bluuebunny/crossref_metadata_2025 huggingface dataset:
Blood Transfusion and Caesarean section
Authors: Maxwell Chris N.
Published: February 2008

EDITORIAL COMMENT: The AIDS epidemic has resulted in a reexamination of the need for blood transfusion and many patients express the wish to avoid a blood transfusion if possible. It is reasonably easy to reduce the incidence of blood transfusion for postpartum anaemia in a patient who is not bleeding — our criterion is a haemoglobin value of less than 8 g/dl whereas previously it was a value of less than 10 g/dl. This paper presents useful information concerning the incidence of urgent blood transfusion at Caesarean section, and argues that preoperative cross‐matching of blood is necessary only in patients with placenta praevia, abruptio placentae and severe preeclampsia. It may interest readers to note the following incidence of blood transfusion associated with Caesarean section at the Mercy Maternity Hospital, Melbourne: 13.7% of 1,214 Caesareans (1971–1974), 10.8% of 1,513 (1975–1977), 8.2% of 1,906 (1978–1980), 8.3% of 2,305 (1981–1983) and5.7% of 2,530 (1984–1986). We should remember that acute blood loss at Caesarean section cannot always be anticipated. If the author's recommendation for blood group and antibody screening alone for most patients is to be taken, the anaesthetist must always have an intravenous line in place, volume expanding fluids available and be prepared to give uncross‐matched blood of appropriate group and Rh type if the need arises.

Summary: A clinical audit of 1,000 consecutive Caesarean sections at the Royal Women's Hospital indicated that 9.4% of patients required blood transfusion. Urgent blood transfusion was required in 53% of the 33 patients requiring Caesarean section because of placenta praevia, 43% of the 23 with accidental haemorrhage, 11% of the 36 with severe preeclampsia, but in only 2.3% of the remaining 908 patients.

Blood was cross‐matched preoperatively in 47.7% of patients and 90% of this blood was either not administered or given as a delayed nonurgent procedure. It is suggested that routine preoperative cross‐matching of blood could be replaced by a blood type and antibody screening procedure for Caesarean sections being performed for those indications associated with low risk of blood transfusion requirement.
Gestational Trophoblastic disease in New Zealand, 1980 — 1986
Authors: Duff G.B.
Published: February 2008

EDITORIAL COMMENT: This community based study reports an incidence of hydatidiform mole ofl in 1,497pregnancies in New Zealand, including spontaneous abortions, terminations of pregnancy and ectopic pregnancies. In 21% of the 299 histologically confirmed cases, the diagnosis of hydatidiform mole was made only, when the specimen was examined by a pathologist, illustrating the importance of routine examination of curettings. Analysis of the symptoms and signs on presentation indicated that the ‘classical’ presentation of hydatidiform mole (uterus large for dates, severe hyperemesis ± preeclampsia) is the least common. The most common presenting symptom was bleeding, illustrating the importance of ultrasonography in all patients with a threatened abortion. In this series the incidence of malignant sequelae was 10.9%.

Summary: During the period 1980 to 1986 inclusive 350 cases of gestational trophoblastic disease were recorded within New Zealand; of these cases nearly 70% were reported to a Register established to obtain epidemiological information. Clinical information obtained with the notifications revealed no difference in incidence of gestational trophoblastic disease among the 3 main ethnic groups which make up the New Zealand population; the uterine fundus was recorded as being large for dates in only 26%; the most common clinical presentation was as a threatened abortion; 7% of the cases were diagnosed at either routine ultrasound examination or at termination of pregnancy, there having been no suspicions prior to that procedure. A review of histological material obtained following notification suggested that the histological diagnosis of trophoblastic disease could not be substantiated in 14.7% of cases. During the period under review, therefore, there were 299 cases of trophoblastic disease (all but 2 of which were hydatidiform mole) and 447,667 pregnancies giving an incidence of 1 case of trophoblastic disease per 1,497 pregnancies.
Burns in Pregnancy — Maternal and Fetal Prognosis
Authors: Cheah Sin‐Hing , Sivanesaratnam V.
Published: February 2008

Summary: In this series the incidence of pregnancy in women in the reproductive age group admitted to hospital with burns was 7.8% (9 of 116). The maternal and perinatal outcome is related to the extent, presence or absence of complications of burns and to the gestational age of the fetus. Two maternal deaths in this series occurred in patients with burns involving more than 85% of the skin surface; in both instances stillbirths occurred less than 48 hours after the burns. In view of the high perinatal mortality, patients with extensive burns who are more than 32 weeks' pregnant should be delivered soon after admission. The extensively burned anterior abdominal wall can make assessment of uterine size difficult. An assessment in such a situation would be useful.
Simple Office Methods to Predict Ovulation: The Clinical Usefulness of a New Urine Luteinizing Hormone Kit Compared to Basal Body Temperature, Cervical Mucus and Ultrasound
Authors: Yong Eu Leong , Wong Peng Cheang , Anandakumar MRCOG  , Wong Yee Chee , Goh Hng Hang , Hagglund Leif , Ratnam Shan
Published: February 2008

Summary: A new urine luteinizing hormone (LH) kit, First Response (Tam‐brands Inc., Palmer, MA) was compared with basal body temperature (BBT), cervical mucus scoring and abdominal ultrasound follicular scanning in their ability to predict ovulation to within 2 days of the serum LH peak. BBT was kept daily. From day 10 daily ultrasound scanning and cervical mucus examination were performed and serum oestradiol, luteinizing hormone, follicular stimulating hormone and progesterone were assayed.
Monitoring Early Pregnancy with Transvaginal Ultrasound and Choriogonadotrophin Levels
Authors: Hay D.L. , de Crespigny L. Ch , McKenna M.
Published: February 2008

Summary: Serum human chorionic gonadotrophin levels were correlated with gesta‐tional sac size detected by transvaginal ultrasound in a series of 178 women undergoing in vitro fertilization. The improved resolution of transvaginal ultrasound enables pregnancy to be detected between 17 and 20 days post‐ovum retrieval, when HCG levels were greater than an average threshold level of 1,300 IU/L. The lower HCG discriminatory zone enables improved evaluation of ectopic pregnancies. Also, higher HCG titres observed in multiple pregnancies enable estimation of implantation rates when more than one embryo is transferred.
Deep Venous Thrombosis in Pregnancy and the Puerperium
Authors: Paraskevaides E. C.
Published: February 2008

EDITORIAL COMMENT: How have we done so well in preventing maternal deaths from pulmonary thromboembolism when most deaths from this cause are judged to be unavoidable? The number of maternal deaths from thromboembolism in Australia has fallen 90% in the 7 reported triennial 44 (1964–1966), 43 (1967–1969), 22 (1970–1972), 11 (1973–1975), 13 (1976–1978), 8 (1979–1981), 4(1982–1984).

The remarkable reduction in the death rate has continued although the Caesarean section rate, an acknowledged contributing cause, has continued to increase. How important is the reduction in the number of grand multiparas?

In high risk patients (previous deep vein thrombosis, previous pulmonary thromboembolism) prophylactic therapy (aspirin, anticoagulation with heparin or warfarin) is indicated during pregnancy and for about 6 weeks after delivery, but prophylactic anticoagulation therapy in all patients having Caesarean section, in the Editor's opinion, is definitely not indicated — when he was a Resident Medical Officer at the Royal Women's Hospital, Melbourne, in 1957, routine prophylactic anticoagulation therapy with heparin was used in gynaecology patients having radical hysterectomy and in patients having Caesarean section. These were the days when the death rate from thromboembolism was a great deal higher than now. This therapy was abandoned because of the complications of the use of heparin short‐term, namely, haemorrhage into wounds. We should remember lessons learned by past mistakes. This paper provides a good review of those aspects of patient care in modern obstetrics that probably account for the considerable reduction in what was for many years the leading cause of maternal death in Australia and the United Kingdom.
Ethical Aspects of Surrogacy
Authors: Walters William A. W.
Published: February 2008

Summary: Ethical issues related to surrogacy are explored and an argument made for its ethical approval in circumstances where the particularities of the case warrant this approach to reproduction. Despite recent and impending legislation to prohibit commercial surrogacy in some States of Australia, although data are difficult to obtain, unofficial and anecdotal reports from medical practitioners specializing in the management of infertility throughout the country indicate an increasing number of requests for surrogacy and increasing referral of infertile couples to the USA for commercial surrogacy arrangements.
Laparoscopic Removal of Translocated Intrauterine Contraceptive Devices
Authors: Gupta I. , Sawhney H. , Mahajan U.
Published: February 2008

Summary: Data is presented regarding 20 translocated intrauterine contraceptive devices (IUCD). Successful laparoscopic removal was made in 13 (65%) cases though all these devices were Copper ‘T’ 200 model which tend to produce dense adhesions. Only when the IUCD was suspected to be partially or fully in the gut lumen or thick adhesions were present, or the device was not visualised, was laparotomy performed. Hence it is advocated that laparoscopy should be performed as a routine in patients with suspected translocated IUCD, as it obviates the need for laparotomy and thus decreases the duration of the hospital stay as well as preventing morbidity associated with laparotomy.
Serum CA‐125 Levels m Women with Endometriosis
Authors: Fraser Ian S. , McCarron Gay , Markham Robert
Published: February 2008

Summary: Forty‐two women with laparoscopically‐confirmed pelvic endometriosis (assessed according to the American Fertility Society modified classification) had serum levels of the cell‐surface antigen CA‐125 measured before, during and after medical therapy with nafarelin acetate or danazol combined with follow‐up laparoscopic surgery or laparotomy. Serum levels before treatment (39.3 [SE 6.61 U/ml) were elevated above accepted normal levels in many subjects, and these were highly significantly suppressed during medical therapy with both nafarelin and danazol (13.1 [SE 1.5] U/ml at 5 months); t = 3.198; p = 0.002). Levels tended to rise following therapy but a clear correlation between a rise in serum CA‐125 and recurrence of disease was not demonstrated.

In 3 individuals treated with nafarelin a dramatic rise in serum CA‐125 levels was seen after 2 weeks of therapy. This did not correlate with any exacerbation of symptoms or with any rise in serum oestradiol or with pretreatment AFS scoring.

Serum CA‐125 levels provide a potential approach to the monitoring of treatment and recurrence in a substantial proportion of women with endometriosis. although preliminary evidence suggests that there will be individual exceptions to any broad correlations.
Abnormal Cornual Ostia and Infertility
Authors: Finikiotis George
Published: February 2008

Summary: Hysteroscopy performed on 126 infertile patients and on 73 fertile patients revealed a significant association between abnormal uterine cornual ostia and infertility (p<0.002). Ostial abnormalities included absence of cupping with uterine cavity distension, diminution of ostial diameter and complete ostial occlusion. High intrauterine pressures from dye pertubation can overcome the occluded ostial state giving a false impression of adequate tubal patency. These findings may explain some cases of apparently unexplained infertility and may bear on the success rates of procedures such as artificial insemination and gamete intrafallopian transfer.
A New Look at Biparietal Diameter
Authors: de Crespigny Lachlan Ch , Speirs Andrew L.
Published: February 2008

Summary: A biparietal diameter (BPD) chart is presented based on an Australian population whose gestational age was confirmed by ultrasound early in pregnancy. The data show the gestational age to be predicted to within ± 7 days until 16 weeks and ± 10 days until 20 weeks gestation. Some of the reasons for the wide discrepancies in previously published charts are discussed, and the methods used in this study to avoid repetition of such errors detailed.
Evaluation of Serial Cervical Cytology in the Assessment of Preinvasive Cervical Neoplasia
Authors: Sfameni S. F. , Jobling T. W. , Trickey N. R. A. , Havelock C.
Published: February 2008

Summary: Examination was made of the cervical cytology in 107 patients who underwent cone biopsy with a subsequent diagnosis of severe dysplasia or carcinoma in situ (105) or microinvasive carcinoma (2). Multiple smears had been performed for each patient over a period of time. From the total number of smears a “false‐negative‘ cervical cytology rate of 10.3 per cent was found. The time interval from the initial abnormal smear until definitive surgical treatment was carried out was calculated. The cervical smear prior to cone biopsy was found to correlate with the histological diagnosis in only 46.7 per cent. The implications of performing repeated cervical cytology are discussed and a firm recommendation is made that patients with abnormal cervical smear be promptly referred to definitive treatment.
Generalized Peritonitis Due to Spontaneous Rupture of Pyometra
Authors: Bui A. , Wilkinson S.
Published: February 2008

Summary: Spontaneous rupture of pyometra is a rare cause of generalized peritonitis. Only a few cases have been recorded in the English medical literature, most of which were associated with gynaecological malignancy. We have recently treated a patient with generalized peritonitis due to ruptured pyometra, in which there was no evidence of malignancy or other cervical disease. From comparison with the other published case reports, several features deserve emphasis.
Undergraduate Education in Obstetrics and Gynaecology in Australia and New Zealand, 1989
Authors: Biggs John S.G. , Humphrey Michael D.
Published: February 2008

Summary: Medical schools in Australia and New Zealand provide an average of 10.7 weeks for instruction in obstetrics abd gynaecology. The stated aims and objectives in 14 clinical schools vary from none at all to those which establish the programme with great clarity. The learning exercises provided vary from the conventional, ward and clinic‐based to those with an accent on observing closely a mother, her baby and her family. Newer methods for learning about pelvic examination have not been widely adopted. Schools expect students to gain experience in an average of 9 vaginal deliveries. Competition with midwives for available deliveries was described by 9 clinical schools. The survey shows a need for greater emphasis in text books on communication skills and psychological aspects of patient care.
Acute Polyhydramnios in Twin Pregnancies
Authors: Steinberg L. H. , Hurley V. A. , Desmedt E. , Beischer N. A.
Published: February 2008

Summary: This paper reports the experience with acute polyhydramnios complicating twin pregnancies at the Mercy Maternity Hospital for the 10‐year and 2‐month period from January, 1979 to February, 1989 during which time there were 13 such cases, an incidence of 1 in 4,044 pregnancies. Acute polyhydramnios complicated 1.7% of all twin pregnancies. The perinatal mortality rate was 88.5% and accounted for 16.7% of the perinatal deaths in twins. No major fetal malformations were found. One case of acute polyhydramnios was successfully managed with ultrasonographically guided serial amniocenteses. The management of this rare condition is considered.
Chlamydia Trachomatis: the Prevalence, Trend and Importance in Initial Infertility Management
Authors: Hodgson Ray , Driscoll Geoffrey L , Dodd Janis K , Microbiol MI , Tyler John PP
Published: February 2008

Summary: One thousand and five women, and 354 of their partners, attending an infertility clinic have been assessed for the presence of Chlamydia trachomatis antibodies in their serum. The overall prevalence in women was 12.4% (125/1,005) but appeared to have increased over a 2‐year period. A similar trend was not apparent for men and the prevalence was only 4.2% (15/354). Of the 125 seropositive women 81 had their pelvis examined for the first time by laparoscopy. Fifty seven had tubal disease of varying severity, but only 16 had had an ectopic pregnancy or admitted to a previous history of pelvic inflammatory disease or nonspecific urethritis. These findings suggest that laboratory testing for chlamydial antibodies should be routine in the initial investigation of an infertile couple and that early laparoscopy is indicated in seropositive women.
A Review of Placenta Accreta at Aberdeen Maternity Hospital, Scotland
Authors: Mahmood T.A. , Kok K.P.
Published: February 2008

Summary: There were 7 cases of placenta accreta (a frequency of 1 per 12,700 deliveries) at the Aberdeen Maternity Hospital where emergency postpartum hysterectomies were performed on account of uncontrollable postpartum haemorrhage from January, 1977 to May, 1989. There was no maternal death. The presentation and risk factors are discussed.
Long‐term Neurological Sequelae Following Vacuum Extractor Delivery
Authors: Ngan Hextan Y.S. , Miu Peggy , Ko Lillian , Ma H.K.
Published: February 2008

Summary: Two hundred and ninety‐five children delivered by vacuum extractor (VE) 10 years ago were studied to determine if they had an increased incidence of neurological abnormality; 302 children delivered spontaneously in the same hospital looked after by the same doctors in the same year matched for maternal age, gestational age and birth weight were used as controls. Fine‐ and gross‐motor control, perceptual integration and behavioural maturity were screened by 4 tasks selected from the Quick Neurological Screening Test. Intelligence assessment was based on scholastic performance, speech ability and ability of self‐care as commented by teachers and parents. Similar scorings were found between the 2 groups. Mental sub‐normality or severe neurological abnormality was found in 3 children delivered by VE and in 3 children delivered spontaneously and there was no evidence that it was birth‐related.
Contraction Stress Fetal Heart Rate Monitoring at Preterm Gestational Ages
Authors: Thompson Graeme , Newnham John P. , Roberman Brian D. , Burns Sybil E.
Published: February 2008

Summary: The evaluation of fetal well‐being by fetal heart rate monitoring at preterm gestational ages remains a difficult and important area for investigation. While the nonstress test has achieved widespread usage, a role for the contraction stress test remains uncertain. This study describes the outcome of 113 contraction stress tests which were performed for persistent fetal heart rate nonreactivity in 78 pregnancies of less than 37 completed weeks' gestation. There were no fetal deaths and no obstetric complications which could be attributed to these tests. The finding of a negative contraction stress test provided reassurance which facilitated significant prolongation of pregnancy. Contraction stress tests appear to be a safe and effective method of investigating further the clinical dilemma of persistent fetal heart rate nonreactivity in high risk pregnancies at preterm gestational ages.
Pulmonary Thromboembolism Complicating Recurrent Placental Abruption at 29 Weeks' Gestation
Authors: von Dadelszen Peter , Peddie David J.
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication mainly because the discussion presents a useful review of the use of heparin in patients with placental abruption. Readers may be interested to know that the editor does not possess the ‘degree of courage’ advocated by Scott (5) in using intrapartum heparin to prevent disseminated intravascular coagulation in patients with severe placental abruption. Although the use of heparin is frequently discussed in such patients, the editor has never seen it used in patients with abruption in his 32 years of obstetric experience. Moreover there was a time in the 1960's when heparinization was used, in selected patients, at the Royal Women's Hospital, Melbourne, to control severe preeclampsia and achieve prolongation of pregnancy Fairley KF, Adey FD, Ross IC, Kincaid‐Smith P. Heparin treatment in severe preeclampsia and glomerulonephritis in pregnancy. Perspect Nephrol Hypertens 1976; 5:103–112., 3 of the 10 patients who presented before 30 weeks, and were treated with heparin, had living babies, but 2 accidental haemorrhages, 1 mild and I severe, both resulting in intrauterine fetal death, occurred in this group of women. As far as the editor can ascertain the occurrence of placental abruption in these patients led to the abandonment of heparin therapy in patients with preeclampsia in this hospital. The use of heparin in patients with glomerulonephritis, with or without associated preeclampsia, is a different problem. In the present report the patient's postoperative heparinization was continued in spite of the development of an abdominal wall haematoma and the need for 14 units of blood. Pulmonary thromboembolism is a risk to life but heparinization also has its problems. We leave it to readers to judge if they would have sterilized the patient, ‘under heparin prophylaxis 6 weeks after completing warfarin therapy’.

ABSTRACT A patient with major pulmonary thromboembolism associated with recurrent placental abruption is described. Delivery by Caesarean section was necessary, followed by full heparinization. The use of peripartum heparinization and Caesarean section is reviewed.
Hydatid Disease of the Female Genital Viscera—A Report of 3 Cases
Authors: Varty P.P. , Shroff Chandralekha P. , Niyogi Geeta M. , Shanbhag A.M.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because although hydatid disease is rare it may, as these cases illustrate, present to the gynaecologist simulating a benign or malignant ovarian tumour. Hydatid disease is now rare in Australia even in specialist hepatobiliary units in major centres. At the Westmead Hospital, Sydney, 39 cases (all hepatic—23 males, 16 females) were seen in the 7 years, 1980–1986 (1), and at the Repatriation General Hospital, Melbourne, 23 cases (all hepatic—no pulmonary), were seen in the 10 years, 1977–1987 (Dr Avni Sali, personal communication).
The Phenotype in Placental Trisomy 7
Authors: Watt Ainslie J. , Devereux Fenella J. , Monk Ngaire A. , Myers Colleen J. , Gardner R. J. McKinlay
Published: February 2008

Summary: Trisomy 7, in mosaic state, was identified at chorionic villus sampling. The pregnancy was closely followed, and proceeded uneventfully. Mosaic trisomy 7 was confirmed in the term placenta, the organ having no structural abnormalities; the karyotype of the phenotypically normal baby was 46, XY. Trisomy 7, mosaic or nonmosaic, detected at chorionic villus sampling in an ultrasonographically normal pregnancy, appears typically to be associated with a normal fetal karyotype, and placental growth, structure, and function are not discernibly compromised.
Evaluation of an Antenatal Education Programme: Characteristics of Attenders, Changes in Knowledge and Satisfaction of Participants
Authors: Redman Selina , Oak Stephanie , Booth Peggy , Jensen Jean , Saxton Anne
Published: February 2008

EDITORIAL COMMENT: As the authors of this paper point out there have been only 5 published studies exploring the operation of antenatal education programmes in Australia and New Zealand ‐ yet most obstetricians support the concept of antenatal education and recommend it to patients, especially their private patients. This paper provides the sort of data we need and will interest readers ‐ reading it will hopefully encourage obstetricians to support further studies of the best ways to deliver antenatal education to our patients and their partners/family members.

Summary: The evaluation of the efficiency and effectiveness of antenatal education programmes has been identified as a priority in improving maternity services in Australia. Two hundred and ninety four primiparas completed a brief questionnaire in the 3 days following delivery; 82% of the women surveyed attended antenatal education classes. Women were less likely to attend if they were single, younger than 26 years, had lower levels of education, received care during pregnancy from the antenatal clinic and did not have private health insurance. Attenders at antenatal education were also more likely to plan on breast feeding, to be nonsmokers and to know of a greater number of community organizations to help new mothers. However, logistic regression analyses indicated that, with the exception of number of community organizations known, these differences were attributable to demographic differences between attenders and nonattenders. One hundred and forty two women and their partners attending the major provider of antenatal education classes in Newcastle were surveyed prior to and following classes. Significant increases in knowledge were evident following the programme among both women and their partners. Satisfaction with the programme was high as indicated by a large proportion of respondents attending all 4 classes, most programme components being reported as useful or very useful and only a small proportion of respondents experiencing problems with the programme.
Maximum Effort in the Management of Ovarian Cancer, Including Pelvic and Para‐aortic Lymphadenectomy
Authors: Allen D. G. , Planner R. S. , Grant P. T.
Published: February 2008

EDITORIAL COMMENT: There is no doubt that the competent gynaecological oncologist has marvellous skill at removing tumour in women with Stages 3 or 4 ovarian cancer ‐ in the very type of patient regarded as inoperable 10–30 years ago by general gynaecologists. Present‐day general surgeons presumably have the skill, but apparently not the will, to remove tumour in women with metastatic bowel cancer, for reasons not clear to the editor. Is it established fact that removing as much tumour as possible is a waste of time in women with extensive peritoneal metastases from bowel cancer; or does the general surgeon have a different therapeutic philosophy because a high proportion of his patients with bowel cancer have early stage disease, a state of affairs not enjoyed by those who operate on women with carcinoma of the ovary? Readers must be patient and await the publication of the 2 to 5‐year results of treatment of women with ovarian cancer managed by members of this oncology unit in Melbourne.

Summary Patients treated for ovarian cancer at the Mercy Hospital for Women, Melbourne over a 51/2 year period were studied with an emphasis on the need for lymphadenectomy. There were 80 patients identified with ovarian cancer. Forty patients underwent pelvic and/or para‐aortic lymphadenectomy and 25 (62.5%) were found to have lymph node metastases, in 7 of the 40 women the lymphadenectomy resulting in upstaging of the disease. FIGO has adopted a surgicopathological approach to the staging of ovarian cancer and this requires lymphadenectomy to be performed. The importance of accurate staging in clinically early ovarian cancer and maximum surgical effort in advanced disease is discussed with particular regard to the place of lymphadenectomy.
Headache Following Epidural Analgesia
Authors: Umstad Mark P. , Ross Andrew W. , Adey F. Douglas
Published: February 2008

Summary Many headaches following epidural analgesia are a consequence of a dural tap having occurred. However, this is not always the case and careful evaluation is required. A case of postpartum headache caused by an intracerebral haemorrhage is presented.
The Demographic Characteristics of Early and Late Attenders for Antenatal Care
Authors: Essex Charles , Counsell Anthea M. , Geddis David C.
Published: February 2008

EDITORIAL COMMENT: The findings in this study will probably not surprise readers but the authors have established clinical markers for first antenatal attendance after 13 weeks' gestation in New Zealand. Although the authors provide references (1–4) for an association between late initial antenatal attendance and unfavourable perinatal results we urge them to analyze data from their own population and tell us what correlations exist.

Summary: In the Royal New Zealand Plunket Society's 1990‐91 Cohort study, 581 of 4,286 women questioned (13.7%) had not initiated antenatal care until after the first trimester. These late attenders were more likely to be non‐European or of high parity; 42.9% of Pacific Islander mothers and 28.9% of Maori mothers did not initiate antenatal care until after the first trimester. Late attenders were also more likely to be unmarried, of lower socioeconomic status, young or with lower educational attainment. The reason for delayed antenatal care needs to be investigated and mothers who are high parity and non‐European need to be particularly targeted to encourage them to attend for antenatal care early.
Outpatient Hysteroscopy: A Comparison of 2 Methods of Local Analgesia
Authors: Finikiotis G. , Tsocanos S.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication to inform readers who perform hysteroscopy that the procedure can be done under local analgesia with minimal patient discomfort. This is important now that we must increase the number of patients managed as day cases and because in many major institutions hysteroscopies are still done under general anaesthesia.

Summary: A prospective, randomized study was undertaken to objectively compare pain tolerance of 2 methods of local analgesia for outpatient hysteroscopy. Patients in group 1 received a paracervical block using 20 ml of 1% lignocaine. Patients in group 2 received a uterosacral block using 2 ml of 2% lignocaine. There was no statistical difference between the 2 groups (p = <0.65) in efficacy of pain relief. The method used for patients in group 2 reduces time and costs for outpatient hysteroscopy.
A Controlled Trial of Amnioinfusion: the Prevention of Meconium Aspiration in Labour
Authors: Lo Keith W. K. , Rogers Michael
Published: February 2008

Summary: The purpose of this study was to examine the effect of amnioinfusion on the incidence of meconium aspiration syndrome, perinatal asphyxia and obstetrical intervention rate amongst patients with moderate and thick meconium‐stained liquor. A total of 112 patients were studied in a prospective fashion; 60 received amnioinfusion and 52 served as controls. We have shown that amnioinfusion is a simple, relatively inexpensive and safe procedure. It benefits the patient in terms of reduction in the likelihood of operative intervention (specifically Caesarean section) for fetal distress and improvement in neonatal outcome with reduced frequency of neonatal acidaemia.
Spinal Cord Injury After Forceps Rotation: the Role of Glioneuronal Heterotopias
Authors: Pamphlett Roger , Cala Allan
Published: February 2008

EDITORIAL COMMENT": We accepted this report for publication since the unusual tragic details will interest readers and remind them of the value of a carefully performed postmortem examination which may, as in this case, reveal unexpected pathologyw.
Value of Early Glucose Tolerance Testing in Women Who had Gestational Diabetes in Their Previous Pregnancy
Authors: Dong Z. G. , Beischer N. A. , Wein P. , Sheedy M. T.
Published: February 2008

Summary: The patterns of glucose tolerance, clinical characteristics, and follow‐up results of 1,027 pregnant women who had gestational diabetes diagnosed in their previous pregnancy, were analyzed. Glucose tolerance testing was performed before 24 weeks (mean 16.6 ±4.5 weeks) in 180 women (group 1); when the result was normal the test was repeated at 26–30 weeks' gestation. In this group the incidence of recurrent gestational diabetes was 49.4%, and early testing diagnosed 61.8% of cases. Group 2 consisted of 685 women in whom glucose tolerance was tested only at 26–30 weeks' gestation. In this group the incidence of recurrent gestational diabetes was 34.0%. Group 3 consisted of 162 women in whom glucose tolerance was not tested in the subsequent pregnancy. Perinatal mortality rates in Groups 1 to 3 were 2.2%, 0.6% and 3.1% respectively in the pregnancy subsequent to that in which gestational diabetes was first diagnosed.

The risk of emerging diabetes mellitus on follow‐up was greater in women in whom gestational diabetes was diagnosed early than in those diagnosed at the usual time (33.3% versus 12.5%, p<0.05).

Analysis of the 13 perinatal deaths in Groups 1–3 revealed 5 that were potentially avoidable; none of the 3 women with recurrent gestational diabetes in the early tested group who had perinatal deaths received insulin in their subsequent pregnancies. Although perinatal deaths are unavoidable in some high‐risk pregnancies associated with gestational diabetes, this study suggests that early diagnosis of gestational diabetes may allow further reduction of perinatal mortality. However, early diagnosis is wasted unless it results in early treatment, including insulin therapy when dietary measures fail to control hyperglycaemia.

Women who have had gestational diabetes in a previous pregnancy warrant glucose tolerance testing early in a subsequent pregnancy, since those with recurrent disease, especially when the degree of intolerance is severe, have a high perinatal mortality rate, which may be improved by early management.
Communication of Pain: Vocalization as an Indicator of the Stage of Labour
Authors: RN Angela Baker , Kenner Andrew N.
Published: February 2008

Summary: The sounds made by women in the first and second stages of labour were recorded. One minute segments were replayed to 40 medical staff with at least 6 months labour ward experience who were asked to determine whether the sounds played were made by a woman in the first or second stage of labour. The stage of labour associated with each of the sound segments was correctly identified at much greater than chance frequency. It is suggested that further research into the nature and significance of these sounds may have the potential to allow them to be used more systematically by midwifery staff as an unobtrusive aid in monitoring the labour process.
Nuchal Translucency in the First Trimester
Authors: Hewitt Beverley
Published: February 2008

Summary: All fetuses reported as having nuchal (nape of the neck) thickening or translucency detected by a first trimester ultrasound at 2 centres were reviewed to determine the incidence of aneuploidy. Twenty nine pregnancies were registered, amongst which 12 (41%) had an abnormal karyotype, the most common aneuploidy being trisomy 21 (5 fetuses). The likelihood of aneuploidy increased with increasing thickness of the translucency. Where the karyotype was found to be normal, there was complete resolution of this ultrasound appearance by the second trimester in 15 of the 16 ongoing pregnancies: 9 have delivered normal neonates and 6 pregnancies are continuing. The other fetus developed evidence of a skeletal dysplasia by the second trimester.
Persistent Postmolar Gestational Trophoblastic Disease: Use of Transvaginal Sonography and Colour Flow Doppler
Authors: Carter Jonathan , Carlson Jay , Hartenbach Ellen , Saltzman Andrew , Fowler Jeffrey , Carson Linda , Twiggs Leo B.
Published: February 2008

Summary: Invasive moles have been difficult to diagnose except at hysterectomy. Many patients with persistent gestational trophoblastic disease (GTD) have been treated without ever demonstrating the site of the persistent trophoblastic focus. High resolution transvaginal sonography (TVS) has provided a technique of demonstrating very small uterine lesions, previously unsuspected by transabdominal sonography. The addition of colour flow Doppler further increased diagnostic sensitivity and provides another means of monitoring response to therapy. Three patients with persistent GTD, scanned by TVS and CFD (colour flow Doppler) performed as part of their metastatic work‐up are presented. The only abnormalities detected were foci demonstrated within the myometrium that demonstrated increased flow on CFD. Single agent chemotherapy was commenced and the patients were monitored periodically through their course with repeat ultrasonography. After an initial lag period, the lesions decreased in size as the beta‐HCG titres fell. An unsuspected adnexal mass was diagnosed on 1 patient, later proving to be a mature ovarian teratoma.
Nonobstetrie Lower Genital Tract Trauma
Authors: Sau Ashish K. , Dhar Kalyan K. , Dhall Gian I.
Published: February 2008

EDITORIAL COMMENT": We accepted this paper for publication to remind readers of the different types of nonobstetric trauma to the lower genital tract. The mechanism of tearing in the upper vagina during coitus is debated; this report does not favour the theory that tearing in the unsupported upper vagina results from levator spasm rather than direct injury (A).

A. Ahnaimugan S, Asuen MI. Coital laceration of the vagina. Aust NZ J Obstet Gynaecol 1980; 20: 180–181.

Summary: In a 4‐year‐period there were 31 admissions to Nehru Hospital, because of nonobstetrie injuries of the female genital tract. This constituted 0.8% of all gynaecological admissions over this period. The injuries were caused by voluntary coitus, automobile accidents and various types of astride injuries. Seven of the 18 patients with noncoital injuries presented with vulval haematomas and all were managed by evacuation under general anaesthesia. Two of the 13 patients with coital injury were admitted with haemorrhagic shock and required initial resuscitation with blood transfusion. The vaginal vault, especially the right and posterior fornices were the frequent sites of coital injury for parous women; on the other hand lower vaginal and introital injuries were caused by first acts of coitus. Except for trivial superficial lacerations with minimal bleeding, primary definitive surgical repair other than vaginal packing was favoured for better healing and to reduce morbidity.
Why do Asian‐born Women Have a Higher Incidence of Gestational Diabetes? An Analysis of Racial Differences in Body Habitus, Lipid Metabolism and the Serum Insulin Response to an Oral Glucose Load
Authors: Shelley‐Jones David C. , Wein Peter , Nolan Christopher , Beischer Norman A.
Published: February 2008

Summary: We have observed a higher incidence of gestational diabetes (GDM) in Asian‐born than in Caucasian women. Body habitus, serum lipid levels and the serum insulin response to a glucose load in pregnancy were compared in 15 women with normal glucose tolerance, 16 Caucasian women with GDM and 19 Asian‐born women with GDM. Caucasian women with GDM, unlike Asian‐born women with GDM, were obese compared with control women as measured by body mass index (p = 0.022). Both groups of GDM women had similar patterns of insulin response to oral glucose with a delayed insulin peak and an elevated 2‐hour insulin level (p = 0.0021). In addition, the insulin response per unit of glycaemic stimulus (incremental insulin area/incremental glucose area at 1 hour) was reduced in both GDM groups (p = 0.035). Fasting serum triglyceride levels were higher in women with GDM although this was only significant in the
A Direct Comparison of the Measurement of a Random Plasma Glucose and a Post‐50 g Glucose Load Glucose, in the Detection of Gestational Diabetes
Authors: McElduff A. , Goldring J. , Gordon P. , Wyndham L.
Published: February 2008

Summary: We have compared the use of a random plasma glucose measured within 2 hours of a meal and a plasma glucose measured 1 hour after a 50 g glucose load to detect pregnant patients likely to have an abnormal 100 g glucose tolerance test at 28 weeks' gestation.

The 50 g glucose load detected 24 of 28 women with gestational diabetes whereas the random plasma glucose detected only 13 of these patients. The 50 g glucose load gave fewer false positives, that is, patients who had an abnormal screening test but went on to have a normal glucose tolerance test (8.8% versus 13.4%).

These data support the use of the 50 g glucose load to screen pregnant women for gestational diabetes as recommended by Australian authorities (1).
Autoimmune Disease and Pregnancy
Authors: Jones Warren R
Published: February 2008

Summary: Autoimmune diseases are relatively common in women, and tend to occur in the childbearing years. These disorders fall broadly into two groups:

Multisystem diseases such as systemic lupus erythematosus (SLE) and related connective tissue disorders (CTD). This group includes the ‘pre‐clinical’ anti‐phospholipid or lupus obstetric syndrome which may first manifest itself as a pregnancy disorder causing recurrent abortion, fetal death, fetal growth retardation and early onset severe pre‐eclampsia.

Tissue‐ or organ‐specific disorders such as autoimmune thrombocytopaenic purpura (ATP), autoimmune thyroid disease (Graves' disease, Hashimoto's autoimmune thyroiditis, and post‐postum thyroiditis), autoimmune haemolytic anaemia, and the very rare myasthenia gravis.

The study of autoimmune diseases against the background of pregnancy as an experimental system of nature has provided important insights into the nature of the disease processes and the relevance or otherwise of circulating autoantibodies to pathological effects. Thus, for example, if neonatal manifestations of adult disease are causally related to the transfer of autoantibodies across the placenta, they will disappear over a time course consistent with the catabolism of IgG, providing no permanent damage is produced. Conversely, if autoantibodies are demonstrable in the neonate, in the absence of clinical effects, they may only be an epiphenomenon of the maternal disease. In addition, on occasions, disease manifestations may be seen in the baby when the mother shows none. This may occur when the mother is in remission, but still has circulating antibodies, or when she has an occult form of the disease.

It is important also for clinicians to be aware of the reciprocal clinical effects in the mother of the disease‐pregnancy relationship. In addition to their potential importance for the fetus and neonate, individual autoimmune diseases may dictate care and specific action in the management of pregnancies complicated by these disorders. Of a more general nature, however, are the possible effects of drug therapy where this is necessary during pregnancy complicated by autoimmune disease.
Successful Pregnancy in Patients with Diabetes Following Myocardial Infarction
Authors: Wilson J. Dennis , Moore Geoff , Chipps David
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication to remind readers that women in Australia with severe medical disease, which in the past would be considered grounds for sterilization or even termination of pregnancy (Case 2) now expect or hope to tackle pregnancy successfully. It will be a challenge for obstetricians to maintain the maternal mortality rate in Australia at 1 in 7,860 births with current expectations of low and high‐risk mothers (A). In Case 2 the mother died more than 6 weeks after delivery and so would not be classified as a maternal death. Such cases explain why Henry et al have discussed the value of the maternal mortality definition being changed to include all deaths of women dying within 1 year of confinement (B). This paper informs us that women with a past history of significant myocardial infarction can cope safely with pregnancy and the puerperium.

Report on Maternal Deaths in Australia, 1988–1990.

Henry OA, Sheedy MT, Beischer NA. When is a maternal death a maternal death? A review of maternal deaths at the Mercy Maternity Hospital, Melbourne, M J Aust 1989; 151:629–631. Also editorial comment, same issue, 615–616.

Summary: Two cases of successful pregnancy are described in insulin‐dependent diabetic patients following myocardial infarction. Both mothers survived the pregnancies but 1 died from presumed cardiovascular causes 3 months postpartum. The relevant current literature is reviewed.
Management of Vaginal Agenesis with a Functioning Uterus. Is Hysterectomy Advisable?
Authors: Fliegner John R. H. , Pepperell Roger J.
Published: February 2008

Summary: Cryptomenorrhoea associated with vaginal agenesis is uncommon. However, when laparoscopy or ultrasound reveal the uterus to be present early laparotomy is mandatory unless there is clear evidence of haematocolpos, in order to define the cervix and undertake reconstructive surgery. Once a uterovaginal tract has been established prolonged use of a mould is necessary to maintain patency of the neovagina. If the cervix is absent or atretic then immediate hysterectomy is required.
Acute Puerperal Coital Headache and Hypertension
Authors: Adinma J.I.B.
Published: February 2008

Summary: An unusual case of acute headache and hypertension occurring at the height of sexual excitement during the puerperium is presented. The patho‐mechanism of this phenomenom is discussed and the literature reviewed.
Neonatal Infection Due to Haemophilus Influenzae Biotype IV
Authors: Webster Phillip B. , Maher Christopher F. , Farrell David J.
Published: February 2008

Summary: Neonatal infection due to Haemophilus influenzae has several clinical similarities to infection by the more common Streptococcus agalactiae (Strep group B). A high frequency of H. influenzae biotype IV in association with genital, maternal and neonatal infections has been reported in the literature, suggesting this biotype has an affinity for the female genital tract. Cefotaxime should be considered as part of the treatment regimen when this organism is suspected because of the emerging resistance of H. influenzae to ampicillin. We present a case of H, influenzae biotype IV infection in a premature (32 weeks) neonate.
Fetomaternal Haemorrhage After External Cephalic Version at Term
Authors: Lau Tze Kin , Stock Anthony , Rogers Michael
Published: February 2008

Summary: The incidence of fetomaternal haemorrhage after external cephalic version was 1.8% in 167 patients. The occurrence of this complication was not found to be associated with difficult or unsuccessful version, or with any adverse perinatal outcome. We conclude that routine assessment of fetomaternal haemorrhage after external version is not necessary, except in rhesus negative women to detect the 2% in whom the routine dose of 500 iu (100 μg) of anti‐D immunoglobulin is inadequate.
Clinical Trial with Praneem Polyherbal Cream in Patients with Abnormal Vaginal Discharge Due to Microbial Infections
Authors: Mittal Aruna , Kapur Sujala , Garg Sanjay , Pharma M. , Upadhyay Shakti N. , Suri Sushma , Das Subodh K. , Gupta Sunanda , Talwar Gurusharan P.
Published: February 2008

EDITORIAL COMMENT: We accepted this short report of a longer manuscript which the authors agreed to summarize at our request since readers should be interested to read of a polyherbal cream that seems active against Chlamydial infection, although inactive against Candida albicans and Trichomonas vaginalis. Readers should also note the high rate of Chlamydial infection (up to 50%) in women in this community in India who present with an abnormal vaginal discharge and cervicitis.