bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Influencing the Selection of Analgesia in Spontaneously Labouring Nulliparous Women at Term
Authors: Dickinson Jan E. , Godfrey Maryellen , Evans Sharon F. , MD John P. Newnham
Published: February 2008

Summary: We investigated the maternal characteristics, labour performance and delivery mode of 497 nulliparas entering labour spontaneously at term to identify the obstetric factors which influenced their choice of analgesia; 51.7% of these women used epidural analgesia. They were shorter (163 versus 165 cm, p=0.002) and the mean gestation was 3 days greater than those not using epidural analgesia (40.2 versus 39.6 weeks, p=0.0007). Median birth‐weight in the epidural group was greater by 155 g (3,450 versus 3,295 gs, p=0.0001). Analysis of the labour characteristics showed a lesser cervical dilatation on admission, significantly longer latent and active phases of labour and second stage length in the epidural cohort. The need for oxytocin augmentation was significantly greater in the epidural group, both prior to and after insertion. Oxytocin augmentation was strongly associated with an increased risk of operative intervention regardless of analgesia. Selection of intrapartum analgesia is not a random event and epidural analgesia appears to be an indicator of abnormal labour patterns. To further investigate the impact of analgesic methods on nulliparous labour we are currently conducting a prospective randomized controlled trial.
Prophylactic Amnioinfusion During Labour Complicated by Meconium
Authors: MD Anju Huria Khosla , MD Krishna Sangwan , MBBS Shanti Devi Ahuja
Published: February 2008

EDITORIAL COMMENT: This study of amnioinfusion during labour complicated by the known passage of meconium shows that the technique seems clinically worthwhile, even in a centre without facilities for electronic fetal heart monitoring or scalp blood pH and blood gas analysis. The series is small and more data from larger studies is required to test the conclusions reported by the authors.

Summary: A prospective study to see the safety and efficacy of transcervical amnioinfusion in labour complicated by meconium‐stained amniotic fluid (MSAF) was carried out in a teaching hospital with limited resources. Fifty patients in labour with meconium‐stained amniotic fluid and fulfilling the inclusion criteria (vertex presentation, gestational age of 36 weeks or more, no medical or obstetrical complications and normal fetal heart rate at time of inclusion) were taken for the study; 25 patients received amnioinfusion. The control group received only supportive therapy. Labour outcome was compared in the 2 groups. The incidence of Caesarean section was seen to be decreased but neonatal parameters showed no significant difference in the amnioinfusion group.
Why We Choose Caesarean Section: A Prospective Study
Authors: Spurrett Brian , Cook Colleen‐M.
Published: February 2008

Summary: We wished to inquire into the reasons why obstetricians choose Caesarean section as the preferred delivery mode and how they make that decision in individual settings. We therefore surveyed obstetricians to ascertain die obstetrical events at the time of the decision and the reasons for the decision. Two hospitals with the same consultant medical staff were chosen for the study, The Jamison Private Hospital and The Nepean Hospital. The study group was analyzed using hospital, classification, parity, whether the procedure was elective or in labour, the stage of labour at which the Caesarean section was performed, and the primary and secondary reasons for the decision.

Six hundred and twenty‐four women were studied. When comparing the 2 institutions, there were 2 statistically significant findings. Firstly, the women at The Nepean Hospital were younger (27.9 ± 5.6) than at Jamison Private Hospital (30.5 ± 4.4; p<0.001). Secondly, in the numbers of women undergoing Caesarean section in the ‘failure to progress’ category, there was a higher incidence (p<0.001) at the private hospital. Apart from these differences, the 2 groups were remarkably similar.
Postpartum Microangiopathic Haemolysis Complicating Severe Preeclampsia
Authors: Sfameni S.F. , Ihle B. , Dobsoni P.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication to remind readers that microangiopathic haemolysis or the HELLP syndrome can present postpartum in women with preeclampsia especially if the condition has been treated conservatively which is usually done in an attempt to gain fetal maturity. It seems to the editorial staff that the take‐away message of this paper is that liver and renal function tests and coagulation studies are necessary in all patients with preeclampsia especially if delivery is to be deferred. Also when microangiopathic haemolysis occurs postpartum it is probably a manifestation of further deterioration of the severe preeclampsia and not due to haemolytic uraemic syndrome or thrombotic thrombocytopenia purpura. The differentiation of these disorders is detailed in the Discussion section of this paper.

The Editor asked the authors to perform an audit of all cases of preeclampsia seen in their institution in a 12‐month interval to provide readers with insight concerning the frequency of severe preeclampsia with or without microangiopathic haemolysis.

Authors'reply: A 12‐month audit of the cases of preeclampsia within our hospital for the year 1995 revealed 128 cases of mild preeclampsia and 130 of severe preeclampsia. In 1995 there were 5,119 deliveries including all booked and nonbooked patients. Of those with severe preeclampsia there were 8 cases of HELLP syndrome, of which 4 occurred postpartum and 3 are presented in this paper. Thrombocytopenia with a platelet count of less than 150,000/L was found in 26 patients. Clearly microangiopathic haemolysis is an uncommon occurrence particularly when it is seen for the first time postpartum.
Human Parvovirus B19 Infection Associated with Hydrops Fetalis
Authors: Cameron A.D. , Swain S. , Patrick W.J.A.
Published: February 2008

Summary: Human parvovirus B19 infection has been associated with fetal anaemia, hydrops and in some cases fetal demise. We report our experience with nonimmune hydrops fetalis due to human parvovirus B19 infection in 17 pregnancies which were identified sonographically over a period of 10 years. The only baby who survived received repeated intrauterine transfusions and was normal neurodevelopmentally at 2 years follow‐up. Two other fetuses who also received intrauterine transfusion did not survive. All pregnancies complicated with nonimmune hydrops should be investigated by fetal blood sampling looking for the evidence of parvovirus infection. Intrauterine transfusion should be reserved for hydropic fetuses with a low haematocrit. A greater understanding of the natural history of human parvovirus infection is needed prior to deciding the optimum mode of therapy.
Effect of Zidovudine Treatment in Late Pregnancy on HIV‐1 In Utero Transmission
Authors: MD Surasak Taneepanichskul , Sirinavin Sayomporn , Phuapradit Winit , Chaturachinda Kamhaeng
Published: February 2008

EDITORIAL COMMENT: This paper was accepted for publication to update readers on the effectiveness of treatment with zidovudine to prevent vertical transmission (mother to child by any route before or after delivery) of HIV infection antenatally. In the ACTG 076 trial referred to in this paper the treatment regimen was antepartum zidovudine (ZDV) (100 mg orally 5 times a day) initiated between 14 and 34 weeks' gestation and continued throughout the remainder of pregnancy, followed by intrapartum intravenous ZDV (loading dose 2 mg/kg, starting in labour followed by continuous infusion 1 mg/kg/hour until delivery), followed by oral administration of ZDV (syrup 2 mg/kg every 6 hours for 6 weeks beginning 8 to 12 hours after birth) to the infant. HIV infection of the infant was defined by 1 positive viral culture obtained from peripheral blood specimens taken at birth, 12, 24 and 78 weeks postpartum. Preliminary results showed HIV infection (at least 1 positive culture) in 7.2% (13 of 180) in the treatment group and 21.7% (40 of 184) in the untreated control group. The present study suggests that a less complex ZDV regimen is effective against vertical transmission since no evidence of HIV infection was found in any of the 50 infants within 48 hours of birth. The authors properly comment that these infants require follow‐up to assess intrapartum and postpartum transmission of HIV, and long‐term side‐effects of the ZDV treatment.

Summary: In Thailand, the prevalence of paediatric HIV‐1 infection has increased rapidly through vertical transmission. According to the ACTG 076 trial regimen, zidovudine treatment in HIV‐infected pregnancy can reduce vertical transmission. However, this treatment is complex and costly. It is not applicable for developing countries. We conducted a study to evaluate the effect of zidovudine treatment in late pregnancy on HIV‐1 in utero transmission. Fifty cases of asymptomatic HFV‐1 infected‐women were voluntarily enrolled to the study. Zidovudine 250 mg orally twice a day was given to these patients from gestational age 36 weeks until labour. The newborns were evaluated at birth by a neonatologist and peripheral blood was tested for HIV genome by PCR technique within 48 hours of birth. The study revealed that no HIV genome was detected from the peripheral blood of newborns. It is suggested that zidovudine treatment in late pregnancy could reduce HIV‐1 in utero transmission.
Transvaginal Sacrospinous Colpopexy ‐A New and Easier Way
Authors: Barker Glen K. , Viggers John C.L. , Mason T. , FRACS G.O. Smith.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it provides useful technical details of another method to place a suture in the sacrospinous ligament in the operation of transvaginal sacrospinous colpopexy. Our urogynaecologist reviewer stated that long‐term review of results is essential to judge any such new technique and that postoperative findings at 6 weeks give no indication even of short‐term outcome. Nonetheless we believe many readers will be interested in this paper.

Summary: Sacrospinous colpopexy is an operation which is gaining wide acceptance for suspending the vaginal vault in a woman with prolapse who wishes to retain the ability to maintain coitus. However, wider use may be prevented by the technical difficulty of the procedure. This article is a review of 63 cases where the operation was performed using a new ‘ENDO STITCH’ method which offers advantages both in ease (because it avoids the necessity of direct visualization of the ligament), and possibly safety (because it avoids the need for retractors).
Ovarian Pregnancy; Relationship to an Intrauterine Device
Authors: Ercal Tijen , Cinar Oya , Mumcu Alper , Lacin Selman , Ozer Erdener
Published: February 2008

Summary: Ovarian pregnancy is a rare form of ectopic pregnancy in which the gestational sac is implanted within the ovary. The incidence is 0.5 to 3% of all ectopic gestations (1). In contrast to patients with tubal pregnancies, traditional risk factors, such as pelvic inflammatory disease and prior surgical procedure upon the pelvis, may not play a role in the aetiology. In the 2 cases reported here, it seems that using an intrauterine contraceptive device was an important factor.
Syphilis Resurgent
Authors: Schramm Mary
Published: February 2008

EDITORIAL COMMENT: Dr Mary Schramm was asked by the editor to provide this editorial to share her unique long‐term experience of the treatment of syphilis during pregnancy with readers. Our recent editorial policy is to highlight important sentences in papers in bold print. This paper contains so many punchlines, mostly objective but some interestingly subjective, that readers are advised to read it all with care, since there were far too many important passages for bold‐print emphasis of all. This editorial expands the report ‘Syphilis in Fiji’ provided by Dr Mary Schramm and published in the Pacific Health Dialog 1996; 3: 2: 216–219.
Fetal Oxygen Saturation Monitoring in Labour: An Analysis of 118 Cases
Authors: East Christine E. , Dunster Kimble R. , Colditz Paul B. , Nath Christa E. , Earl John W.
Published: February 2008

Summary: Fetal oxygen saturation (FSpO2) was recorded during labour to determine the relationship between FSpO2 and indicators of fetal well‐being, including umbilical blood gases, xanthine (X), hypoxanthine (Hx) and Apgar scores. This is one of me largest reported series of fetal pulse oximetry, with 118 fetuses monitored for over 329 hours. Mean FSpO, for all cases was 46.9% (SD=9.1%). There was no correlation between FSpO, during the last 10 minutes of monitoring and arterial pH, Hx or X. A mean FSpO2, ≤ 30% was associated with a 5 minute Apgar score of ≤ 7 in the majority of cases. One fetus had a mean FSpO2, <30% during the final 10 minutes of monitoring and an umbilical arterial pH<7.20, while there were 10 fetuses with an umbilical arterial pH<7.20, and mean FSpO2, ≥ 30%. As these numbers are small, a larger series is necessary to further characterize the small number of fetuses who are significantly hypoxic.
Studies of Postnatal Diabetes Mellitus in Women Who Had Gestational Diabetes
Authors: Wein Peter , Beischer Norman A. , Sheedy Mary T.
Published: February 2008

Summary: An important part of the management of women with gestational diabetes (GD) is their subsequent follow‐up after delivery. At this postnatal visit a glucose tolerance test (GTT) is essential. We have analysed the results of the postnatal GTT's in 2,957 women whose pregnancies were complicated by GD. Diabetes mellitus was diagnosed in 59 women (2.0%) in the first 6 months after delivery. As stated in Part 1 of this paper, 31 of these 59 women may have had unrecognized prepregnancy diabetes mellitus. The significant independent predictors of postnatal diabetes mellitus on logistic regression analysis in these women were severity of GD, Asian origin and the 1‐hour plasma glucose level during the antenatal GTT.
Is There Any Change in the Prolactin Levels of Nurses in the Morning After Night Shift?
Authors: Aktan Erdal , Kaleli Babür , Alatas Erkan
Published: February 2008

Summary: Our purpose was to determine if blood samplings in the mornings after night shifts should be avoided for measuring the basal serum prolactin levels in women working at night and with regular menses; 20 nurses with regular menses, all working only at night shifts, were enrolled in this study. Serum prolactin levels of the subjects were determined twice, first in the morning after a typical night's sleep, with no intercourse within the previous 24 hours, second, in the morning after a typical night shift. All measurements of serum prolactin levels were performed in the follicular phase of the menstrual cycle. Prolactin levels in the mornings after typical night's sleeps and in the mornings after typical night shifts were not significantly different. Prolactin level in the morning after a night shift of a woman with regular menses may represent basal prolactin level of that woman.
Female Sterilization in New South Wales, 1981 to 1994–1995
Authors: Yusuf Farhat , Siedlecky Stefania , Leeder Stephen
Published: February 2008

Summary: This paper investigates and confirms the dramatic decline in female sterilization in New South Wales over the past decade, a period when male sterilization has remained fairly constant. The most significant decline occurred among women under 30 years of age, which resulted in a rise in the mean age at sterilization. In 1994–1995, 70% of sterilization operations were performed for contraceptive management only, 11% were concurrent with Caesarean section, and 9% with abortion. Incidental findings were an increase in Caesarean section and the proportion of women having concurrent sterilization, and a large decline in intrauterine device removals, more than half of which were accompanied with sterilization in 1994–1995. Currently‐married women accounted for 80% of sterilization cases. Immigrant women generally had lower incidence of sterilization compared to the Australian‐born.
The Use of the Bladder Neck Support Prosthesis in Combined Genuine Stress Incontinence and Detrusor Instability
Authors: Moored K.H. , Footer A. , Siva S. , King J. , Burton G.
Published: February 2008

Summary: The Bladder Neck Support Prosthesis (BNSP) was used in 21 women with combined genuine stress incontinence (GSI) and detrusor instability (DI). Outcomes included frequency volume charts, pad tests, voiding cystometry and quality of life scores, up to the sixth month. Of the 21 recruits, 5 never wore the BNSP home, leaving 16 participants. A further 2 did not reach week 4 because of poor efficacy or inability to fit the device. In the 14 who reached week 4, the median number of leaks/day declined from 4.3 to 1.0 (p=0.002). Median pad test loss fell from 53 to 7mL (p=0.012). Cystometry showed an increase in maximum bladder capacity (p<0.05) and a modest reduction in severity of detrusor instability, with no evidence of outflow obstruction. Three further women discontinued because of poor efficacy (2) or a poorly fitting device (1), leaving 11 of 16 participants (69%) at week 8, when median pad test loss fell to 2 mL. The BNSP is a useful option in patients with the unfortunate combination of an unstable bladder and an incompetent urethra, but requires careful fitting and attention to detail.
Blood Transfusion Requirements for Abdominal Hysterectomy: 3‐year Experience in a District Hospital (1993–1995)
Authors: Ng Stanley P.H.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because the blood transfusion rate is an important consideration when discussing methods of hysterectomy. The author also provides interesting data concerning the complications encountered in this series of 236 abdominal hysterectomies. Readers are encouraged to give due attention to the details shown in table 1 especially the rates of injury to organs and need for unplanned return to the operating theatre.

Summary: Two hundred and thirty six women who underwent abdominal hysterectomy for benign disease at Fairfield District Hospital were studied retrospectively. Eleven patients received a total of 28 units of blood. The transfusion rate was 4.7%. The average number of units transfused per operation was 0.12. Each transfused patient received an average of 2.5 units with a range of 1 ‐4 units. Only 27% of cross‐matched blood was actually transfused. Patients with preoperative anaemia, prolonged operation time and a larger uterus were more likely to require blood transfusion. The group and screen procedure is an adequate preoperative blood order for patients having abdominal hysterectomy.
A Case of Many Ovarian Cystectomies
Authors: Steigrad Stephen J.
Published: February 2008

EDITORIAL COMMENT: This comment was prepared to discuss the question of whether or not a macroscopically normal ovary should be sectioned for evidence of bilaterality when the opposite ovary is found to contain a cystic teratoma. This practice is often mentioned but, in the experience of the editorial committee, seldom performed. Wedge resection of a normal ovary can result in adhesions and impairment of fertility. Readers are referred to a series of clinicopathological evaluation of286 cases of ovarian teratomas in Turkey (A). In this series bilaterality of the tumour was present in 65.9% (29 of 44) of women with bilateral adnexal masses but only in 1.1% (2 of 182) of women who had a unilateral mass and who had histological examination of a wedge resection from the macroscopically uninvolved ovary. The authors concluded that ‘as the risk of bilaterality of the tumour in the normal‐appearing contralateral ovary was so small, we no longer perform the routine ovarian wedge biopsy in patients with mature ovarian teratoma, in order not to decrease the fertility potential of the patient’. Readers can decide whether the case presented here is an exception to this rule!

Ayhan A, Aksu T, Develioglu O, Tuncer S, Ayhan A. Complications and Bilaterality of Mature Ovarian Teratomas. Aust NZ J Obstet Gynaecol 1991; 31: 83–85.

Summary: Over a period of 6 years a young patient had 3 laparotomies resulting in the removal of 5 benign ovarian dermoid cysts and 1 ovarian mucinous cystadenoma. The occurrence of 3 dermoid cysts at I procedure and the recurrence of bilateral dermoid cysts raises questions regarding the histogenesis of these tumours. The subsequent occurrence of a mucinous cystadenoma confirms the known relationship between these benign ovarian neoplasms.
Schwannoma Presenting as a Bartholin's Gland Abscess
Authors: Hanafy Ash , Lee Richard M. , Peterson C. Matthew
Published: February 2008

escribed is a case of Schwannoma (neurilemmoma) presenting as Bartholin's duct abscess.
Re: The Intravaginal Slingpiasty Operation, a minimally invasive technique for cure of urinary incontinence in the female (1)
Authors: Richardson Peter , Laurie David
Published: February 2008

EDITORIAL COMMENT: The following comment to this letter was provided by Dr Robert Cowie, Director of Anaesthesia, Mercy Hospital for Women: To maintain stability, local anaesthetic solutions are pH adjusted to be between 4.0–7.0 for plain solutions and 3.5‐5.0 for those containing adrenalin. This acidity is considered to be a prime cause of the burning sensation which can accompany subcutaneous infiltration. Numerous studies indicate that this stinging can be reduced by the addition of ImL sodium bicarbonate 8.4% to each 10mL of local anaesthetic solution. The resultant increase in the pH increases the nonionized basic form of the drug allowing better tissue perfusion, a higher concentration of the drug in the nerve axoplasm and a more rapid block of the sensory fibres. Neutralized lignocaine solutions remain stable for some time, those containing adrenalin for approximately I week. The addition of excessive bicarbonate will result in precipitation.
The Incidence of Respiratory Distress Syndrome Does Not Increase When Preterm Delivery Occurs Greater Than 7 Days After Steroid Administration*
Authors: McNamara Michael F. , Bottoms Sidney F.
Published: February 2008

EDITORIAL COMMENT: This and the preceding article analyzing obstetric practice in Australia concerning steroid administration to prevent the respiratory distress syndrome are complementary. Readers should give both careful attention. There seems sufficient evidence available suggesting that a single steroid dose is adequate, and that a prospective randomized trial should be mounted to address the issue of repeat steroid administration, as recommended by both groups of authors, rather than to persist with the possibly/probably unnecessary usual regimen of repeat steroid administration. Such a trial has been proposed by the Australian Collaborative Trials group, the originators of the ACTOBAT and ACTOMgS04 studies. It should be noted that the respiratory distress syndrome (hyaline membrane disease) remains a major contributor to perinatal morbidity and mortality. The Editorial Board and reviewers of this paper do not recommend alteration to current regimens of steroid administration; all are agreed that a prospective randomized trial is required to decide if repeat steroid administration is indicated.

Summary: We sought to determine if the risk of the respiratory distress syndrome (RDS) is increased when preterm delivery occurs greater than 7 days from the last steroid administration. At our hospital, steroids were repeated weekly only on inpatients. Linking pharmacy and delivery records, we analyzed the risk of RDS with preterm delivery by interval since last steroid administration. Discriminant function analysis revealed that adjusted for gestational age, there was a negative correlation between interval since last steroids administration and risk for RDS (p<0.05, n=254). Using analysis of variance to control more precisely for gestational age (28–32 weeks, n=19) we found no difference in the risk for RDS with longer intervals since the last steroid administration. We then used multiway contingency analysis to consider intervals as zero to 7 versus greater than 7 days and similar results were obtained. Our findings suggest that the process of pulmonary maturation induced by steroid administration is permanent rather than transient. Repetitive steroid administration does not appear to be beneficial. Only a large, prospective randomized trial could definitively address the issue of repeat steroid administration. However, on the basis of our findings and review of available literature, we believe there is insufficient data to recommend weekly repeat steroid administration to women at risk for preterm delivery.
Emergency Cervical Suture: The Obstetrician's Dilemma
Authors: Templeman Claire , Ferrier Alan , Kluckow Martin
Published: February 2008

Summary: We studied the perinatal mortality and morbidity associated with emergency cervical suture at Royal North Shore Hospital over 7 years. There were 23 patients who had an emergency cervical suture inserted and they were divided into 3 groups for analysis, Group 1: patients with cervical dilatation initially detected on routine 18–20 week ultrasonography and later confirmed on clinical examination, Group 2: cervical dilatation <3 cm and Group 3: cervical dilatation >3 cm at presentation. The median delay in delivery in each group was 6, 5 and 3 weeks respectively. The perioperative membrane rupture rate for emergency suture insertion in this study was 13%. The perinatal mortality rate for each group was 0%, 33% and 43% respectively with an overall rate of 33%. Follow‐up at 3–5 years of 9 babies with a birth‐weight ≤1,000 g, revealed that of 6 survivors, 1 had moderate disability and 2 had mild disability. No survivors had severe disability. From the results of our study, emergency cervical suture can prolong gestation and in the absence of prolapsed fetal membranes, the perioperative membrane rupture rate is low. However, it is important to consider that the time gained from emergency cervical suture insertion may convert a previable fetus into an extremely premature infant with the risk of long‐term disability.
Sublingual Glyceryl Trinitrate for Uterine Relaxation at Caesarean Section—a Prospective Trial
Authors: Craig Simon , Dalton Russell , Tuck Mark , Brew Fiona
Published: February 2008

Summary: We report a prospective study on the use of sublingual glyceryl trinitrate at Caesarean section to induce uterine relaxation; 23 women were entered into the study with both emergency and elective cases considered. A metered dose spray was used to deliver a dose of 400 or 800 microgrammes of glyceryl trinitrate to the women. There were no major side‐effects of hypotension or postpartum haemorrhage. The mean maximal systolic blood pressure drop in the patients following drug administration was 18% of the systolic pressure prior to drug administration. Subjective assessment of uterine tone showed the uterus to contract well postdelivery in response to standard oxytocic regimens. Minimal maternal side‐effects were reported. We conclude that glyceryl trinitrate is a safe form of uterine relaxation at Caesarean section which may be used in emergency situations and may also be given prophylactieally in cases such as breech presentation and in delivery of the preterm infant where fetal trauma is possible. The use of a metered‐dose sublingual spray is ideally suited to obstetric practice, being both easy to use and also rapidly administered.
Birth Centre Practices in Australia
Authors: Waldenström Ulla , Lawson Julie
Published: February 2008

Summary: The aim of this study was to review birth centre practices in Australia. Questionnaires were completed from 22 of 24 centres. Great variations were observed between the centres in clinical practices like number of routine antenatal visits, pattern of medical review, and transfer rates. Definition of low‐risk as expressed by booking and transfer criteria also showed great variations, and generally these criteria became more liberal with experience. From 1991 to 1995 there was an average increase of approximately 1,000 bookings per year in the 22 centres taken together. The average transfer rate over the whole period was 22% antepartum and 18% intrapartum. The transfer rates increased slightly over the 5‐year period, by 4.8% during pregnancy and 2.5% intrapartum. A majority was optimistic about the future, and estimated that the potential market for birth centres was around 16% compared with the present figure of less than 5%. A general view was that women were not well informed about the birth‐centre option.
Comparison of Perforation Between Single and Double‐gloving in Perineorrhaphy After Vaginal Delivery: A Randomized Controlled Trial
Authors: Kovavisarach Ekachai , Jaravechson Siriwat
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because all surgeons are concerned, or should be concerned, about the possibility of contracting hepatitis or the immunodeficiency virus due to contamination with the patient's blood when operating. It goes without saying that all surgeons should be immunized against hepatitis B. There have been a number of studies recommending double‐gloving either as a routine or in high‐risk patients. We believe the Royal Australian and New Zealand College of Surgeons video recommends double‐gloving as a routine! There have been comments that double‐gloving causes clumsiness which could indeed be counter‐productive in rendering glove perforation more likely. However the reviewer of this paper made the point that with his experience with the double‐gloving technique the initial impression of clumsiness soon resolves.

Summary: A prospective randomized controlled trial of single and double‐gloving methods in perineorrhaphy after vaginal delivery was performed between August 1, and September 30, 1996 at Rajavithi Hospital to compare glove perforation between both methods. We examined 1,316 individual gloves in the double‐gloving method and 742 individual gloves in the single‐gloving method. These gloves were tested by immersing in water. The glove perforation rate was 5.2% (107 of 2,058). There was significant reduction in the glove perforation rate of double‐inner gloves (2.7%) compared with the single‐gloving group (6.7%).

The perforation rate of the double outer‐gloves group was 5.9%. The perforation rate in the matched outer and inner perforation was found only in 0.3% (2 of 658). The double‐gloving method had a significant benefit in protection of the surgeon's hand from the exposure to blood compared with the single‐gloving method.
A 6‐year Review of the Outcome of Endometrial Ablation
Authors: Tsaltas Jim , Taylor Nancy , Healey Martin
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication since it informs readers that more than 3 in 4 women who have endometrial ablation, and who can be contacted and are willing to provide follow‐up information, are satisfied with the results. This is important information in the context of the recent spate of papers, in this and other journals, advancing the merits of laparoscopically‐assisted vaginal hysterectomy, usually performed for dysfunctional uterine bleeding, which is also the main indication for endometrial ablation. The 2 procedures are competitive, but endometrial ablation has many advantages if it can produce the results presented in this paper. The hysterectomy rate of17% is a minimum figure since many of the 36% of women sent the follow‐up questionnaire, and who did not respond, may have had hysterectomy performed elsewhere. Women who have abdominal pain, chronic or periodic, and amenorrhoea after endometrial ablation require special consideration. They probably warrant cervical dilatation and/or ultrasonography to exclude haematometra if the pain is persistent.

Summary: In June, 1995 a postal questionnaire was distributed to all 232 women who had an endometrial ablation at Monash Medical Centre between July, 1989 and December, 1994. Data was analyzed from the 149 who responded. Length of follow‐up ranged from 6 months to 6 years 6 months. Of these 78% were satisfied with their ablation and 84% found their menses to be lighter or to have stopped. The repeat ablation rate was 13% and the hysterectomy rate was 17%.
Outcome of Hysterectomy for Pelvic Pain in Premenopausal Women
Authors: Tay Sun‐Kuie , Bromwich Nicki
Published: February 2008

EDITORIAL COMMENT: This article once again emphasizes that hysterectomy can be successful in alleviating chronic pelvic pain even in those women in whom the operative pathology is not usually associated with pain. Hillis (A) showed that in a group of 308 women who had a hysterectomy for chronic pelvic pain and were followed up for at least 6 months, 74% experienced complete resolution of pelvic pain and a further 21% reported decreased pain. Hillis found that pain was more likely to resolve in women with identifiable pathology, private health insurance or fewer than 2 pregnancies. However even in women with no identifiable pelvic pathology, 62% had complete resolution of their pain postoperatively. This indicates that in the woman for whom all other therapy has failed, after appropriate counselling, hysterectomy may be a reasonable option for the treatment of chronic pelvic pain.

(A) Hillis SD, Marchbanks PA, Peterson HB. The effectiveness of hysterectomy for chronic pelvic pain. Obstet Gynecol 1995; 86: 941–945.

Summary: The outcome of abdominal hysterectomy for pelvic pain in premenopausal women was studied retrospectively in 228 women. In 17 women, pelvic pain was the sole indication while in the others, pelvic pain was one of the contributory indications for hysterectomy. The most common surgical histopathological diagnoses were uterine leiomyoma (73.9%), uterine adenomyosis (40.4%), benign ovarian cyst (19.3%) and endometriosis (7.9%); 118 (51.8%) patients had single pathology and 48.2% had multiple pathologies. The agreement between operative clinical diagnosis and histopathological diagnosis was 66.1% for leiomyoma, 57.1% for uterine adenomyosis and 30% for endometriosis. The incidence of early postoperative complication was 20.6%, mainly minor morbidities including urinary tract infection (3.9%), wound infection (3.1%) and unexplained fever (6.0%). These complications significantly prolonged the duration of hospital stay from an average of 7 days to 9–17 days. Of 98 patients with pain as the sole or the most predominant indication for hysterectomy, 72% responded to an outcome survey 12 or more months after hysterectomy. Of these, 62 (87%) were satisfied with the operation, 8 were unsure and 1 was dissatisfied; 68 (95.8%) patients reported relief of their symptoms. Relief of symptoms did not correlate with the patient's report of her satisfaction with hysterectomy. Pain in the abdominal wound a year or more after surgery was one of the commonest reasons cited for dissatisfaction with hysterectomy. We conclude that in well‐selected cases, hysterectomy is an appropriate and satisfactory treatment for premenopausal women with pelvic pain irrespective of clinical evidence of associated pathology. Effective measures to reduce postoperative complications and wound pain are needed to further improve the outcome of abdominal hysterectomy.
The Safety of Laparoscopic Treatment for Ovarian Dermoid Tumours
Authors: Rosen David M. B. , Lam Alan M. , Carlton Mark A. , Cario Gregory M.
Published: February 2008

Summary: Whilst laparoscopic surgery has largely replaced laparotomy as the standard surgical option for the management of benign ovarian cysts, concern remains regarding the safety of laparoscopy for benign cystic teratomas. This is based on a higher rate of cyst content spillage compared to laparotomy and the known sequelae of chemical peritonitis and granuloma formation. We present 18 cases of laparoscopic dermoid cystectomy with recommendations for specimen removal from the peritoneal cavity. Our findings together with evidence from the literature confirms the safety of laparoscopy for the treatment of ovarian dermoid cysts.
Comparison of Low Molecular Weight Heparin (Fragmin) With Sodium Heparin for Prophylaxis Against Postoperative Thrombosis in Women Undergoing Major Gynaecological Surgery
Authors: Ward Bruce , Pradhan Sujata
Published: February 2008

Summary: A randomized controlled trial was undertaken comparing the efficacy and safety of low molecular weight (LMW) heparin (Fragmin) with sodium heparin for prophylaxis against postoperative thromboembolic disease after major gynaecological surgery. Women were randomized to receive subcutaneous injections of 5,000 U of either once daily LMW heparin or twice daily sodium heparin. A total of 566 women were recruited, of whom 552 completed the study. Most women (461) had malignant disease and 430 of these underwent radical surgery. The remainder underwent major, but not radical surgery. There were 5 thromboembolic events in the LMW heparin group and 2 in the sodium heparin group, with no significant difference between these groups. No significant difference was found in the incidence of intraoperative or postoperative transfusion in the 2 groups. The decision of which heparin to use in routine practice cannot be made on clinical grounds.
Endometriomas in Pregnancy
Authors: Gregora Michael , Higgs Peta
Published: February 2008

Summary: Endometriomas are rare in pregnancy, may not be large, may be difficult to diagnose definitively and although benign, may cause significant complications at any stage during gestation. They remain a management dilemma.
Fatal Myocardial Infarction Associated with Bromocriptine for Postpartum Lactation Suppression
Authors: Dutt S. , Wong F. , Spurway J.H.
Published: February 2008

Summary: Bromocriptine (Parlodel®) has attracted widespread controversy for its use for postpartum lactation suppression because of recent reports of cerebral and cardiovascular complications. This case describes a maternal death in which bromocriptine therapy may have triggered myocardial infarction in a patient with asymptomatic coronary artery disease. We suggest its use with caution, especially in patients with identifiable risk factors of coronary artery disease or arteriovascular disease.
Clear‐Cell Carcinoma of the Ovary in a 19‐year‐old Woman
Authors: Parker Jim , Proietto Anthony M. , Lowe Glenn
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication as the youngest reported patient with clear‐cell carcinoma of the ovary and for the issues that arise in relation to the diagnosis and the sequelae of treatment. All cyst aspirate or tissue taken at any procedure must be submitted for cytological or histological examination and, as is evident in this case report, a specialist in gynaecological histopathology and cytology is essential for evaluation of the material. The dilemma of fertility preservation in such a young patient with Stage 1 disease has not been addressed by this paper and it is unclear whether the uterus and right ovary were removed. The classical teaching of complete pelvic clearance for disease greater than Stage la is now challenged on a number of issues. If the contralateral ovary and the uterus is retained will chemotherapy lead to infertility? If chemotherapy or surgical removal will result in infertility should the ovary be removed for cryostorage? The possibility of embryo donation or IVF with cryopreserved ovum would support the retention of the uterus in all nulliparous patients, as a major quality of life consideration. These become important issues for discussion and decision‐making by the patient and treating oncologist when dealing with potentially curable cancer in the young patient.

Summary: The risk of inadvertently treating an ovarian malignancy is always present regardless of the patient's age, clinical history, ultrasound features, serum tumour markers, menopausal status and intraoperative findings. This risk can be minimized by paying particular attention to high‐risk characteristics in any of the above assessment criteria and by obtaining an intraoperative frozen section if there is any suspicion of malignancy. The same approach should be used whether the initial treatment is by laparotomy or laparoscopy. We present a case of clear‐cell carcinoma of the ovary in a 19‐year‐old woman where there was delay in diagnosis and treatment as a result of an incorrect initial histopathology assessment. This appears to be the youngest patient reported in the literature with a clear‐cell carcinoma of the ovary.
Hormone Replacement Therapy in the Developing Countries
Authors: Oei Pau‐Ling , Ratnam S. Shan
Published: February 2008

Summary: The sales data of oestrogen replacement products for 8 developing countries from 1993 to 1995 were analyzed. The data from Malaysia, Pakistan, Taiwan, Thailand, Indonesia, Philippines and South Korea showed the increasing use of oestrogen replacement products. The total usage however varied widely, from only US$11,153 (Philippines in 1993) to as much as US$6,306,717 (Taiwan in 1995). In Singapore, where oestrogen replacement is an accepted and established form of therapy for the postmenopausal woman, there has been an increase in the usage of the nonoestrogen replacement products. There are multiple reasons for the increasing sales of hormone replacement products in the developing countries and these are explored in this article. In some of the developing countries, for example China and India, hormone replacement therapy has just been introduced. However, in those developing countries in which hormone replacement therapy is already available, sales figures show increasing usage. The future augurs well for hormone replacement therapy.
Heterotopic Pregnancy Complicating In Vitro Fertilization
Authors: Johnson Neil , McComb Penelope , Gudex Guy
Published: February 2008

Summary: A review was undertaken of the cases of heterotopic pregnancy resulting from in vitro fertilization/embryo transfer (IVF/ET) and frozen embryo replacement (FER) in a 6‐year cohort of women at National Women's Hospital in Auckland. The incidence of heterotopic pregnancy was 2.9% (5 cases) in 173 clinical pregnancies resulting from 901 embryo replacements. Of the 5 women with heterotopic pregnancy, 1 had unilateral tubal patency and 4 had bilateral tubal blockage; 3 had ‘high responder’ peak serum oestradiol levels (greater than 9,000 pmol/L) prior to oocyte pick‐up (OPU); 3 had a serum human chorionic gonadotrophin beta subunit (beta‐HCG) level greater than 600 IU/L on Day 14 following embryo transfer (ET) in the absence of a multiple intrauterine gestation on subsequent ultrasound scan. In the 4 women in whom unequivocal diagnosis of heterotopic pregnancy was not made on the initial ultrasound scan, there was delay in appropriate management, in 1 for more than 5 months. In conclusion, early IVF pregnancies require a transvaginal ultrasound scan performed by a sonographer experienced in the diagnosis of ectopic pregnancy and management of early pregnancy complications by clinicians in close consultation with the IVF centre itself. No single risk factor, laboratory test or combination of these is sensitive or specific enough to predict the occurrence of heterotopic pregnancy. The first‐line surgical treatment of heterotopic pregnancy should be laparoscopic salpingectomy with excision of all except the intramural portion of the affected Fallopian tube.
Abnormal Cervical Cytology in Pregnancy: Experience of 811 Cases
Authors: Woodrow Nicole , Permezel Michael , Butter‐field Louis , Rome Robert , Tan Jeffrey , Quinn Michael
Published: February 2008

Summary: This paper reviews our hospital's experience spanning 15 years and involving 811 women referred with abnormal cervical cytology in pregnancy. It supports the safety and accuracy of managing dysplasia in pregnancy with colposcopy, directed punch biopsy and deferral of treatment until the postpartum period. The histologically‐proven progression in pregnancy to a higher grade of dysplasia postpartum was 7%. None of the women are known to have developed microinvasive or invasive cancer between antenatal assessment and postpartum review. Of these 811 women, 16% were lost to follow‐up, 1 of whom subsequently represented 4 years later with invasive cervical cancer.
Cystic Fibrosis and Pregnancy
Authors: Jankelson D. , Robinson M. , Parsons S. , Torzillo P. , Peat B. , Bye P.
Published: February 2008

Summary: The case records of 11 patients with cystic fibrosis (CF) who had 13 completed pregnancies between 1975 and 1995 were retrospectively reviewed to assess: (1) the changes in spirometry and body mass index (BMI) during pregnancy; and (2) maternal and neonatal complications and outcomes. Prepregnancy the mean age of the group was 24 (range 17–27) years. Two patients were exsmokers, 7 had pancreatic insufficiency and 7 had chest X‐ray evidence of bronchiectasis. None of the patients had diabetes mellitus but 3 developed gestational diabetes. The mean ± SEM (% predicted) forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) prepregnancy were 2.3 ± 1.0 (83%) litres and 3.0± 0.9 (85%) litres respectively. Five patients had normal spirometry (FEV1 and FVC >80% predicted) prior to 6 pregnancies. The mean body mass index (kg/height(m)2) for the group was 20.5 ± 2.0. There was a significant decline in spirometry during pregnancy (FEV1 15.5 ± 6.6% p<0.01; FVC 14.0 ± 8.3% p<0.5). However, FVC but not FEV1 recovered to prepregnancy values by 12 months postpartum. There was a significant increase in both weight (7.1kg) and BMI (2.6 kg/height(m)2) at the time of delivery compared with prepregnancy (p = 0.0004). However, postpregnancy both weight and BMI had returned to their prepregnancy values (p<0.2). Mothers with an FEV1 >80% had less decline in FEV1 related to pregnancy, better outcomes, fewer operative and instrumental deliveries, fewer preterm infants and fewer neonatal complications. Suggestions for the planning and management of pregnancy in women with CF are discussed.
Study of Cervicovaginal Fetal Fibronectin Status to Guide Treatment of Threatened Preterm Labour
Authors: Watson David L. , Kim Stephano J. , Humphrey Michael D.
Published: February 2008

Summary: A sequential controlled pilot study of 48 women (16 study, 32 controls) was performed to explore the place of bedside fetal fibronectin testing in the managment of apparent preterm labour; 80% of the study group were successfully managed without tocolytic therapy, on the basis of fetal fibronectin test results, without detriment to the babies. Rapid bedside fetal fibronectin testing holds promise that protocols for management of women in apparent preterm labour, with intact membranes and without significant cervical dilatation, may be altered so that most of the unnecessary use of tocolytic drugs is avoided.
Fetal Biomodelling
Authors: D'Urso P.S. , Thompson R.G.
Published: February 2008

Summary: A study has been performed to determine if a stereolithographic (SL) biomodel of a fetal face could be created from 3 dimensional (3D) ultrasound (US). 3D ultrasound images were acquired by Diasonics Gateway 2D Array ultrasound systems (Diasonics Ultrasound, San Jose, CA, USA) using an electromagnetic localizer (Tomtec Free Hand Scanning Device, Tomtec Imaging Systems, Middle Cove, Australia). 3D volumetric reconstruction of the fetal face was performed and the data was prepared to guide the construction of an exact solid biomodel by stereolithography (SLA 250 3D Systems, Valencia, CA, USA). A faithful solid representation of the fetal face was produced within 12 hours of the US scan. The fetal biomodel seemed to improve the display of the 3D data. The user‐friendly nature of biomodelling may have clinical utility for fetal morphological assessment and as an aid when counselling parents.