bluuebunny/crossref_metadata_2025 huggingface dataset:
Can Ultrasonography Reliably Predict the Occurrence of Multiple Pregnancies in Gonadotropin Ovulation Induction?
Authors: Yu Su Ling , Pepperell R. J. , Evans J. H.
Published: February 2008

EDITORIAL COMMENT: This paper illustrates the limitations of ultrasonography and estimation of urinary excretion of oestrogen in prediction of multiple pregnancy when ovulation is induced by gonadotropin therapy. However, the reviewer of this paper wishes to point out to readers that the authors presumably still use these techniques and do not wish to imply that they are useless. During the time of this study of 380 cycles, there were 28 cycles abandoned (table 1) presumably in order to avoid the risk of multiple pregnancy but the details are not provided. It is noteworthy that figure 2 in this paper shows that multiple pregnancy resulted in 6 of the 10 conceptual cycles in which total urinary oestrogen excretion was 200 ug/24 hours or above; had these 10 cycles been abandoned the 1 quadruplet and 3 of the 6 triplet pregnancies would have been avoided.

Summary: retrospective study of 78 patients with 106 stimulated conception cycles after successful gonadotrophin ovulation induction was made to analyze the relationship between the sizes and numbers of ovarian follicles seen on ultrasound and the eventual number of conceptions that resulted in each cycle.

Fifteen cycles (14.2%) resulted in spontaneous abortions. There were 58 singleton pregnancies (54.8%), 26 sets of twins (24.5%), 6 sets of triplets (5.6%) and 1 set of quadruplets (0.9%).

In 86 cycles with the last scans performed shortly before the ovulating dose of HCG, 3 or more mature follicles were found in 50 (58%). These cycles resulted in 31 (62%) singletons, 16 (32%) twin pregnancies and 3 (6%) triplet pregnancies. Pregnancies resulted even when there were no ‘mature’ follicles seen on scan. No statistical correlation was found between plurality of pregnancy and size or number of follicles, or oestradiol excretion on the day the ovulating dose of HCG was given, although high‐order multiple pregnancies were more likely if the oestrogen excretion was more than 200 ug/24 hours (p = 0.001). The dosage of HCG correlated inversely with the occurrence of multiple pregnancies (p = 0.02).

In conclusion, neither oestrogens nor ultrasonography could accurately predict multiple conceptions in gonadotrophin stimulated cycles.
Laparoscopy in the Management of Women with Chronic Pelvic Pain
Authors: Al‐Suleiman Suleiman A.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it analyses the fallibility of bimanual pelvic examinations in assessment of pelvic pathology, in comparison with laparoscopy, in a large series of women with chronic pelvic pain. Although 85% of patients had ultrasonography, the value of this investigation was not presented. We were surprised to read that only 9 of the 246 women had laparoscopic evidence of endometriosis. Although all patients had preoperative bacteriological study, the authors do not discuss the findings, nor indicate if chlamydial infection was sought for by culture or immunofluorescence testing. It would seem wise to perform bacteriological cultures (including testing for Chlamydia trachomatosis)from the pelvic peritoneum and any identified focus of infection in all women with chronic pelvic pain who have laparoscopy performed.

Summary: review of 232 women who had diagnostic laparoscopy for chronic pelvic pain was undertaken. Diagnostic error in the preoperative pelvic examination in the series varied from 21% to 61%; of 135 patients who had normal pelvic examination findings preoperatively, 82 (61%) were found to have pelvic pathology on diagnostic laparoscopy, whereas 21 of 97 women (21.6%) who had abnormal pelvic examination, had normal findings on laparoscopy. The overall incidence of pelvic pathology in the series was found to be 69%. Our results suggest that there is poor correlation between findings of pelvic examination and the existence of pelvic disease. Laparoscopy has a definite place in the evaluation of patients with chronic pelvic pain and certainly justifies its increasing use in their management.
Complications and Bilaterality of Mature Ovarian Teratomas (Clinicopathological Evaluation of 286 Cases)
Authors: Ayhan Ali , Aksu Tarik , Develioglu Osman , Tuncer Z. Selcuk , Ayhan Ayse
Published: February 2008

EDITORIAL COMMENT: This large series of cystic teratomas of the ovary, treated in one institution, should provide reliable figures for bilaterality of the tumour (13.7%; 31 of 226), and the incidence of complications. However, the most interesting information provided is that histological examination of both ovaries in 182 of 242 women with a unilateral ovarian mass led to identification of a teratoma in the ‘normal ovary’ in only 2 cases (1.1%). This finding would seem to support the authors'conclusion that bisection of the opposite ovary to exclude a tumour is not indicated, since it could decrease the fertility of the patient. Most textbooks recommend that after treatment of a cystic teratoma (usually by conservative cystectomy in the premenopausal patient) the opposite ovary should be sectioned, although in the editor's experience this is seldom performed‐correctly so, according to the findings in this paper.

Summary: Bilaterality, complications and associated pathology were reevaluated in 286 cases of mature teratoma of the ovary, treated in the last 25 years. Torsion was the most frequent complication, occurring in 22 (7.7%) patients. Rupture, infection and secondary malignant change were uncommon complications, occurring in 11 (3.8%), 7 (2.4%) and 1 (0.3%) patients, respectively. Both ovaries were evaluated histologically in 226 patients, 31 (13.7%) of whom were shown to have bilateral tumours, including 2 patients with tumour in the normally appearing ovary, contralateral to the gross tumour.
Continuing Medical Education in Obstetrics and Gynaecology: The Challenge of the Nineties*
Authors: Hewson A. D.
Published: February 2008

Summary: The Obligatory Continuing Medical Education (CME) programme of the Royal Australian College of Obstetricians and Gynaecologists (RACOG) which is linked to time‐limited certification has now been in operation for over a decade. Its somewhat unique features have attracted widespread interest both nationally and internationally and may be seen as part of an international movement towards obligatory CME in Western Medicine. However, the programme should also be seen as just a part of the educational responses necessary as the medical profession moves into the 1990s, particularly for those of us in the discipline of Obstetrics and Gynaecology.

This paper reviews the increasing pressures from within the profession and from the community towards the obligatory CME concepts pioneered by the RACOG, but suggests that the challenges that have been faced in this area in the past although significant, are much less than those which will be faced in the 1990's, as the discipline addresses the challenges of educating obstetricians in the third phase of Continuing Medical Education ‐ education in managing the environment in which our discipline is practised.
Uterus Didelphys with Unilateral Imperforate Vagina and Ipsilateral Renal Agenesis
Authors: Altintas Aytekin , Aridogan Nihat , Atay Yilmaz , Koker Ismet
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication to remind readers that genital tract abnormalities are common; just about any combination of uterovaginal malformations, with or without retained menses, that can be imagined, has been reported, and many presentations are bizarre in both obstetric and gynaecological practice. We consider the authors are excessively self critical in condemning the laparotomy performed on this patient, although it is always wise to have the results of intravenous pyelography before laparotomy. The Editor also wishes to report a similar case he encountered with Dr. Peter Dobson at the Austin Hospital in 1979. The patient was a 14‐year‐old menstruating girl, who also presented with abdominal pain. At examination under anaesthesia a large mass was noted bulging into the vagina through the upper two‐thirds of the posterior wall; after discussion we aspirated the mass and when chocolate‐brown fluid blood was obtained the mass was incised and drained. There was no evidence of a second cervix or vaginal septum. Intravenous pyelography revealed a normal right‐sided and absent left kidney. At subsequent laparotomy a rudimentary left‐sided uterine horn was found and excised with more difficulty than anticipated. The patient had no further menstrual problems but had 2 subsequent episodes of urinary tract infection. She was next seen at the Mercy Maternity Hospital antenatal clinic in 1984; after a pregnancy complicated by hyperemesis, she had an outlet forceps delivery at 38 weeks' gestation, of a healthy but growth retarded male infant, birth‐weight 2,440 g, on September 18, 1984.
Recurrent Miscarriage ‐ Outcome After Supportive Care in Early Pregnancy
Authors: Liddell H. S. , Pattison N. S. , Zanderigo A.
Published: February 2008

Summary: One hundred and thirty three couples were investigated at a recurrent miscarriage clinic In their next pregnancy 42 women (Group 1) with unexplained recurrent miscarriage were managed with a programme of formal emotional support and close supervision at an early pregnancy clinic Two women were seen in 2 pregnancies (44 supervised pregnancies); 86% (38 of 44) of these pregnancies were successful. Four of the 6 miscarriages had an identifiable causal factor. Nine women (Group 2), also with unexplained recurrent miscarriage, acted as a control group. After initial investigation they were reassured and returned to the care of their family practitioner and did not receive formal supportive care in their subsequent pregnancy; 33% (3 of 9) of these pregnancies were successful (p = 0.005; Fishers Exact Test). Whilst acknowledging that there is a significant spontaneous cure rate in this condition, emotional support seems to be important in the prevention of unexplained recurrent miscarriage, giving results as good as any currently accepted therapy.
Amniocentesis in the Management of Preterm Premature Rupture of the Membranes
Authors: Dudley Jan , Malcolm Girvan , Ellwood David
Published: February 2008

EDITORIAL COMMENT: The clinical value of amniocentesis in the management of patients with premature rupture of the membranes is not established although this investigation is widely practised in the United States of America for this indication. This paper presents important information regarding the usefulness and limitations of amniocentesis, especially concerning the diagnosis and treatment of intrauterine infection. We support the authors' conclusion that a randomized controlled trial of amniocentesis is needed to assess its possible contribution to the management of patients with premature rupture of the membranes.

Summary: A retrospective analysis has been performed of perinatal outcome in 81 pregnancies in which preterm premature rupture of membranes (PPROM) was managed using amniocentesis to diagnose intrauterine infection and lung maturity. Ten patients (13%) had a positive Gram stain on microscopy whilst 29 (37%) had a positive culture. Forty‐one patients (58%) had a mature lecithin:sphingomyelin ratio. There was evidence of sepsis in 13 neonates (16%), with a further 16 (20%) being colonized. Both Gram stain and amniotic fluid culture were relatively poor predictors of neonatal sepsis. For Gram stain the sensitivity was low at only 15%. Although the sensitivity for culture was higher (69%), the specificity (71%) was too low to be clinically useful. It is recommended that a randomized controlled trial of amniocentesis in PPROM is needed to define the role of this diagnostic test.
Bromocriptine (Parlodel) for Suppression of Lactation
Authors: Spalding Gordon
Published: February 2008

EDITORIAL COMMENT: This pharmacology comment is published to inform readers of possible complications of bromocriptine therapy and to remind them that most women who elect not to breast‐feed do not require drug therapy to suppress lactation, especially if breast‐feeding has not been attempted. As noted in a previous comment (IA), suppression of lactation by oestrogen therapy was discontinued 24 years ago when it was found to be associated with thromboembolism. We then realized how few women were troubled by severe breast engorgement. Opinion has hardened against the routine use of drug therapy for inhibition of ‘physiological’ lactation
When Predictions Don't Predict
Authors: Speirs Andrew L. , Asch Ricardo H. , Siiber Sherman J.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper to remind readers that the rules of clinical common sense as well as the results of statistical calculations are needed to judge published results of clinical trials. Statistical rules for design of a trial should be followed, and advice of a statistician sought before rather than after a study begins. It seems self‐evident that if the raw data does not show a clinically meaningful difference in the results obtained, that statistical gymnastics cannot save the day; for example if a series of patients with prolonged pregnancy is large enough, then a difference in the perinatal mortality rate of0.2% between conservative treatment and induction of labour will be statistically highly significant, yet the difference may be too small to convince clinicians that one regimen is superior to the other.

Summary: One of the most widespread abuses of statistical methods involves the misinterpretation of statistical significance after the application of multiple comparisons. This paper highlights the problem by demonstrating ‘significance’ when clearly none exists.
Total Perineal Reconstruction After Major Obstetrical Injuries with Extensive Tissue Loss: A Report of 2 Cases
Authors: Lee S. H. , Cheah D. S. H. , Poopalarachagan S. , Sivanesaratnam V.
Published: February 2008

EDITORIAL COMMENT: This paper was accepted for publication to remind readers that trauma to the genital tract at forceps delivery can result in infection and gangrene, with awesome tissue loss following debridement. Except for abortional Clostridial infection and one case of uterine gangrene with wound dehiscence after Caesarean section, the Editor has seen no such cases in 34 years practice in our discipline. Nor has he encountered a case of ‘symbiotic gangrene of a gynaecological abdominal wound requiring debridement’, although there are many reports of such cases. The details of the corrective surgery used in these 2 patients will particularly interest those surgeons trained to tackle cases of rectovaginal fistula.

Summary: Major perineal injuries following obstetrical complications represent difficult problems of reconstruction. We describe 2 such patients with perineal injuries simulating infantile cloacas. Surgical repair using an abdominoperineal pullthrough procedure in 1 patient, and a Bricker loop type of repair in another resulted in successful restoration of function in both. The operative details and basis for the reconstruction are described.
Racial Variation in Serum Uric Acid Concentration in Pregnancy: a Comparison between European, New Zealand Maori and Polynesian Women
Authors: Barry Christopher L. , Royle Gordon A. , Lake Yvonne
Published: February 2008

EDITORIAL COMMENT: This paper confirms the findings of the study reported by Carter and Child (Aust NZ J Obstet Gynaecol 1989; 29: 213–214) that serum uric acid values increase during pregnancy. It provides extra data that the serum uric acid values are higher in New Zealand Maori and Pacific Islanders than in New Zealand European women. The authors did not tackle RA Fay's hypothesis (Aust NZ J Obstet Gynaecol 1990; 30:141–142) that the rise in serum uric acid in patients with preeclampsia is secondary to placental damage rather than alteration in renal function. None of the patients in this New Zealand study had hypertension or renal disease. The next step is to tell us when women with chronic renal disease, with or without superadded preeclampsia, and who have uric acid values well above the 0.45 mmol/l upper limit of normal, require delivery when tests of fetal well‐being (cardiotocography, blood flow studies) remain within normal limits. When do sustained high uric acid values signal that irreversible renal failure is imminent?

Summary A prospective study was undertaken to measure serum uric acid levels in normal pregnant women of different races, to ascertain if there was any significant interracial variation. A total of 48 women were studied of which 13 were European, 11 New Zealand Maori, 22 Pacific Islanders and 2 Indian. In the second trimester, European, Maori and Cook Island women had similar uric acid levels and other Polynesian groups showed significantly higher levels. In the third trimester, both Maori and Cook Island women showed a marked rise so that their levels came to equal those of other Polynesian groups, all 3 having significantly higher levels than European women. The importance of these observations relates to the use of uric acid levels in the management of patients with gestational proteinuric hypertension. It is possible that in these cases unusually high results may alarm the clinician into hasty intervention.
A Comparison of Syntocinon Infusion with Prostaglandin Vaginal Pessaries When Spontaneous Rupture of the Membranes Occurs Without Labour After 34 Weeks Gestation
Authors: Rymer Janice , Parker Ashton
Published: February 2008

SummaryIn a prospective randomized trial of 106 patients who had spontaneously ruptured their membranes ≥ 4 hours in the absence of labour, vaginal prostaglandin E2 pessaries and intravenous Syntocinon were compared. There was no significant difference in the treatment to delivery times between the 2 groups. The number of operative deliveries in each group were comparable. No untoward side‐effects were noted. The use of vaginal prostaglandin E2 tablets appears to be a safe alternative to Syntocinon for induction of labour when spontaneous rupture of membranes has occurred in the absence of uterine contractions.
Prospective Study of the Quality of Survival of Infants with Critical Fetal Reserve Detected by Antenatal Cardiotocography
Authors: Drew J. H. , Kelly E. , Chew F. T. K. , Ratten V. , Beischer N. A.
Published: February 2008

Summary From 1981 to 1986 antenatal cardiotocographic monitoring was performed on 9,992 high‐risk pregnancies selected from a total obstetrical population of 31,518 patients (31.7%). A critical fetal reserve pattern was detected in 89 patients (0.9%) whose pregnancies resulted in 68 surviving infants, 19 perinatal deaths and 2 sudden infant deaths. Since 47.4% of the infants who died in the perinatal period did so because of a related congenital malformation, such a defect should be excluded in the fetus with critical fetal reserve, by ultrasonography, before delivery (there is usually insufficient time for fetal karyotyping). Sixty‐three (92.6%) of the surviving children were assessed at our Growth and Developmental Clinic and disabilities were detected in 16 (25.4%); however, the disability was major in only 5, including 2 children with Down syndrome. The quality of survival of infants born from pregnancies complicated by critical fetal reserve was satisfactory as 60 of 63 children (95.2%) had neither a major disability related to intrauterine hypoxia identified by the cardiotocographic pattern, or had one likely to significantly interfere with their quality of life. Our results suggest that pregnancies can be continued until the cardiotocographic pattern becomes critical in order to gain fetal maturity, without compromise to the fetal brain.
Endocervical Chlamydia Trachomatis Infection in Pregnancy: Direct Test and Clinico‐Sociodemographic Survey of Pregnant Patients at the Port Moresby General Hospital Antenatal Clinic to Determine Prevalence and Risk Markers
Authors: Klufio Cecil A. , Amoa Apeawusu B. , Delamare Olivier , Kariwiga Grace
Published: February 2008

EDITORIAL COMMENT: Chlamydia trachomatis causes symptomatic and asymptomatic infections which in pregnant women have been linked to chorioamnionitis, premature rupture of the membranes and premature labour (A). Chlamydial infection is easily treated (by erythromycin) but recognition requires screening. This study has shown that this means screening the entire population, since clinical methods are unable to identify a high risk group. Screening for C. trachomatis is reported to be cost‐effective when the prevalence of the infection exceeds 6% (B), as it did in the present study, and in studies reported in this journal from Saudi Arabia (1987; 27:126 ‐ antenatal incidence 12.6%) and Fiji (1987; 27: 213 ‐ antenatal incidence 38–50%). The standard antenatal investigations recommended in Australia do not include testing for C trachomatis. Readers are referred to the recently available compendium produced by the Royal Australian College of Obstetricians and Gynaecologists which includes a section on routine screening in pregnancy and lists those investigations generally accepted as necessary and also those frequently done in certain groups of patients.

A. The Chlamydia Challenge. Am J Obstet Gynecol 1991; 164: 6: 2: 1776–1796.

B. Nettleman MD, Bell TA. Cost‐effectiveness of prenatal testing for Chlamydial trachomatis. Am J Obstet Gynecol 1991; 164: 5: 1: 1289–1294.

Summary The prevalence of endocervical C. trachomatis infection in 181 consecutive antenatal clinic patients at the first attendance and who had not received antibiotic therapy in the previous 4 weeks, was 17.7%. The direct fluorescent antibody test was used for diagnosis. There was no significant clinical or sociodemographic factor which distinguished patients who tested positive from those who tested negative.
Bilateral Ureteric Obstruction Due to Recurrent Endometriosis Associated with Hormone Replacement Therapy
Authors: Lam A. M. , French M. , Charnock F. M.
Published: February 2008

EDITORIAL COMMENT: We accepted this case report for publication since it addresses the important problem of whether hormone replacement therapy should be withheld after bilateral oophorectomy (usually associated with hysterectomy) in the premenopausal woman who had extensive endometriosis. Our endocrinologist reviewer withholds oestrogen for 6 months in such women and prescribes medroxyprogesterone acetate 10 mg BD continuously if they have flushes or associated symptoms; he is especially unwilling to prescribe oestrogen if removal of endometriotic deposits is deemed by the surgeon to be incomplete. Our editorial panel consensus is that it is cruel to withhold oral hormone replacement therapy from these women but that the regimen should include a progestogen as well as oestrogen as in women who still have a uterus. We agree with the authors that we need data telling us how often hormone replacement therapy is associated with return of symptoms due to endometriotic deposits ‐ in the editor's experience the problem is uncommon. Our Senior Gynaecologist Chairman states that in the few patients he has managed in whom endometriosis has been reactivated by hormone replacement therapy after pelvic clearance, the problem has been controlled by low‐dose X‐ray therapy ‐ in his experience this has not resulted in ureteric obstruction although he has seen 2 women present with unilateral ureteric obstruction from previously untreated endometriosis involving the lateral pelvic wall.
Temperature Drop in Normal Term Newborn Infants Born at the University Hospital, Kuala Lumpur
Authors: Raman S. , Shahla A.
Published: February 2008

EDITORIAL COMMENT: This paper was accepted for publication to remind readers that newborn infants, especially if premature, should promptly be dried, wrapped and placed in a cot. It is recommended that at about 1 hour of age, if the temperature is normal (≥ 36.5 oC per axilla, 36.8oC per rectum) and stable, the baby is undressed for measurement, estimation of birth‐weight and the routine examination. Our paediatrician reviewer commented that many obstetricians may have forgotten the importance of prevention of cooling of the newborn infant, the care of whom is usually left to members of the nursing staff. We all agree that bonding between mother and baby is important but should not delay the baby being dried and covered promptly after birth.

Summary: A prospective study of temperature drop in 141 normal term newborn infants delivered vaginally at the labour ward, University Hospital, Kuala Lumpur were studied. The effect of various manoeuvres on the temperature drop were also studied. They were randomized into 3 study groups, 63 cases where the babies were wiped with dry cloth alone, 37 cases where the babies were put into a plastic bag immediately after birth and lastly 41 cases where the babies were wiped with dry cloth and then inserted into a plastic bag. There was significant temperature drop in all the 3 groups maximum in the first 15 minutes and the fall continued for 1 hour after delivery (p< 0.001). This shows that in an airconditioned labour ward in a tropical country the temperature fall in newborn infants can be significant. This study also showed that plastic is a poor insulator against significant temperature drop.
A Case for Revising the ‘Weight Gain During Pregnancy’ Guidelines for Australian Women
Authors: Goodman Meta M. , Clarke John A. , Jehne Claus
Published: February 2008

Summary: In 1989, an average weight gain during pregnancy of 14 kg was determined for a sample of 1,253 public patients at the Royal Women's Hospital, Brisbane. This greatly exceeded the weight gain of 10 to 12 kg which was recommended by the hospital and which is based on United States of America (US) data. The finding prompted a comparison of characteristics of Brisbane mothers (weight gain during pregnancy, age, prepregnant weight, height, birth‐weight of infant, etc) with the characteristics of mothers in two large US studies. Significant differences were found to exist with Brisbane women being taller, heavier in body mass, more overweight and gaining less weight during pregnancy than the US women. Unexpectedly, the birth‐weight of infants was neither more nor less than reported for the American studies. Further studies to gain more information about Australian women during their pregnancies should be undertaken.
Invasive Squamous Cell Carcinoma of the Vulva: Behaviour and Results in the Light of Changing Management Regimens
Authors: Lingard D. , Free K. , Wright R. G. , Battistutta D.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because detailed analysis of results in 90 cases of invasive carcinoma of the vulva treated by one team of surgeons in a 10‐year period provides important information for those who must decide how to treat women with these lesions. The legends to Figure IA and B present an anecdotal case illustrating that even aged women with invasive cancer merit consideration of radical surgery.

Summary: Ninety‐nine patients with carcinoma of the vulva were referred to the Gynaecologic Oncology Unit, Royal Brisbane Hospital, over 10 years. Ninety of these patients had a squamous cell carcinoma (SCC). They were assessed by the 1969 FIGO clinical staging. Each stage was related to nodal involvement, size, depth, histological grade, lymphvascular space involvement, perineural permeation and multifocal disease site. The operability rate was 85%. Treatment was individualized in line with recent philosophies for more conservative surgery where appropriate. Mortality was 2.6%. Five‐year survival of surgically treated patients was 60.3%; node negative patients 100%, and node positive patients 25.2%. After adjustment for stage and size, the only other independent statistically significant feature was perineural penetration. Local recurrence was more likely with increased stage and size, unclear margins and multifocal involvement. It is important to note that medically unfit patients who had vulvectomy alone and who later developed positive nodes had 100% mortality. This group of patients significantly decreases survival rates, confirming the importance of carrying out inguinofemoral lymphadenectomy at the time of initial surgery. Morbidity was decreased by conservative surgery. Lymphoedema remains the most common chronic complication. No significant difference was shown in local recurrence between different types of surgery, wide excision, hemivulvectomy, simple vulvectomy or radical vulvectomy (22%), confirming the safety of the more conservative approach of recent years.
Endometriosis and Race
Authors: Arumugam Kulenthran , Templeton A. A.
Published: February 2008

Summary: The pelvic findings of 202 infertile women undergoing diagnostic laparoscopy in Kuala Lumpur, Malaysia were compared to that of 464 infertile women undergoing diagnostic laparoscopy in Aberdeen, United Kingdom. Endometriosis was significantly more common in the women from Kuala Lumpur (51% against 22%, p < 0.001). There was however no significant difference seen in the severity of the disease (AFS Classification, 1985). These findings confirm our clinical impression that endometriosis is more common in Asian women when compared to Caucasian women.
The Timing of Delivery in Diabetic Pregnancy: A 10‐Year Review
Authors: Rasmussen M. J. , Firth R. , Foley M. , Stronge J. M.
Published: February 2008

Summary: The approach of term in the pregnancy of a diabetic woman is a time of anxiety for patient and physician alike. The impact of a conservative approach to the timing of delivery is outlined in this review of the clinical course and outcome of 276 pregnancies of diabetic women, delivered at the National Maternity Hospital, Dublin between 1981 and 1990. The mean gestation at delivery was 39 weeks, 229 patients (83%) delivered at or beyond 38 weeks and 112 patients (41%) delivered at or beyond 40 weeks. The overall induction of labour rate was 27% and the elective Caesarean section rate was 19%. Sixty seven percent of patients achieved a normal delivery, the forceps rate was 5%, and 28% of patients were delivered by Caesarean section. There were 16 perinatal deaths in the series, with 7 due to lethal malformations. There were 5 deaths of normally formed infants occurring at or beyond 38 weeks' gestation. All of these 5 deaths had been preceded by clinically apparent polyhydramnios or macrosomia and recognized poor control. This study stresses the value of strict diabetic control in the management of diabetic pregnancy and highlights the significance of polyhydramnios and macrosomia as indicators of risk approaching term in diabetic pregnancy.
Neonatal Herpes Simplex: Royal Women's Hospital 10‐year Experience with Management Guidelines for Herpes in Pregnancy
Authors: Garland Suzanne M.
Published: February 2008

Summary: In the 10‐year period 1982–1991 inclusive, 6 cases of neonatal herpes simplex were diagnosed at the Royal Women's Hospital, Melbourne (1 disseminated, 1 pneumonitis, 4 cutaneous [1 with central nervous system involvement]), resulting in an incidence of 1 in 11,000 livebirths for this population. Three cases were due to HSV 1 and 3 to HSV 2. In no case did the mother have a recent or past history of overt genital herpes infection. Two cases were acquired in utero, an uncommonly recognized form of infection. A favourable long‐term outcome occurred in 2 of 4 cases in which diagnosis was prompt and antiviral therapy was instituted rapidly.

Routine antenatal screening in the last trimester of pregnant women with a history of genital herpes before pregnancy is not advised, because the results have been shown to be unreliable in predicting viral shedding and hence the infants' risk of exposure to virus at delivery. A protocol for management of herpes in pregnancy is included.
Family Planning Practices Among Lebanese, Turkish and Vietnamese Women in Sydney
Authors: Yusu Farhat , Siedlecky Stefania , Byrnes Monica
Published: February 2008

Summary: This paper is based on some of the data collected in a fertility and family planning survey conducted in 1988 among a probability sample of 980 married immigrant women in Sydney. The sample consisted of 507 Lebanese, 250 Turkish and 223 Vietnamese women. This study has revealed differences within and between the 3 migrant groups and the general population. Fertility among the 3 groups, but particularly among the Lebanese, was relatively high. While most women understood about birth control, there was a heavy reliance on traditional methods. Incidence of sterilization and hysterectomy was low compared to the general population. Use of abortions as a method of birth control was quite common among the Turkish women. Most women relied on their doctors for contraceptive advice and there was little knowledge and even less use of family planning and women's health centres. The study revealed an unmet need for culturally sensitive family planning information and services to these women.
Measurement of Blood Pressure During Pregnancy: Evaluation of the ‘TriCUFF’
Authors: Brown Mark A. , Buddie Megan L. , Whitworth Judith A.
Published: February 2008

Summary: Previous surveys have revealed that a major source of error in measuring blood pressure in pregnant women is failure to use a large cuff when necessary. We have tested the hypothesis that this problem could be overcome by using a single cuff containing automatically selected inflation bladders of appropriate size, the TriCUFFr̀.

We compared readings obtained with the TriCUFFr̀ with those obtained using standard adult or large (obese) cuffs in 51 pregnant women. Thirty nine had normal upper arm circumferences (< 34 cm) and 12 increased arm circumferences (≥34 cm). The TriCUFFr̀ overestimated standard cuff systolic and diastolic (phase IV) readings by 2 (0–4) mmHg (mean, 95% confidence limits)(< 0.05). There was no difference between readings for women with large arms. Agreement between readings by both methods was acceptable for clinical practice in most cases.

Use of the TriCUFFr̀ could significantly improve the accuracy of blood pressure recording in pregnant women.
A Case of Spontaneous Resolution of Nonimmune Hydrops Fetalis
Authors: Flynn Michael , Goh Judith , Stone Murray
Published: February 2008

Summary: Spontaneous intrauterine resolution of severe nonimmune hydrops fetalis has been rarely reported in the literature. A case of severe fetal hemolytic anaemia with hydrops fetalis but subsequent spontaneous resolution is reported along with a discussion of possible aetiologies.
Catamenial Epilepsy
Authors: Chia Kee Vui , Scarffe Robert John
Published: February 2008

EDITORIAL COMMENTS: We accepted this case so readers can judge when menstruation‐related epilepsy may warrant such a radical remedy as bilateral oophorectomy. We have published the report of a case of severe menstrual migraine which also responded to bilateral oophorectomy and hysterectomy, and in which subsequent oestrogen replacement therapy likewise did not cause a relapse (A).

A. Holdaway IM, Parr CE, France J. Treatment of a patient with severe menstrual migraine using the depot LHRH analogue Zoladex. Aust NZ J Obstet Gynaecol 1991; 31: 164–165.
Education for the Management of Obstetric Conditions in Rural General Practice
Authors: Craig Mark , Nichols Anna , Price David
Published: February 2008

EDITORIAL COMMENT": The Editorial Subcommittee of this journal agreed to publish this important curriculum statement for advanced obstetric training for rural general practitioners partly because we thought that general practitioner obstetricians who comprise more than half of our 5,000 subscribers will be interested to read this document carefully if for no other reason than to check their own clinical abilities in the various sections provided.
Rural Obstetrics in NSW
Authors: Woollard Les A. , Hays Richard B.
Published: February 2008

Summary: Rural general practitioners are responsible for providing obstetric services to the majority of women living in rural communities. This paper reports a comparison of 5,950 deliveries conducted by rural GPs in NSW during 1990–1991 with all 88,275 deliveries during the same period in NSW. No evidence that obstetric care in accredited rural GP obstetric units is of less than acceptable standards could be found. There is scope to increase the use of rural obstetric units for the training of future rural GP obstetricians.
Choroid Plexus Cysts in the Fetal Brain
Authors: Burrows Anna , Ramsden G. H. , Frazer M. I.
Published: February 2008

Summary: Choroid plexus cysts may be detected in the fetal choroid plexus on routine second trimester ultrasound scanning. The presence of these cysts is associated with trisomy 18 (Edward syndrome) in 3.47% of cases and with trisomy 21 (Down syndrome) in 0.46% of cases. The cysts themselves almost always disappear by 23 weeks and are thought to be a normal developmental variant. The world literature experience would indicate that the size of the choroid plexus cyst and the presence of bilateral cysts has no bearing on the magnitude of risk of chromosomal abnormality; 76% of babies with trisomy 18 also have other dysmorphic features which may be detectable by ultrasound. It is strongly advised that genetic counselling be undertaken and amniocentesis be considered when choroid plexus cysts are identified in the fetus.
Should Assessment of Amniotic Fluid Volume Form an Integral Part of Antenatal Fetal Surveillance of High Risk Pregnancy?
Authors: Anandakumar C. , Biswas A. , Arulkumaran S. , Wong Y. C. , Malarvishy G. , Ratnam S. S.
Published: February 2008

Summary: This study was conducted to evaluate the role of the Amniotic Fluid Index (AFI), used along with nonstress cardiotocography (NST) and fetal acoustic stimulation test (FAST), when required, in prediction of adverse pregnancy outcome. Over a 3‐year period 565 pregnant women had antepartum fetal surveillance due to various high risk pregnancy factors and delivered within 7 days of the test. Antepartum fetal surveillance included nonstress cardiotocography together with estimation of AFI. Need for induction of labour, presence of meconium at rupture of membranes, Caesarean section for fetal distress, Apgar score at 5 minutes, need for neonatal endotracheal intubation, admission to neonatal special care unit and perinatal death were the main outcome measures.

Nonreactive nonstress tests and Caesarean sections for fetal distress were more common and neonatal outcome was significantly poorer in patients with AFI < 5 cm than in those with higher AFI values. Of the 4 perinatal deaths in the group with AFI < 5 cm, 3 had a reactive NST within 7 days of fetal death.

It is concluded that pregnancy outcome is often poor in the presence of very low AFI and in these cases a reactive NST loses its usual reassuring value. It is suggested that AFI estimation should be included as an integral part of antepartum fetal surveillance of high risk pregnancies.
Urinary Calcium/Creatinine Ratio in the Prediction of Preeclampsia
Authors: Phuapradit Winit , Manusook Sakol , Lolekha Porntip
Published: February 2008

Summary: The prediction of preeclampsia by the urinary calcium/creatinine ratio during the early third trimester was assessed in 190 primigravidas, aged less than 35 years and between 28 and 32 weeks' gestation without pregnancy complications. Preeclampsia developed in 6.8% of the patients. The mean maternal age, gestational age at entry into the study and at delivery, and the average mean arterial blood pressure at entry into the study did not differ significantly between the 13 patients with subsequent preeclampsia and the 177 normotensive patients. The patients with preeclampsia did not have significantly less excretion of calcium than the normotensives.
Laparoscopic Hysterectomy ‐ a Technique
Authors: Jones Robert A.
Published: February 2008

EDITORIAL COMMENT": We accepted this paper for publication because it considers many of the minutiae of how to perform a laparoscopic hysterectomy. The editorial board considers it is appropriate to publish this information since there is an apparent revolution in consideration of this new method of rendering vaginal hysterectomy safe in the patient who otherwise would require an abdominal hysterectomy. Readers are also directed to the discussion in this paper which considers the philosophy of the operation and the possible changes it may inspire regarding gynaecological surgery in general.

The laparoscope and hysteroscope seem engaged in a new competition for the best way to manage menorrhagia and abdominal pain in the patient who previously was treated by abdominal hysterectomy. This Journal has published a number of papers in the past 18 months that present an overview of both of these 2 new techniques.

Summary: A technique for the performance of laparoscopic hysterectomy (laparoscopic‐assisted vaginal hysterectomy) is described. There are particular advantages to the patient in using this technique. There are also social and financial advantages. It is envisaged that this technique will become part of the routine surgical armamentarium of the gynaecological surgeon, whose personality disposes him towards this type of surgery. A prediction is made as to the future use of this surgical technique.
Laparoscopic Removal of Endometriosis in the Pouch of Douglas
Authors: Wood Carl , Maher Peter , Hill David
Published: February 2008

EDITORIAL COMMENT": This paper provides important data on dealing, via the laparoscope, with endometriosis involving the uterosacral ligaments and peritoneum of the pouch of Douglas in patients with pelvic pain and/or infertility. None of the 26 women in this study had had a hysterectomy, although this procedure usually relieves pain associated with endometriosis involving the pouch of Douglas and uterosacral ligaments. Perhaps we require more data regarding symptoms from residual endometriosis in patients having hysterectomy and uterosacral endometriosis; relevant considerations include whether bilateral oophorectomy is also performed or whether the patient receives postoperative hormone replacement therapy in this circumstance. It seems to the editor that the uterosacral ligaments and pouch of Douglas are seldom removed when hysterectomy is performed in the type of cases reported in this paper; one achieves mobility of the uterus before its removal by cutting the uterosacral ligaments, not removing them; in these cases we are concerned about the keeping away from the ureters and rectum rather than excising scarring due to endometriosis ‐ yet the authors note that ‘biopsy of scarred lesions often shows active endometriosis!

Summary: Twenty‐six patients with endometriosis in the pouch of Douglas were treated by laparoscopic excisional surgery; previous medical and surgical therapy had failed in 24 of them. Endometriosis in the pouch of Douglas occurred infrequently in association with bladder or ovarian endometriosis. Coital and rectal pain were markedly reduced or cured 6 months after surgery in all except 2 patients. Laparoscopic surgical excision of endometriosis is indicated when drug or other surgical treatments fail and may avoid the need for hysterectomy in some patients.
Bilateral Tubal Pregnancies After Pronuclear Stage Embryo Tubal Transfer to 1 Tube
Authors: Chan Yuen‐Fai , Ho Pak‐Chung
Published: February 2008

EDITORIAL COMMENT": We accepted this case report for publication not only because of the intriguing and potentially dangerous outcome of bilateral tubal ectopic pregnancy after implantation of pronuclear stage embryos into 1 tube, but also because of the insight provided regarding possible routes of transport of the early embryo within the reproductive tract. In addition, the members of the editorial subcommittee of this journal wish to make it clear to readers that they do not recommend expectant management of women with a clinical diagnosis of ectopic pregnancy.
A Pregnancy After Planned Partial Endometrial Resection
Authors: Wood Carl , Rogers Peter
Published: February 2008

Summary: A 28‐week pregnancy is reported after a planned partial endometrial resection in an infertile patient. The fetus died 32 hours after birth because of prematurity consequent to premature membrane rupture and premature labour. A partial placenta accreta was dealt with at Caesarean section.

Complete endometrial resection may not be required to cure menorrhagia. It may be possible to control menorrhagia by targeting specific areas of endometrium associated with menorrhagia. Fertility may be retained by leaving the fundal and peritubal endometrium.

The increased risks of pregnancy complications following endometrial resection suggest that more information is required to design endometrial resection so as to both cure menorrhagia and to sustain successful pregnancy.
Primary Liver Carcinoma Complicating Pregnancy
Authors: To W. K. , Ghosh A.
Published: February 2008

EDITORIAL COMMENT": We accepted this case report because the Australian population now has many women who are hepatitis B surface antigen positive. This case will remind readers that primary carcinoma of the liver can occur in such women and that effective management is now available by spectacular major surgery. Ideally all women (and men) who are hepatitis B surface antigen positive should have regular (every 1–2 years) serum alpha fetoprotein estimations to facilitate early diagnosis of primary hepatocellular carcinoma.

Summary: Primary hepatic carcinoma complicating pregnancy has been sporadically reported in the literature. Its association with grossly raised serum alphafetoprotein values is of particular interest to obstetricians who perform routine maternal alphafetoprotein screening in the second trimester. A case with favourable maternal and fetal outcome is presented.
Primary Endometrial Squamous Cell Carcinoma with Long‐term Survival
Authors: Dalrymple J. C. , Russell P.
Published: February 2008

Summary: Primary endometrial squamous cell carcinoma is a rare variant of uterine epithelial malignancy. A review of records over a 10‐year period at a major referral centre for gynaecological malignancy identified 4 patients with this disease. They were treated primarily by surgery, with adjuvant radiotherapy or chemotherapy in 3 cases. In comparison to previously reported cases the length of survival for these patients was long.
Clinical Estimate of Birth‐weight in Labour: Factors Influencing Its Accuracy
Authors: Chauhan Suneet P. , Meydrech Edward F. , Washburne Joseph F. , Hudson Jeffrey L. , Martin Rick W. , Morrison John C.
Published: February 2008

Summary: Clinical assessments of birth‐weight were made among 88 parturients at term, to determine what maternal and neonatal factors influence the accuracy of predicting neonatal weight. An estimate within ±10% of actual weight was considered accurate, while a prediction off by more than 10% was classified as inaccurate.

Seventy‐one per cent (63 of 88) of the estimates were considered accurate and 28% (25 of 88) inaccurate. Among these 2 groups of patients, univariate analysis did not identify maternal age, gravidity, parity, gestational age, maternal height, prepregnancy weight and maternal body mass index, maternal weight and maternal body mass index at the time of delivery, change in body mass index during pregnancy, intrapartum amniotic fluid index, newborn's weight, length, and ponderal index as being significant correlates of an accurate clinical estimate of the birth‐weight. Over 2 years, as the provider gained experience in predicting the neonatal weight, the accuracy of the clinical estimate of birth‐weight did not improve.