bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiple Pregnancy and Fetal Abnormalities in Association With Oral Contraceptive Usage
Authors: Macourt D. C. , Stewart P. , Zaki M.
Published: February 2008

Summary: 1,000 multiple births were examined in relation to maternal exposure to an oral contraceptive before conception. There was a significantly higher rate of monozygotic twinning among pregnancies which took place within 6 months of cessation of the contraceptive.

In the monozygotic group there was a significant increase in the incidence of congenital abnormalities (P < 0.01) when conception occurred within 3 months of cessation of the contraceptive.
Cytogenetic Studies in Recurrent Fetal Loss
Authors: Mulcahy Marie T.
Published: February 2008

Summary: The results of cytogenetic studies of 19 couples with a history of a malformed stillbirth plus 1 or more early spontaneous abortions were compared with those of 66 couples with a history of 2 or more early spontaneous abortions and a control group of 583 couples with no history of fetal loss. The incidence of structural chromosome abnormality was highest in the first group and there was no significant difference between groups in the incidence of polymorphisms of the 9 and Y chromosomes.
A Randomised Trial and a Comparative Study of the Copper 7 200 and the Multiload Copper 250 Intrauterine Devices
Authors: Wilson Jennifer
Published: February 2008

Summary: A randomized trial of the Copper 7 200 (Cu 7 200) and the Multiload Copper 250 (ML Cu 250) intrauterine devices (IUD) was carried out for 13 months. On life table analysis at 12 months, net cumulative closure rates for use‐related terminations (net rates) for the Cu 7 200 were higher than for the ML Cu 250 for accidental pregnancy (NS), expulsions (P<0.02) and medical removals for pain and/or bleeding (P<0.01). The continuation rate was lower for the Cu 7 200 (P<0.001). In a larger comparative study, at 12 months there was a highly significant difference (P<0.001) in favour of the ML Cu 250 in accidental pregnancy, expulsions and removals for pain and/or bleeding and continuation of use.

Since the ultimate purpose of the use of an IUD is pregnancy protection with a minimum of side effects, the continued use of the Cu 7 200 is not recommended.
Decapitation and Vaginal Delivery for Impacted Transverse Lie in Late Labour: Reports of 4 Cases
Authors: Marsden D. E. , Chang A. S. , Shin K. S.
Published: February 2008

Summary: Four cases are presented to illustrate clinical situations where decapitation of a dead fetus in a transverse lie is a practical alternative to Caesarean section. Emphasis is placed on the relative ease and safety of the procedure in such circumstances, with reference to relevant literature
Hereditary Spherocytosis With Haemolytic Crisis During Pregnancy
Authors: Ventura C. Savona
Published: February 2008

Summary: A haemolytic crisis was detected late in the second pregnancy of a young woman. A diagnosis of hereditary spherocytosis was made and the patient was successfully managed by supportive therapy alone. The relevant literature is reviewed.
Carcinoembryonic Antigen in Ovarian Cancer: Correlation of Concentrations in Tumour Tissue, Cyst Fluid, Ascitic Fluid and Peripheral Blood
Authors: Khoo S. K. , Hill R. , Daunter B. , Mackay E.V.
Published: February 2008

Summary: The interpretation of CEA levels in patients with malignant disease is still difficult in some instances because of lack of knowledge of the factors which influence the concentrations of CEA in peripheral blood. In the present study of patients with advanced ovarian cancer, CEA was measured in extracts of the tumour, in cyst fluid, in ascitic fluid, as well as in serum. A gradient in CEA level was found in the various compartments, highest values being found in the primary tumour and cyst fluid, intermediate values in the surrounding ascitic fluid, and the lowest values in peripheral blood. A significant correlation was found between CEA concentrations in tumour and cyst fluid or ascitic fluid, but not between CEA concentrations in tumour and serum. CEA was more frequently detected in the ascitic fluid than the corresponding serum; it increased the CEA positivity rate from 57% to 78%.
Genetic Amniocentesis in Twin Pregnancy
Authors: Field Barbara , Picker Richard
Published: February 2008

Summary: In a series of 800 referred patients, the diagnosis of 11 twin pregnancies was made by ultrasound prior to genetic amniocentesis. Amniocentesis of both gestation sacs was successful in all 11 patients. Genetic counselling in twin pregnancy should assess precisely the indications, specificity and complications of differential amniocentesis.
Extra‐Amniotic Prostaglandin Gel in the Management of Fetal Death and Fetal Abnormality
Authors: Quinn M. A. , Murphy A. J.
Published: February 2008

Summary: Seventeen cases of fetal death in utero and 3 cases of anencephaly have been managed by the extra‐amniotic instillation of prostaglandin F2α in Tylose, followed 12 hours later by amniotomy and the intravenous infusion of oxytocin in escalating doses. The mean amniotomy‐delivery interval was 7.4 hours and all patients delivered within 12 hours. There were no complications.
Mood Changes as Reported by Women Taking the Oral Contraceptive Pill
Authors: Chang A.M.Z. , Chick P. , Milburn S.
Published: February 2008

Summary: This paper reports a series of sequential studies into the nature of mood changes as reported by women taking the pill. The results identified 4 specific and uncorrelated dimensions of mood changes. The implications of the findings are discussed.
An Infertile Female with Ring (X) Chromosome Constitution and Evidence of Ovulation
Authors: Smith Arabella , Shale Donald J.J. , Dulk Gesina Den
Published: February 2008

Summary: A short female with several stigmata of Turner's syndrome was investigated for infertility. She was found to be mosaic for a ring X chromosome and a 45, X cell line in peripheral blood, but skin culture showed only 45, X cells. Gynaecological investigation revealed endometriosis and there was clear evidence that this patient ovulated.
Problems in the Diagnosis of Ectopic Pregnancy: The Pseudogestational Sac
Authors: O'Neil A. G. B. , Hammond I. G. , Reid S. E.
Published: February 2008

Summary: The term pseudogestational sac was first suggested by Mueller in 1979. It was applied to the echo pattern which he noted on ultrasonic examination of 2 patients with ectopic pregnancy. He suggested that the echo pattern, which can easily be misinterpreted as a gestational sac, is produced by the decidual cast with blood contained in its centre.

During the past 3 years, 6 cases of pseudogestational sacs have been recorded at K.E.M.H. In 3 of these the possibility of ectopic pregnancy was suggested by the ultrasonologist because of suspicious extra‐uterine echo patterns associated with the pseudogestational sac.

In the remaining 3 patients the ultrasonologist reported that there was an intrauterine pregnancy, an error which influenced clinical management. These 3 cases are summarized below.
Massive Enlargement of the Ovaries After Evacuation of Hydatidiform Moles
Authors: Planner R. S. , Abell D. A. , Barbara C. A. , Beischer N. A.
Published: February 2008

Summary: Three cases of massive ovarian cystic enlargement occurring after evacuation of hydatidiform moles are presented. The management of these cases is discussed and the probable aetiology is reviewed.
Strum a Ovarii With Meigs' Syndrome
Authors: Mantouvalos C. , Metallinos C. , Gouskos A.
Published: February 2008

Summary: A case of struma ovarii with ascites and hydrothorax is presented.
Positive Peritoneal Cytology in Corpus Carcinoma Report of a Fatal Outcome
Authors: Hacker Neville F. , Castaldok Thomas W. , Morrow C. Paul , Ballon Samuel C.
Published: February 2008

Summary: A 64‐year‐old patient underwent total abdominal hysterectomy and bilateral salpingo‐oophorectomy in October, 1978 for a Stage IA, grade 2 papillary adenocarcinoma of the endometrium. Peritoneal washings contained numerous malignant cells, although the tumor invaded the myometrium only superficially.

Two weeks after operation, 12 mCi of P32 were instilled into the peritoneal cavity. In May, 1979, laparotomy was performed for clinical obstruction of the small intestine and revealed diffuse peritoneal, omental, and hepatic metastases. Radiation changes involved the terminal ileum, ascending and sigmoid colon; an ileorectal fistula was also identified.

The factors that might cause malignant cells to be present in the peritoneal cavity and the ideal treatment of such patients have yet to be determined. The risk of intraperitoneal P32 might outweigh its benefits.
Pulmonary Pseudotumours Following Chemotherapy for Endodermal Sinus Tumour of the Ovary
Authors: Friedlander M. L. , Halley J. B. W. , Sinosich M. J. , Coates A.
Published: February 2008

Summary: We report a case of a 20‐year‐old woman with an endodermal sinus tumour of the ovary which showed tumour marker evidence of relapse after unilateral oophorectomy. Tumour markers returned to normal after chemotherapy, but the development of pulmonary opacities led to exploratory thoracotomy which revealed an organized nodular lymphoid aggregate in the lung showing active sclerosing interstitial pneumonitis. The patient remains well without tumour relapse 28 months after oophorectomy.
Preleukaemia Presenting as Sideroblastic Anaemia After Successful Therapy of Ovarian Carcinoma
Authors: Planner R. S. , Taft L. I. , Cooper I. A. , Campbell J. J.
Published: February 2008

Summary: Sideroblastic anaemia, developing as a preleukaemic state was seen in a patient treated for late stage ovarian carcinoma after completion of radiotherapy and chemotherapy. This condition rapidly progressed to acute myelomonocytic leukaemia. The significance of acute leukaemia developing after cancer therapy is discussed.
Scleroderma and Pregnancy
Authors: Sivanesaratnam V. , Chong H. L.
Published: February 2008

Summary: A case of pregnancy complicated by scleroderma is reported. Although the disease runs a variable course during pregnancy, maternal mortality is a likely sequel once renal involvement occurs. General systemic deterioration occurred in this patient during pregnancy, but there was a remarkable recovery after delivery.
A New Catheter for the Female Patient
Authors: O'Neil A. G. B. , Jenkins D. T. , Wells J. I.
Published: February 2008

Summary: A new method of catheterizing the female patient has been designed. This method is aimed at reducing transfer of organisms from the distal urethra to the bladder at the time of catheterization. In an initial trial on 132 patients, post‐catheterization bacteruria was reduced from 25% to 4%.
Intrauterine Fetal Skull Fracture Diagnosed by Ultrasound
Authors: McRae S. M. , Speed R. A. , Sommerville A. J.
Published: February 2008

Summary: Fetal trauma without significant maternal injury, although rare, has been reported on a number of occasions. We describe a case of fetal skull fracture that was diagnosed antenatally by ultrasound.
Well Differentiated Combined Sertoli‐Leydig Cell Tumour of the Ovary
Authors: Tucker Ian , Pounder D. J. , Gilbert J.
Published: February 2008

Summary: A virilising ovarian neoplasm in a 31‐year‐old woman proved to be a well differentiated combined Sertoli‐Leydig cell tumour. The case is of interest, not only because of its rarity, but also because it illustrates a characteristic clinico‐pathological correlation, which is supported by electron microscopic and clinical hormonal studies.
Fetal Distress Due to Intravenous Administration of Pethidine (Meperidine) with Promethazine During Labour
Authors: Bergman Arieh , Eckstein Nachman , Yedwab Gideon , David Menahem P.
Published: February 2008

Summary: Fetal bradycardia due to uterine hypertonia was observed after the intravenous administration of pethidine (meperidine) 75 mg with promethazine 25 mg during active labour. These analgesic drugs are known to affect uterine contractions by enhancing both amplitude and frequency, but are thought to affect uterine tone minimally.

Twenty cases of uterine hypertonia resulting in fetal bradycardia were monitored in a period of 6 months in women receiving these drugs during labour. In all cases, the uterine hypertonia appeared shortly after the drug administration. The uterine hypertonus as well as the fetal bradycardia were self limited and no intervention was undertaken.

Recognition of this phenomenon is important in order to prevent unnecessary anxiety on the part of medical attendants.
The Place of Surgery in the Management of Ovarian Cancer
Authors: Free Keith , Bourne Robert G.
Published: February 2008

Summary: One hundred and eighty‐eight patients with ovarian cancer treated at the Mater Hospital gynaecological radiosurgical unit, Brisbane are surveyed. The place and results of different surgical techniques are assessed and related to pathology findings. Although significant improvement of results can be obtained with meticulous assessment combined with aggressive surgery and subsequent chemotherapy and radiotherapy, the 5‐year survival rate (34%) remains disappointing.
Fine Needle Aspiration in Gynaecologic Oncology
Authors: Choo Y. C. , Hsu C. , Choy T. K. , Woo J. S. K. , Ngan H. , Ma H. K.
Published: February 2008

Summary: One hundred and ten fine needle aspirations were performed on 73 patients with primary and recurrent gynaecological cancers. The sampling sites included superficial and retroperitoneal lymph nodes, soft tissue masses, liver, lungs, abdominal and pelvic masses, parametrium, thyroid and breast nodules. This relatively simple, safe and yet reliable technique can obviate the need for biopsies in most situations, and a more liberal use of aspiration cytology in gynaecological malignancies is advocated.
Study of Bleier Tubal Clip for Fertility Control
Authors: Vear C. S.
Published: February 2008

Summary: Sterilization by oviduct occlusion with plastic mono‐construction clips was carried out on a series of 21 doe‐rabbits; effective sterilization resulted. Subsequent oviduct re‐anastomosis over nylon splints resulted in 58% restoration of fertility as proven by term pregnancies. There were no complications attributable to the clip application.
Advanced Intraligamentary Pregnancy: A Report of 2 Cases
Authors: Schramm Mary
Published: February 2008

Summary: Two cases of advanced intraligamentary pregnancy have been seen at the Colonial War Memorial Hospital, Suva, Fiji, in the 10 years, 1972‐81, during which time approximately 50,000 births have occurred. One patient presented with diarrhoea, and the other with the development of shock early in spurious labour.
Benign Teratoma of the Fallopian Tube
Authors: Walter A.
Published: February 2008

Summary: Teratoma of the Fallopian tube is very uncommon. Only 47 cases have been reported since 1865. Many have been discovered incidentally and none has been diagnosed preoperatively. The majority are cystic, show great variation in size, are commonly located in the ampulla or isthmus and are either intraluminal or attached to the luminal surface by a pedicle. Histologically they are similar to teratomas of the ovary and elsewhere. Only one instance of malignant tubal teratoma has been recorded. An association with nulliparity or reduced parity has been noted in some cases. The present case of benign tubal teratoma is the 48th and apparently the smallest reported.
Book Reviews
Authors: Wilson L. Hardy
Published: February 2008

Book reviewed in this article:

Atlas of Pelvic Surgery

The Fetus and Independent Life

Abortion and Sterilisation … Medical and Social Aspects

The Infertility Resources Handbook.

Developmental Effects of Diethylstilbestrol (DES) in Preg‐nancy

Malignant Disease of the Vulva

Principles and Practice of Obstetrics and Perinatology

Novak's Textbook of Gynaecology

Gynaecology
Acute Appendicitis Complicating Pregnancy and the Puerperium A Study of 5 Cases
Authors: Humphrey M. D. , Ayton R. A.
Published: February 2008

This series of 5 cases of appendicitis complicating all stages of pregnancy and the puerperium illustrates particularly the potentially rapid course of the disease and the need to perform laparotomy on suspicion. Diagnosis may be aided, in later pregnancy, by the finding of pain increments when the fetus moves, as well as by the use of Alders test. Though a muscle‐splitting incision over the point of maximal tenderness is usually suggested, we recommend a right paramedian incision when the fetus is viable as it gives greater flexibility.
Ptyalism and Partial Hydatidiform Mole Associated with a Normal Term Male Fetus
Authors: Hartfield V. J.
Published: February 2008

The case is described of a subfertile woman whose only successful pregnancy was complicated by the unusual combination of ptyalism and a partial hydatidiform mole. Review after delivery of an ultrasonic scan taken at 17 weeks showed the mole to be present at that time. A normal male child was delivered at term. It is concluded that there was no causal relationship between these 2 conditions.

Excessive salivation in pregnancy is a rare condition. Cooper (1956) found only 1 true case in 60,520 admissions to the University of Cape Town maternity hospitals. Likewise a hydatidiform mole with a co‐existent fetus is uncommon. Beischer (1966) gave an incidence of 1 in 20,000 pregnancies at the Royal Women's Hospital in Melbourne. However, in 12 of the 15 cases reported by him in 1961, the pregnancy ended before the third trimester. Jones and Lauersen (1975) reported 1 case with a live baby at term amongst the 8 studied; the incidence at the New York Hospital was 1 in 22,000 pregnancies. I have not been able to find any report of a case where a hydatidiform mole has been associated with ptyalism. The present case, as well as being apparently unique, provides some interesting insights into the 2 conditions.
A Giant Lutein Cyst in Pregnancy
Authors: Jones Robert A.
Published: February 2008

A case is described of a giant lutein cyst presenting late in pregnancy, together with problems encountered in obstetrical management.
Chromosome 1 C‐band Heteromorphisms in Patients with Carcinoma in Situ and Invasive Carcinoma of the Cervix Uteri
Authors: Atkin N. B. , Brito‐Babapulle V.
Published: February 2008

A significantly higher incidence of heteromorphism for the size of the C‐band regions of the chromosome 1 homologues was found in the lymphocytes of patients with carcinoma in situ and invasive carcinoma of the cervix uteri than in controls (15 out of 19 and 12 out of 18 patients, respectively, as compared with 13 out of 38 controls). There was also a higher incidence of partial inversions of this region in patients with carcinoma in situ and invasive carcinoma although the differences from that found in the controls were not statistically significant. C‐band variants of chromosome 1 may play a part in the cytogenetic events that determine the early stages of some forms of malignancy.
Acute Fatty Liver of Pregnancy – Survival Despite Associated Severe Preeclampsia, Coma and Coagulopathy
Authors: Cheng Chee Yam
Published: February 2008

Acute fatty liver of pregnancy is the least common and most serious cause of jaundice of pregnancy. It is rare, fewer than 100 cases having been reported (Koff, 1981). There is a high probability that it is frequently misdiagnosed and categorized vaguely as some form of variant of ‘toxaemia of pregnancy’ which is not surprising because of its late‐pregnancy onset and the production of multi‐system manifestations (Holzback, 1976). In the case reported here, there was associated severe preeclampsia with fetal intrauterine death but maternal survival.
A Solitary Diverticulum of the Fallopian Tube
Authors: Hertzanu Y. , Ferteira M. , Blumentha N. J.
Published: February 2008

Summary: A rare case is described in which a diverticulum of the middle portion of the right Fallopian tube was demonstrated by hysterosalpingography. The patient aged 26 years, had a history of a ruptured left mid‐tubal pregnancy 8 years previously and was suffering from infertility. The radiographic appearance of the lesion is characteristic, the aetiology is obscure and treatment should be conservative.
Editorial Comment: Is a Basement Membrane Necessary for the Histological Diagnosis of Intraepithelial neoplasia?: Glandular Intraepithelial Neoplasia (GIN) – A Unifying Concept Of The Precursors Of Endometrial Adenocarcinoma
Authors: Ruffol Eugene H. , Cavanagh Denis , Marsden Donald E.
Published: February 2008

There is considerable variation and a good deal of confusion surrounding definitions and nomenclature for premalignant lesions of the endometrium. A unifying concept, based on the model of cervical intraepithelial neoplasia, is proposed to provide a uniform, practical basis for the diagnosis and management of the precursors of endometrial cancer. Lesions would be classified as glandular epithelial neoplasia (GIN) Grades, 1, 2 and 3. Illustrated examples, and comparisons with other classifications are provided.
An Evaluation Of Teaching Cervical Mucus Symptoms To Ovulating Infertile Women
Authors: Graham Frederick M. , Gosling Leonie , France John T.
Published: February 2008

Women (n=l 13) with ovulatory menstrual cycles but complaining of infertility were instructed in the observation and charting of cervical mucus symptoms. At the completion of 3 teaching cycles, 80 subjects (70.8%) had successfully charted at least one cycle with an ovulatory mucus pattern (10 subjects became pregnant). Sixty‐two (54.9%) of the women continued for a further 3 cycles of investigation during which, around the time of ovulation, an assessment was made of the mucus at the cervix. On the basis of this assessment subjects were classified as either Group I: charting ovulatory mucus symptoms with ‘fertile type’ mucus observed at the cervix – 48 subjects (10 became pregnant); Group 2A: charting uninterpretable mucus symptoms but 'fertile type’ mucus observed at the cervix – 8 subjects; or, Group 2B: charting uninterpretable mucus symptoms and mucus of poor quality observed at the cervix – 6 subjects. The study shows that infertile ovulating women can be taught to observe and chart their mucus symptoms. Such charting is useful in identifying the fertile period of the cycle for timing of intercourse and for timing of postcoital tests and cervical assessment. It is also useful in identifying the small number of women (5.3%) with an apparent deficiency in mucus production. Whether the 20 subjects (17.7%) who became pregnant were assisted in this objective by their charting of symptoms is unclear.
The Rise of the Caesarean Section: A Review
Authors: Biggs John S. G.
Published: February 2008

Summary: Caesarean section is of recent development as a credible procedure. A rapidly increasing incidence in many countries has led to far‐ranging concern. Proposed causes for the increase include insistence on repeat operations and a resultant cumulative effect, more frequent diagnoses of disproportion and ineffective labour, the use of fetal heart monitoring, and a steady trend away from vaginal breech delivery. Increased perinatal morbidity is seen in Caesarean section, together with a qualified increase in perinatal mortality. Maternal morbidity is greater and maternal death rates are reportedly 2–4 times greater in Caesarean section births. More work is needed on the psychosocial sequelae of abdominal delivery.
Observations of Fetal Lung Reflectivity Using Real‐Time Ultrasound
Authors: Reeves G.S. , Garrett W.J. , Warren P.S. , Fisher C.C.
Published: February 2008

Summary: The ultrasonic appearance of the fetal lung alters as pregnancy progresses and this is expressed as increased reflectivity to ultrasound. Evidence is presented that demonstrates that these changes can be induced and that they may reflect increasing lung maturity.
The Clinical Significance of Endometrial Prolactin
Authors: Healy David L.
Published: February 2008

Summary: Prolactin (PRL) is produced not only by the anterior pituitary gland but also by human endometrium. That decidual stromal cells secrete PRL from day 22 of the menstrual cycle is demonstrated by: 1) nett accumulation of PRL during in vitro culture; 2) PRL accumulation is prevented by inhibitors of protein synthesis; and 3) identification of PRL mRNA within endometrial decidua. Endometrial PRL is biologically and immunologically equipotent with pituitary PRL and its amino acid sequence is very similar. In human pregnancy, decidual PRL binds to receptors on the fetal chorion and amnion and thereby passes into amniotic fluid in high concentration. Three putative functions of uterine PRL are suggested from current studies: a) a PRL receptor defect is present in the chorion laeve of patients with pregnancies complicated by chronic polyhydramnios and this deficiency in chorionic receptors for endometrial PRL may result in the development of excessive amniotic fluid; b) decidual PRL may modulate prostag‐landin synthesis not only within the endometrium prior to menstruation, but also within the chorion and amnion to allow labour to proceed in a timely manner; and c) amniotic fluid PRL may pass into the fetal tracheo‐bronchial system to promote surfactant production. Unlike pituitary PRL with distant target organs, decidual PRL appears to have paracrine or cybernetic functions in the human uterus, placental membranes and the fetus.
The Clinical Importance of Vaginal Discharge in Childhood
Authors: Kingsbury Andrew
Published: February 2008

Summary: The characteristics of vaginal discharge in childhood are outlined and the causes tabulated. Necessary instruments and techniques for examination of children are described together with suitable formats for treatment.
A Review of Primary Caesarean Sections in Tasmania
Authors: Murray‐Arthur F. , Correy J. F.
Published: February 2008

EDITORIAL COMMENT: Changes in practice should be evaluated. Rising rates of Caesarean section should be questioned in terms of fetal results and risks to the mother. Perinatal mortality rates are easily calculated but the justification of an increased Caesarean section rate is likely to be an improved quality of survival of the infant — this information is not readily available but must not be overlooked in the Caesarean section argument. Finally, the perinatal mortality rate associated with Caesarean section cannot be expected to fall when the increased rate takes in more of the fetuses at greatest risk (prematurity ±breech presentation, severe preeclampsia, premature rupture of the membranes, antepartum haemorrhage).

Summary: In the years 1975–1982 inclusive there were 55,095 deliveries in Tasmania and of these 2,738 patients (4.9%) were delivered by primary Caesarean section. The primary Caesarean section rate increased from 4.3% in 1975 to 6.6% in 1982. This increase has been due to the increased incidence of primary Caesarean section associated with breech presentation and to a lesser extent fetal distress. Although the overall perinatal mortality rate fell from 19.5 per 1,000 births in 1975 to 10.8 per 1,000 births in 1982, there has been no corresponding fall in the perinatal mortality rate associated with primary Caesarean section. As an increase in Caesarean section will lead to an increase in maternal mortality and morbidity it is considered that an active review of the reasons for the rise in Caesarean section should be undertaken by those hospitals where the rate is unusually high.
Ultrasound Imaging in the Management of Ovulation Stimulation
Authors: Biggs J. S. G. , Cooper D. H. , Miklosi S. , McKenzie E.
Published: February 2008

Summary: The present role of ultrasound imaging in the assessment of ovarian response to gonadotrophin therapy was assessed by comparing a group of patients in whom ultrasound was used to determine suitability of follicles for induction of ovulation with a group in whom ultrasound was not available. Ultrasound provides new and useful information, and may allow a reduction in the incidence of multiple pregnancies.
The Outcome of Pregnancies Complicated by Narcotic Drug Addiction
Authors: Oats J. N. , Beischer N. A. , Breheny J. E. , Pepperell R. J.
Published: February 2008

Summary: The incidence of known narcotic drug addiction at 2 Maternity Hospitals in Melbourne was 0.06% (45 of 80,950 confinements). The obstetric results of these 45 pregnancies were unexpectedly favourable, the main complications being fetal growth retardation (27%) and premature birth before 37 weeks (27%). There were no fetal malformations and only 1 perinatal death. Follow‐up information is necessary to ascertain if the main hazard to these infants lies in the environment to which they return.
Unexplained Intracranial Haemorrhage in Utero: The Battered Fetus?
Authors: Gunn Tania R. , Becroft David M. O.
Published: February 2008

Summary: Twenty stillborn infants with unexplained intracranial haemorrhages were identified in a review of approximately 3,500 perinatal postmortems performed between 1966 and 1982. After apparently uneventful pregnancies, fetal death occurred before the onset of labour and was recognized at a mean of 10 days before delivery; 80% had subdural haemorrhages, others had intraventricular and/or intracerebral haemorrhages, and many had haemorrhages at more than one of these sites. These haemorrhages were of sufficient size to have caused death and no other causes were found at postmortem examinations.

All 20 mothers were immigrants to New Zealand from the Pacific Islands and almost all were older, married, multi‐gravidas with uneventful medical histories and in stable socio‐economic circumstances. In the period studied the incidence of stillbirths with unexplained intracranial haemorrhages was 1.15 per 1,000 Pacific Islander births and, at one hospital, these haemorrhages were found in 14.6% of Pacific Islander stillbirths. There were no unexplained intracranial haemorrhages in other racial groups.

Prenatal subdural haemorrhage without a history of maternal trauma is extremely rare. In the absence of supporting maternal histories and other fetal or maternal injuries the possibility that these are ‘battered’ fetuses remains circumstantial.
Clinical and Biochemical Evaluation of Patients with Hirsutism
Authors: Holdaway I. M. , Croxson M. S. , Frengley P. A. , Ibbertson H. K. , Sheehan A. , Fraser A. , Evans M. C. , Knox B. S. , France J. T. , Graham F. M. , Liggins G. C.
Published: February 2008

Summary: Patients with moderate to severe hirsutism presenting over an 18‐month period to an endocrine clinic were assessed by clinical evaluation and hormone measurements. Hair growth rate was estimated by a photographic technique and the severity of hirsutism graded using an objective scale. Of 43 patients, 9 had polycystic ovaries and the remainder were considered to have idiopathic hirsutism. The most severely affected group had significantly increased hair growth rates compared with less clinically affected subjects, and 47% of this group showed objective features of virilization. However, apart from a significantly higher 24‐hr urine 17‐ketosteroid excretion all other hormonal patterns were not significantly different between severely and mildly affected patients. Serum levels of testosterone (T), sex hormone‐binding globulin (SHBG), free T (calculated from T and SHBG values), and androstenedione (A) were abnormal in 44%, 51%, 60% and 60% of patients respectively, whereas plasma levels of the specific adrenal androgen DHAS were increased in 40% of patients. There was an overlap between patients with elevated hormone levels, although isolated elevation of T, A or DHAS were seen in 9%, 19% and 3% of patients respectively. In 19% of patients all serum androgen measurements were normal. Gonadotrophin levels were significantly lower in the more severely affected group. Thus androgen levels in patients with idiopathic hirsutism or polycystic ovaries, show considerable overlap with measurements in normal subjects, and elevated plasma androgens may be of adrenal (DHAS) or combined adrenal/ovarian (T, A) origin.
Cervical‐Vaginal Bacterial Flora in Patients with Cervical Carcinoma Treated with Irradiation and Febrile Morbidity During Intracavitary Radium Therapy
Authors: Choo Y. C. , Seto W. H. , Ma H. K.
Published: February 2008

Summary: The cervical‐vaginal bacterial flora of 57 patients with invasive carcinoma of the cervix were found to be identical to those reported in studies of different population groups, except for a lower frequency of anaerobic bacteria. Radiation suppressed significantly both the aerobic and anaerobic bacteria. Following 4,000 rads of external irradiation, 47.4% of the cervical cultures were bacteriologically sterile. During the first and second radium treatment, 21% and 25.5% of the patients respectively developed fever of 38d̀C or more, the cause of which could not definitely be established. The significance of fever during radium treatment is discussed.
Tubal Pregnancy Following Late Luteal Vaginal Hysterectomy
Authors: Marut Edward L. , Zucker Alan J.
Published: February 2008

Summary: A patient who had a vaginal hysterectomy performed on day 24–25 of her cycle by histological dating was found to have a ruptured left tubal pregnancy 55 days later. The patient used barrier contraception up to the time of hysterectomy, and an undetectable level of β‐HCG was noted the week prior to hysterectomy. The likelihood of delayed tubal implantation having occurred in the same luteal phase as the hysterectomy distinguishes this case from the 27 others previously reported, which are briefly reviewed.
Clinical Analysis of Intracranial Metastases in Gestational Choriocarcinoma: A Series of 15 Cases
Authors: Kanazawa Koji , Takeuchi Shoshichi
Published: February 2008

Summary: Between 1963 and 1980 we have had experience of 54 patients with gestational choriocarcinoma and 29 are alive, a survival rate of 53.7%. The disease had metastasized to the central nervous system in 15 of these 54 patients, an occurrence rate of cerebral metastases of 27.8%. 13 of these 15 patients have died and 2 are now in a state of remission. Autopsy was performed in 8 cases. The following points are emphasized: 1) cases with the pulmonary disease risk intracranial spread; 2) the serum/cerebrospinal fluid ratio of human chorionic gonadotropin concentrations and computerized tomography are recommended as useful investigations in the diagnosis of CNS disease; 3) decompression surgery in patients with increased intracranial pressure is indispensable; 4) radiotherapy is temporarily effective for brain deposits; 5) powerful systemic chemotherapy using multiple anticancer drugs is suggested to be helpful both in preventing and in treating CNS disease.
Gynaecological Importance of Unusual Pituitary Tumours
Authors: Fraser Ian S. , Shearman Rodney P.
Published: February 2008

Summary: Sixty‐eight women with pituitary tumours exhibiting gynaecological symptoms have been reviewed. Fifty‐two tumours were prolactinomas while 6 were growth hormone secreting, 6 ACTH secreting, 1 was a large ‘inert’ adenoma and 3 were late‐presenting craniopharyngiomas. Several of the prolactinomas exhibited unusual features including excessively high prolactin secretion, a wide spectrum of sensitivity to bromocriptine, rapid expansion in pregnancy, association with the empty sella syndrome and even a secondary malignancy. The behaviour of tumours secreting other hormones but presenting with gynaecological symptoms is described.
Ectopic Pregnancy — Potentials for Diagnosis Using Ultrasound and Urine and Serum Pregnancy Tests
Authors: Robinson Hugh P. , de Crespigny Lachlan J. Ch. , Harvey James , Hay David L.
Published: February 2008

Summary: The ultrasound findings from 260 patients with a clinical suspicion of ectopic pregnancy have been analysed and correlated with the results of urine pregnancy tests and tests of serum LH and/or HCG levels. Most importantly in a practical clinical context, it was found that a negative serum test virtually excludes an ectopic pregnancy, and an empty uterus with an adnexal mass and/or the presence of free fluid together with a positive urine test gives a very high probability of an ectopic pregnancy. The absolute diagnosis of an ectopic pregnancy by the demonstration of a living fetus outside the uterus is an uncommon finding (8%). Conversely, an empty uterus alone on ultrasound examination in the absence of other ultrasound findings in those patients with a positive serum test is not a reliable guide to the presence of an ectopic pregnancy unless there is an irrefutable conception date at least 5 weeks previously. It is recommended that pathology laboratories and ultrasound departments establish absolute levels of HCG above which an intrauterine pregnancy should always be visible within the uterus. Given appropriate attention to the clinical condition of the patient, the combined use of diagnostic ultrasound, simple urine pregnancy tests and serum assays of beta HCG levels goes a long way to discriminating between those patients with and those without an ectopic pregnancy.
The Birthing Chair in the Second Stage of Labour
Authors: Liddell H. S. , Fisher P. R.
Published: February 2008

Summary: A prospective study of 56 primigravidas was performed to assess the advantages, disadvantages and acceptability of the upright posture during the second stage of labour. Twenty‐seven patients laboured in the second stage in a birthing chair, in an upright position. Twenty‐one patients laboured in bed in the recumbent position and acted as controls. No difference could be found in the length of second stage, ease or type of delivery between the 2 groups. No differences were detected in the condition of the neonates between the 2 groups. This birthing chair was found to be an acceptable mode of delivery to most of those patients using it.
Cigarette Smoking by Pregnant Women with Particular Reference to Their Past and Subsequent Breast Feeding Behaviour
Authors: Counsilman J. J. , Mackay E. V.
Published: February 2008

Summary: 1,790 postpartum women were asked about their smoking habits and baby feeding practices and about a number of other attitudes and physical attributes. For those variables not concerned with baby feeding, our findings generally support previous research; for example, smokers in comparison to non‐smokers tended to have more emotional problems, more reproductive failures and babies with lower birth‐weights. For baby feeding, we found that smokers tended to (i) have little prior knowledge of breast feeding, (ii) favour bottle feeding, (iii) have been fed by bottle by their mothers, and (iv) wean earlier than non‐smokers or ex‐smokers. In fact, non‐smokers as a group were similar to breast feeders as a group, and smokers like bottle feeders for over 20 characteristics. These similarities were mostly the result of features of smoking and baby feeding behaviour being found in a common personality type; for example, use of tobacco and choice of bottle feeding are probably attributes of nervous, insecure mothers. But some similarities were the result of the influence of tobacco smoke; for example smokers who do breast feed wean earlier, probably because chemicals in tobacco smoke inhibit milk production.
Colonic Pseudo‐Obstruction: An Uncommon Complication of Caesarean Section
Authors: Hall Barbara
Published: February 2008

Summary: Four cases of pseudo‐obstruction following lower segment Caesarean section are presented with a review of the condition. In the first patient the diagnosis was made at laparotomy, but the other 3 were diagnosed on clinical and radiolographic grounds. Two of these subsequently required surgical caecal decompression, while only 1 was successfully managed conservatively. This is typical of the spectrum of this uncommon but well recognized syndrome which may complicate Caesarean section, vaginal delivery, hysterectomy or other gynaecological operations. When diagnosed, the initial management may be conservative, but close surveillance of caecal diameter must be maintained in order to prevent disastrous caecal rupture. When this is imminent, decompression by either colonoscopy, or laparotomy and caecostomy is indicated. With early surgical intervention, the high mortality rate for this condition can be greatly reduced.
Bilateral Juvenile Granulosa Cell Tumours Associated with Skeletal Enchondromas
Authors: Pounder Derrick J. , Iyer P. V. , Davy M. L. J.
Published: February 2008

Summary: Asynchronous bilateral granulosa cell tumours of the ovary occurred in a patient with enchondromas. The first tumour, presenting at age 15, was misdiagnosed initially as an androblastoma. The second tumour presented 7 years and 3 pregnancies later. The possible therapeutic and pathogenetic implications of these observations are discussed.
Bacteriuria in Pregnancy
Authors: Reddy J. , Campbell Alison
Published: February 2008

Summary: In a racially mixed community in Gisborne, New Zealand, the prevalence of asymptomatic (covert) bacteriuria of pregnancy was 9.6%. The prevalence in Maori women was 17.1% and in non‐Maori women 4.7%. There was a higher prevalence of bacteriuria in the younger women. Escherichia coli was the infecting organism in 58 of the 72 women with bacteriuria. Twenty‐five (44%) of the E. coli were resistant to ampicillin and amoxycillin. Fifty‐eight (81%) of the women with bacteriuria also had pyuria. In 37 of the 44 women (84%) who received antimicrobial therapy, the infection was cured. Single dose therapy was just as effective as a course of treatment. In 14 of the 28 untreated women, the infection cleared spontaneously. Four of the 28 (14%) patients in the untreated bacteriuric group developed acute pyelonephritis. More patients with bacteriuria had anaemia and a low fetal birth‐weight.
Treatment of Dysfunctional Uterine Bleeding with Danazol
Authors: Fraser Ian S.
Published: February 2008

Summary: Twenty‐six women completed a 6‐month course of treatment with danazol (at various dosages between 200 and 800 mg daily) for menorrhagia due to dysfunctional uterine bleeding. Objective measurements of menstrual blood loss (MBL) were undertaken in 9 women, while the remainder merely recorded a detailed prospective but subjective menstrual calendar. A very substantial decrease in blood loss was recorded by all women, and the majority of women on 400–800 mg daily developed amenorrhoea by 3 months. Six women experienced episodes of prolonged or frequent bleeding or spotting throughout the 6 months. Three women used 200 mg daily throughout with a mean measured MBL falling from 95.3 ml to less than 14 ml per month after 2 months therapy. This may become a valuable therapy for menorrhagia for women requiring temporary medical management. However, possibilities for long‐term therapy may be limited in some women by side‐effects and metabolic effects.
A Comparison of Intravaginal PGF2α and Intravenous Oxytocin to Stimulate Labour after Membrane Rupture*
Authors: Day Andrew , MacLennan Alastair , Green Roslyn
Published: February 2008

Summary: A prospective randomized controlled trial of 202 patients was set up to examine the efficiency and safety of 40mg of intravaginal prostaglandin F2α (PGF2α) in a tylose gel to stimulate labour after artificial or spontaneous membrane rupture. The control group received a standard intravenous oxytocin regimen. The PGF2α treated group had a significantly shorter length of labour (6.2 ± 3.6 hours) compared to the oxytocin group (7.5 ± 4.3 hours) (p < 0.05). The analgesic requirements were significantly reduced in the PGF2α treated patients. In PGF2α treated patients 46 of 105 required no analgesia whereas 17 of 97 oxytocin treated patients required no analgesia (p < 0.001). There were similar reductions for epidural (p < 0.005) and pethidine requirements (p < 0.005). No differences were found between groups with regards mode of delivery. There were no adverse maternal side‐effects associated with PGF2α usage. A significant reduction (p < 0.05) in the incidence of neonatal jaundice requiring phototherapy occurred in the PGF2α group. Prostaglandin F2α appears to be a safe, efficient and better alternative to intravenous oxytocin to stimulate labour in the presence of ruptured membranes, allowing ambulation, a reduction in length of labour and less need for analgesia and intravenous therapy.
Estimation of Fetal Weight in Utero from Symphysisfundal Height and Abdominal Girth Measurements
Authors: Woo Joseph S. K. , Ngan Hextan Y. S. , Au Kelly K. L. , Fung K. P. , Wong Vivian C. W.
Published: February 2008

Summary: The ability to estimate fetal weight accurately from symphysisfundal height (SFH) and abdominal girth (AG) measurements was evaluated. Multivariate regression analysis was performed on measurements made on 208 primigravidas within 48 hours of delivery. A better correlation with birth‐weight was obtained with the SFH than with the AG. The equation BW = ‐1.515 + 0.092 (SFH) + 0.016 (AG) yielded a coefficient of multiple correlation of 0.7259. Using this equation, the mean percentage prediction errors were 5.7%± 4.2(SD) in fetuses between 2,500 and 3,500g (n=156), 9.4%± 5.25(SD) in those larger than 3,500g (n = 33), and 19.1 %± 8.2(SD) in those smaller than 2,500g (n = 19). All the generated equations similarly underestimated the fetal weight in the larger babies and overestimated in the smaller babies. Inclusion of quadratic and logarithmic functions as well as skin‐fold thickness measurements into the equations did not decrease the error or alter the distribution of errors. It was concluded that although fetal weight estimation may be reasonably accurate between 2,500g and 3,500g, the error is too great for the method to be clinically useful in the smaller and larger babies. Moreover, a theoretical basis for a high sensitivity in the detection of small for dates fetuses from these parameters would be difficult to establish.
Pelvic Adhesiolysis—The Assessment of Symptom Relief by 100 Patients
Authors: Chan C. L. K. , Wood C.
Published: February 2008

Summary: This study reports the effectiveness of pelvic adhesiolysis in relieving symptoms in patients with gross pelvic adhesions. Based on 100 patients' responses to a questionnaire, adhesiolysis was found to be of value in treating infertility, chronic pelvic pain and dyspareunia. Its value in relieving dysmenorrhoea was less certain while it did not influence menstrual pattern or premenstrual tension.
Preoperative Cervical Dilatation: A Trial of Laminaria Tents and Prostaglandin Fα2 Gel
Authors: Morris N. D. , McCallum G. I. , Hammond L.
Published: February 2008

Summary: Surgical damage to the cervix in patients undergoing termination of pregnancy may be responsible for serious complications in subsequent pregnancies.

Sixty nulliparous women undergoing first trimester termination of pregnancy were randomly allocated to 3 treatment groups, one using laminaria tents preop‐eratively, one using intracervical PGF2α gel preoperatively and one using no pre‐treatment.

Results showed clear benefits in the laminaria group, in terms of achieving preoperative cervical dilatation and ease of further operative dilatation. Laminaria tents were superior to PGF2α gel which was, in turn, superior to no pretreatment. There were no differences in blood loss or postoperative complications among the 3 groups.

Laminaria tents provide a cheap, effective and safe method of reducing the risk of cervical damage in women undergoing surgical termination of pregnancy.
A Mother and Baby Unit in a Psychiatric Hospital
Authors: Sharp Peter T. , Dennerstein Lorraine , Hrasky Manuela , Lynch Carmel , Burrows Graham D.
Published: February 2008

Summary: Two rooms where women with puerperal psychiatric illness could be admitted together with their babies were provided in a general psychiatric unit. Over a 21‐month‐period demand for joint admission far exceeded capacity and most referrals could not be accepted. Women with various psychiatric disorders were referred to and managed in the unit. Greatest demand was for young women suffering from psychosis following childbirth.