bluuebunny/crossref_metadata_2025 huggingface dataset:
Standard Parameters of Preeclampsia: Can the Clinician Depend Upon Them to Reliably Identify the Patient with the HELLP Syndrome?
Authors: Magann Everett F. , Chauhan Suneet P. , Naef Robert W. , Blake Pamela G. , Morrison John C. , Jr James N. Martin
Published: February 2008

EDITORIAL COMMENT: We accepted the following 3 gapers concerned with the HELLPsyndmme (haemolysis, elwated liver enzymes and low platelets) becuuse a series of 454 cases merits attention and we asked the authors to explain how they gathered such a large series. It has been standard teaching to recommend delivery of the patient with swere preeclampsia, more or less irrespective of the period of gestation. At times this ruling is not followed when the baby is judged to be immature. There is also the question of whether betamethasone thempy should be used when these women are treated conservatively. Readers should note that the authors are not recommending comernative management of women with severe preeelampsia and the HELLPsyndrome. TWO of these 3 paperspresent results in 270f the 427patients (6.3 %)given corticosteriods when it was judged pmper practice to allow conservative management for a few days.

Our senior miewer from the Royal Women's Hospitai, Melbourne, calculated that in our community we would need about 225,000pregnancies to obtain 454 cases of the HELLPsyndrome (preeclampsia 2% and the HELLPsyndmme in 10% of these). ‘The syndrome described is really one of thrornbocytopenia and hyperuricaemia. The authors do not define their criteria for haemolysis or elevated liver enzymes. The value of classijication of the severity of the HELLP syndmme on the basis of the platelet count is questioned since the worst prognosis in these cases is when there is consumptive eoagulopathy, microhaemangiopathic anaemia and epigastric pain in association with impaired liver function’.

The senior author was asked to explain the source of the series and the clussification of severity of the condition and he provided the following:
Ultrasound Fetal Weight Estimation: Precision or Guess Work?
Authors: Rogers Michael S. , Chung Tony K. H. , Chang Allan M. Z.
Published: February 2008

Summary: We compared the prediction of birth‐weight based on factors shown by epidemiological studies to influence it with the performance of 2 clinical examples of ultrasonic fetal weight estimation reported in the literature. The standardized absolute error of the 2 examples of ultrasonic fetal weight estimation was similar to estimation by multiple regression of birth‐weight on maternal age, parity, height and weight in 11,516 Chinese mothers. This severely limits the clinical utility of the estimation derived from these ultrasonic measurements.
The Predictive Value of Abnormal Fetal Heart Rate Patterns in Early Labour
Authors: Umstad Mark P.
Published: February 2008

Summary: An abnormal early intrapartum cardiotocogram was found to have a sensitivity of 26.4% and a positive predictive value of 28.3% for the detection of fetal acidaemia at birth and a sensitivity of 27.3% and a positive predictive value of 3.3% for the prediction of 5‐minute Apgar scores below 7. The presence of meconium in the liquor amnii improved the predictive properties of the test. Although an abnormal early intrapartum fetal heart rate pattern indicated a higher risk group, the majority of patients with abnormal early intrapartum cardiograms had a favourable outcome. A normal pattern does not exclude an adverse outcome.
A New South Wales Population‐based Study of Stillbirths Weighing 2,500 g or More
Authors: Adelson Pam , Spurrett Brian , MD Brian Trudinger , Frommer Michael
Published: February 2008

Summary: This paper describes factors associated with singleton stillbirths weighing 2,500 g or more, born in 1987 and reported to the NSW Midwives' Data Collection (MDC), a statewide perinatal data collection system. A total of 136 singleton stillbirths in this weight range were notified to the MDC, representing one‐quarter of all singleton stillbirths in NSW. MDC records on these stillbirths were linked with perinatal death registrations for 125 of the 136. The death registrations indicated that fetal death occurred during labour in 20 cases, prior to the onset of labour in 98, and at an unknown time in the remaining 7 cases. Placental complications, including haemorrhage and functional abnormalities of the placenta, were the most frequent group of conditions associated with the stillbirths, being recorded as the underlying cause of death in 42 (34%) of the 125 cases. Cord complications (such as cord compression or cord around the neck) were given as the underlying cause of death in 30 cases (24%). The death certificate diagnosis was confirmed by autopsy in only 27 of the 125 cases (22%), although autopsies may have been done on a further 45 cases (36%). An adequate explanation of the cause appeared to be lacking for many of the fetal deaths. This highlights the importance of a thorough and systematic investigation of stillbirths. A list of standard investigations to be carried out following a stillbirth is proposed.
Comparison of Cytology and Cervkography in Screening a High Risk Australian Population for Cervical Human Papillomavirus and Cervical intraepithelial Neoplasia
Authors: McKinnon Kay J. , Ford Robert M. , Hunter J. Christopher
Published: February 2008

Summary: Two different screening methods, the Papanicolaou (Pap) smear and cervigram were compared in screening 245 Sydney women over a 6‐month period in 1988 at a city sexually transmitted diseases (STD) centre, for cervical human papillomavirus (HPV), cervical intraepithelial neoplasia (CIN) and cervical cancer. The Pap smear through the identification of cytologically abnormal cells correctly detected 54% of cases of histologically proven CIN and 39.2% of cases of HPV. The cervigram through the identification of acetowhite epithelium and/or abnormal vessels on the cervix correctly detected 64% of cases of histologically proven CIN and 70.6% of cases of HPV. However, when both tests were used together, 92% of CIN lesions and 82.4% of HPV lesions were correctly identified. Histology of a colposcopically directed biopsy was used as the ‘gold standard’. The sensitivity and specificity of the Pap smear after correction for verification bias was 46% and 78% respectively, and for the cervigram was 49% and 60% respectively. Hence neither screening test appears adequate on its own, at least in an STD population.
The Value of Vaginal Ultrasound in the Management of Menorrhagia
Authors: Wood Carl , Hurley Victor A. , Leoni Maria
Published: February 2008

Summary: Vaginal ultrasonography has been carried out on 97 patients with menorrhagia who were either not responding to or not suitable for drug therapy. Ultrasonography demonstrated normal uteri in 33, benign uterine enlargement in 4, bicornuate uteri in 2, intracavitary polyps or fibromyomas in 9, possible adenomyosis in 13 and intramural or subserous fibromyomas in 36. The ultrasound diagnosis markedly increased the accuracy of clinical diagnosis and assisted in the proper choice of treatment which included the avoidance of surgery and the selection of patients most suited to endometrial resection, intrauterine resection of polyps and fibromyomas, and open or laparoscopic myomectomy and hysterectomy. The routine use of high resolution vaginal ultrasound in the management of menorrhagia is recommended.
Elevated Serum Alpha Fetoprotein and Normal Liquor Alpha Fetoprotein Values in Association with an Abdominal Pregnancy
Authors: Jackson Simon , Hollingworth Tony , Macpherson Marion
Published: February 2008

Summary: A case report is described in which abdominal pregnancy was misdiagnosed by ultrasound scanning as a pregnancy within a horn of a bicornuate uterus. Two serum alpha fetoprotein (SAFP) results were greatly elevated and an amniocentesis was performed, the liquor alpha fetoprotein (LAFP) and karyotype were normal. Elective Caesarean section was performed at 38 weeks for a persistent transverse lie and an abdominal pregnancy was found. The outcome was excellent for both the mother and child.

This is the first reported case of amniocentesis and measurement of LAFP in an abdominal pregnancy and confirms abdominal pregnancy as a rare cause of an elevated SAFP.
Recent Advances in the Use of Doppler Waveform Indices in the Antenatal Assessment of Intrauterine Growth Retardation
Authors: Chang T. C. , Cheng H. H.
Published: February 2008

Summary: Doppler ultrasound has been advocated as a useful tool to evaluate pregnancies with intrauterine growth retardation (IUGR). However, many previous studies have used smallness for gestational age (SGA) at birth to define IUGR. The ability of Doppler ultrasound to predict SGA, neonatal morphometric indices of wasting such as a low ponderal index, and perinatal morbidity is reviewed. Doppler assessment of the umbilical and uteroplacental vasculatures were inferior to ultrasound measurements of fetal size in the prediction of SGA. In low risk fetuses, umbilical artery waveform indices were of limited value in the prediction of neonatal morphometric indices of wasting. Within a group of high risk fetuses, Doppler assessment of the umbilical artery and, in particular, the middle cerebral and aortic vessels, were useful in predicting fetuses with neonatal wasting. Similar findings were noted in the prediction of perinatal morbidity. The review confirms the usefulness of umbilical artery Doppler waveform indices in the antenatal assessment of IUGR. Whilst preliminary studies appear to suggest that Doppler waveform indices of the middle cerebral and aortic vessels may confer an additional advantage in the antenatal assessment of IUGR, randomized controlled trials evaluating their effect on perinatal outcome and studies on the reproducibility of these indices need to be carried out before their widespread introduction into obstetric practice.
A Descriptive Study of Community Input into the Evolution of John Hunter Hospital Birth Centre: Results of ‘Open Entry’ Criteria
Authors: Rowley Maralyn , Epid Grad Dip , Kostrzewa Christine
Published: February 2008

Summary: The key feature of John Hunter Hospital Birth Centre is that consumer input influences the philosophy and protocols of the unit through a management executive. The executive includes representatives from all groups who use the Birth Centre, including general practitioners, visiting midwives, obstetricians and staff midwives, as well as 50% consumer representation. This has resulted in a unique Birth Centre with open and flexible entry criteria. Since its opening in February 1991,1,492 women have been admitted to John Hunter Hospital Birth Centre, and of these 1,221 (82%) gave birth there. This figure is greater than any other Birth Centre utilization rate in Australia (1–4). An examination of outcomes for 1992 indicates that neither the higher than usual utilization rate nor the open entry criteria has compromised safety for either women or their infants.
Predilatation of the Cervix Before Suction Curettage for Therapeutic Abortion in Early Pregnancy
Authors: Edwards Diana , Aitken Robert E. , Begg Alison F. , MacKay Philippa M. , Marchant Robin M.
Published: February 2008

Summary: The oral use of a synthetic methyl ester analogue of prostaglandin El (misoprostol) prior to suction curettage for therapeutic abortion in early pregnancy is reported. Misoprostol was found to be an effective, inexpensive and safe agent for preoperative cervical treatment.
Paroxysmal Nocturnal Haemoglobinuria and Pregnancy
Authors: Svigos John Michael , Norman John
Published: February 2008

Summary: A woman with paroxysmal nocturnal haemoglobinuria (PNH) who was successfully delivered of 3 healthy infants after 4 pregnancies is reported. The obstetric literature of women with PNH is reviewed and the consequent view presented that judicious advice should not preclude pregnancy in such women.
The Antenatal Diagnosis of Cephalothoracopagus Janiceps Conjoined Twins
Authors: Ramadani Hisham Mahmoud , Johnshrud Nils , Nasser Mohamed AI , Rayes Osama
Published: February 2008

Summary: A case of cephalothoracopagus conjoined twins (Janiceps twins) is presented. The abnormality was detected antenatally by the use of ultrasonography and confirmed postnatally, clinically and by computed tomography (CT scan).
Folliculogenesis ‐ The Natural Way
Authors: Cooke I. D. , Lenton E. A.
Published: February 2008

Summary: Natural cycle IVF (NIVF) arose from a wish to understand intrafollicular events in couples with unexplained infertility. Single follicle aspiration required unusual technical skill and a precise understanding of the endocrinology in the ostensibly normal cycle. The application of NIVF to all candidates for assisted conception resulted in a low delivery rate. However once data had accumulated it became apparent that age, follicular phase FSH concentrations and other endocrine abnormalities were associated with high failure rates. The concept of using NIVF as a preliminary screening cycle arose. By early elimination of some candidates and selective inclusion of others a highly cost effective regime can be developed. Taking delivery rates into account the cost per maternity is only half that of stimulated IVF. Using clear cut algorithms for the investigation of different categories of infertility the place of NIVF can be defined.

Current UK discussions relate to exclusions from access to IVF. Biological exclusions such as age could further enhance the cost effectiveness of NIVF. When NIVF can contribute to at least 50% of cycles in an assisted conception programme it has the potential to have a major economic impact.
Folliculogenesis ‐ The Stimulated Way
Authors: Pepperell Roger J.
Published: February 2008

Summary: The initial techniques of stimulating follicular development in the anovulatory woman involved the use of human pituitary gonadotropin (hPG) and thus replaced the function of the pituitary gland. Despite extreme care with administration of hPG and extensive monitoring to assess the ovarian response, ovarian hyperstimulation and multiple pregnancy were common. Less expensive and easier methods of treatment soon followed with oral clomiphene citrate (early 1960s), oral bromocriptine (early 1970s) and pulsatile gonadotrophin‐releasing hormone (late 1970s) being used. Currently all of these methods, alone or in combination, are employed and successful ovulation induction (except in women with elevated FSH levels) can now virtually be guaranteed.

Controlled ovarian hyperstimulation, just the outcome one was attempting to avoid in the treatment of anovulatory women, has become the treatment of choice for women having in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT). The extra oocytes produced by this treatment results in more embryos being available for transfer and/or freezing and improves the overall pregnancy rate. The concurrent use of gonadotrophin‐releasing hormone agonists (GnRH‐a) has resulted in more mature oocytes being developed, less cancelled cycles for a spontaneous midcycle LH surge, and allowed even more embryos to be produced thereby increasing the pregnancy rate further to the current expected 20% per cycle commenced. As techniques are further modified, adverse effects of elevated LH levels on pregnancy and take home baby rates should be able to be overcome, and oocyte freezing and long‐term storage should become a possibility.

The latest advance in treatment has been the production of pure FSH by a recombinant technique, thereby allowing anovulatory or ovulatory women to be given the pure hormone rather than one contaminated with significant amounts of LH. Normal follicular development, as assessed ultrasonically, has been observed during such treatment cycles despite the fact the oestradiol levels are low.
Ovulation and the Polycystic Ovary Syndrome
Authors: Jansen Robert P.S.
Published: February 2008

Summary: In the 1930s, Stein and Leventhal added amenorrhoea to anovulatory dysfunctional uterine bleeding among the known clinical manifestations of the polycystic ovary syndrome (PCOS). Whatever the menstrual pattern, infrequent or absent ovulation with symmetrical enlargement of the ovaries is now a familiar abnormality in women of reproductive age. Diagnosis of PCOS has developed from just the clinically obvious to an appreciation, through ultrasound imaging of the ovaries and endocrine testing, of its subtler forms. Today's clinicians will identify PCOS on the ultrasound image of many small follicles apparent in the periphery of both ovaries, on raised serum unbound testosterone assays, on exaggeration of serum LH levels with the start of pulsatile GnRH therapy, and on follicular overresponsiveness to injections of FSH. Once among the most treatable causes of infertility, ovulation‐induction for PCOS remained unsophisticated while microsurgery and assisted conception dissolved frontiers for other causes of infertility. Whereas we now have the benefit of high technology embryo cryostorage to cope with embarassingly high yields of PCOS oocytes, we still need to explain why, the bigger the ovaries, the more likely (we have long known it to be) that PCOS can be cured simply by reducing ovarian mass. Some cases of PCOS are hereditary and most seem constitutionally determined. PCOS is so common that the questions must be asked, Are we appreciating an extreme of normal? Could the milder forms of PCOS have ‐ or could PCOS have had ‐ evolutionary usefulness?
Breast Cancer Risk with Oral Contraceptives and Oestrogen Replacement Therapy
Authors: Mishell Daniel R.
Published: February 2008

Summary: A detailed review of the international epidemiological literature is very reassuring in confirming that exogenous oestrogen in oral contraceptives and postmenopausal hormone replacement therapy does not induce breast cancer in women. However, there may sometimes be a promotional effect which accelerates the time of breast cancer diagnosis in certain subgroups of women. This promotional effect may occur in young oral contraceptive users, and in long term users of high dose oestradiol postmenopausal replacement formulations. Use of oral contraceptives while young may protect against the development of breast cancer after age 45. Physiological doses of conjugated equine oestrogens do not appear to increase breast cancer risk even with long‐term postmenopausal use. Current data do not support an effect of progestogens in increasing or decreasing risk of breast cancer.
Vaccination for Contraception
Authors: Jones Warren R.
Published: February 2008

Summary: Vaccination for birth control has several advantages over currently available methods of family planning and should prove an attractive addition to the contraceptive armamentarium both in developing countries and in a developed country such as Australia. Concerns have been voiced by consumer health advocates that vaccines, like other long acting contraceptive methods, may be abused by health authorities in developing countries and by their use in vulnerable groups such as aborigines in our own country. These concerns need to be recognised and addressed. More difficult to accomodate are the anxieties expressed by feminist groups about the ‘loss of control’ and ‘lack of body awareness’ inherent in a method, such as a vaccine, that is relatively easily administered and has no overt side effects. There is no evidence that these concerns are shared by women in general.

The antifertility vaccine that will most likely be applied first in family planning programmes is one directed against the pregnancy hormone hCG. A WHO vaccine directed against the C‐terminal peptide of beta‐hCG provokes a specific and safe immune response and will enter Phase 2 trials in Sweden this year. Subsequent developments with this vaccine will include the replacement of the current emulsion vehicle by a delivery system based on biodegradeable microspheres which will give a more sustained antigen release and duration of effectiveness.
The Biochemistry of Prostaglandins: A Primer
Authors: O'Neill Chris
Published: February 2008

Summary: The membranes of cells serve to endow structural integrity, compartmentalize regions of the cell and allow the generation of a stable intracellular milieu. The lipid component of the membrane forms a matrix for structurally and functionally important proteins. It is also increasingly obvious that these lipids form substrates for the synthesis of a range of molecules which have a central role in cellular communication and regulation. The prostaglandins were the first class of such molecules described and to some extent may serve as an archetype for an understanding of the various classes of lipid mediators. The release of arachidonic acid from lipids (phospholipids in particular) is achieved by lipases (phospholipase A2). Arachidonic acid itself may act directly on cells to modify function. For instance, it may modulate ion channel function. However, it is more often a substrate for cyclooxygenase which produces prostaglandin H2, being the precursor for further prostaglandin and thromboxane synthesis, or for lipoxygenase, to produce the precursor for leukotrienes (a related class of mediators). The prostaglandins may act intracellularly, are readily released from cells to act in an autocrine or paracrine fashion, and may enter the blood vessels or lymphatics to exert endocrine effects. Target cells may contain receptors with relative specificity for various members of the prostaglandin family, thus eliciting some specificity of action by the mediators.
Prostaglandin E2, Fetal Maturation and Ovine Parturition
Authors: Young I. R. , Thorburn G. D.
Published: February 2008

Summary: The major source of PGE2 in ovine pregnancy is the placenta, with secretion occurring bidirectionally into fetal and maternal circulations. The placental output of PGE2 appears to increase when demand on placental function is increased, suggesting that the normally observed increase in its concentration towards term is driven by the growing demands of the fetus. The fetal pituitary is also involved in the control of PGE2 synthesis. PGE2 has potent stimulatory actions on the fetal pituitary to increase both the absolute concentration and the bioactive fraction of ACTH‐containing peptides in the fetal circulation. It also directly stimulates glucocorticoid secretion from the fetal adrenal gland.

We propose that PGE2 provides a tonic stimulation of the fetal HPA axis in late gestation, contributing to phenomena such as the apparent insensitivity of the pituitary to Cortisol feedback and the increasing sensitivity of the fetal adrenal. Because of its apparent responsiveness to placental workload, it may transduce stimuli from the placenta and transmit them to the fetal HPA axis, giving a possible biochemical basis to the empirically observed correlation between fetal metabolic demand and gestation length.
Strategic Planning of Obstetric Services: The United Kingdom Way
Authors: Cooke I. D.
Published: February 2008

Summary: From 1944 when the first British Report on a National Maternity Service was published until 1989 there have been seven publications on the Maternity Services. Against this background the Shearman Report is described in comparison with its British counterparts. There has however been much debate in the UK since 1989 with a redesign of the National Health Service. A sub committee of the House of Commons (Winterton) advocated major changes in maternity services and the Government responded with a detailed critique announcing the appointment of an Expert Maternity Group (Cumberlege) which has just published its recommendations for widespread consultation. The three Royal Colleges have published a joint report and in the next year Government policy will be published. Scotland however has developed an independent view and has progressed further in analysis and rational planning. The fate of the Shearman report will be awaited with interest.
Computerization of Obstetric Antenatal Histories
Authors: Kohlenberg Christopher F.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it explains the basic facts of life concerning computerization of obstetric antenatal histories. The editorial committee is convinced that such a system should now be introduced into all obstetric hospitals at least for the purposes of prompt production of a discharge summary and letter to the referring practitioner. This system is easily adapted to the coding requirements for clinical audit and Diagnostic Related Group (DRG) coding now required for funding of Public Hospitals in Victoria. We encourage all readers to seek more information about these systems and to request that the administrators in the hospitals where they work at least introduce them for generation of discharge summaries and letters. The rest will follow.

Summary: Computers have existed for over 40 years. Their evolution has transformed them from being merely big calculators into versatile user‐friendly machines with the possibility to interact with the operator.

Within their clinical capacity one of their main benefits is within the area of quality assurance. When applied in an appropriate way in obstetrics, they can actually lead to improved antenatal care. This can be achieved through obtaining a more standardized and comprehensive patient history and the use of management suggestions, made by the computer, in response to specific items in the patient history. These suggestions are titled ‘action prompts’. Other quality assurance advantages exist within the areas of legibility and availability of individual patient files, while within a general setting they lend themselves easily to research and education.

All these advantages will make computer generated antenatal histories and summaries more likely to be widely implemented in the future.
An Audit of Labour Following Caesarean Section at the Aga Khan Medical Centre
Authors: Wasti Shahnaz , Turab Azhar , Agha Zia , Qazi Fahim , Hussany Fuad , Farid Hamida , Rizvi Javaid H.
Published: February 2008

Summary: An audit of labour following Caesarean section was carried out over a 70‐month‐period to assess our management of labour following Caesarean section and to support the hospital quality assurance review progress for obstetric care: 419 patients with 1 previous Caesarean section were given a trial of labour: 314 (75%) women had a vaginal delivery and 105 (25%) had a repeat Caesarean section. The highest failure rate was observed in women whose previous indication for Caesarean section was cephalopelvic disproportion. There were 6 (1.4%) cases of scar dehiscence and 4 (1%) of uterine rupture. Vaginal delivery following Caesarean section is a viable cost‐effective, safe procedure in a high quality labour and delivery unit in a developing country.
Home Deliveries and Third Stage Complications
Authors: Sawhney Harjeet , Gopalan Sarala
Published: February 2008

EDITORIAL COMMENT: We have accepted this paper for publication not only because it tells us about the conditions under which obstetrics is practised in a very large proportion of the world's population but because, by implication, it reminds us of the importance of careful management of the third stage of labour. We learn from this paper that approximately 80% of parturients in India are cared for by an untrained birth attendant and that oxytocic agents are not available or used routinely at delivery. One can only wonder at how many maternal deaths occur in patients who are never referred to hospital. As far as the editorial subcommittee of the Journal is aware the national maternal mortality rates are not available for India and hospital figures are quoted when the proportion due to various complications are discussed. This paper does not allow comparison of third stage complications in home deliveries and hospital deliveries because the 122 cases referred to in this paper come from a population whose size is unknown. It is salutary to note from table 1 that in 13% (16 of 123) of cases the baby had been stillborn. The high incidence of uterine inversion in this series no doubt is explained by attempts at removal of a retained placenta without the use of oxytocic agents. There is a message here for us all ‐ in developed and in developing countries. The third stage of labour is a killer and requires routine management with an oxytocic drug used appropriately.

Summary: Women with third stage complications following home deliveries admitted as emergencies to a referral hospital are discussed. Retained placenta constituted 68% (83 of 122) of emergencies. Primary and secondary postpartum haemorrhage was seen in 16.4% and 15.6% respectively. There was a considerable delay in referral and 31.4% patients were admitted in shock. Two patients required prolonged hospitalization. Training of traditional birth attendants in management of the third stage of labour will reduce these complications in the developing countries where approximately 80% of all births are managed by these untrained personnel who conduct deliveries at home.
Genital Mycoplasmas in Pregnancy and Obstetric Outcome
Authors: Chua S. , Arulkumaran S. , Chow C. , Leong W.P. , Kumarasinghe G. , Kuah B.G. , Ratnam S. S.
Published: February 2008

Summary: This prospective study was conducted to determine the incidence of genital mycoplasma carriage in an antenatal pregnant population in Singapore, and to study the association of genital mycoplasma with preterm labour, prelabour rupture of membranes (PROM) and low birth‐weight babies.

Genital mycoplasma was isolated in 26.3% of 312 pregnant women. The carrier rate was twice as high in women between 28 and 34 weeks (37.9%) compared with women at <28 weeks (23.8%) (p <0.05). In the individual women, the carriage of genital mycoplasmas was not persistent throughout pregnancy even without treatment, and a negative swab did not exclude colonization later on in pregnancy.

Our study does not support an association between genital tract colonization with genital mycoplasmas (Mycoplasma hominis or Ureaplasma urealyticum) and prematurity (8.5% in carriers compared with 8.3% in noncarriers), PROM (3.7% in carriers compared with 4.8% in noncarriers) or low birth‐weight babies (2.4% in carriers compared with 5.6% in noncarriers).
A Comparison of Ovarian Cyst Aspirate Cytology and Histology. The Case Against Aspiration of Cystic Pelvic Masses
Authors: Nicklin J.L. , van Eijkeren M. , Athanasatos P. , Wain G.V. , Hacker N.F.
Published: February 2008

Summary: The management of simple ovarian cysts by laparoscopically or sono‐graphically‐directed aspiration is widely practised. A study was undertaken to correlate the accuracy of cyst aspirate cytology with histology in 29 consecutive cystic pelvic masses managed in a gynaecological oncology unit. The results of a literature review are then presented to determine the role for aspiration of simple cysts. Aspiration cytology was found to correlate poorly with histology. On the basis of these results and literature evidence, the case against aspiration of ovarian cysts, as either a diagnostic or a therapeutic modality, is presented.
Current Practices in the Management of Cervical Intraepithelial Neoplasia in Australia
Authors: Erian Mark M.S. , Goh Judith TW. , Mackay Eric V. , McLaren Glenda , Battistutta Diana
Published: February 2008

Summary: Responses from 181 returned questionnaires (from members of the Australian Society for Colposcopy and Cervical Pathology) regarding the management of cervical intraepithelial neoplasia (CIN) were analysed. The preferred methods of ablation of CIN were laser treatment and electrocoagulation diathermy. Diathermy of lesions was more commonly used by older respondents and those in provincial centres. Fifty‐percent of those surveyed used a combination of local and general anaesthesia for ablation of CIN; 30% used either local or general anaesthesia but 15% reported no use of anaesthesia.
Early Stage Cervical Cancer: A Multivariate Analysis of Histopathological Prognostic Factors
Authors: Allen D.G. , Roovers J.P.W.R. , van Lindert A.C.M. , Heintz A.P.M.
Published: February 2008

Summary: A multivariate analysis of the histopathological prognostic factors in early stage carcinoma of the cervix was performed. A total of 140 patients were studied (Stage 1A 6, Stage IB 107, Stage 2A 27 patients). Five‐year follow‐up data were available for 124 patients and 10‐year data for 76 patients. The histopathological factors considered were the histological type, lymph node metastases, tumour diameter, lymph vascular space invasion, parametrial invasion and corpus and vaginal invasion. Multivariate analysis identified lymph node metastases (p = 0.0003) and tumour diameter (p = 0.0016) as significant variables for survival at 5 and 10 years. There was a high incidence of occult parametrial invasion (20% in Stage IB and 37% in Stage 2A). Univariate analysis identified lymph node metastases (p < 0.0001), tumour diameter (p < 0.0001), lymph vascular space invasion (p = 0.0041) and parametrial invasion (p = 0.0024) as significant variables for survival at 5 years, with lymph node metastases, tumour diameter, lymph vascular space invasion remaining significant at 10 years. If there were 2 or more pelvic lymph node metastases the survival decreased considerably (up to 40% over 5 years). Microscopic parametrial invasion was identified in 20% of Stage IB and 37% of Stage 2A tumours. The critical period for recurrence was the first 2 years after surgery.
Clinical and Urodynamic Follow‐Up of Women with Established Urinary Dysfunction After Radical Hysterectomy
Authors: O'Callaghan David J. , Dwyer Peter L.
Published: February 2008

Summary: The aim of this study was to examine the symptomatic and urodynamic changes seen in women presenting with urinary dysfunction after radical hysterectomy and ascertain whether there is any significant improvement over time. Sixteen women with persistent urinary dysfunction after radical hysterectomy were assessed on 2 occasions by interview and urodynamic studies over an average time interval of 35 months. Urinary incontinence, decreased bladder sensation and voiding difficulty were common symptoms of urinary dysfunction after radical hysterectomy. The sign of stress incontinence was an unreliable indicator of urethral sphincter incompetence. The only symptom to show significant improvement was bladder sensation (p<0.02). No significant improvement was found in any urodynamic parameter during the interval in either women who had surgery alone or had surgery and radiotherapy. The persistent nature of urinary dysfunction after cervical cancer treatment highlights the importance of prevention and long‐term follow‐up.
Electrosurgical Principles and Problems
Authors: Cooper Michael
Published: February 2008

EDITORIAL COMMENT: We have not previously published information concerning electrosurgical principles applicable to the instrumentation now widely used in gynaecological practice. This is our beginning. The information presented should, at the very least, warn surgeons, especially those using electrosurgery in combination with laparoscopy, that a thorough understanding of these principles should be mastered before surgical training in these techniques is commenced.

Summary: Major technological advances in electrosurgical generator equipment have reduced many of the problems associated with early generation equipment. The appropriate use of cutting or coagulation waveforms and an understanding of electrosurgical principles will enhance performance and further reduce operative risk.
Replacement of Abdominal Hysterectomy by the Laparovaginal Technique – Its Success and Limitations
Authors: Wood Carl , Maher Peter , Hill David
Published: February 2008

Summary: The objective of this study was to study the effect of replacing of most abdominal hysterectomies with the laparovaginal technique. Three gynaecologists trained in advanced operative laparoscopy performed 160 laparovaginal, open and vaginal hysterectomies in 3 private hospitals in Melbourne.

One hundred and twenty seven (79.4%) of hysterectomies were laparovaginal, 16 (10.0%) were open and 17 (10.7%) were vaginal. The distribution of technique was similar for the 3 surgeons.

The high incidence of laparovaginal hysterectomy was partly due to the ability to remove uteri up to the size of a 16‐week pregnancy, to divide severe pelvic adhesions and to perform recto‐vaginal excisional surgery in severe endometriosis. Abdominal hysterectomy was preferred for patients with uteri larger than a 16‐week pregnant size, tough intestinal adhesions, multiple pelvic pathology requiring prolonged surgery or with excessive obesity.

The infrequent use of vaginal hysterectomy was related to the low occurrence of vaginal prolapse, the routine use of endometrial ablation for the treatment of menorrhagia resistant to drug therapy in uteri less than 10 cm, and the preference for laparoscopic rather than vaginal removal of the ovaries.

The considered advantages of laparovaginal hysterectomy compared to abdominal hysterectomy were the reduced time in hospital and reduced convalescence.

The cost of laparovaginal hysterectomy in the present study is 600–700 higher than abdominal hysterectomy. The cost may be reduced by decreased use of disposable equipment or by earlier discharge of patients from hospital. Gasless laparoscopy facilitating a combined abdominal and vaginal technique using 2 surgeons may further reduce operating time.

Laparovaginal hysterectomy is capable of replacing most open procedures. Its future may depend upon the ability to reduce the operating time to be comparable to that of abdominal hysterectomy and to maintain similar costs. Vaginal hysterectomy is a suitable alternative to laparovaginal hysterectomy for surgeons skilled with this technique.
Nerve Entrapment ‐ An Important Complication of Transverse Lower Abdominal Incisions
Authors: Challis Daniel E. , Bennett Michael J.
Published: February 2008

Summary: Eleven patients with atypical lower abdominal pain following gynaecological surgery were clinically assessed for the features of nerve entrapment syndrome. Eight iliohypogastric nerves in 6 patients were subsequently explored and divided with satisfactory results in all patients. Diagnostic criteria for this syndrome are suggested, and the surgical management is described.
Lithotomy Position‐Induced Femoral Neuropathy
Authors: Goh Judith TW. , Gregora Michael G. , Welch Mark
Published: February 2008

Summary: Femoral neuropathy can occur following placement in the lithotomy position and has been rarely reported following vaginal hysterectomy. Contributing factors to this condition include positioning of the patient, duration of surgical procedure and glucose intolerance. The prognosis of lithotomy position induced femoral neuropathy is excellent. An illustrative case is herein reported.
Splenic Artery Aneurysm in Pregnancy
Authors: Wiegand M.H. , Smith D. , Bowman M. , Delbridge L.W. , Lucas P. , Roche J.
Published: February 2008

EDITORIAL COMMENT: We accepted this rather detailed case report for publication because of the special relationship of rupture of splenic artery aneurysms with pregnancy. It is wise for obstetricians to know that this condition is an important uncommon cause of abdominal pain and collapse during pregnancy, labour or the puerperium.

Summary: Rupture of a splenic artery aneurysm during pregnancy or delivery is a rare event. Only 99 cases have been reported. There is significant risk to mother and fetus. This paper describes a splenic artery aneurysm rupture with a concomitant unruptured hepatic artery aneurysm and coincidental partial placental abruption with fetal death at 22 weeks' gestation. Splenectomy was performed to achieve haemostasis. Nonsurgical treatment by embolization of the hepatic artery aneurysm was performed after a routine postoperative computed tomogram (CT) and angiogram revealed the lesion. CT screening of high‐risk patients and ultrasound/pulsed Doppler screening of pregnant women with unexplained abdominal pain might be an important precaution in the avoidance of obstetric catastrophies.
Isolated Torsion of the Fallopian Tube During Pregnancy
Authors: Massoud M.A.K. , Owen E.J. , Wingfield J.G.
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication because it will remind readers of an unusual cause of right‐sided abdominal pain during pregnancy. The case particularly appealed to the Editor who had in the previous few weeks seen 3 women with quite severe round ligament strain. Round ligament strain can usually be diagnosed over the telephone by asking the patient to feel the tender area lateral to the uterus on one or other side although occasionally it is bilateral. This common condition receives scant attention in textbooks yet often causes women considerable distress in the middle of the second trimester. Presumably later in pregnancy the changes in the ligament are accommodated because the patient no longer experiences localized spasm and tenderness. In one of the cases referred to above the pain was sufficient to raise the possibility of appendicitis and the fact that the nearby uterus was tender also raised the possibility of placental abruption and an ultrasound was performed for this reason. In the present case although the tube was gangrenous one wonders whether laparotomy would have been performed had the ultrasound scan been negative!
Intrachorial Placental Haematoma at Cord Insertion and Stillbirth: A Case Report
Authors: Ibbetson S.J. , Cochrane L. , Castle B. , Becroft D.M.O.
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication because it clearly documents a rare lesion ‐ intrachorial placental haematoma. A second ultrasound examination was performed but cardiotocography or biochemical tests of fetal condition apparently were not. Readers may wonder whether antenatal diagnosis of such large placental lesions warrants elective Caesarean section or induction of labour, perhaps after testing for fetal lung maturity, even when retroplacental haemorrhage has been excluded as a differential diagnosis.
Dermatomyositis and Ovarian Cancer: A Rare Occurrence but a Significant Association
Authors: Parker Jim , Sykes Peter , Rome Robert
Published: February 2008

Summary: The relationship between the inflammatory myopathies, polymyositis (PM) and dermatomyositis (DM), and internal malignancy, has been gradually established during this century. The controversy over the existence of this association continued into the latter half of the 1980's, mostly as a result of their rare occurrence (1). A number of studies have now clearly demonstrated the increased risk of malignancy in patients with myositis (2–4). In particular, the gravity of the relationship between DM and ovarian cancer (OC) in female patients over 40 years of age has been recognized by both physicians and gynaecologists (3, 4). We describe a case of OC in a patient with DM to highlight the importance of this association.
The Swedish Insemination Act and Its Impact*
Authors: Daniels Ken
Published: February 2008

Summary: In the debate surrounding secrecy in donor insemination (DI), the semen donor is often cited as a person needing the protection of anonymity. Sweden's unique legislation, the 1985 Insemination Law which, among other things, gives mature DI offspring the right of access to donor identity, has attracted much comment. Prior to the legislation's enactment, there were fears that the law would result in a rapid and irreversible decline in DI as a treatment in Sweden. It was also predicted that it would be almost impossible to recruit donors under the legislation. This paper describes the provisions of the legislation and examines what its impact has been in terms of the reactions of the medical profession, DI treatment provision, and the availability and recruitment of donors.
Intrapartum Haemorrhage due to Idiopathic Rupture of the Fetal Placental Artery
Authors: Tarn Wing Hung , Fung Hedy Y. M. , Haines Christopher J.
Published: February 2008

EDITORIAL COMMENT: We accepted this interesting case report to remind readers that cardiotocography may identify fetal distress and the need for immediate delivery in women with intrapartum haemorrhage, which in this case resulted from fetal haemorrhage. May we also remind readers that a fetal origin should be considered in all cases of intrapartum blood loss since an abnormal cardiotocograph can be a late (too late!) sign from a fetus bleeding to death. Since fetal haemoglobin is resistant to alkali denaturation, a sample of blood from the vagina, diluted in water, will remain pink on the addition of 10% sodium hydroxide if fetal in origin, whereas it will turn brown if maternal (Apt test). A bottle of 10% sodium hydroxide should be available in every delivery suite so that this test can be performed when indicated; this is very often since how else can an ‘excessive show’ be distinguished from haemorrhage from a vasa praevia? The solution has a shelf‐life of only 1 month; a time‐expired solution may fail to turn maternal blood brown and thus give a false positive test for fetal blood.
An Unusual Cause of Vaginal Bleeding and Abdominal Pain ‐Prolapsed Ureterocele
Authors: Goh Judith TW , Gregora Michael G. , Heap Graeme
Published: February 2008

EDITORIAL COMMENT: The editor has never seen a urinary tract vulval mass like this. However, in 1963 at the Austin Hospital, Melbourne, he saw and unfortunately failed to photograph, a pink vulval mass in a woman with paraplegia who had turned her bladder inside out and passed it per urethra like an intussusception. The nature of the mass became apparent when urine spurted from the ureteric orifices. This woman was managed by a urologist by ureteric transplantation into an ileal loop.
Why Do Aboriginal Newborns Weigh Less? Gestational Age at Delivery: Estimation, Distribution and Determinants
Authors: Blair Eve , Morich Patricia , Stanley Fiona
Published: February 2008

Summary: We reviewed birth records pertaining to 1,301 Western Australian singleton Aboriginal pregnancies dated before 24 weeks by ultrasound fetometry using Caucasian standards.

We compared i) ultrasound‐ and LMP‐derived estimates of age at delivery for 323 pregnancies with available last menstrual period (LMP) dates and ii) distributions of ultrasound‐estimated age at delivery for full‐blood with part‐blood Aboriginal neonates and with statutorily collected estimates for Caucasian neonates. We investigated determinants of age at delivery for Aboriginal neonates.

Ultrasound‐derived estimates of gestational age for Aboriginal pregnancies were statistically but not clinically significantly shorter than estimates derived from LMP dates claimed to be certain: mean difference = 0.4 weeks (95% 0:0.09‐0.71). Aboriginal gestations were shorter than Caucasians' by 2 weeks (median) or 1 week (mode). Some shortening of gestation was accounted for by antepartum haemorrhage, congenital anomaly, history of syphilis, diabetes, hypertensive disease and inductions before 40 weeks without recorded medical complication but not by full‐blood (relative to part‐blood) Aboriginality.

We conclude that Caucasian fetometry standards gave gestational estimates acceptably close to those derived from certain menstrual dates for dating scan before 24 weeks. Aboriginal gestations tended to be shorter than Caucasian gestations but since factors recorded in the medical record accounted for little of this difference, socioeconomic factors may be partly responsible.