bluuebunny/crossref_metadata_2025 huggingface dataset:
A Randomized Controlled Trial in a Hospital Population of Ultrasound Measurement Screening For the Small For Dates Baby
Authors: Duff G.B.
Published: February 2008

Summary: Poor fetal growth is an important cause of perinatal mortality and morbidity. Based on the hypothesis that early diagnosis of fetal growth problems leads to more appropriate management and therefore, improved outcome, a randomized controlled trial of ultrasound measurement was performed on 1,528 women booked though a hospital antenatal clinic This compared a number of perinatal outcomes between the group who had a routine 2‐stage examination (early dating and 34‐week scan) and a group who had only a dating scan and then additional scans as generated by their clinical situations. No significant differences could be found between the groups when these perinatal outcomes were considered. These results mirror previously published randomized controlled trials. Selection of women for third trimester ultrasound examination for suspected fetal growth problems should be based on careful clinical assessment and should not be routine.
Urinary N‐Acetyl‐β‐D‐Glucosaminidase in the Prediction of Preeclampsia and Pregnancy‐induced Hypertension
Authors: Jacob Molly , Wilfred G. , Kanagasabapathy A. S. , Balasubramaniam N.
Published: February 2008

Summary: Urinary N‐acetyl‐ β‐D‐glucosaminidase was estimated in 109 primigravidas and the level correlated with the subsequent development of preeclampsia and pregnancy‐induced hypertension in these women. The enzyme value was significantly higher in those who developed preeclampsia. Its sensitivity and specificity for the prediction of the disorder were 80% and 78% respectively. The positive predictive value was 21% while the negative predictive value was 98%.
Women with a Pelvic Mass ‐ When to Perform an Ultrasound
Authors: Dowd Jennifer R. , Quinn Michael A. , Rome Robert , Koh Hoon
Published: February 2008

Summary: A retrospective study of 264 patients with a pelvic mass who had a preoperative serum CA 125 level performed was undertaken to compare the sensitivity, specificity and predictive values of this test as a predictor of malignancy, compared with clinical impression and ultrasonography (USG). The values were calculated for each parameter alone and in combination, and the effect of menopausal status, histological type and stage of disease was also assessed. The results indicate that in postmenopausal women with a pelvic mass, a CA 125 level should be performed and the patient referred to a gynaecological oncologist if the value is raised. In contrast both CA 125 and USG should be performed in the premenopausal woman to allow appropriate referral. In this study a CA 125 level of 35 u/ml or more correctly identified malignancy in 90% of postmenopausal women.
Staphylococcal Septicaemia After Endometrial Destruction
Authors: Maher Chris , McLaughlin John , Kelsey Geoff , Cave Don , Haran Mano
Published: February 2008

Summary: Two cases of staphylococcus aureus septicaemia secondary to endometritis following endometrial destruction are presented. After surgical endometrial destruction, endometritis has been reported rarely, but there are no previous reports of staphylococcal septicaemia.
Detection of Human Papilloma Virus (HPV) Infection in Paraffin‐embedded Tissues of Endometrial Carcinoma
Authors: Wong W. S. F. , Wong Y. F. , Tam O. S. P. , Tarn J. S. L.
Published: February 2008

Summary: Although human papilloma virus (HPV) associated lesions constitute a well recognized clinical entity in the female lower genital tract, namely vulva, vagina and cervix, few studies have demonstrated HPV infection in other genital sites, particularly in the ovary and uterine corpus. Recently, with the highly sensitive polymerase chain reaction (PCR) technique, HPV infections were found in an ovarian tumour and adenocarcinoma of the cervix. This prompted a retrospective analysis of HPV DNA in 22 cases of endometrial adenocarcinoma in order to investigate the possible carcinogenesis of HPV in the uterine corpus. In this study DNA extraction was performed from paraffinized cancerous tissues and the normal cervical counterpart. HPV 6, 11, 16 and 18 primers specific oligonucleotides were used in PCR to detect the presence of this oncogenic virus. HPV 16 DNA was found in 1 endometrial adenocarcinoma and 4 cervical tissues. Our result did not support the aetiological role of HPV in the carcinogenesis of endometrial carcinoma.
Withdrawal from a Donor Insemination Programme
Authors: Danesh‐Meyer Helen V. , Gillett Wayne R. , Daniels Ken R.
Published: February 2008

Summary: The aim of this study was to examine the factors that influenced the withdrawal of couples from a regional donor insemination programme. Demographic, medical, treatment and outcome data were prospectively recorded on 375 referrals. One hundred and eight women had conceived at least 1 normal pregnancy. Withdrawals from the programme, without pregnancy, accounted for 165 couples, whilst 47 had begun treatment, and a further 29 were on the waiting list. Thirty nine (24%) of those withdrawing did so without notice or reason. Most of these (33) were in couples waiting to begin treatment. Natural conception, adoption, identifiable medical or social reasons (including separation) and moving to another region were the predominant causes for withdrawing. Women who had entered the programme because of their partner's oligospermia had a high natural conception rate. Age, socioeconomic status, geographic location and length of infertility did not affect the withdrawal rate.
Limitations of CA125 in the Preoperative Evaluation of a Pelvic Mass: Struma Ovarii and Ascites
Authors: Leung Y. C. , Hammond I. G.
Published: February 2008

Summary: This report discusses the limitations of using the serum tumour marker C A 125 in the preoperative evaluation of a woman presenting with a pelvic mass. We present 2 cases of benign struma ovarii which were associated with elevated levels of CA 125.
Intrapartum Cardiotocography and the Expert Witness
Authors: Umstad Mark P. , Permezel Michael , Pepperell Roger J.
Published: February 2008

Summary: Fetal heart rate changes occur in the majority of labours and correlate poorly with perinatal outcome and subsequent neurological development. Obstetricians giving expert evidence related to the interpretation of intrapartum cardiotocographs are advised to exercise caution when expressing their opinions.
Clomiphene Citrate and Pregnancy Outcome
Authors: Venn Alison , Lumley Judith
Published: February 2008

Summary: Data from Australia and elsewhere have shown consistently that adverse perinatal outcomes such as preterm birth and perinatal mortality are more common in pregnancies resulting from assisted conception with IVF and GIFT than normally conceived pregnancies. Factors that may contribute to the excess of poor outcomes include maternal factors, the assisted conception procedures themselves and possibly the influence of drugs used to induce superovulation. This review examines the medical literature describing pregnancies following ovulation induction with one of the drugs used to induce superovulation, clomiphene citrate, and compares their outcomes with Australian IVF and GIFT pregnancy outcomes.

The review shows that whilst some studies have suggested higher rates of ectopic pregnancy, spontaneous abortion and congenital malformations in clomiphene citrate induced pregnancies, the findings are inconsistent and the data are flawed. There are only very poor data available on the incidence of preterm birth. Multiple pregnancy is a well‐recognized adverse outcome of clomiphene citrate induced pregnancies. Attempts to improve perinatal outcomes of pregnancies following assisted conception will be helped by a better understanding of the relative contributions of maternal and treatment factors and further studies of pregnancy outcome after ovulation induction are needed.
EMACO in High Risk Gestational Trophoblast Disease ‐ The Australian Experience
Authors: Quinn M. , Murray J. , Friedlander M. , Steigrad S. , Khoo S. , Marsden D. , Hammond I. , Jobling T.
Published: February 2008

Summary: Sixty‐five patients with high‐risk trophoblast disease have been treated with the EMACO combination split regimen therapy in the 10 year period, 1981 to 1990. Four patients died but the remaining 61 (94%) remain free of disease up to 10 years later. Toxicity was manageable in most cases with minimal delay in treatment from myelosuppression. EMACO is a well tolerated regimen with a high cure rate in patients with high‐risk gestational trophoblast disease (GTD).
Beta HCG Levels after Conservative Treatment of Ectopic Pregnancy: is a Plateau Normal?
Authors: Thompson G.R. St.J. , O'Shea R.T. , Harding A.
Published: February 2008

Summary: In 32 women with unruptured tubal ectopic pregnancies we undertook conservative laparoscopic treatment [local injection of 20 mg methotrexate (n = 18), laser salpingotomy (n = 14)]. The results of serial quantitative beta HCG measurement were followed until either a negative level was reached or until rising levels necessitated alternative/additional therapy. Plateaued values of beta HCG were observed in both the successful (n = 16) and the unsuccessful cases (n = 5).

To test the hypothesis that daily variation in the assay could account for some or all of the observed plateaued results in successful cases, the sera were retested serially on the same ‘run’. In only one case did laboratory variation account for the observed plateau. The clinical implications of the findings are discussed. We conclude that serially monitored beta HCG results after conservative treatment of ectopic pregnancy may show plateaued values without indicating failure of treatment.
What the Breast Does for the Baby, and What the Baby Does for the Breast
Authors: Short R. V.
Published: February 2008

Summary: Breastfeeding is nature's effective method of child‐spacing, proovided that feeding is exclusive and prolonged. Yet, its popularity has been limited in modern societies for a range of cultural, social and medical reasons. It is a matter of surprise and regret that no medical specialty has claimed overall ‘ownership’ of the physiology, function, pathology and management of this conspicuous organ, the female breast. The breast has major benefits for the baby in protecting against debilitating diarrhoea, necrotising enterocolitis and certain allergies, as well as providing highly specific nutritional requirements for the human neonate. It is less widely appreciated that, in addition to its major child‐spacing benefits for the mother, breastfeeding also provides major protection against the development of breast cancer, up to 50% reduction in incidence in one study. Few other measures can approach this.
The Menopause: When It Is All Over or Is It?
Authors: Burger Henry G.
Published: February 2008

Summary: The menopause is defined rigorously as the cessation of menstruation as a result of ovarian follicular depletion. Although in common clinical usage, the term is used to encompass the menopausal transition, a period which may average 4 years in duration, and during which alterations in menstrual regularity and/or flow may be accompanied by somatic or psychological symptoms. Measurement of serum follicle‐stimulating hormone (FSH) with or without oestradiol (E2) is frequently advocated as providing a useful indicator of menopausal status.

Several studies have shown an increase in serum FSH, with or without decrease in E2, in women over the age of 40 years who continue to cycle regularly. Abrupt fluctuations in serum FSH and E2 may be observed, with typically post menopausal levels subsequently returning to the normal reproductive range. In a cross sectional study, of regularly cycling women randomly selected from the Melbourne community, and over the age of 45 years, 7% had FSH levels typical of the post menopause, and 39% had levels above those found during the follicular phase in women aged less than 35 years. It is concluded that serum FSH is of little diagnostic value in the assessment of menopausal status, which can currently be made only on clinical grounds. An elevated serum FSH level cannot tell us reliably ‘when it is all over’.
Practical Problems Which Women Encounter with Available Contraception in Australia
Authors: Weisberg Edith
Published: February 2008

Summary: Australian women face major difficulties with contraception because of the limited range of choices, the need for meticulous attention to compliance with most available methods and because of cost limitations for a significant minority of the population. The most commonly used methods are oral contraceptive pills and barrier methods, and each has substantial compliance problems which can be minimized with care and counselling. There is an urgent need for a wider range of options in Australia and for good information and publicity about them. Present progress in this direction gives some hope for the near future.
Contraceptives of the Future in the Light of HIV Infection
Authors: Short R.V.
Published: February 2008

Summary: The AIDS and sexually transmissible disease pandemics have helped to focus the world's attention on the need for good protection against transmission of infections during sexual intercourse. Most of the highly effective modern contraceptives provide only limited protection against STD transmission, although recent progress with the development of loose‐fitting plastic male condoms and new spermicides gives some hope. Urgent attention must continue to be given to contraceptives with STD protective qualities which are under the woman's control. Refinements of the female condom and vaginal sponges with new spermicides and microbicides may be a step in this direction.
Prostaglandins and Biological Control of Cervical Function
Authors: Calder Andrew A.
Published: February 2008

Summary: The uterine cervix is a vital structure for the success of pregnancy. It must remain firmly closed to contain the developing conceptus within the uterus until the fetus has grown to a stage of maturity appropriate for extra‐uterine survival. During the birth process itself, the cervix must undergo the rapid opening known as dilatation to allow the fetus to travel through the birth canal with a minimum of stress and trauma.

The process of cervical dilatation must be preceded by the phenomenon of effacement whereby the substance of the cervix shortens and thins out. Both effacement and dilatation would be impossible unless the dense fibrous connective tissue of the cervix had undergone a radical modification. Cervical ripening requires a change of the collagen within the cervical stroma from a highly organised network of tightly bound collagen fibrils to a much looser arrangement whereby the tissue becomes more compliant. This is associated with profound changes in the composition of the ground substance of the cervical stroma with an alteration in the concentration and type of glycosaminoglycans (GAGs) which constitute the proteoglycan complexes.

It was formerly assumed that these changes were under the control of those cellular elements within the cervical stroma (fibroblasts and smooth muscle cells) but it seems quite possible that the ripening process is associated with an infiltration of inflammatory cells especially neutrophils. Currently much interest is centering on the possible role of cytokines such as interleukin‐8 and there may also be a role in cervical ripening for leukotrienes. What is beyond dispute however is that prostaglandins, especially prostaglandin E2, are intimately concerned in the biological control of cervical ripening. This can be exploited clinically by using PGE2 to ripen the cervix and it also has implications for the prevention of pre‐term delivery by resort to inhibitors of prostaglandin synthesis.

The role of prostaglandins in these processes and the additional factors which control their activities have been the subject of much investigation in recent years but further progress in understanding these phenomena will be essential before the clinician can control the processes of pregnancy and parturition more effectively.
Maintenance of High Risk Pregnancies: Role of Prostaglandins and Other Mediators
Authors: Gillin A. G.
Published: February 2008

Summary: The initiation of a complex cascade of events resulting in the delivery of a healthy newborn appears to involve the integrated actions of the fetus, mother and the placenta. Many putative factors have already been extensively reviewed. Instead of concentrating on the action of estrogen and progesterone, the role of regulators of myometrial activity such as prostaglandins as well as the fetal pituitary‐adrenal system, oxytocin, corticosteroids, leukotrienes, platelet activating factor, endotoxin and cytokines to name a few, will be discussed. Nevertheless, there is an increasing weight of evidence suggesting that many of the above agonists converge upon a final pathway of prostaglandin production which subsequently increases myometrial responsiveness. Prostaglandins are involved at levels of myometrial regulation such as myometrial gap junction formation, intracellular calcium flux modulation, synchronisation of myometrial contraction via interaction with oxytocin thus having stimulatory effects on uterine contractility, as well as cervical maturation (via PGE2).

Importantly, there has been clinical benefit of a more thorough understanding of the physiology of rnyometrial regulation at the time of partuition. The approach to the treatment of preterm delivery has improved, eventhough the exact mechanism(s) and cause(s) of this phenomenon remain an enigma. Current tocolytic therapy is not generally prophylactic but commences after labour, contractions and cervical dilatation are underway. Key regulatory pathways have been pin‐pointed that present opportunity for tocolysis including:‐ c‐AMP inhibition of contraction by (3‐mimetic agents, inhibition of calmodulin‐calcium function, inhibition of calcium influx by calcium channel blockers, inhibition of prostaglandin production, modulation of rnyometrial function by peptide hormones or antagonists (e.g. relaxin, VIP and oxytocin antagonists). New pathways and regulators may lead to further specific therapy. For example, Platelet Activating Factor may be one area of increased consideration; Changes in intracellular calcium concentrations in uterine muscle are clearly important in muscle contraction and Platelet Activating Factor increases cytosolic calcium concentration.
Strategic Planning of Obstetric Services: The Australian Way
Authors: Sweet Ross
Published: February 2008

Summary: This paper presents a number of documents developed at State and Territory Government level including the ‘Shearman Report’ concerning the strategic planning of obstetrical services. The papers are presented in chronological order. The aims, objectives and implementation arising from the reports are discussed including the mechanism by which the various studies were undertaken. The author acknowledges the existence of the many other reports relating to strategic planning for obstetrical services which were not able to be discussed due to the constraints of the presentation.
Caesarean Section: An Audit of Time‐Based Efficiency in Providing a Clinical Service
Authors: Clark F.L.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication to encourage all our readers who practise obstetrics to examine the situation which obtains in the hospitals where they practise obstetrics to see if emergency Caesarean sections are performed within a reasonable time of the decision to deliver abdominally being made. Lance Townsend's favourite dictum that ‘clinical scrutiny improves performance without the need for witch hunt’ is supported by the findings in this paper. It may be noted that in the author's hospital the theatre was incorporated within the labour ward which unfortunately is not the case in many institutions, even level 3 hospitals. It seems obvious that Caesarean section when ordered can be performed quicker when the patient does not need to be shifted very far especially to another floor where a journey in a lift and the availability of a theatre orderly is a requirement. Availability of anaesthetic equipment and staff in conventional operating theatres is often a factor since it is claimed that an effective service cannot additionally be provided within the labour ward environment. These considerations should be considered in all hospitals where obstetrics is practised. Having visited a number of obstetric units in Australia and abroad in small and large hospitals it is the observation of the Editor that ironically the smaller the hospital the more likely it is to be able to perform a Caesarean section within the labour ward or in an operating theatre close‐by.

Summary: An audit of the time taken to deliver a baby by emergency Caesarean section was conducted at a District General Hospital in Norfolk, U.K. An assessment was made of reasons for delay in delivering a potentially compromised fetus, and a follow‐up audit showed an improvement in time‐based efficiency that was marginally significant. Median decision to deliver until delivery time in Audit 1 was 40 minutes and at follow‐up in Audit 2 was 31 minutes, p=0.068 (Wilcoxon Rank Sum Test). Discussion of these results by an interdepartmental obstetric, midwifery and anaesthetic meeting concluded that, (a) continuous audit of efficiency should be implemented and, (b) the major factor needed to effect efficient and safe delivery was clear, ‘level headed’, directive leadership by the senior medical staff on duty.
Sheehan Syndrome: An Analysis of Possible Aetiological Factors
Authors: Ammini A.C. , Mathur S.K.
Published: February 2008

EDITORIAL COMMENT: This condition is rare but the message is clear. These cases require a high index of suspicion to allow diagnosis before the woman is in dire straits. In 1962 the editor visited Professor Sheehan in Liverpool to discuss follow‐up of women who had had haemorrhagic shock to seek cases of pituitary failure. Professor Sheehan said to write letters to all the women who had required intensive resuscitation, then discard the names of those who answered the letter, and start to search for the remainder! At that time women with undiagnosed pituitary necrosis descended the social scale and tended to lack the application to seek medical assistance. Fancy seeing 12 cases of Sheehan syndrome in 1 hospital within 2 years! The problem of diagnosis remains. In this series the mean time from delivery to diagnosis was 5 years. The Editorial Committee members are doubtful if the recommendation in the last sentence of the summary is realistic because there is no simple screening test available for diagnosis of pituitary necrosis at the postpartum visit. The editor arranged for histories of all women with panhypopituitarism seen in 3 major teaching hospitals in Melbourne to be reviewed. There were 43 cases and review of the histories showed that none were cases of postpartum pituitary necrosis although one endocrinologist stated that he had seen 1 case of Sheehan syndrome diagnosed in the past 10 years. Apparently gonadotropin and prolactin secretion are the first hormone deficiencies that show up and early testing should be directed towards patients with amenorrhoea and lactation failure.

Summary: Clinical features and obstetric care factors of aetiological importance were analyzed in 12 cases of Sheehan syndrome seen during the years 1992–1993. Eight patients were from urban areas. Eight of them were multiparas. Half of the patients had had hospital deliveries. The average duration between the onset of symptoms and diagnosis was 5 years. Patients were misdiagnosed as having general debility, hypothyroidism or unexplained amenorrhoea. Amenorrhoea, lactation failure, loss of body hair and signs and symptoms suggestive of hypothyroidism were present in most cases. Sheehan syndrome could be diagnosed on clinical grounds in our patients. We recommend that all women with peripartum complications should be followed in a postpartum clinic for early evidence of hypopituitarism.
Ultrasound‐Guided, Transabdominal Needling and Methotrexate Instillation as Treatment for Ovarian Ectopic Pregnancy Following an IVF Treatment Cycle
Authors: Hurley Victor A. , Leoni Maria A. , Coniglio Stella T.
Published: February 2008

Summary: A case of ovarian ectopic pregnancy associated with ovarian hyperstimulation following in vitro fertilization and embryo transfer is reported where potentially dangerous conventional forms of treatment were avoided by the use of transabdominal ultrasound‐guided needling and methotrexate instillation.
Heterotopic Pregnancy After Natural Conception Exhibiting the Ultrasound Signs of Antegrade and Retrograde Tubal Bleeding
Authors: Bowditch John D.P.
Published: February 2008

Summary: Heterotopic pregnancy is being encountered more commonly after assisted reproductive techniques. A case of heterotopic pregnancy after spontaneous conception is reported. Clinician based ultrasound to reveal an indirect ultrasound sign suggesting the condition was utilized. The case was managed successfully by laparoscopic partial salpingectomy.
Prediction of Caesarean Section from Ultrasound and Clinical Assessment of Fetal Size
Authors: Stock Anthony , Ming Wong Wai , Rogers Michael , Chang Allan MZ
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because the authors have explored the possible value of ultrasound versus clinical assessment of fetal size to see whether they can predict the need for Caesarean section when the baby is large. In this study both the ultrasound and the clinical assessment were impressively accurate and fetal femur length was the most accurate of the ultrasound parameters in assessing fetal weight in predicting the need for Caesarean section. However, as the authors indicate, none of these methods of assessment of fetal size are recommended as an absolute indication for Caesarean section. Every obstetrician uses clinical assessment of the fetus when evaluating management of the patient but the need for clinical judgment remains.

Summary: One hundred and five women with singleton pregnancies and cephalic presentation were assessed. Fundal height and a clinical estimate of fetal weight were recorded. The fetal biparietal diameter, abdominal circumference and femur length were measured with ultrasound. Ultrasound estimated fetal weight was calculated using 3 different formulas (Shepard, Campbell and CUHK). The liquor volume was assessed using the amniotic fluid index.

Ultrasound was able to predict Caesarean section with more reliability than clinical assessment of fetal size or weight. The biparietal diameter, fundal height and amniotic fluid index were poor predictors of mode of delivery. The measurements which best predicted the mode of delivery were the fetal femur length and abdominal circumference. Femur length, but not abdominal circumference, was a statistically better predictor of Caesarean section than clinical estimation of fetal weight. There was no improvement in prediction using ultrasound estimated fetal weight.
A Perinatal Audit of Stillbirths in a Teaching Hospital in Hong Kong
Authors: Lau T. K. , Li C. Y.
Published: February 2008

EDITORIAL COMMENT: We have accepted this paper for publication became of the excellence of the results obtained in Hong Kong. We have previously reported in this Journal the low incidence of prematurity in Hong Kong and other Asian countries and this may be an important reason why the results published here are superior to those reported from Victoria (A). In Victoria in 1991 the stillbirth rate using the 500 g birth‐weight criterion was 5.8 per 1,000 total births and in 1992 the figure was 4.9 per 1,000. In 1992 the perinatal mortality rate in Victoria was 7.8 per 1,000 births which was a remarkable improvement on 1991 when the figure was 9.2 per 1,000. Perinatal mortality rates in teaching hospitals in Australia are almost double those of the State as a whole. For instance in the triennium 1987–1989 the perinatal mortality rate at the Mercy Hospital for Women was 14.7 per 1,000 total births. This is explained by referral of high‐risk patients especially women in premature labour or with premature rupture of the membranes. Deliveries between 20 and 28 weeks' gestation accounted for 45% of the perinatal deaths in the Mercy Hospital for Women figures referred to above for the 1987–1989 triennium. These figures are given to emphasize the excellence of the perinatal results reported in this paper from a level 3 hospital with a very high proportion of nonbooked patients. The authors were asked to include a statement about the number of terminations done for malformations of babies weighing less than 500 g at birth since this could have a potent influence on the stillbirth rate. For comparison in 1991 in Victoria there were 375 stillbirths (5.8 per 1,000 births) but excluded from this total were 138 terminations of pregnancy after prenatal diagnosis of a malformation before 20 weeks' gestation.

Summary: In a 5‐year period, the stillbirth rate in a teaching hospital in Hong Kong was 4.4 per 1,000 total births, which accounted for 61% of the perinatal deaths. The stillbirth rate was 5.8 times higher in twin pregnancies, and 17 times higher in triplet pregnancies. One quarter of the patients were nonbooked, and 14.5 % had no antenatal care. The stillbirth rates were 3.8 and 8.0 per 1,000 among the booked and nonbooked cases respectively. The major causes of stillbirths were congenital abnormalities, haemoglobin Bart disease, abruptio placentae and gestational diabetes. No specific cause could be found in 46% of cases. There were 31 intrapartum deaths, of which 5 were potentially salvageable.
The Obstetrician and the Extremely Immature Fetus (24–26 weeks): Outcome to 5 Years of Age
Authors: Doyle Lex W. , Permezel Michael , Ford Geoffrey W. , Knoches Annette M.L. , Rickards Anne L. , Kelly Elaine A. , Cailanan Catherine
Published: February 2008

Summary: The aims of this study were to determine the outcome to 5 years of age for fetuses 24–26 weeks of gestational age from the obstetric viewpoint, and to determine if their outcome has improved over time. Consecutive fetuses with gestational ages from 24–26 weeks born at the Royal Women's Hospital, Melbourne, during 2 separate eras, Era 1 (1977–1982; n = 198) and Era 2 (1985–1987; n = 128) were studied and their outcome to 5 years of age determined. Fetuses referred with lethal malformations or clearly dead before the onset of labour were excluded. The stillbirth rates were similar in both eras (Era 123.7%, Era 2 21.9%), but the proportion of survivors to 5 years of age was much higher in Era 2 (Era 1 19.7%, Era 2 30.5%, X2= 5.0, p<0.03; odds ratio 1.80; 95% confidence interval [CI] 1.07 to 3.04). Overall, both the proportion and the absolute number of severely disabled children fell over time; 4 children survived with severe sensorineural disability in the 5¼ years of Era 1, but only one child in the 3 years of Era 2. From the obstetric viewpoint, only 1.5% of total births survived with a severe sensorineural disability, no higher than the rate expected for children born at term. Fetuses born at 24–26 weeks of gestational age need not contribute disproportionately to the number of severely disabled children in the community; furthermore, their outcome is improving over time. From the obstetrician's viewpoint, survival chances rather than sensorineural outcome should dominate decision‐making at these extremely preterm gestations.
Stage 1 Endometrial Cancer: Treatment Modalities and Factors Influencing Recurrence
Authors: Foote Andrew J. , Proietto Anthony
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because the results of treatment of a group of women with Stage I endometrial cancer may interest readers. Although the overall 5‐year survival rate in this series of 93% is good, the paper does not provide statistically significant information regarding which patients with Stage 1 endometrial cancer warrant irradiation of the vault or of the pelvis following operation. The paper confirms other reports stating that the poorly differentiated lesion or the one that invades the myometrium has a worse prognosis. The Australian collaborative trial on the treatment of women with endometrial cancer has been concluded and we look forward to reading whether this larger study can give a clear indication of whether patients with endometrial cancer are better treated with pelvic lymphadenectomy or postoperative irradiation and whether Provera is useful adjuvant therapy in those who are shown to have high‐risk Stage 1 disease (deep myometrium invasion and/or a poorly differentiated lesion).

Summary: One hundred and nineteen patients treated for FIGO Stage 1 endometrial adenocarcinoma were reviewed retrospectively to determine if adjuvant radiotherapy reduced disease recurrence. The patients had all been treated in the Hunter Region of New South Wales over a 10‐year period from 1978 to 1988. Median follow up was 82 months with a range of 24 to 163 months. Treatment consisted of surgery alone (75.6%), surgery and brachytherapy (17.6%), surgery and megavoltage therapy (4.2%), and surgery with both brachytherapy and megavoltage therapy (2.5%). The overall recurrence rate was 10.1%. Recurrence at the vaginal vault alone occurred in 3.4%. The median time to recurrence was 25.0 months. A statistically significant correlation was found between overall recurrence risk and poorly differentiated lesions (p < 0.0001). Just failing to reach statistical significance were age over 70 years (p < 0.06) and patient weight less than 70 kg (p = 0.06). Depth of myometrial invasion (p = 0.17), use of adjuvant radiotherapy (p = 0.17) and uterine cavity size (p = 0.48) were not significantly correlated with risk of recurrence. The 5‐year survival rate was 93.8%.
Transcervical Resection of the Endometrium Using Intracervical Block Only A Review of 278 Procedures
Authors: Ferry James , Rankin Lloyd
Published: February 2008

Summary: The objective of this study was to assess the efficacy and safety aspects of performing transcervical endometrial resection (T.C.R.E.) on a selected group of 278 patients with menstrual disorders under local analgesia (intracervical block) only. Patient acceptance of the procedure was high, with only 3 cases not completed due to insufficient analgesia (1.07%), although a further 9 (3.2%) were completed with the help of intravenous sedation. Patient satisfaction at 4 months was 90%. There were 4 perforations (1.4%), but no laparotomy was required. Five cases (1.7%) of haemorrhage required a Foley catheter, with 1 needing a transfusion. There was no case of clinically evident glycine overload. Twelve patients required an overnight stay.

Patient acceptance of T.C.R.E. under local analgesia, and the incidence of major complications, compared favourably with other published series, including a series of 330 cases performed concurrently by the same operators under general anaesthesia.
Endocervicosis of the Urinary Bladder
Authors: Seman E.I. , Stewart C.J.R.
Published: February 2008

Summary: A further case of endocervicosis of the urinary bladder is described. It is important that gynaecologists and pathologists be aware of this entity and its possible relationship to previous Caesarean section to avoid confusion with a neoplastic process.
Ultrasound‐Guided Fetal Intravascular Transfusions for Severe Erythroblastosis, 1984–1993
Authors: Sampson A.J. , Permezel M. , Doyle L.W. , de Crespigny L. , Ngu A. , Robinson H.
Published: February 2008

Summary: The results of the first 10 years' experience in ultrasound‐guided fetal intravascular transfusions at the Royal Women's Hospital were reviewed. Since the first transfusion, a variety of techniques have been employed in 78 fetuses, all with severe erythroblastosis. A total of 288 intrauterine transfusions have been attempted with an overall survival rate of 75.6% (59 of 78). The overall survival rate for delivered fetuses improved from 64.3% (18 of 28) in 1984–1987, to 82.0% (41 of 50) in 1988–1993. There was a total of 33 hydropic fetuses, of whom 20 (60.6%) survived, significantly fewer compared with 86.7% (39 of 45) of the nonhydropic fetuses (odds ratio {OR] 0.25, 95% confidence interval [CI] 0.09 to 0.70, p <.01). Fetuses who were sicker at the time of transfusion, as reflected by larger haemoglobin deficits, had lower survival rates, as did those requiring transfusions at earlier gestational ages. When these variables were allowed for, the survival rate significantly improved over time (OR 6.3, 95% CI 1.3 to 30.4, p<0.05), probably reflecting the increased skill of the ultrasonologists, but the presence of hydrops per se was no longer important. Variations of the technique employed, such as exchange or intraperitoneal transfusion, or different sites for transfusion, were not significantly related to survival. Ultrasound‐guided fetal intravascular transfusions are associated with good fetal outcome, even in the most severe cases of erythroblastosis.
A Safer and More Effective Treatment Regimen for Eclampsia
Authors: Bhalla A.K. , Dhall G.I. , Dhall K.
Published: February 2008

Summary: In a prospective controlled trial 91 consecutive women with eclampsia were randomly allocated either to a magnesium sulphate and nifedipine regime or to a lytic cocktail and nifedipine group. The type and severity of disease, details of labour and delivery, and the maternal and perinatal outcomes and complications related to the 2 treatment regimens were compared. Recurrence of fits, aspiration pneumonia and sudden hypotension were signficantly reduced when patients were treated with the new magnesium sulphate and nifedipine regimen compared with the lytic cocktail plus nifedipine regimen. No patient treated with the new regimen died or had respiratory depression; in the other group there were 2 maternal deaths plus 1 case of severe hypoxic brain damage. No difference was observed in duration of labour or mode of delivery. Perinatal mortality was significantly lower in the magnesium sulphate plus nifedipine treated group. The synergistic action of magnesium sulphate and nifedipine in the dosage employed in this study may be used to reduce maternal and perinatal mortality and morbidity in women with eclampsia.
Unusual Contents of a Dermoid Cyst of the Ovary Removed by Laparoscopy
Authors: Erian Mark M.
Published: February 2008

Summary: Benign cystic teratoma (dermoid cyst) of the ovary is a common pathological entity. Usually, the cyst contains representative tissues of the 3 embryonic germ cell layers: ectoderm, mesoderm and endoderm. Sebaceous material, hairs, cartilages, teeth, even thyroid tissue are frequently observed. In this case, the tumour was a well‐formed jaw and tongue, and was successfully removed via the laparoscope.
Uterine Arteriovenous Malformation ‐ A Rare Cause of Uterine Haemorrhage
Authors: Manolitsas Tom , Hurley Victor , Gilford Eric
Published: February 2008

Summary: Uterine arteriovenous malformation (AVM) is a rare cause of massive uterine bleeding, with 70 cases reported in the English literature. Although uterine AVM is a rare cause of menorrhagia or postmenopausal bleeding, it is important to consider in the assessment of a patient with abnormal (especially heavy) uterine bleeding because accurate diagnosis can allow appropriate treatment to be planned and avoid hysterectomy in women who wish to retain their reproductive capacity. Until relatively recently this condition was difficult to diagnose and management almost always required hysterectomy. Special investigations (hysteroscopy, Doppler flow ultrasound and pelvic angiography) are important for diagnosis and assessment. Transcatheter embolization has replaced hysterectomy as the treatment of choice in women who wish to retain their fertility. Curettage may precipitate life‐threatening haemorrhage and is therefore contraindicated when uterine AVM is suspected.
Unknown Uterine Sears, Unknown Risks
Authors: Lau T. K. , Chan F.
Published: February 2008

EDITORIAL COMMENT: We accepted these case reports for publication not only to remind readers that a classical Caesarean scar is more likely than a lower uterine segment scar to rupture or dehisce, but also to stress that women should be counselled appropriately when classical Caesarean section has been performed. Our Australian population is also mobile and women may not return to the same institution or obstetrician for their next confinement. Tracing the details of a previous delivery from another hospital or practitioner even in the same community should be a routine enquiry when a patient has had a Caesarean section in a previous pregnancy but the required information is often difficult to obtain. The woman herse(fis the essential repository for this information. It should also be noted that the recent increase in the number of Caesarean sections performed for fetal indications before 30 weeks' gestation has resulted in more vertical incisions because of a poorly formed lower uterine segment.
A Letter of Importance
Authors: Buttery Beresford , Davison Gregory , Hurley Victor , Crespigny Lachlan De , Robinson Hugh P.
Published: February 2008

EDITORIAL COMMENT: We have published this letter in the position of an article to make sure that readers do not overlook it. The letter is signed by a number of specialist medical obstetrician ultmsonologists in Melbourne and they clearly state a different point of view to that expressed by Burrows, Ramsden and Frazer. (Aust NZ J Obstet Gynaecol 1993; 33:262–264).
Variation in Caesarean and Instrumental Delivery Rates in New Zealand Hospitals
Authors: Johnson Neil , Ansell David
Published: February 2008

EDITORIAL COMMENT: There is much data in this paper which we believe should interest readers. The policies established at Middlemore Hospital that have undoubtedly led to the reduction in the Caesarean section rate merit special scrutiny. We agree with the authors that a national perinatal database should be established in New Zealand. This will no doubt require regional centres to maintain their own statistics as is done in the various States in Australia. Hopefully perinatal mortality statistics will use the World Health Organization definitions namely that birth‐weight of 500 g or if birth‐weight is not known, birth after at least 22 weeks' gestation, becomes the criterion for inclusion. Readers should realise that the legal requirements for registration of perinatal deaths vary in different countries and are unsuitable for presentation of statistics. In Australia the statistical definition of neonatal death uses the 500 g birth‐weight criterion as for stillbirth, and includes all deaths occurring within 28 days of birth. If deaths occurring only within 7 days of birth are included this should be stated even although deaths occurring in the first 7 days outnumber those occurring from 8–28 days by about 4:1 (e.g. Victoria, 1992; 151:40 in 65,815 total livebirths).

Summary: A study of Caesarean section and instrumental delivery rates in the maternity hospitals in New Zealand delivering over 1,000 women per year was undertaken. The results at Middlemore Hospital were compared with those seen elsewhere. The Caesarean section rate at Middlemore Hospital in 1993 was significantly lower than the other large maternity hospitals in New Zealand. The Caesarean section rate at Middlemore from 1988 to 1993 has shown a significant downward trend which is different from the trends at other hospitals. The spontaneous vaginal delivery rates at Middlemore Hospital were higher than at other New Zealand hospitals between 1988 and 1993. We conclude that Middlemore Hospital has been successful in maintaining low interventional delivery rates by New Zealand and international standards ‐ the Caesarean section rate remains below 10% and the spontaneous vaginal delivery rate approaches 85%. This is likely to be a consequence of a number of factors operating together but there is evidence to suggest that the obstetric management policies at Middlemore do play a role in this.
Sacrospinous Colpopexy
Authors: Brieger G.M. , MacGibbon A.L. , Atkinson K.H.
Published: February 2008

Summary: Sacrospinous colpopexy is a useful procedure in the cure of pulsion enterocele, high rectocele, and posthysterectomy vault prolapse. It allows the surgeon to correct coincident cystocele and rectocele and permits restoration of a relatively normal and comfortable vaginal depth and axis. It is a quick procedure, avoids intraabdominal trauma, has a high success rate and a low complication rate (1) and is useful in the management of patients who wish to maintain coital function. This paper retrospectively reviews the techniques, results and complications of 107 sacrospinous colpopexies performed in 104 patients over an 8‐year interval.
Successful Pregnancy in the Didmoad Syndrome (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, Deafness)
Authors: Wilson J. Dennis , Moore Geoff
Published: February 2008

Summary: A case of successful pregnancy in a patient with the complete DIDMOAD syndrome is described. Attention is drawn to the need to monitor fluid balance carefully during and after pregnancy in this condition. The current literature in the area is reviewed.
Gynaecological Complications of Women Treated with Tamoxifen for Breast Cancer
Authors: Dew J.E. , Eden J.A.
Published: February 2008

Summary: We present 6 cases illustrating some of the gynaecological complications associated with tamoxifen treatment of women with breast cancer. The first 2 represent cases of myometrial hypertrophy secondary to tamoxifen use, a postmenopausal woman and a premenopausal women with recurrent carcinoma of the breast. The third is a case of probable ovulation induction in a perimenopausal woman with recurrent breast cancer who was commenced on tamoxifen 20 mg daily. The other 3 cases illustrate some of the endometrial effects associated with tamoxifen therapy in women with a history of breast cancer, namely cystic glandular hyperplasia, endometrial polyps and endometrial cancer.
Initial Experience with a New Microlaparoscope 2mm in External Diameter
Authors: Downing Bruce G. , Wood CarJ
Published: February 2008

Summary: The microlaparoscope was used for diagnostic and operative purpose in 20 patients, including 6 GIFT and 2 microoperative procedures. No complications occurred and there was only 1 failure of the technique. Microlaparoscopy was performed successfully under local analgesia in 2 patients. The microlaparoscope may be safer and less traumatic than traditional laparoscopy. The technique is simple, effective and easy to learn. Its current place is mainly in diagnosis but with planned future improvement in instrumentation it will have a place in operative laparoscopy.
A Hepatic Ectopic Pregnancy Treated with Direct Methotrexate Injection
Authors: Nichols C. , Koong D. , Faulkner K. , Thompson G.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication not only because of its rare anecdotal interest but also because it seems to us that if ever an ectopic pregnancy warrants management with direct injection of methotrexate it is when it is attached to areas such as described in this paper where horrendous haemorrhage or damage to the biliary tract could occur as mentioned in the cases reviewed from the literature.

Summary: An ectopic pregnancy of the liver posterior to the porta hepatis and therefore in a surgically hazardous area was successfully treated with injection of methotrexate at laparotomy.