bluuebunny/crossref_metadata_2025 huggingface dataset:
Changing Caesarean Section Rates Experience at a Sydney Obstetric Teaching Hospital
Authors: Blumenthal N. J. , Harris R. S. , O'Connor M. C. , Lancaster P. A. L.
Published: February 2008

Summary: The Caesarean section rate has been rising in Australia in recent years. This study compares Caesarean section rates and indications for Caesarean section in 2 separate 2‐year periods, 1970–71 and 1980–81, in a Sydney teaching hospital. The Caesarean section rate increased from 6.4% to 16.2% in this decade. Dystocia is now the most frequent indication for Caesarean section and accounted for 33.2% of the increase in rate while fetal distress contributed 23.8% of that increase. Repeat Caesarean section and breech presentation contributed 16.9% and 13.3% of the increase respectively. Caesarean section rates for all birth‐weights increased, but particularly in the very small infant and those above 3,500 g. Caesarean sections for public patients rose from 3.4% to 9.3% while for private patients the rate increased from 12.0% to 20.7%. While there has been some convergence of rates for public and private patients during the decade, private patients were still twice as likely to have a Caesarean section in 1980–81. The contribution of dystocia, as an indication for Caesarean section, to the increase in the rate over this period is consistent with recent international experience and indicates a strong trend towards procedural intervention.
Indications for the Treatment of Tubal Infertility Patients by Microsurgery or In Vitro Fertilization
Authors: Paterson Peter J.
Published: February 2008

Summary: Pregnancy rates following the treatment of tubal infertility patients by microsurgery or in vitro fertilization (IVF) have been analysed.

The results indicate that microsurgery should be the primary treatment for the following: (a) Sterilization reversal (except fimbriectomies or tubes of less than 3cm length); (b) Incomplete lateral tubal occlusion; (c) Medial tubal occlusion; (d) Peritubal or periovarian adhesions.

IVF is indicated as the primary treatment for tubal infertility patients when investigation demonstrates (a) Total lateral tubal occlusion; (b) Previous fimbriec‐tomy sterilizations; (c) Reconstructable tubal length of less than 3cm.
Induced Lactation in Adoptive Mothers
Authors: Thearle M. J. , Weissenberger Rolf
Published: February 2008

Summary: The results of a pilot study of 6 women who undertook breast feeding their adopted infants are discussed, with a review of methods available for inducing lactation if this form of infant feeding is undertaken. It is concluded that whilst induced lactation can be successful for the mother and baby, further studies are necessary before conclusive advice can be given that this technique is effective and safe.
Fulguration Versus Resection of Experimental Endometrial Peritoneal Implants in the Rat
Authors: Golan A. , Dargenio R. , Winston R. M. L.
Published: February 2008

Summary: Endometriosis was induced in 20 rats. Treatment by diathermy was compared to treatment by microsurgical resection of endometrial implants. No significant differences were found between the 2 groups regarding ovulation, nidation index or pregnancy rates but significant difference in the extent of adhesion formation after surgery was evident. There were fewer adhesions in the microsurgical group. As the adhesions here were periuterine (and not peritubal as in the human) this could explain the lack of impact on the actual fertility of these rats.
Altered Hypothalamic‐Pituitary‐Testicular Function in Incomplete Testicular Feminization Syndrome
Authors: Gunasegaram R. , Loganath A. , Peh K. L. , Sinniah R. , Kottegoda S. R. , Ratnam S. S.
Published: February 2008

Summary: An 18‐year‐old 46 XY patient with the syndrome of incomplete testicular feminization was investigated. The clinical phenotypic features were distinctive and typical of the 4 46 XY cases previously reported. The findings of elevated plasma T4 with evidence of incomplete development of female secondary sex characteristics suggest partial end organ insensitivity to the androgen at the target tissues. This possibility is substantiated by the high plasma LH level, presumably the consequence of the relative inability of the hypothalamic‐pituitary unit to respond to testosterone in the feedback regulation of LH secretion. It is therefore suggested that, compared to normal males, the patient had an altered hypothalamic‐pituitary‐testicular function.
Value of Maternal Anti‐D Concentration in Predicting the Outcome of Rh(D) Haemolytic Disease
Authors: Harrison K. L. , Baker J. W. , Popper E. I. , Harden P. A.
Published: February 2008

Summary: The outcomes of 43 pregnancies complicated by the presence of Rhesus antibodies were studied in relation to the peak concentrations of anti‐D reached during pregnancy. Antibody concentration was measured by an automated method calibrated against the British Anti‐D Working Standard. Where the anti‐D concentration remained below 5 IU/ml, the infants at worst suffered only moderate jaundice controllable with phototherapy. Above this level the incidence of requirement for exchange or top‐up transfusion was high with concentrations greater than 50 IU/ml being predictive of a very severely affected fetus. It is recommended that amniocentesis in these patients be deferred until maternal anti‐D levels exceed 5 IU/ml.
Dysfunctional Uterine Bleeding in Women Over 40 Years of Age
Authors: Ngu A. , Quinn M. A.
Published: February 2008

Summary: Two hundred patients aged 40 years or more who were discharged from hospital with a diagnosis of dysfunctional uterine bleeding were followed up for 6 years. Ninety‐three patients eventually underwent hysterectomy and in 64% a pathological abnormality was noted in the uterus. The length of the uterine cavity and the presence of painful and/or heavy periods were the best predictors of outcome. Response to hormonal therapy was poor.
A Successful Pregnancy Outcome in Transfusion Dependent Thalassaemia Major
Authors: Meadows Keith
Published: February 2008

Summary: A case of a successful pregnancy outcome in a patient with transfusion dependent beta thalassaemia major is presented. This is the first case reported from Australia, the only other in the literature being from the United Kingdom(l).
Homozygous Beta Thalassaemia and Pregnancy
Authors: Grech E. S. , Silva L. J. P. , Ventura C. Savona
Published: February 2008

Summary: Pregnancy complicating homozygous beta thalassaemia is a rare entity. Two cases are described, I of which was further complicated by thrombocytopenia due to secondary hyperslenism. These cases are discussed in the light of current management of homozygous haemoglobinopathies.
Vaginal Delivery Following Caesarean Section
Authors: Ngu A. , Quinn M.A.
Published: February 2008

Summary: A retrospective analysis was made of 456 patients who had previously undergone Caesarean section and who were considered suitable for a trial of labour. Sixty percent of patients had a vaginal delivery. Patients with obstructed labour or failure to progress as the indication for primary Caesarean section were significantly more likely to require a repeat operation but 44% of these patients still achieved a vaginal delivery. Patients who had had a vaginal delivery prior to, or subsequent to, the Caesarean section had a low incidence of repeat Caesarean section. X‐ray pelyimetry was of limited value in predicting outcome. Intravenous oxytocin was used in 17% of patients. No uterine rupture occurred and no fetal mortality resulted directly due to the trial of labour. Trial of labour following Caesarean section is a safe procedure when conducted in an appropriate hospital setting.
Evaluation of Fundal Height Measurement in Antenatal Care
Authors: Rogers Michael S. , Needham Peter G.
Published: February 2008

Summary: The value of symphysis‐fundus measurement (fundal height) as a screening procedure for fetal growth was assessed. The reproducibility of measurements between staff of differing antenatal experience was ± 2 cm in 95% of cases. Fundal height was correlated with ultrasound measurement of biparietal diameter and abdominal area, and coefficients of 0.84 and 0.74 respectively were obtained; 73.1% of babies weighing below the 10th percentile for gestation were detected by one measurement of 3 cm or more below the mean for gestation.
Epidemiology of Meconium Staining of Amniotic Fluid in Hong Kong
Authors: Wong W. S. Felix , Wong K. S. , Chang Allan
Published: February 2008

Summary: The characteristics of 94 patients with meconium stained amniotic fluid diagnosed during labour in the Prince of Wales Hospital, Hong Kong, from July to August 1984, were analysed. The incidence was 21.4% of deliveries. These patients were compared to a group of non‐meconium patients (349 cases) in demographic and obstetric aspects. Patients in low social class and patients with antenatal and medical complications did not have a higher incidence of meconium staining of amniotic fluid. However, a history of previous spontaneous or induced abortion was significantly more common in the meconium group. The labour performance of these patients and the perinatal outcome are discussed.
Prostaglandin Inhibitors in Gynaecology
Authors: Fraser Ian S.
Published: February 2008

Summary: Several prostaglandin inhibitors have substantial efficacy in treating menstrual symptoms and many patients will experience relief of multiple symptoms. The treatment regimen for most symptoms is simple and the onset of relief is rapid. Side‐effects are mild and uncommon, and serious complications have not been reported with the short‐term dosage regimens. These drugs appear to have an important place in the management of several menstrual disorders.
A Decidual Cast Following Therapy with Norethisterone
Authors: Shaw D. D. , Baker J. W.
Published: February 2008

Summary: A case is presented of a decidual cast following progesterone therapy, an extraordinarily rare event.
Benign Senile Pyometra, Endometrial Cholesterol Granulomas and Adenosquamous Carcinoma
Authors: Pounder Derrick J. , Iyer Prema V.
Published: February 2008

Summary: Endometrial curettage of a 78‐year‐old patient with benign senile pyometra revealed endometrial cholesterol granulomas. Five years later cytological studies were suspicious of malignancy. Hysterectomy disclosed an endometrial adenosquamous carcinoma associated with cholesterol granulomas. We speculate that endometrial cholesterol granuloma, like endometrial xanthogranuloma, represents a rare morphologic variant of benign senile pyometra. Consequently a strong association with carcinoma is to be expected.
Return to Theatre –Experience at the Mercy Maternity Hospital, Melbourne 1971–1982
Authors: Ashton Peter , Beischer Norman , Cullen John , Ratten Graeme
Published: February 2008

Summary: This paper summarizes the problems which necessitated return to theatre at the Mercy Maternity Hospital, 1971–1982. There were 154 of 29,488 patients (0.5%) having obstetrical or gynaecological treatment in theatre who made this journey. They all survived, some after heroic resuscitative measures.

Haemorrhage necessitated the patient's return to theatre following 0.2% of Caesarean sections and 0.2% of gynaecological operations.

Many obstetric patients who return to theatre are potential maternal deaths. The assistance of an experienced colleague is essential in their management. When massive or continuing haemorrhage occurs at Caesarean section, hysterectomy should be considered, especially if the placenta appears to be morbidly adherent, these being the very patients at risk of a return to theatre if hysterectomy is not performed. With the increasing Caesarean section rate, placenta praevia accreta has become more common, to the extent that ultrasonographic localization of the placenta is recommended in all patients who have had a previous Caesarean section.

Curettage is not indicated in the treatment of primary postpartum haemorrhage after Caesarean section; moreover, its performance in the management of secondary postpartum haemorrhage when the patient was delivered by Caesarean section should be regarded as a formidable procedure. When a patient who was delivered vaginally returns to theatre because of continuing haemorrhage after curettage performed for secondary postpartum haemorrhage hysterectomy is likely to be required.

Safe methods of suturing the lower uterine segment incision at Caesarean section, and the lateral angles of the vaginal vault after abdominal hysterectomy are described.
Peripartum Concentrations of Beta Endorphin and Cortisol and Maternal Mood States
Authors: Brinsmead M. , Smith R. , Singh B. , Lewin T. , Owens P.
Published: February 2008

Summary: Nineteen women were studied before, during and after labour by assessment of their mood using a variety of psychological tests and by measurement of their plasma concentrations of beta‐endorphin and Cortisol. Beta‐endorphin and Cortisol concentrations rose markedly during labour and were influenced by the type of analgesia used. A deterioration in cognitive performance between days 2 and 4 postpartum correlated positively with the fall in beta‐endorphin concentrations from those in labour to those on the fourth day postpartum. The women were more anxious and depressed at 38 weeks' gestation than on days 1–4 postpartum and the elevation of mood on day 2 postpartum correlated with a measure of depression 8 weeks later. It is postulated that the phenomenon of postpartum blues is a reaction to the euphoria of delivery which in turn is a response to endorphin release during labour. Whilst these changes may have a role in promoting maternal‐infant attachment it is at the expense of maternal depression some weeks later.
Smoking Habits of Pregnant Women in Brisbane, Australia
Authors: Counsilman J. J. , Mackay E. V.
Published: February 2008

Summary: A survey of postpartum women in Brisbane revealed that many gave up smoking just before or shortly after becoming pregnant, and that many of the remainder reduced their rate of consumption. Husbands who smoked showed no comparable changes in behaviour. Thus apparently many couples were aware of the dangers to the fetus of active smoking by the woman, but not of the dangers of her passive inhalation of smoke. Other significant findings included (i) increasing rates of consumption during successive pregnancies, (ii) high degrees of conformity for most habits (e.g. use of filters), and (iii) stronger addiction and earlier starting ages among heavy smokers than light smokers.
Aetiological Factors in the Genesis of Pregnancy Hydronephrosis
Authors: Au Kelly K. L. , Woo Joseph S. K. , Tang Lawrence C. H. , Liang S. T.
Published: February 2008

Summary: In order to identify possible aetiological factors in the genesis of physiological hydronephrosis in pregnancy, the degree of pelvic‐calyceal dilatation in 90 asymptomatic pregnant women was correlated with levels of plasma oestradiol, progesterone, 24‐hour urinary oestriol, the site of the placenta, birth‐weight of the fetus, and pelvic inlet measurements. A grading system based on maximum calyceal diameter was used; 90% of the patients were found to have at least mild dilatation on the right side. No correlation was demonstrated between the degree of hydronephrosis and the levels of oestradiol, progesterone and 24‐hour urinary oestriol excretion. The birth‐weight of the fetus and its relationship with the pelvic inlet measurements also did not correlate with the occurrence of hydronephrotic changes in the kidneys. The only significant positive finding was a higher incidence of moderate and severe hydronephrosis occurring in patients with a right‐sided placenta than compared with the left (x2= 4.77; p < 0.05), although the sensitivity and specificity in predicting hydronephrosis from a right‐sided placenta is low (53% and 66% respectively). Our results support the hypothesis of a mechanical aetiology in the genesis of pregnancy hydronephrosis, where vascular compression on the ureters may be an important contributory factor. Our study has also shown that urinary tract infection and reduction of creatinine clearance were not more common in patients with moderate or severe pelviccalyceal dilatation.
Second Trimester Maternal Serum Alpha‐fetoprotein as an Indicator of Fetal Risk
Authors: Legge M. , Duff G. B. , Pike L. , Aickin D. R.
Published: February 2008

Summary: Serum alpha‐fetoprotein levels were raised to 2.0 or more times the median for gestation in 30 of 507 singleton pregnancies after excluding pregnancies complicated by fetal neural tube defects.

The serum alpha‐fetoprotein levels were significantly more often elevated in pregnancies complicated by prematurity, fetal heart rate abnormalities, delivery of a small for dates infant, a perinatal death and admission of the baby to the neonatal unit. While the predictive value of an elevated serum alpha‐fetoprotein was 76% for abnormal outcomes in general it ranged between only 16% and 46% for specific abnormalities. The usefulness of this assay relates only to its ability to predict an abnormal outcome when performed during the second trimester.
Labial Adhesions in Postmenopausal Women with Hip Joint Disease
Authors: Savona‐Ventura C.
Published: February 2008

Summary: Two cases of postmenopausal labial adhesions in patients with severe hip joint disease are presented. The aetiology of labial adhesions in the postmenopausal woman is discussed. Hip joint disease is shown to influence the formation of adhesions by interfering with perineal hygiene and decreasing sexual activity.
Preparation for Induction of Labour of the Unfavourable Cervix with Foley Catheter Compared with Vaginal Prostaglandin
Authors: Thomas I. L. , Chenoweth J. N. , Tronc G. N. , Johnson I. R.
Published: February 2008

EDITORIAL COMMENT: It is salutary to note that many workers now advocate mechanical methods of cervical dilatation condemned in the past for very good reasons (maternal infection, cervical trauma). It is also noteworthy that this paper reports impressive results of Foley catheter with traction (spontaneous vaginal delivery 66%, Caesarean section rate 22%) in patients with an unfavourable cervix who required induction of labour (see Arulkumanan et al Aust. NZJ Obstet. Gynaecal. 1985; 25: 190–193).

Summary: Ripening of the unfavourable cervix prior to induction of labour using traction on a Foley catheter (32 patients) was compared with 40 mg of prostaglandin F2α in Tylose gel applied to the external cervical os and held in place for 12 hours with a vaginal diaphragm (25 patients). Each patient in the above groups had a modified Bishop score of 0–3 and was randomly allocated to one or other group. Comparison was made with a further 25 patients in whom the cervical score was 4–6.

Timing of amniotomy and commencement of Syntocinon infusion were equivalent for all patients.

Prostaglandins conferred no advantage over Foley catheter in terms of am‐niotomy‐delivery interval, operative delivery rate, and condition of the baby one minute after birth.

The disadvantages of prostaglandins for cervical ripening are a longer preparation‐delivery interval, and cost ($77 versus $4.75 for the Foley catheter). Currently, prostaglandins are not officially approved for use in Australia for induction of labour. It is suggested, therefore, that the Foley catheter is preferable for ripening the unfavourable cervix as a prelude to amniotomy.
Chorionic V ill us Sampling Clinical Experience in 50 Diagnostic Cases
Authors: Wass Debbie M. , Warren Peter S. , Stewart Lesley A. , Bennett Michael J. , Garrett William J.
Published: February 2008

Summary: The results of 50 diagnostic chorionic villus samplings (CVS) are presented. In all but 2, the fetus was at risk of a chromosomal abnormality. Sampling was successful in 48 cases. One patient aborted 4 days after the procedure. Two patients had missed abortions diagnosed on ultrasound 44 and 56 days after CVS. Seven patients elected to have their pregnancies terminated. Ail samplings were undertaken with a specially designed cannula using realtime ultrasound guidance between 9 and 11 weeks of amenorrhoea. Endocervical swabs and blood for maternal serum alpha fetoprotein estimations before and after the procedure were routinely taken. All patients were notified of the results in 8 days or less except in 3 where long‐term cultures were necessary. Six patients have delivered and 34 pregnancies are continuing satisfactorily.
Racial Variations in Obstetric Practice
Authors: Cauchi Maurice N.
Published: February 2008

Summary: This study involves a retrospective analysis of 453 pregnant persons, with the aim of comparing certain disorders of pregnancy as well as infant and placental parameters in various racial groups within the same community. Significant variations were seen in the mean age of the patients, age at first pregnancy, frequency distribution of first pregnancy, infant weight as well as gravida: parity ratio. There was a 3‐fold increase in incidence of preeclampsia in the Australian‐born population compared to other racial groups. Mild anaemias (haemoglobin < 11.5 g/dl) were found in up to 61% of the Australian‐born population compared to 32% of the other racial groups; however, more significant degrees of anaemia were more commonly found in certain ethnic groups (e.g. Greek 16%, Italian 15%, Australian‐born 6%).

These studies emphasize that overall incidence studies in a polyglot population can have very limited meaning, and that greater attention must be paid to the actual racial variations within a population.
Subsequent Pregnancy Following the Birth of an Extremely Low Birth‐weight Infan
Authors: Yu V. Y. H. , Davis N. G. , Mercado M. F. , Bajuk B. , Astbury J.
Published: February 2008

Summary: Of 103 mothers who delivered an extremely low birth‐weight (ELBW, < l,000g) infant, 29% were primiparous; 51% of those who were multiparous had at least one previous miscarriage or perinatal death. The 41 (40%) mothers who decided against subsequent pregnancy were significantly older than the remaining mothers. Mothers were also significantly more likely to decide against subsequent pregnancy if their ELBW infant had survived. The outcome of subsequent pregnancies within 3 years of the ELBW birth was ascertained; 28% ended in miscarriage, 3% in stillbirth, 1% in neonatal death, 21% in a surviving preterm infant and 51% in a survivor born at term. Mothers diagnosed to have cervical incompetence had a significantly higher risk of a subsequent preterm birth. During the study period, 87% of mothers who became pregnant subsequent to their ELBW infant gave birth to at least one surviving child. Of the subsequent livebirths, 36% were less than 2,500g, 11% were less than l,500g and 5% were less than l,000g. Significantly more mothers whose ELBW infant had died conceived again within 1 year compared to those whose ELBW infant had survived. The necessary time for recovery from bereavement may be cut short by the subsequent pregnancy. The psychological problems as a result of unresolved mourning which mothers experience and their effects on subsequent children need to be further studied.
Spontaneous Rupture of an Hepatic Adenoma in Pregnancy with Survival of Mother and Fetus
Authors: Monks P. L. , Fryar B. G. , Biggs W. W.
Published: February 2008

Summary: A case of spontaneous rupture of an hepatic adenoma during pregnancy is reported with survival of both mother and baby. The mother had previously taken the contraceptive pill for 9 years. Attention is drawn to the relationship between the contraceptive pill and the previously rare condition of benign liver adenoma, the need for prompt recognition, and for an intensive team effort in the management of rupture of this neoplasm.
Timely Diagnosis by Cardiotocography of Critical Fetal Reserve Due to Fetofetal Transfusion Syndrome
Authors: Goldberg H. James , Oats Jeremy N. , Ratten Valerie , Beischer Norman A.
Published: February 2008

Summary: In a review of 90 twin pregnancies monitored by antenatal cardiotocography there were 8 cases of subsequently proven fetofetal transfusion syndrome. In 2 of these evidence of severe fetal stress had indicated immediate delivery; the 4 babies survived in circumstances that were perilous. In 1 case there was no evidence of critical fetal reserve but the recipient twin died, this probably representing an acute fetofetal transfusion during labour. In the 5 milder cases with no evidence of stress on cardiotocography, all babies survived and they required minimal or no treatment for problems relating to the fetofetal transfusion. In multiple pregnancy the cardiotocograph offers the additional bonus of detection of fetal compromise due to fetofetal transfusion.
Computed Tomography Prior to Surgery for Ovarian Carcinoma
Authors: Simon Alex , Fields Scott , Schenker Joseph G. , Anteby Shaoul O.
Published: February 2008

Summary: The value of investigation of patients with ovarian carcinoma by preoperative computed tomography scan was evaluated in all the patients operated on during the last 2 years; 22 patients were included in this study and evaluated. In 11 patients the scan was performed prior to the primary surgery and in the other 11 patients before second look following chemotherapy.

CT scan was found to be highly sensitive in detecting ascites, pelvic wall extension and spread or involvement of the uterus. Peritoneal and omental spread was detected in only half of the patients before primary surgery. Prior to second look operation CT scan was effective in excluding liver metastasis, ascites, paraaortic lymph node enlargement, pelvic wall extension and pelvic residual tumour. Generally, CT scan failed to detect peritoneal and omental spread. It is an important tool for preoperative evaluation of the extension of the disease and planning of surgery, but still, the final staging deserves explorative laparotomy.
Clinical Aspects of Induced Abortion in South Australia from 1970–1984
Authors: Hart Gavin , Macharper Tony
Published: February 2008

Summary: Clinical changes, and their implication, in medically induced abortion within South Australia from 1970–1984 were assessed by analysis of legally required reports provided by operating practitioners. In the past 15 years vacuum aspiration has largely replaced dilatation and curettage for early abortions, and intrauterine chemical methods have greatly decreased the use of hysterotomy for late abortions. A marked improvement in gestational pattern has also occurred, and recorded complication rates have been halved for all gestational ages. Sterilization rates at the time of abortions increased with increasing age and with increasing gravidity, but the total rates, adjusted for age and gravidity of patients, have changed little in the past 15 years.
A Prospective Randomized Comparative Trial of the Gravigard, Latex Leaf, Dalkon Shield and Multiload Cu 250 IUDs
Authors: McCarthy T. G. , Chew S. C. , Lim S. M. , Cheng M. C. E. , Ratnam S. S.
Published: February 2008

Summary: This prospective randomized trial in 843 patients compared the effectiveness and complications of 4 intrauterine devices. At 24 months the gross accidental pregnancy rate for the Dalkon Shield was higher than for the 7Cu200 (p<0.05) and the MLCu250 (p<0.05). The 7Cu200 had a higher expulsion rate than the Dalkon Shield (p<0.01), Latex Leaf (p<0.001) and MLCu250 (p<0.001). Use‐related terminations were higher for the 7Cu200 than for the MLCu250 (p<0.01). Removal for pelvic inflammatory disease was necessary in 8 women (2 for the Latex Leaf and 3 each for the 7Cu200 and Dalkon Shield). There was no significant difference in termination rates between the MLCu250 and Latex Leaf but subsequently the Leaf has given problems with removal particularly in women who have defaulted follow‐up for several years.
An Unusual Case of Rhesus Isoimmunization
Authors: MD J. Younis , MD G.Ohel , MD E. Sadovsky
Published: February 2008

Summary: A case of rhesus isoimmunization with spontaneous improvement in severity of erythroblastosis with advancing parity is presented. The isoimmunized pregnant woman after having 3 perinatal deaths all due to severe hydrops fetalis, subsequently delivered 2 Rh‐positive surviving infants. In her last pregnancy, the timing of delivery was indicated by cessation of fetal movements, followed by a sinusoidal fetal heart rate pattern. The newborn, needing 5 exchanging blood transfusions, subsequently did well.
Infant Development Following the Use of Intravenous Nutrition to Women with Persistently Low Urinary Oestriol Excretion
Authors: Carne Raymond J. , Drew John H.
Published: February 2008

EDITORIAL COMMENT: This study concludes that dextrose infusions to mothers with high‐risk pregnancies does not compromise the intellectual quality of survival, although it appears to improve perinatal mortality rates. This finding has relevance to the time‐honoured practice of giving 5% dextrose to patients in labour when progress is suboptimal and operative delivery likely — for prevention and/or treatment of maternal ketosis and distress — the assumption being that prevention of maternal dehydration improves fetal and maternal condition and reduces the need for Caesarean section. Recent publications (1,2) suggest that dextrose infusions to the mother in labour could harm the fetus with hypoxia, resulting in anaerobic glycolysis of the dextrose load, which could increase the tendency to fetal acidosis. This objection to the use of dextrose in labour is theoretical and defies clinical experience. Carne and Drew's paper suggests that dextrose infusions to a group of mothers with a high proportion of growth retarded infants is certain& nor harmful and indeed appears to be beneficial, as one would expect to be the case since the fetus lives on glucose. Even Christianity has its critics; the practice of giving 5% dextrose intravenous& to the mother with prolonged or difficult labour to prevent or ameliorate maternal and/or fetal distress has not been discredited.

Summary: During the 6‐year period 1971 to 1976, 10,545 patients had urinary oestriol determinations during pregnancy and 333 (3.2%) had persistently low values. Of the 335 resultant infants 206 were from patients treated with intravenous dextrose and/or amino‐acids (treated group) and 129 from nontreated patients (nontreated group). The stillbirth rate was 2.4% in the treated group and 11.6% in the untreated group (p > 0.001), and the neonatal death rates were 2.9% and 4.7% respectively (p = NS). Assessment of the surviving infants to 7 years of age revealed no significant differences in growth between treated and nontreated groups. There was no increase in the incidence of major neurological abnormalities in the treated infants (2.9%) when compared to those from nontreated pregnancies (1.3%) (p = NS), nor was there a significant difference in the incidence of minor neurological abnormality or findings on psychological assessments. We conclude that dextrose and/or amino‐acid infusions given to pregnant women with low oestriol excretion reduced the perinatal mortality rate without significant compromise to subsequent development of surviving infants.
Pelvic Infection and the Pathogenesis of Tubal Ectopic Pregnancy
Authors: Clark Kenneth , Baranyai Judith
Published: February 2008

Summary: All ectopic pregnancies occurring in a defined New Zealand urban area from the years 1970 and 1984 were studied (232 cases in total). The medical records and histological preparations were reviewed. A 38% increase in the incidence of ectopic pregnancy over this 15‐year period is documented. The percentage of patients with histological evidence of past tubal infection increased from 40.6% in 1970 to 61.2% in 1984. Significant increases in the number of patients with histories of infertility or past pelvic infection and of patients with operative evidence of past infection were also noted. These results support the postulate that the increase in incidence of ectopic pregnancies over recent decades is strongly associated with the increase in prevalence of pelvic infection. Tubal damage secondary to previous pelvic infection is probably the major, although certainly not the only, aetiological factor in the development of tubal pregnancies.
Torsion of the Gravid Uterus
Authors: Steigrad Stephen J.
Published: February 2008

Summary: A case of 90° dextrorotation of the uterus occurring in labour with successful outcome for mother and child is reported. Partial torsion may explain the occurrence of abnormal lie occurring during labour in the absence of detectable uterine pathology.
The Vertical Birthing Position of the Trobrianders, Papua New Guinea
Authors: Pöschl Ulrike
Published: February 2008

EDITORIAL COMMENT: It is considered that this review of birthing positions will interest many readers. Figure 6* provided by Dr Michel Odent, Pithiviers, France, shows remarkable similarities to figure 5, and illustrates that modern Western obstetric practice has not completely abandoned the vertical birthing position!

Summary: During an ethnomedical field study the author succeeded in participating and photographing 4 traditional birthgivings among the Trobrianders/Papua New Guinea. Their various vertical postures are described with special reference to specific Trobriand practices and discussed by literature review. The results suggest that vertical birthing positions are advantageous to horizontal ones and should be reconsidered by modern Western obstetrics.
The Treatment of Advanced Recurrent Carcinoma of the Uterine Cervix with Platinum Based Cytotoxic Chemotherapy
Authors: Hardy J. R. , Maclean G. D. , Foote G. A. , Harvey V. J.
Published: February 2008

EDITORIAL COMMENT: The pessimism expressed in this paper with regard to chemotherapy of recurrent or advanced cervical cancer is shared by all who treat this disease. However, the demonstration of response rates of 30% or greater offers some encouragement and supports a reevaluation of the role of chemotherapy in this disease. Chemotherapy is usually reserved for recurrences after treatment by radiotherapy and surgery with the consequent problems of reduced tumour vascularity and renal impairment. These problems may be overcome by the early institution of cytotoxic therapy in high risk patients; studies are underway in patients with positive pelvic lymph nodes and locally advanced disease using chemotherapy in an adjunctive or primary role.

Summary: Nineteen patients with advanced recurrent carcinoma of the uterine cervix received platinum based chemotherapy between February 1982 and April 1984. All patients had received prior pelvic irradiation. Eleven patients received combination chemotherapy with platinum, vinblastine and bleomycin (PVB), and 8 patients received a regimen of platinum and 5‐fluorouracil (PF).

Two patients achieved a complete response and 4 patients achieved a partial response, a total response rate of 33%. Five out of 6 responders received PVB. The median survival (MS) was 8 months (1–38) months from the first treatment with cytotoxic chemotherapy. In those patients achieving a response, MS was 13.5 months (6–38 + months) with 1 patient alive at 38 months, compared to an MS of 5 months (1–15 months) in those patients without response. Toxicity was significant with nausea and vomiting in the majority of patients. Two patients refused treatment after the first course because of toxicity. The morbidity of treatment was such that despite an encouraging response rate, particularly to PVB (45%), the routine use of such treatment must be questioned.
Emergency Hysterectomy in Obstetrics—a Review of 117 Cases
Authors: Al‐Sibai M. H. , Rahman J. , Rahman M. S. , Butalack F.
Published: February 2008

Summary: A series of 117 cases of emergency obstetric hysterectomy performed between 1976 and 1985 is reviewed. The indications included ruptured uterus (53.8%), intractable postpartum haemorrhage (20.5%), placenta accreta (7.7%), major degree of placenta praevia (7.7%), haemorrhage at Caesarean section (4.5%), couvelaire uterus (3.4%) and abdominal pregnancy (2.6%). Despite a general aversion to hysterectomy by the women in our society, these procedures were undertaken in a desperate attempt to save life. There were 6 (5.1%) maternal deaths, all due to the severity of the indication for the hysterectomy. Presence of an experienced obstetrician is important to make an early decision to operate before the patient's condition is extreme and to provide the technical skills required to minimize morbidity and mortality.
Pregnancy Outcome in Gestational Diabetes with Preconceptional Diabetes Counselling
Authors: Dicker Dov , Feldberg Dov , Yeshaya Arie , Karp Moshe , Samuel Nurith , Goldman Jack A.
Published: February 2008

Summary: One hundred and thirty‐six women with known previous gestational diabetes and normal glucose tolerance between pregnancies attended a preconceptional clinic at least 2 months before conception, and were regularly consulted by a diabetological team. Evaluation consisted of oral glucose tolerance test (OGTT), mean blood glucose, glycosylated haemoglobin and management by self‐blood‐glucose monitoring (SBGM) and nutritional counselling. When these patients were compared to a group of 154 patients with gestational diabetes who attended our clinic at different stages of pregnancy, the former had improved glucose homeostasis whereas the latter had more frequent elevations of fasting and postprandial glucose levels throughout pregnancy. This group had also more maternal complications and higher Caesarean section rates. Congenital anomalies were 0.65% among offspring of nonattenders, while none occurred in those with preconceptional counselling. Macrosomia and hypoglycaemia were significant neonatal complications in infants of nonattending mothers.

We concur with the recommendation that preconceptional counselling in gestational diabetics is required to improve glucose homeostasis throughout pregnancy, and that appropriate evaluation of glucose intolerance should be included as part of prospective family planning.
Outcome of Singleton Infants Delivered Vaginally or by Caesarean Section at 23 to 28 Weeks' Gestation
Authors: Yu V. Y. H. , Loke H. L. , Szymonowicz W.
Published: February 2008

Summary: The survival and impairment rates of 276 inborn singleton infants of 23–28 weeks' gestation were reported according to route of delivery and mode of presentation. The Caesarean section rate was 29% overall, ranging from 13% at 25 weeks to 46% at 28 weeks. In the vertex group, no significant difference in survival or impairment rate was found between Caesarean and vaginal births. In the nonvertex group, Caesarean births had a similar survival rate but a significantly lower impairment rate compared to vaginal births. For Caesarean births, no significant difference in survival or impairment rate was found between vertex and nonvertex groups. In contrast, for vaginal births, the mode of presentation was important: the non‐vertex group had a significantly lower survival rate and higher impairment rate compared to the vertex group. We found no evidence to support the use of Caesarean section in extremely preterm infants with vertex presentation, except for recognized maternal or fetal indications. The findings in the non‐vertex group indicated that there is a definite need for a randomized clinical trial to investigate the possible benefits of Caesarean section in extremely preterm infants with non‐vertex presentation.
Mode Of Delivery Of Preterm Twins
Authors: Doyle L. W. , Hughes C. D. , Guaran R.L. , Quinn M. A. , Kitchen W. H.
Published: February 2008

EDITORIAL COMMENT: This paper concludes that the vaginal route is appropriate, in terms of perinatal mortality and immediate morbidity, for the delivery of approximately 80% of twins born before 33 weeks' gestation. The trend towards Caesarean section in multiple pregnancy should be scrutinized as for singleton pregnancies. Falling perinatal mortality rates associated with increased Caesarean section rates do not prove a cause and effect relationship. The following statistics for multiple pregnancy at a State and Hospital level are quoted for perspective (tables 1A and IB). At the Mercy Maternity Hospital the Caesarean section rate for multiple pregnancy (triplets and quadruplets included) has quadrupled to 32% in 16 years, during which time the overall Caesarean section rate increased from 9 to 16%; this was associated with a modest (25%) improvement in the perinatal mortality rate. Comparable figures for the State of Victoria are not available, but from 1976 ‐ 1985, the total perinatal mortality rate has fallen approximately 30%, and multiple pregnancy continues to account for about 10% of perinatal deaths. In 1985, in Victoria, 2.3% of all infants (1,422 of 61,176) were bom from multiple pregnancies and they accounted for 8.2% (61 of 741) of all perinatal deaths in infants born with birth‐weight of 500g or above.

Summary: At one high‐risk perinatal centre over a 9‐year period, 83.1% (103/124) sets of liveborn twins with gestational ages less than 33 weeks were delivered vaginally. Mortality in vaginal births was 26.7% (55/206), almost double that of Caesarean births of 14.3% (6/42), a non‐significant difference. When gestational age discrepancies were corrected, however, the trend favouring survival of Caesarean births disappeared. Furthermore, there were no significant associations between mode of delivery and the condition of the infants at birth, or the presence of respiratory distress in the nursery. Because Caesarean section carries substantial risks for the mother our practice of predominantly vaginal deliveries for preterm twins should continue.
Lamicel is More Effective in Preparing the Cervix for Midtrimester Termination of Pregnancy than Laminaria Japonicum
Authors: Tan Seang Lin , Cheng Henry , Ho Kok Kee , Mitra R , Hii Joachim , Yeo Ker Chiang
Published: February 2008

Summary: Laminaria tents are often used prior to prostaglandin termination of midtrimester pregnancy to reduce the induction‐abortion interval. Natural laminaria suffers from a number of disadvantages and, recently, a synthetic form Lamicel (Cabot Medical, PA), has been produced. Uncontrolled evaluation has suggested that it is effective for dilating the cervix but scepticism remains because Lamicel does not exert radial force on the cervical canal. One hundred women who requested abortion between 12 and 24 weeks of pregnancy were studied. They were randomly divided into group A who had a Lamicel inserted for 6 hours and group B who had a laminaria tent inserted for 8 hours. The cervical dilatation was assessed at the end of this period and the patients were then given up to 6 injections of sulprostone at 4‐hourly intervals. All patients in Group A aborted, but 7 of those in Group B did not. The mean cervical dilatation in Group A was 7.47 ±1.46mm compared with 4.71 ±1.76mm in Group B (p< 0.001). The mean induction‐abortion interval in Group A was also significantly shorter (p<0.05) than that in Group B: 11.79 ±17.24 hours compared with 12.51 ±6.52 hours in Group B (excluding 7 patients who failed to abort in Group B). The results of the study suggest that the degree of cervical dilatation that can be achieved using Lamicel is significantly greater than that by laminaria tents.
Atypical Ogilvie Syndrome
Authors: Paraskevaides E. C. , Sodipo J. A.
Published: February 2008

EDITORIAL COMMENT: Post‐Caesarean section abdominal distension is a common problem, but spontaneous perforation of the colon, which occurred in this patient, is fortunately a very rare complication. The need for laparotomy in such patients is indicated by the clinical picture (e.g. sudden right hypochondrial pain and peritonitis as in this patient), not the findings on radiography. The Clinical Reports of the Mercy Maternity Hospital, 1971–1983, summarize the findings in the 173 patients who had laparotomy performed for surgical complications during pregnancy and the puerperium, during which time there were 56,842 confinements, including 6,938 Caesarean sections, in this hospital. There were cases of appendicitis (47), cholecystitis/cholelithiasis (12), carcinoma of the colon (I), bleeding Meckel diverticulum (1), volvulus of sigmoid (1), volvulus of small bowel (1), but there was not one case of intestinal perforation in this series.
Metastasizing Leiomyoma of the Uterus
Authors: Ford J. M. , Pang J. , Coutts J. , Evans B. D.
Published: February 2008

Summary: This report describes a patient who underwent a subtotal hysterectomy 6 years ago for fibroids. She re‐presented recently with lung metastases and a pelvic mass. Macroscopic appearances at laparotomy suggested a leiomyosarcoma of the uterine stump, but histological appearances suggested the patient was suffering from the rare condition ‘metastasizing leiomyoma’. Subsequent response to hormone manipulation supported the latter diagnosis.
Transabdominal Chorionic Villus Sampling
Authors: Umstad Mark P. , Robinson Hugh P. , de Crespigny Lachlan Ch , Ngu Andrew C.
Published: February 2008

EDITORIAL COMMENT: Chorion villus sampling is likely to replace genetic amniocentes'is in many patients mainly because the procedure can be performed so much earlier in pregnancy (8–12 weeks rather than 16–17 weeks) when the safety of termination of pregnancy, should this be required, is greater. Most recent reports state that the risk of genetic amniocentesis is less than 1 %, but readers may find it difficult to believe that the loss rate following chorion villus sampling is as low as 2–3% when the spontaneous abortion rate is about treble this figure in patients with apparently normal pregnancies who book for confinement with their obstetrician at about the time that chorionic villus sampling is performed. The important point to note is that, many patients with apparently normal pregnancies clinically at 8–10 weeks have a missed abortion (blighted ovum) which would not be diagnosed unless ultrasonography and/or estimation of urinary or plasma oestrogen and pregnanediol were performed.

Summary: The first 100 patients undergoing first trimester transabdominal chorionic villus sampling (placental biopsy) in our hospital are reviewed. At the time of follow up 24 patients had delivered, 68 pregnancies were at 24 weeks or more and progressing normally, 7 pregnancies were terminated and there was only 1 spontaneous miscarriage. The advantages of the transabdominal approach are discussed.
Recurrent Hydatidiform Mole: A Report of a Patient with 7 Consecutive Moles
Authors: Thavarasah A. S. , Kanagalingam S.
Published: February 2008

Summary: A rare case of hydatidiform mole occurring 7 consecutive times in a Chinese woman is presented. She was first seen in 1979 at the age of 23 years, with a molar pregnancy and subsequently had 6 consecutive moles, the last being in July, 1986; at this visit the patient and her husband were very depressed, and convinced that a normal pregnancy was unlikely and requested a hysterectomy. They were warned earlier several times, of the possible long‐term consequences of a recurrent mole and that their chance of having a normal baby was very remote. A total hysterectomy was performed at her last presentation as the patient requested one, instead of dilatation and curettage for a persistently high HCG and bulky uterus following suction evacuation. Histology revealed an invasive mole. The beta HCG level was less than 4IU/1 by the end of September, 1986 and she is still being followed‐up.