently recorded and therefore can be relied on for planning and research purposes. Furthermore this information is conveniently located and avoids recourse to accessing patients' medical records.
Trends in Ectopic Pregnancy in New Zealand
Authors: Macintosh Mary C. M.
Published: February 2008

EDITORIAL COMMENT: In the Commonwealth of Australia the number of maternal deaths from ectopic pregnancy is substantial, and with reduction in other causes, ectopic pregnancy deaths now have a greater relative importance— 7 of 275 in 1964–1966, 3 of 237 in 1967–1969, 9 of 244 in 1970–1972, 5 of 137 in 1973–1975, 3 of 106 in 1976–1978 and 6 of 98 in 1979–1981. The majority of deaths occur because of failure to diagnose the condition. It is against this background that one must interpret the significance of a rise in the incidence of ectopic pregnancy, and wonder whether this is a consequence of an increased incidence of pelvic inflammatory disease.

Summary: The rate of ectopic pregnancy in New Zealand from 1965 to 1983 was examined and shown to have increased 3‐fold from 4.3 per 103 total births in 1965 to 13.6 per 103 total births in 1983. Over this period the risk was greatest for the older conceiving woman, with a woman aged 35–44 years 2.2 times more likely to experience an ectopic pregnancy than a woman aged 15–24 years.
The Association Between Vulvar Condylomata Acuminata, Cervical Wart Virus Infection and Cervical Intraepithelial Neoplasia
Authors: Sfameni Salvatore F. , östör Andrew G. , Chanen William , Fortune Denys W.
Published: February 2008

Summary: Vulvar condylomata acuminata are the commonest clinical expression of human papilloma virus infection of the female genital tract. Various epidemiological factors were examined in a group of patients with vulvar warts in whom the incidence of biopsy proven human papilloma virus infection of the cervix was 39.7% and the incidence of biopsy proven cervical intraepithelial neoplasia was increased significantly (16.2%).
Twin Pregnancy: Prematurity and Perinatal Mortality
Authors: O'Shea Robert T.
Published: February 2008

EDITORIAL COMMENT: Multiple pregnancy continues to account for approximately 10% of perinatal deaths (72 of 765 in Victoria, 1984); likewise debate continues as to whether or not bed rest in hospital minimizes the onset of premature labour and preeclampsia in these patients. Increased use of ultrasonography has minimized the incidence of unrecognised twins before the onset of labour, which previously occurred in approximately 20% of cases. It is therefore theoretically possible to conduct a controlled trial of rest in a consecutive series of patients with multiple pregnancy. This is not as easy as it sounds because many patients with multiple pregnancy have minimal discomfort and will not agree to rest in hospital before 28–30 weeks' gestation. Likewise, the onset of complications (hyperemesis, gross oedema, premature labour, premature rupture of the membranes, preeclampsia, polyhydramnios, antepartum haemorrhage) will often require admission to hospital irrespective of trial requirements.

This paper presents one side of the rest in bed story. The author has shown that a considerable proportion of perinatal deaths in multiple pregnancy occur before the time at which it is customary to admit patients to hospital for rest. Since this paper did not analyse the details of all patients in the series, it did not consider the possible benefit of rest in patients whose babies survived. This paper emphasizes that for rest to be effective in twin pregnancy, it should be effected between 21 and 28 weeks' gestation. A practical compromise could be for patients with multiple pregnancy to be rested in hospital for 2–3 days every 2–4 weeks from 20 weeks' gestation until the dangers of prematurity are past.

Summary: An 8‐year (1976–1984) retrospective analysis was undertaken of the management and outcome of 245 twin pregnancies delivered at Flinders Medical Centre, Adelaide. The incidence of twin delivery was 1 in 69 with a perinatal mortality of 85.7 per 1,000 total births. Amongst 42 perinatal deaths, 28 were associated with preterm labour at or before 28 weeks' gestation. If bed rest in hospital is to be implemented as a possible means of improving perinatal outcome in twin pregnancy it needs to be effected between 21 and 28 weeks' gestation; there is no rational theoretical basis for hospitalization beyond this time.
Congenital Malformations and Consanguinity
Authors: El‐Shafei Affaf , Rao P.S.S. , Sandhu Amarjit Kaur
Published: February 2008

Summary: In this study in Bahrain increased maternal age, high parity, consanguinity and a history of 2 or more previous abortions were found to increase the risk of congenital malformation.
The Significance of Cardiotocographic Monitoring in Pregnancy Complicated by Intrauterine Growth Retardation and Prematurity
Authors: Sfameni S. F. , Cole M. , McBain J. , Heath P.
Published: February 2008

EDITORIAL COMMENT: It is unlikely that a controlled study to establish the risk of intrauterine death when there is cardiotocographic evidence of critical fetal compromise will ever be conducted or published. These 4 cases are more than anecdotal since they occurred in 1 of 5 obstetric units within a major teaching hospital during a 6‐month interval (information provided by authors)— gestation ranged from 28–33 weeks’, birth‐weight from 425‐l,550g and in all cases fetal death occurred 2–24 hours after critical fetal reserve was identified by cardiotocography.

Summary: Intrauterine growth retardation is a condition of chronic fetal compromise. The most accurate method of fetal assessment in this condition is by serial cardiotocography. In pregnancy associated with intrauterine growth retardation, abnormal cardiotocography with spontaneous decelerations may be an indicator of imminent fetal death in utero. Delivery should be effected immediately if the fetus is at a gestation where viability is probable.
A Comparison of Circulating Immune Complexes, Pregnancy Associated β1‐Macroglobulin and Galactosyltransferase as Tumour Markers for Ovarian Cancer
Authors: Dodd J. , Davey R. A. , McAdam A. , Stimson W. H. , Fay R. , Crandon A. J. , Hicks L. , Tyler J. P. P. , Hudson C. N.
Published: February 2008

Summary: Serial blood samples have been obtained from 12 patients with ovarian cancer who were treated by surgery and, generally, chemotherapy or radiotherapy. Some achieved clinical remission, but the majority relapsed after a variable time interval. Three potential tumour markers (Circulating Immune Complexes, Pregnancy Associated β1‐Macroglobulin and Galactosyltransferase) have been studied longitudinally in serum for clinical correlation, predictive value, and biochemical ‘lead time’ to clinically detectable progression. None of the 3 offered any signal advantage over the others, and each showed an inconsistent relationship to observed disease status, with high levels indicating a poor outlook and the converse not true. Thus, since the ‘lead time’ is short, and reliability low, none of the compounds can be strongly commended as individual markers for ovarian cancer.
Early Reproductive Loss
Authors: Chen Christopher
Published: February 2008

Summary: Although at least 15% of clinically recognized pregnancies end in spontaneous abortion, a much higher loss varying from 8–78% probably occurs subclinically during very early gestation. This ‘early reproductive loss' is largely presumptive and may be caused by factors such as chromosomal abnormalities, infections, endocrine deficiencies, uterine disease, and immunological factors. Little may be offered by way of treatment; but more recently, immunotherapy appears an attractive possibility in selected cases.
Intrapartum Hysteroscopy
Authors: MD Boris Petrikovsky
Published: February 2008

EDITORIAL COMMENT: This technique warrants consideration /evaluation especially in the patient having a trial of vaginal delivery after a previous Caesarean section (Case 2).

Summary: A new method of visualization of fetus, uterus, placenta, umbilical cord and amniotic fluid is presented. A flexible endoscope was inserted into the uterine cavity after spontaneous or artificial rupture of the membranes via the vaginal route in 85 patients. Endoscopy could be beneficial for precise determination of the nature and type of umbilical cord and placental pathology, signs of fetal dysmaturity, the presence of meconium and evaluation of the integrity of a uterine scar. Intrapartum hysteroscopy could be especially helpful for patients with no prenatal care who appear in labour with incomplete histories. The method is proven to be safe for both the mother and the neonate.
A Revaluation of the Ferning Test to Detect Ruptured Membranes
Authors: MRACOG C. Brookes , BMBS K. Shand , FRACOG W. R. Jones MD PhD
Published: February 2008

Summary: The ferning test for the detection of amniotic fluid, when first described, was reported to have no false positive results. Despite this and after initial enthusiasm it has never achieved widespread use. The test is easy to perform but interpretation requires care, and it is necessary to identify potentially confusing crystallization patterns to avoid false positive results. A reevaluation of the test is presented and a hitherto unrecognized false positive reaction due to an antiseptic solution* is reported.
Tubal Resection and Anastomosis II. Isthmic Salpingitis
Authors: FRACOG Robert P. S. Jansen FRACP
Published: February 2008

Summary: The results of 30 consecutive operations for medial occlusion of the tube due to pathological processes other than sterilization are reported. Resection of the obstructed segments was followed by anastomosis of lateral isthmus or ampulla to (a) the medial isthmus, (b) the interstitial portion of the tube, or (c) the endometrium of the lateral uterine angle, deep in the myometrium. Life table analysis of subsequent pregnancies was carried out in a manner that kept those patients with demonstrated reocclusion after anastomosis in the denominator for the duration of longest follow‐up, irrespective of further operations on these patients. The cumulative probability of pregnancy was 55% at 6 months from the time of surgery and 67% at 12 and at 15 months. Empirically, average fecundability, or monthly probability of pregnancy, was 9.3%; of 25 women followed‐up and not on contraception, 14 (56.0%) have conceived. Microsurgical tubal anastomosis can effectively replace uterotubal implantation for acquired organic occlusion of the medial tube or lateral uterine angle. Optimum results require precise techniques, wide excision of abnormal endosalpinx, and preoperative treatment of endometritis.
Attitudes Towards Oocyte and Embryo Donation and Disposal
Authors: MBBS B. Burton + , Puszko Z. , Wood E.C.
Published: February 2008

Summary: The attitudes of In Vitro Fertilization (IVF) patients, their relatives, and their friends towards oocyte and embryo donation and disposal of frozen embryos were determined by questionnaire. The results obtained from a group of patients undergoing IVF treatment in the hospital were compared and some differences in attitudes were detected.
Prospective Study of 3 Metabolic Regimens in Pregnant Diabetics
Authors: Farrag O. A. M.
Published: February 2008

EDITORIAL COMMENT: Tight control of blood sugar values (below 5.6 μmol/l) has many advocates and has been associated with reduction in perinatal mortality rates in overt diabetics. This paper questions the value of very tight control — the answer provided warrants consideration and verification in larger studies, because the point is central to management of the pregnant diabetic. Other considerations are that too tight control risks the harmful effects of hypoglycaemia (on the fetus) which itself is reported to be equally as harmful (to the fetus) as hyperglycaemia (*1, *2). In support of this an increased incidence of fetal growth retardation in strictly controlled diabetics has been noted (*3). The recently published perinatal mortality results (4%) in diabetes must be considered to be satisfactory, although argument continues with regard to the necessary incidence of Caesarean section and the optimal maturity for delivery, Another important area for future study is the value of low fat, high unrefined carbohydrate diet to improve glucose tolerance in diabetics (*4, *5) a consideration that may profoundly influence long‐term maternal prognosis, especially in gestational diabetics where complications of the disease (small vessel changes) are absent or less overt.

*1. Abell, DA, Beischer NA. The effects of hypoglycaemia and hyperglycaemia on pregnancy outcome. ANZ J Obstet Gynaecol 1976; 16: 75–81.

*2. Drew JD, Abell DA, Beischer NA. Congenital Malformations, Abnormal Glucose Tolerance, and Estriol Excretion in Pregnancy. Obst Gynecol 1978; 51: 129–132.

*3. Harley G, Belfast. Personal communication.

*4. Brunzell JD, Lerner RL, Hazard WR, Porte D Jnr, Beirman EL. Improved glucose tolerance with high carbohydrate feeding in mild diabetes. N Engl J Med 1971; 284: 521–524.

*5. Nolan CJ. Improved glucose tolerance in gestational diabetic women on a low fat high unrefined carbohydrate diet. ANZ J Obstet Gynaceol 1984; 24: 174–177.

Summary: Three tight regimens to maintain blood sugar values of 5.6 SI (group A), 5.6–6.7 SI (group B), and 6.7–8.9 SI (group C), were studied in 60 pregnant diabetic patients. The perinatal salvage rate was 96.6%. Maternal hypoglycaemia occurred only in group A. The group C regimen produced more complications than occurred in the other 2 groups. Very tight control of blood sugar is not necessary for successful management of diabetes in pregnancy and blood sugar value between 5.6–6.7 SI offers the best outcome.
A Reappraisal of Urinary Oestriol Excretion as a Screening Test in Pregnancy6
Authors: Beischer Norman A. , Parkinson Patricia , Walstab Janet
Published: February 2008

Summary: During the years 1971–1982 urinary oestriol excretion was tested in 38,536 patients (group 1). One or more low oestriol value was found in 11.0% of patients; in this group the stillbirth rate was 8 times higher, the neonatal death rate 4 times higher, and fetal growth retardation rate 4 times higher than in patients with normal oestriol values (all p < 0.001).

During the years 1982–1984 a further 12,887 patients were tested (group 2) and 9.5% had one or more low oestriol value. The perinatal mortality rate in patients with normal oestriol excretion fell from 0.8% in group 1 to 0.5% in group 2 (p < 0.05), and in patients with low oestriol excretion from 4.7% in group 1 to 2.4% in group 2 (p < 0.01). However, patients in group 2 with low oestriol values still had significantly unfavourable results, compared to those with normal oestriol values — stillbirth rate 4 times higher, neonatal death rate 5 times higher, and fetal growth retardation rate 4 times higher (all p< 0.001).

Although perinatal results have improved, fetal growth retardation and the risk of perinatal death are still identified by urinary oestriol assay.
Low Rectovaginal Fistulas
Authors: Pepe F. , Panella M. , Arikian S. , Panella P. , Pepe G.
Published: February 2008

Summary: Twelve patients aged between 25 and 48 years with parity ranging from 2 to 4 were treated for rectovaginal fistula at the First Clinic of Obstetrics and Gynecoiogy, Catania University Medical School, Catania, Italy from 1965 to 1985. In all patients the rectovaginal fistula was in the inferior third of the vagina and of maximum diameter of 5 cm. Therapy consisted of surgical correction in 9 patients with transformation of the fistula into a complete perineal tear cutting the bridge of healthy tissue under the fistula. Follow‐up period varying from 2 to 16 years showed no recurrence.
Antepartum Cardiotocography — an Audit
Authors: Oats Jeremy N. , Chew Franklin T. K. , Ratten Valerie J.
Published: February 2008

Summary: Between 1981 and 1986, 9,840 women were monitored by antepartum nonstressed cardiotocography (CTG). A satisfactory fetal reserve pattern was detected in 91%, a reduced reserve pattern in 8% and a critical reserve pattern in 1%. The incidences of fetal growth retardation, Apgar score < 6 at 1 minute, perinatal mortality and Caesarean section all increased significantly (p < 0.001) as the degree of cardiotocographic fetal reserve worsened. Intrauterine growth retardation and/or low urinary oestriol excretion was associated with a highly significantly increased incidence of abnormal CTG traces (14.2%, p < 0.001).

A satisfactory fetal reserve pattern on cardiotocography was a reliable predictor of fetal well‐being, since after exclusion of lethal malformations, the perinatal mortality rate in those patients monitored within 7 days of delivery was 3/1,000.
The Relevance of Antenatal Cardiotocography
Authors: Humphrey M. D. , Dossor S. L. , Trickey D. J. , Gumley S. J. , Webb L. A. , Bishop A. K. , Davis C. M. , Crook S. L.
Published: February 2008

Summary: In a prospective study of 3,083 patients having antenatal cardiotocography it was shown that ominous fetal heart rate traces were most likely to occur when the test was applied in specific ‘at risk’ situations rather than as a routine screening test, and when the need for monitoring was perceived relatively early in the pregnancy. The majority of ominous traces were not preceded by a normal trace.
Vaginal Delivery After 3 Previous Caesarean Sections
Authors: Lawson Gerald W.
Published: February 2008

EDITORIAL COMMENT: When Caesarean section is performed for the standard indications and trial of scar considered in the next pregnancy, it will seldom be necessary to perform trial of scar after 3 Caesarean sections as reported here. However, this provocative case report, together with the review of similar examples in the literature, indicates that in the unusual patient who requests trial of scar after more than I Caesarean section, this obstetrical finesse is not reprehensible — provided that the labour is monitored with meticulous care, and, in our view, conducted without either induction of labour, oxytocin augmentation, epidural analgesia, or difficult forceps delivery. One reviewer of this paper still has the impression that trial of scar after multiple Caesarean section is inherently dangerous! This case also illustrates how important it is to try to avoid the first Caesarean section.

Summary: A patient who had had 3 previous Caesarean sections was permitted a trial of scar in her subsequent confinement. Labour occurred spontaneously at 39 weeks, and was closely monitored. After an uneventful labour of 3 1/2 hours, a Wrigley forceps lift‐out was performed. There was no maternal or neonatal morbidity and the uterine scar was intact.
The Value of Clinical Symptoms in the Diagnosis of Urinary Incontinence in the Female
Authors: Korda Andrew , Krieger Mark , Hunter Peter , Parkin Gordon
Published: February 2008

EDITORIAL COMMENT: Urodynamic investigation is being used increasingly in patients with urinary incontinence. Although many gynaecologists stress the importance of a careful history and examination as the basis for surgery, the recent literature would support the rule that no patient should have a second operation for stress incontinence without the benefit of preoperative urodynamic assessment.

Summary: In a study of 566 patients with urinary incontinence the presenting symptom or combination of symptoms were shown to have limited diagnostic predictive value as measured by urodynamic diagnostic criteria.
Occult Fetomaternal Haemorrhage As a Cause of Fetal Mortality and Morbidity
Authors: Fliegner John R. H. , Fortune Denys W. , Barrie Jean U.
Published: February 2008

Summary: Spontaneous fetomaternal haemorrhage is an important, but usually overlooked, cause of perinatal mortality and morbidity. Although fetomaternal bleeding in the third trimester of pregnancy is common it is normally less than 0.1 ml. A fetal macrotransfusion (> 5 ml) is uncommon, but is important because it is insidious, unexpected and usually occurs in completely normal pregnancies. This paper analyses the perinatal mortality and morbidity associated with occult fetomaternal haemorrhage at the Royal Women's Hospital, Melbourne. It may lead to fetal distress before and during labour, unexplained stillbirth, or nonhaemolytic neonatal anaemia. A Kleihauer test on maternal blood will readily detect fetomaternal bleeding, and we describe a simple way of calculating the absolute volume of fetal red cells present. Greater awareness of the problem may eventually lead to diagnosis sufficiently early to permit effective treatment.
Massive Multiple Theca Lutein Cysts Complicating Nonmolar Pregnancy
Authors: O'Loughlin J. , Brookes C. M.
Published: February 2008

Summary: A case of massive bilateral multiloculated theca‐lutein cysts occurring in association with a nonmolar singleton pregnancy is described. Surgical removal of the cysts became necessary and was followed some weeks later by the spontaneous rupture of the membranes at a nonviable stage of gestation.
Cervical Entrapment of a Polythene Vaginal Ring Pessary — a Clinical Curiosity
Authors: MBBS(Cey‐) M. Sivasuriya
Published: February 2008

Summary: An extremely rare complication of cervical entrapment of a polythene ring pessary within an epithelial ‘tunnel’ of the cervix is reported. The pessary was removed by dividing a segment of it with bone cutting forceps.
Closed Mitral Valvotomy in Pregnancy—A Malaysian Experience
Authors: Goon M S , Raman S , Sinnathuray T A
Published: February 2008

Summary: Our experience from 1968 to 1985 in 12 women requiring closed mitral valvotomy during pregnancy is reviewed. All patients had severe mitral stenosis and were in functional class 3 (2 patients) or class 4 (10 patients). Mitral valvotomy was performed between the 18th and the 30th week of pregnancy using a transventricular dilator. Improvement in functional class was noted in all patients postoperatively. One patient had postvalvotomy mitral regurgitation and heart failure, which responded to diuretics; the subsequent course was uneventful. Eleven patients had normal deliveries; whilst one patient had a Caesarean section for an obstetric indication. All babies were normal and there was no maternal death. This series confirms that closed mitral valvotomy can be performed with an acceptable degree of safety during pregnancy, when indicated.
Trial of Labour in Patients with a Prior Caesarean Section and an Intervening Vaginal Delivery
Authors: Schneider J. , Gallego D. , Benito R.
Published: February 2008

Summary: 202 patients having had one vaginal delivery after a prior Caesarean section between 1980 and 1984 were followed‐up to December, 1986; 77 of them came again for delivery during this time. Four elective Caesarean sections and 103 trials of labour were carried out in this patient group. Of these, 88 (85.4%) ended in vaginal delivery. There was no fetal loss, nor any significant maternal or fetal morbidity; in particular there was no uterine rupture or scar dehiscence. It is concluded that the prognosis for vaginal delivery is good once a successful trial of scar has occurred, so long as the labour is carefully monitored and a repeat Caesarean section performed when indicated.
Escalating Consumption of Nursery Resources by Extremely Immature Infants
Authors: Doylel Lex W , Murton Laurence J , Kitchen William H
Published: February 2008

Summary: Over a 9‐year period at one tertiary perinatal centre there were 59,650 livebirths; although only 1,123 (1.9%) were born at or before 30 weeks' gestation, this small minority of infants consumed 71.7% of total patient‐days in the neonatal intensive care unit (NICU) and an inordinate 87.9% of total patient‐days of assisted ventilation. Infants born at 24 weeks required 39 times the patient‐days of assisted ventilation and 19 times the patient‐days in the NICU per survivor compared with those born at 30 weeks' gestation. In infants born before 28 weeks, for each week of decrease in gestation, survivors averaged an extra 13.0 days of assisted ventilation, stayed in the NICU 13.8 days more, and in hospital 14.9 days longer. Any therapy before 28 weeks which can keep infants safely in the uterus could save approximately 2 weeks of nursery resources for each extra intrauterine week and would be beneficial economically, even if it meant hospitalization of the mother over that time.
Can Anything Be Done About Mid‐Trimester Fetal Wastage?
Authors: Fliegner John R. H.
Published: February 2008

Summary: In Victoria in the triennium 1982–1984, perinatal losses between 22 and 28 weeks' gestation accounted for 32% of the overall perinatal wastage of 12.7 per 1,000 births. Over the same period only 1.2% of babies were delivered weighing less than 1,500g, but this group made up 40% of the total stillbirths and 50% of the neonatal deaths. By contrast the perinatal wastage was only 7 per 1,000 births in babies born weighing more than 1,500g and this included lethal congenital malformations. The major antenatal risk factors contributing to the high mid‐trimester fetal wastage were premature labour (17.7%), multiple pregnancy (13.9%), cervical incompetence (12.9%), antepartum haemorrhage (12.9%), premature rupture of the membranes (11.5%), lethal congenital malformations (10.6%) and hypertensive disorders (7.4%). Cognizant of the frequency of preventable factors, the Consultative Council on Maternal and Perinatal Mortality and Morbidity in Victoria recommends that, where feasible, the mother of these high‐risk pregnancies be transferred to a centre where facilities are available to monitor the pregnancy and labour, and which offers intensive care facilities for the baby.
Cephalhaematoma: A 10‐Year Review
Authors: Thacker K. E. , Lim T. , Drew J. H.
Published: February 2008

Summary: The incidence of cephalhaematoma at the Mercy Maternity Hospital over a 10‐year period was 2.5%; of the 1,030 infants 68.4% were born to primiparas, 65.6% were males, the majority (91.1%) were between 37 and 42 weeks' gestation and 3,000 and 4,000 g birth‐weight (71.6%). Forceps delivery and vacuum extraction were associated with increased incidences of cephalhaematoma (5.1% and 22.9% respectively), and the incidence was slightly increased (3.8%) when a scalp electrode had been applied. Hyperbilirubinaemia was more prevalent (12.9%) in infants with a cephalhaematoma as was exchange transfusion (0.8%) and the need for phototherapy (4.9%).
The Evaluation of a Pregnancy Test (Tandem ICON) in the Management of Ectopic Pregnancy
Authors: Leung Ares , Wong Felix , Chang Allan
Published: February 2008

Summary: A comparison was made between the Tandem ICON and Gravindex tests in the management of suspected ectopic pregnancy in 38 patients. The Tandem ICON test was significantly more accurate than the Gravindex in predicting an ectopic pregnancy. After the exclusion of cases with intrauterine pregnancy, there was no error when the Tandem ICON test was used, but 8 false negative cases were found with the Gravindex.
Adjuvant Cytotoxic Chemotherapy Following Wertheim Radical Hysterectomy for Cervical Cancer
Authors: Sivanesaratnam Y. , Sen D. K. , Jayalakshmi P.
Published: February 2008

Summary: Patients at high risk of recurrence or metastases following radical surgery for Stage 1B and 2A cervical carcinoma include those with pelvic node metastases, lymphatic or vascular space permeation in the cervix by tumour cells, large size of the primary tumour, involvement of the full thickness of the cervix and parametrial spread. We report the initial results of adjuvant chemotherapy using a combination of cisplatinum, bleomycin and vinblastine in 22 patients who had undergone Wertheim radical hysterectomy and were thought to be at high risk of developing recurrence. The mean duration of follow‐up was 23 months. All are alive after follow‐up ranging from 13 to 43 months. Three patients developed recurrences—one in the pelvis, another at the posterior aspect of the urethral meatus and the third developed pulmonary secondaries at 20 to 23 months after surgery. Toxicity from the chemotherapy was acceptable.
Diagnosis of Endometrial Carcinoma by Histopathological Examination of the Endometrial Aspirate by the Curity‐Isaacs Sampler
Authors: Ngan Hextan Y. S. , Hsu MRCOG C. , Ma H. K.
Published: February 2008

Summary: The Curity‐Isaacs Endometrial Cell (CIEC) sampler was used for endometrial tissue and cell sampling in 230 patients before dilatation and curettage to determine the efficacy of its use as an outpatient endometrial sampler. Its use was found to be safe and without complication. It could be easily inserted into the uterine cavity in 92.0% of patients and did not cause undue discomfort in 88.9% of them. Using histopathological diagnostic techniques, there was 100% accuracy in the diagnosis of endometrial carcinoma. However, it was found that diagnostic accuracy of endometrial hyperplasia was only 33.3%. It is suggested that the CIEC sampler could be used as a first‐line diagnostic procedure to exclude endometrial carcinoma in patients with abnormal vaginal bleeding.
The Aldridge Sling Procedure in the Treatment of Urinary Stress Incontinence
Authors: McIndoe G. A. J. , Jones R. W. , Grieve B. W.
Published: February 2008

Summary: The long‐term results of the Aldridge sling procedure for the treatment of recurrent urinary stress incontinence were assessed in 50 women most of whom had had previous failed vaginal surgery; 78% of patients were cured of all symptoms and a further 20% were symptomatically improved—a 2% failure rate. Only one patient reverted from a cure to improved during the lengthy follow‐up. The procedure is not difficult to perform and is a good surgical option in patients with failed vaginal surgery.
The Donation of Oocytes to Known Recipients
Authors: Leeton John , Harman Jayne
Published: February 2008

Summary: The supply of donated oocytes from an in vitro fertilization programme has always been inadequate, especially following the successful cryopres‐ervation of human embryos. There have been no previous reports of women donating their oocytes to known recipients. All of 7 women who donated all their oocytes to known recipients responded to a posted questionnaire. No differences in social characteristics between this group and another group of infertile women treated on an in vitro fertilization programme, who donated some of their excess oocytes anonymously were noted, except that the known donor group had a relatively high average parity, i.e. 3. No differences in attitudes towards donating oocytes were noted between these groups except that the known donor group felt a significantly greater connection towards the potential child.
Ovarian Ectopic Pregnancy—A Diagnostic Dilemma
Authors: Hughes Susan J. , Jotkowitz Max W. , Sumithran Eric
Published: February 2008

Summary: A recent case of ovarian pregnancy, the diagnosis of which is often retrospective, is presented. The discussion is based on current literature concerning the diagnostic difficulties associated with this condition.
Prevention of Emotional Disability Following Stillbirth—The Role of the Obstetric Team
Authors: Condon John T.
Published: February 2008

Summary: As many as one‐third of women bereaved by stillbirth suffer psychological decompensation and a similar proportion see the obstetric team as unsupportive. The present paper adopts the view that the actions of the obstetric team during the crucial hours preceding and following the death are powerful determinants of the emotional outcome. Twelve guidelines for practical management of the delivery room situation are described. The characteristics of women most at risk of subsequent psychological decompensation are outlined. Indications for psychiatric referral are summarized.
Obstetric High Risk Screening and Prediction of Neonatal Morbidity
Authors: Webster M. A. , Linder‐Pelz S. , Martins J. , Greenwell J.
Published: February 2008

EDITORIAL COMMENT: I commend the aim of the paper, that of assessing the ability of an obstetric risk score protocol to predict low risk pregnancies thus enabling patients to attend alternative birth centres. It is salutory to note that this retrospective study was not selective in predicting low neonatal morbidity for patients confined in birth centres.

If a risk‐scoring protocol could be devised which would adequately predict low perinatal, intrapartum and neonatal risks, then births at alternative birth centres could be recommended on more scientific grounds than is possible at this time.

Data predictive of the need for birth centre beds and of the need for support services for birth centres could be obtained. This might reduce the load on labour ward beds for level II and III patients and could assist the organization of obstetric services in the community.

Summary: A retrospective study using an obstetric risk score protocol was applied to a stratified sequential sample of 843 singleton livebirths, occurring in the Royal Hospital for Women, Sydney, over a 12‐month period (March, 1985‐February, 1986). Data collection included 53 prenatal factors, 41 intrapartum factors and 37 neonatal factors. The study was comprised of 346 women admitted to the hospital birth centre and 497 women admitted to labour ward.

In labour ward admitted women there was a significant association between high prenatal scores, high intrapartum scores and high neonatal morbidity scores. Women admitted to the birth centre were subjected to a screening procedure which resulted in low prenatal and relatively low intrapartum risk scores. However, neonatal morbidity scores were similar for both groups.

The risk scoring protocol used in this study requires further revision to allow the adequate selection of low risk women delivering infants with a low risk of neonatal morbidity in a low risk obstetric setting.
Cervical Ripening: An Evaluation of Current Methods
Authors: Wei Jen Shek , Tan Seang Lin
Published: February 2008

EDITORIAL COMMENT: The state of the cervix is an important factor in determining the outcome of induction of labour. Arulkumaran and colleagues reported (Aust NZ J Obstet Gynaecol 1985; 25: 190–193) that 65% of nulliparas with an unfavourable cervix, who had induction of labour performed by amniotomy and simultaneous oxytocin infusion, came to Caesarean section, two‐thirds because of failed induction. The numerous reports on induction of labour do not dispel confusion since no one method is clearly superior. Problems are the size of the series, the proportion of porous to nulliparous patients, and whether or not the control group assists in evaluation of results obtained, since amniotomy and oxytocin infusion are usually employed in addition to the method being evaluated to ripen the cervix. This journal recently published a comprehensive account of the physiology of the initiation of human reproduction (Roy AC, Kottegoda SR, Ratnam RR. 1985; 25: 94–100). This paper reviews recent reports on cervical ripening and includes a summary of a number of studies with details of results obtained according to the method used and the patients' parity.
Suppression of Puerperal Lactation Using Jasmine Flowers (Jasminum Sambac)
Authors: Shrivastav Pankaj , George Korula , Balasubramaniam N. , Jasper M. Padmini , Thomas Molly , Kanagasabhapathy A.S.
Published: February 2008

EDITORIAL COMMENT: It is unlikely that the use of jasmine flowers for suppression of lactation will become the rage but we thought that readers would be interested in this safe and simple method. We respectfully disagree that it would be unethical to have included a placebo treated control group in the study (read on for reason). Twenty years ago (2), when the association between oestrogen therapy and venous thromboembolism was reported (1), our management of suppression of lactation changed abruptly from stilboestrol 5 mg tds for 5 days, to avoidance of breast stimulation, the use of a good supporting brassiere, and aspirin for pain if engorgement occurred — we were surprised to see how little difference there was and how few patients required analgesic drugs. Provoked by this paper, discussion with 12 charge sisters of postnatal wards disclosed that about 20% of patients who elect to suppress lactation are prescribed bromocriptine — in most cases prophylactically rather than as treatment of severe engorgement. This miniaudit revealed that the nursing staff were not in favour of bromocriptine therapy except when engorgement was severe, because of nausea and rebound lactation (often after the patient had gone home) — interestingly in one postnatal ward in Melbourne, the charge sister used cabbage leaves to treat engorged breasts and claimed that the method was successful! Routine therapy can become a crutch you can afford to throw away.

Summary: The efficacy of jasmine flowers (Jasminum Sambac) applied to the breasts to suppress puerperal lactation was compared that of Bromocriptine. Effectiveness of both regimens was monitored by serum prolactin levels, clinical evaluation of the degree of breast engorgement and milk production and the analgesic intake. While both bromocriptine and jasmine flowers brought about a significant reduction in serum prolactin, the decrease was significantly greater with bromocriptine. However, clinical parameters such as breast engorgement, milk production and analgesic intake showed the 2 modes of therapy to be equally effective. The failure rates of the 2 regimens to suppress lactation were similar; however, rebound lactation occurred in a small proportion of women treated with bromocriptine. Jasmine flowers seem to be an effective and inexpensive method of suppressing puerperal lactation and can be used as an alternative in situations where cost and nonavailability restrict the use of bromocriptine.
Obstetric Profiles of Immigrant Women from Non‐English Speaking Countries in South Australia, 1981–1983
Authors: Chan Annabelle , Roder David , Macharper Tony
Published: February 2008

Summary: Obstetric profiles of non‐English speaking immigrant women in South Australia are presented to assist in planning for health services. They were derived from perinatal data routinely collected by midwives and neonatal nurses. The characteristics of 5,675 immigrant women were compared with those of a random sample of approximately 5% of Australian‐born women who delivered babies in 1981–1983 in South Australia. This study demonstrates that immigrant women tended to be urban dwellers and to deliver their babies in large metropolitan hospitals. They were less often from unemployed families but more often from those of low occupational status. They were older, with fewer teenagers and single women among them. They were of higher parity, and tended to commence antenatal care later. They had lower incidences of pregnancy hypertension and induced labour, but were more likely to have anaemia, antepartum haemorrhage and a Caesarean section. There were also important differences between the 7 largest immigrant groups. For example, the very high Caesarean section rate (36%) in Filipino women is of concern. Also, the mean birth‐weight of babies of Vietnamese women was 263g lower than that of babies of Australian‐born women. Support services need to be logistically located and address the findings of this study in a culturally acceptable way.
A New Technique for Closure of the Uterus at Caesarean Section
Authors: Sivasuriya M. , Sriskanthan R. , Sriskandarajah M. N.
Published: February 2008

EDITORIAL COMMENT: This paper was accepted for publication so that readers might pause and review their technique for closure of a Caesarean section incision. This paper favours a one layer closure in patients in whom sterilization is planned, presumably because the authors fear that the resultant scar would be more likely to rupture if a subsequent labour occurred. The time saved would not seem of great importance in most centres. Our editorial panel still favour the technique of closure of the incision in uterine muscle in 2 layers, with both lateral angles being secured before proceeding medially with the first continuous stitch. The use of a guide stitch in the centre of the lower edge of the uterine wound also facilitates closure (Ashton P, Beischer N, Cullen J, Rattan G. Return to Theatre — Experience at the Mercy Maternity Hospital, Melbourne 1971–1982. Aust NZJ Obstet Gynaecol 1985; 25: 159–169).

Summary: A new method of closure of the uterus at Caesarean section is described. The technique which comprised suturing the uterine incision in a single layer was employed in 100 patients, in all of whom there was also a valid indication for sterilization. Apart from being simple, safe and effective the main advantage of the technique appeared to be saving operating time. A noteworthy feature was that the incidence of postoperative complications was no higher compared with the standard 3‐layer suture of the uterus.
Vaginal Delivery After Caesarean Section: Is It Safe in a Developing Country?
Authors: Muylder Xavier De
Published: February 2008

EDITORIAL COMMENT: Evaluation of trial of vaginal delivery after previous Caesarean section (trial of scar) is at the cutting edge of modern obstetric practice and so we offer no apology for the number of papers we accept for publication on this subject. Trial of scar has been practised successfully, and reported consistently from centres in the United Kingdom and Eire for decades, but recent interest stems mainly from the United States of America where Caesarean section rates of 20–30%, and the realization that the leading indication for Caesarean was ‘Previous Caesarean’, has resulted in the abandonment of the philosophy of ‘Once a Caesarean always a Caesarean’, a dictum attributed to Dr E. Cragin, in 1916, at a time when the Caesarean section rate was only about 1% and most were by the classical technique! This paper reports impressive results from a centre where electronic fetal heart monitoring and X‐ray pelvimetry were not available. The elective Caesarean rate (28.2%) was low and 82% of those having a trial of labour delivered vaginally — the incidence of uterine rupture was 0.7% (2 of 288), but readers please note that in this series trial of scar was not performed if induction of labour was required, and there was no oxytocin augmentation in cases of dysfunctional labour — 59% of the 401 patients with a previous Caesarean were delivered vaginally. Readers may be interested to compare these results with those at the Mercy Maternity Hospital, 1971–1984 — of 3,524 patients with a previous Caesarean section 2,337 (66.3%) had an elective Caesarean and trial of vaginal delivery was attempted in 1,187 (33.7%). Vaginal delivery occurred in 895 patients i.e. in 75.4% of those having a trial of scar which was only 25.4% of the 3,524 patients with a previous Caesarean. Uterine rupture occurred in 10 of the 1,187 patients having a trial of scar; the price paid (by fetus, mother and obstetrician) for vaginal delivery after previous Caesarean section can be excessive.

Summary: Many studies from developed countries have shown that a trial of vaginal delivery after a Caesarean section can be a safe alternative to repeated Caesarean section when certain criteria are fulfilled. However, few data are available from developing countries where, in most cases, there is no electronic fetal heart rate monitoring, no information about the prior section and no X‐ray pelvimetry. At Gweru Hospital, 401 patients with a scarred uterus have been managed according to a standard protocol and 288 were allowed to have a trial of scar. The results show that the trial was successful in 235 mothers (82%) and there were only 2 uterine ruptures (0.7%). Postpartum morbidity was higher after Caesarean section than after vaginal delivery.