bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in Lymphocyte Status and Responsiveness in Pregnancy Detected by a Fluorescent Cell Probe
Authors: Rolland Jennifer M. , Barnett Mark A. , Lampard Amanda F. , Nairn Richard C. , Pihl Eric , Walters William A. W. , Wood Carl , Cauchi Maurice N.
Published: February 2008

Summary: Lymphocyte reactivity assessed by a fluorescent lipophilic probe test of responsiveness to concanavalin A (con A) was shown to differ from normal in early pregnancy. The difference was most marked in multiparas. Abnormal reactivity was detected in the earliest pregnancy examined (5 weeks' gestation) and up to about the 20th week; after 20 weeks, reactivity was normal in all of the multiparas and most of the nulliparae studied. However, in pregnancy induced hypertension (PIH), a disorder of late pregnancy, the same responsiveness as in early pregnancy was found. When unstimulated lymphocytes were examined, abnormal reactivity associated with increased fluorescence was observed in early pregnancy and in PIH, compared with normal late pregnancy, reflecting alteration in lymphocyte membrane phospholipids. It is postulated that pregnancy is associated with sequential change in immunity, disturbance of which may result in immunologically‐determined obstetric morbidity.
Fetal Movements in Hypertensive Pregnancies
Authors: Simon A. , Ohel G. , Mor‐Yosef Sh. , Brjejinski A. , Sadovsky E.
Published: February 2008

Summary: The maternally perceived fetal movements counts of 273 hypertensive patients were compared to normal controls and their degree of fetal activity was related to perinatal outcome. Pregnancy induced hypertension was associated with fetal activity which was significantly lower than controls at the beginning of the third trimester and significantly higher at term. In cases of chronic hypertension fetal activity was similar to controls at all gestational ages. Of all the hypertensive patients, 8 had cessation or marked reduction of fetal movements to less than 4 in 12 hours, and all had poor fetal outcome. The remaining 265 hypertensive patients had a 92% incidence of good fetal outcome. Markedly reduced fetal movements in hypertensive patients are highly suggestive of fetal distress and following verification by additional tests the appropriate clinical measures should be undertaken.
Rapid Urinary LH assay for Prediction of Ovulation
Authors: Ho P. C. , Kwan M. , Chan S. Y. W. , Chan P. H. , Tang L. C. H.
Published: February 2008

Summary: The results of the cervical mucus score (CMS), basal body temperature (BBT) and a rapid urine luteinizing hormone (LH) assay by haemagglutination immunoassay were compared with plasma LH radioimmunoassay in 28 ovulatory cycles. There was good correlation of the CMS peak with the plasma LH peak while the urine LH peak usually occurred one day later. The first day when the CMS was ≥ 8 occurred within ± 1 day of the plasma LH peak in 89.3% of cycles. The first day when the urine LH was ≥ 100 iu/1 occurred within ± 1 day of the plasma LH peak in all the cycles. BBT nadir could be identified in only 82% of cycles and it coincided with the plasma LH peak in only 28.6% of cases. These findings suggest that both the CMS and the rapid urine LH assay are acceptable methods for determining the time of ovulation while the BBT is not useful.
Outcome for the Very Low Birth‐weight (500–1,499g) Singleton Breech: Benefit of Caesarean Section
Authors: Doyle Lex W. , Rickards Anne L. , Ford Geoffrey W. , Pepperell Roger J. , Kitchen William
Published: February 2008

Summary: Between January 1, 1977 and March 31, 1982, 84 of 131 (64.1%) consecutive liveborn very low birth‐weight (VLBW) singletons delivered after breech presentation were discharged home alive. Of babies delivered by Caesarean section 40 of 47 (85.1%) survived, versus 44 of 84 (52.4%) delivered vaginally (X2=12.6, p < 0.0005). When differences in birthweight and antenatal steroid therapy were adjusted by multiple regression analysis, after excluding a lethally malformed baby who was diagnosed antenatally and babies who were not treated aggressively because they were thought to be too immature (n = 19), those delivered by Caesarean section were still more likely to survive (p = 0.038). In survivors completely assessed at 2 years of corrected age, there was a statistically significant association between Caesarean section and reduced handicap (p = 0.019). For the VLBW singleton breech, there is good evidence that delivery by Caesarean section is beneficial.
Sinusoidal Antenatal Fetal Heart Rate Patterns
Authors: Gumley S. J. , Humphrey M. D.
Published: February 2008

Summary: The sinusoidal fetal heart rate pattern is significantly associated with severe fetal anaemia when seen in the antenatal period. Strict adherence to definition is important, as pseudosinusoidal patterns do not have the same grave prognostic significance. If this fetal heart rate pattern is seen antenatally it is our contention that the baby should be delivered urgently by Caesarean section, unless the fetal anaemia can be treated in utero.
Angiosarcoma of Breast Metastatic to the Ovary and Placenta
Authors: Sedgely Michael G. , Östör Andrew G. , Fortune Denys W.
Published: February 2008

Summary: Angiosarcoma of the breast with spread to the ovary and placenta during a pregnancy 6 years after initial diagnosis is described. The ovarian lesion was discovered during Caesarean section. It is postulated that the pregnancy altered the biological behaviour of the tumor.
Intravenous Labetalol and Intravenous Diazoxide in Severe Hypertension Complicating Pregnancy
Authors: Michael C. A.
Published: February 2008

Summary: The results of a prospective trial to evaluate the use of diazoxide and labetalol given intravenously in the management of severe hypertensive disease in pregnancy are presented.

Both drugs had an efficient hypotensive action. The reduction in blood pressure in the labetalol group was better controlled and this may be a factor influencing perinatal outcome.

Because of the freedom of maternal and fetal side‐effects, labetalol given by intravenous infusion is a more appropriate drug for use in the management of hypertensive crises occurring in pregnancy and labour.
Timing of Ovulation by Determination of the Urinary Luteinizing Hormone Surge with an Enzyme‐linked Monoclonal Antibody Dipstick (OvuStick)
Authors: Baker H. W. G. , Bangah M. L. , Burger H. G. , Kovacs G. T. , Summerbell D. , Warnes G. M.
Published: February 2008

Summary: An enzyme‐linked double monoclonal antibody dipstick for measuring luteinizing hormone in urine was tested for timing ovulation in thrice daily urine samples collected for several days around mid‐cycle in 24 women undergoing artificial insemination. The assay produced information comparable to single daily serum LH measurements. The dipsticks could be used by untrained people to test their own urine as an aid to the detection of ovulation for the timing of artificial insemination or of sexual intercourse to promote or avoid conception.
Catamenial Pneumothorax
Authors: Balasingham Saraswathy , Arulkumaran S. , Nadarajah K. , Jayaratnam F. J.
Published: February 2008

Summary: Catamenial or menses related pneumothorax is a rare clinical manifestation of pulmonary endometriosis. We document a case where the clinical history was the key to diagnosis, and evidence of endometriosis elsewhere was scanty. Prolonged medical therapy was not preferred in our patient in view of her age and parity. Surgical pleural ablation was carried out to prevent further episodes of life threatening pneumothoraces. The investigations that may be useful in such a patient are discussed and the clinical profile of our patient is compared with those of the few cases reported in the literature.
Unexplained Intrauterine Death near Term
Authors: Beischer N. A. , de Garis C. N.
Published: February 2008

Summary: In Victoria, in 1984, intrauterine hypoxia of unknown aetiology accounted for 59 of the 252 perinatal deaths of infants with a birth‐weight of 2,500 g or more (1). These unexplained deaths occur in approximately 1 in 1,000 pregnancies near term, and in more than 90% of cases the infants are neither small nor large for dates (tables 1 and 2). In 27 of the 59 cases, a fetoplacental function test (oestriol assay, cardiotocography) had been performed, and in 6 glucose tolerance had been tested either before (5) or after (1) the fetal death occurred. We endorse recent recommendations that all pregnant women should be screened for gestational diabetes at approximately 24–28 weeks' gestation (2) as a possible means of reduction in the number of intrauterine deaths of mature infants. Consideration of these cases indicates that induction of labour should not be deferred after 37–38 weeks' gestation in high risk pregnancies, merely because tests of fetoplacental function are normal — i.e. laboratory tests should not outweigh clinical judgment especially in high risk pregnancies! It is considered that the cost of identification of these infants at risk of ‘unexplained death, if possible, is likely to be justified by the fact that they are mature and apparently normal.
The Realities of Screening for the Small for Dates Fetus Using Ultrasound Measurement
Authors: Duff G. B.
Published: February 2008

EDITORIAL COMMENT: This study stresses that only a proportion of small for dates fetuses suffer intrauterine starvation, and questions the value of routine screening with ultrasound for their indentification. We agree that not all small for dates fetuses are at risk, and on the other hand, many at risk of intrauterine hypoxia and death are not by definition growth retarded. To recognize and treat the fetus with intrauterine starvation, tests for fetoplacental function (oestriol assay, cardiotocography) are necessary and are complementary to, not competitive with, ultrasonography.

Summary: Screening for the small for dates fetus using ultrasound measurement of the fetal abdominal circumference resulted in a significantly increased rate of diagnosis compared with clinical examination. However, when the perinatal mortality and morbidity amongst infants with a birthweight less than the 10th percentile for gestation in the screened group was compared with that of similar infants in a nonscreened groups who attended the same antenatal clinic but who either booked or were referred late, there was no significant difference.
Atypical Condylomas of the Cervix Uteri in Singapore Women: A Histopathological and Immunohistochemical Stud
Authors: Sutherland I. H. , Arulkumaran S. , Kitchener H. C.
Published: February 2008

Summary: Subclinical flat cervical warts are commonly recognized by means of colposcopy. These warty lesions frequently contain cellular atypia of a varying degree showing all the features of cervical intraepithelial neoplasia (CIN) together with the features of wart virus infection e.g. koilocytosis. Human papillomavirus (HPV) antigens and DNA have been found in these lesions which can be called atypical condylomas. The presence of such markers in lesions regarded as having neoplastic potential implicates HPV in cervical carcinogenesis.
Peritoneal Fluid Biochemistry in Infertile Women with Mild Pelvic Endometriosis
Authors: Khoo S. K. , Brodie A. , Mackay E. V.
Published: February 2008

Summary: Although the factors involved in the pathophysiology of endometriosis are probably multiple and interrelated, prostaglandins may play an important role in the infertility of women with mild disease. In the present study, prostaglandin F2α (PGF2α) and 17β‐oestradiol were measured in the peritoneal fluid of a selected group of infertile women who had mild pelvic endometriosis (without anatomical distortion) and compared with those values in normal women who had no pelvic disease and in women with pelvic infection. Although there was a wide scatter of PGF2α values, the mean (1,066 pg/ml) in the endometriosis group was significantly greater than that in the other 2 groups (542 pg/ml, normal and 688 pg/ml, pelvic infection); the increase was found in both phases of the menstrual cycle. The mean concentration of 17β oestradiol was markedly higher in the luteal than the follicular phase in all 3 groups; however, no significant differences were found between the groups. Interestingly, the mean value of PGF2α and 17β‐oestradiol was higher in women with endometriosis who failed to conceive than in those who became pregnant. An estimation of PGF2α in the peritoneal fluid may have prognostic value in the evaluation of infertile patients, especially those with mild endometriosis or in whom the problem is unexplained.
Immunohaematological Testing of the Antenatal Patient: Is the Rh(D) Positive Woman as important as the Rh(D) Negative Woman?
Authors: Davis Kenneth G. , Abbott Richard L.
Published: February 2008

Summary: During a 4‐year period postnatal samples referred for testing for anti‐Rh(D) immunoglobulin eligibility were analysed for irregular red cell antibodies. Fifty two (2%) of 2,600 samples received contained antibodies to a variety of red cell antigens. Twenty four (46%) of these antibodies were undiagnosed prior to term and were a chance finding only on postnatal testing. Eleven of these latter antibodies (45%) had the potential for neonatal morbidity. The frequency of antenatal testing is discussed in relation to the Rh(D) positive as well as the Rh(D) negative woman.
The Management of Prolapsed Submucous Fibroids
Authors: MD Dov Dicker , MD Dov Feldberg , MD Arie Dekel , MD Arie Yeshaya , MD Nurith Samuel , MD Jack A. Goldman
Published: February 2008

Summary: Prolapsed submucous fibroids, are not an uncommon finding in young women of fertile age. They may be either ordinary fibromyomas of any size, or else occur as necrotic or degenerated tumours. They are expelled by the uterus, and usually present in the vagina on a pedicle, following uterine contractions. In a retrospective study of 142 patients seen over a 10‐year period at the Golda Meir Medical Center, 46 were managed by vaginal myomectomy, 12 by abdominal myomectomy, 68 by abdominal hysterectomy, usually following vaginal removal of the fibroids, and in 16 women vaginal hysterectomy was performed. The postoperative course and morbidity in these patients was comparable to that of abdominal and vaginal hysterectomy, performed for intramural or subserous fibromyomas.
Unexpected Problems in Patients Selected for Birthing Unit Delivery
Authors: Permezel J. M. H. , Pepperell R. J. , Kloss M.
Published: February 2008

Summary: Although delivery in the Family Birthing Unit of our hospital has been associated with good perinatal results, unexpected serious complications were observed necessitating the availability of immediate resuscitation facilities for both mother and baby. Of the 1,794 patients initially selected for confinement in the Family Birthing Unit, 326 were transferred out because of antenatal complications, 241 were transferred out because of intrapartum complications, and the incidence of postparturn haemorrhage and/or neonatal asphyxia in thebecause of intrapartum complications, and the incidence of postparturn haemorrhage and/or neonatal asphyxia in the remaining lowest risk patients were 3.7% and 1.3% respectively. Ten of these lowest risk patients required blood transfusions and 4 babies required admission to the Special Care Baby Unit because of neonatal asphyxia.
Meconium Aspiration — Role of Obstetric Factors and Suction
Authors: Benny Peter S. , Malani Seleima , Hoby Mark A. , Hutton John D.
Published: February 2008

Summary: Meconium aspiration occurred in 66 of 120 infants with meconiumstained liquor admitted to a Neonatal Unit. Four of the 66 infants died, whilst 17 others required ventilatory support. Meconium aspiration syndrome, especially when severe, was more likely if the mother was a smoker, hypertensive, anaemic, Maori or the pregnancy was greater than 42 weeks' gestation. Meconium aspiration was also associated with thick meconium, prolonged labour, late fetal heart decelerations and inadequate suctioning of the airway at birth.

Although meconium‐stained liquor is a common occurrence in labour, a bad neonatal outcome will only be obviated by vigilant intrapartum care and active suctioning of the infant's airway at birth. Once aspiration has occurred, intensive treatment is often required and sometimes fails.
Necrotizing Enterocolitis: A 15‐Year Experience
Authors: Leong G. M. , Drew J. H.
Published: February 2008

Summary: Eighty‐seven infants (0.13% of livebirths) developed necrotizing enterocolitis (NEC) during a 15‐year period at the Mercy Maternity Hospital, Melbourne. The disease was associated with 23 deaths, representing a mortality rate of 26.4% and comprising 2.6% of all neonatal deaths. The incidence of NEC increased from 0.07% of all livebirths for the years 1971–1974 to 0.25% for the 19‐month period from January, 1984 to July, 1985. The mean age at onset was 9.9 days with an inverse relationship between birth‐weight and age of onset of the disease. The mothers of the infants who developed NEC belonged to a significantly higher risk obstetric population; gestational diabetes was identified in 3 of 28 mothers (10.6%) having glucose tolerance tested, and 1 other patient was a known diabetic. Subnormal oestriol excretion was detected in 15 of 45 patients tested, treble the overall hospital incidence. Of the 87 infants, 26 (29.9%) were VLBW (birth‐weight < 1,500 g), 5 were term (5.7%) and 9 (10.3%) were small for gestational age. The mean gestational age was 34.7 weeks and mean birth‐weight was 1,988 g. Sixty‐seven (77%) infants received medical treatment alone and 20 (23%) also received surgical treatment. Sequelae which developed in survivors were colonic strictures (4), fistulas (2) and the short‐gut syndrome (1).
Early Midtrimester Oligohydramnios: A Sign of Poor Fetal Prognosis
Authors: Svigos John Michael
Published: February 2008

Summary: The outcome of 6 pregnant women with second trimester oligohydramnios in the absence of ruptured membranes before 20 weeks' gestation is reported. The overall prognosis of these pregnancies was poor with only 2 survivors. Review of the literature confirms the poor outcome of such pregnancies.
Maternal Narcotic Addiction: Pregnancy Outcome in Patients Managed by a Specialized Drug‐Dependency Antenatal Clinic
Authors: Ellwood David A. , Sutherland Paul , Kent Chester , O'Connor Michael
Published: February 2008

EDITORIAL COMMENT: The obstetrician's concerns regarding maternal narcotic addiction in pregnancy are ft) difficulties in recognition (ii) results of management in pregnancy and (iii) the long‐term results for mother and child — we leave to our politicians and police the problems of prevention of drug trafficking and the socioeconomic ills on which the trade flourishes! This paper reports a relatively large experience, confirming that pregnancy results are satisfactory, although there are increased incidences of prematurity and fetal growth retardation. The problems of diagnosis and long‐term follow‐up remain.

The cost‐effectiveness of the numerous available antenatal screening tests is an important consideration, since together with clinical findings they provide the basis of antenatal care. Should urinary drug screening be added to the list below, which is considered by the editor to be appropriate for Australasia? Can we believe paediatric claims that babies of unrecognized addicts never escape detection after birth because of their withdrawal symptoms? The authors of this paper on questioning have stated that ‘not all babies born to our patients went through a classical withdrawal and there are certainly some who would escape detection unless a formalized abstinence scoring chart is used’ Another problem that has tested at least I Australian ethics subcommittee is whether or not urinary drug screening in pregnancy is ethical without the informed consent of the patient!

Summary: A retrospective analysis has been made of the outcome of pregnancy in 174 women abusing narcotics, managed by a specialist team from a drug‐dependency antenatal clinic. These women were cared for through 182 pregnancies of greater than 20 weeks' gestation, resulting in 183 live and 5 stillbirths. The majority of patients were enrolled in a methadone programme and stabilized on the drug before the third trimester.

The group was characterized by a high prevalence of previous obstetric and medical problems. The most common antenatal complications were preterm labour (24%) and anaemia (12%). Preterm delivery and small‐for‐gestational‐age each occurred in a quarter of pregnancies. The mean birth‐weight for the group was 2.746g ± 721g; mean ± S.D. Eight perinatal deaths occurred (5 stillbirths, 3 neonatal deaths). giving a perinatal mortality rate of 43/1,000.

The data on narcotic abusers have been compared with similar data obtained from randomly selected public antenatal clinic patients who delivered during the same period.
Trend in Breech Delivery in Saudi Arabia
Authors: Chattopadhyay Sisir K. , Sengupta Bijoy Sree , Zaidi Muzammil H. , Edrees Yaseen Burhan
Published: February 2008

Summary: An analysis of 2,168 consecutive singleton breech deliveries showed significant improvement in neonatal mortality and morbidity rates for babies delivered by Caesarean section (CS) compared with vaginal delivery (p < 0.001). The CS rate was 19%. The uncorrected perinatal mortality (PNM) rate was 90.4/1,000 which was 2.5 times higher than the overall hospital PNM rate. In the vaginal delivery group the neonatal death (NND) rate of 206/1,000 among low birth‐weight infants (<2,500 g) was significantly higher than that of 18/1,000 among babies of > 2,500 g (p > 0.001). There was no significant difference in the NND rate between these 2 birth‐weight groups delivered by CS (p > 0.3). Social conservatism, large family size and limited neonatal care facilities were deterrents to an increase in the Caesarean section rate.
Vacuum Extraction and Forceps Delivery in a District Hospital
Authors: RACOG Jonathan Carter Dip , FRACOG Clive W. Gudgeon
Published: February 2008

Summary: We compared 302 vacuum extractions and 205 forceps deliveries at Fairfield District Hospital, Sydney, over a period of 30 months. Age, parity, gestational age, length of labour and birth‐weight were not significantly different between the 2 groups. Significantly less analgesia was required for mothers whose babies were delivered by vacuum extraction compared with mothers with forceps deliveries (p < 0.01). Average blood loss was slightly higher during forceps delivery as compared with vacuum extraction and there was a significantly higher incidence of postpartum haemorrhage after forceps delivery (p < 0.05). More babies were jaundiced after vacuum extraction and more required phototherapy, but the differences were slight and were not statistically significant. We conclude that vacuum extraction is a useful and safe alternative to forceps delivery in a district hospital setting.
The Significance of Human Papilloma Virus Atypia (‘Wart Virus Infection’) Found Alone on Cervical Cytology Screening
Authors: Pagano Ross , Chanen William , Rome Robert M. , Johnstone Neil R.
Published: February 2008

Summary: A series of 429 patients has been analysed in which the cytology smear report suggested human papillomavirus (HPV) infection alone. All patients were examined colposcopically and in 58 (13.6%) associated histologically confirmed cervical intraepithelial neoplasia (CIN) was demonstrated. CIN subsequently developed in an additional 10% of those patients who returned for follow‐up over an ensuing 3‐year period. Follow‐up with repeat cervical cytology smears alone was unreliable as 4% of patients even with normal repeat smears had histologically proven CIN and a further 4% of these patients subsequently developed CIN. Colposcopy is recommended in all patients whose cytology smear shows HPV infection.
Treatment of the Unstable Bladder with Propantheline and Imipramine
Authors: Barker Glen , Glenning Peter P.
Published: February 2008

Summary: This study shows propantheline and imipramine to be effective in the management of the unstable bladder. It emphasizes the need for urodynamic studies for the accurate diagnosis of urinary incontinence. Comparisons have been made of the efficacy of propantheline and imipramine in various groups of incontinent women and indicates that in appropriately selected groups the ‘cure’ rate is over 70% but if sphincter weakness is excluded, urodynamics cannot differentiate between those women with unstable bladders who will respond to this medication and those who will not.
Non‐obstetric Female Genital Tract Trauma in Port Moresby, Papua New Guinea
Authors: Sill P. R.
Published: February 2008

Summary: In a 3‐year period there were 25 admissions to Port Moresby General Hospital because of non obstetric injuries to the female genital tract. The injuries were caused by voluntary coitus, rape, assault and falls. The most frequent injury was a laceration to the posterior fornix of the vagina. Although rape was frequently committed in Port Moresby, it was not the major cause of genital tract injury.
The Prevalence of Sexually Transmitted Disease Agents in Pregnant Women in Suva
Authors: Gyaneshwar R. , Nsanze H. , Singh K. P. , Pillay S. , Seruvatu I.
Published: February 2008

Summary: Routine testing of 440 women (257 Fijians, 183 Indians) at the first antenatal attendance identified Chlamydia trachomatis in 50% of Fijians and 38% of Indians; the seropositivity rates for syphilis were 14.2% and 1.7% respectively, and the isolation rates for N. gonnorrhoeae were 3.1% in Fijians and 1.1% in Indians.
Congenital Absence of the Vagina—Simple Surgical Procedure for Its Relief
Authors: Dhall Kamala
Published: February 2008

Summary: A modified method of treatment of congenital absence of the vagina with the use of amnion graft has been explained with illustrations. Follow‐up of 20 patients treated with this method showed successful results without any postoperative cicarterization provided the marital relationship was started within 6–8 weeks.
A Case of Acute Appendicitis in Pregnancy
Authors: WrightBSc E. A.
Published: February 2008

Summary: An unusual case of appendicitis in the second trimester of pregnancy is presented. The underlying pathology was shrouded by incomplete abortion. The patient's condition worsened after her uterus was evacuated and it was only at laparotomy that a ruptured appendix was discovered. The need for vigilance in suspecting appendicitis is heightened so as to reduce morbidity and mortality from appendicitis in pregnancy.
Intestinal Surgery in Gynaecological Oncology
Authors: Webb Maurice J. , Weaver Edward W.
Published: February 2008

Summary: Over a 4‐year‐period, 117 patients had 139 intestinal operations performed in a gynaecological oncology unit. Most of the patients had gynaecological malignancy as the indication for their operation, but 18% had a gastrointestinal primary and 10% had benign pelvic conditions which required intestinal surgery. Most of the patients with malignancy had an ovarian primary cancer. The next most common primary site was the gastrointestinal tract and here carcinoma of the sigmoid colon was the most common. There were 102 large bowel and 36 small bowel operations. Sixteen patients had more than one intestinal procedure. The most common complication of the intestinal operations was prolonged ileus which occurred in 9 instances. Three patients required repeat laparotomy for postoperative bowel obstruction. There were 3 postoperative deaths occurring within 30 days. An assessment of the usefulness of preoperative investigations showed that there was a 10.3% false negative result reported from X‐rays, scans or endoscopies. This factor makes it imperative that the surgeon operating on gynaecological malignancy should be capable of dealing with intestinal surgical procedures when required as it is not possible to rely on preoperative investigations to point out those that may require intestinal surgery.
Under Reporting of Perinatal Mortality
Authors: Lawson Gerald W.
Published: February 2008

Summary: A detailed analysis of perinatal deaths in 5 maternity hospitals in the Hunter Valley of N.S.W. was performed over a 2‐year period to ascertain whether all such deaths were officially certified. There were 138 perinatal deaths identified, but of these, only 131 were registered with a medical certificate. The 7 cases not certified were all just past the borderline of the official N.S.W. definition, where a late abortion is distinguished from a stillbirth. This suggests that there is a small but significant degree of underreporting of such cases, which in turn marginally reduces the official N.S.W. perinatal mortality rate.
Ovarian Neoplasms in Children and Adolescents in Papua New Guinea
Authors: Sengupta S.K. , Everett V.J.
Published: February 2008

Summary: A study of ovarian tumours in young females under the age of 20 years in Papua New Guinea between the period 1976–1986 is presented. During these 11 years a total of 101 cases was seen among 802 ovarian tumours reported in all age groups. Epithelial tumours comprised the largest number (66.3%) followed by germ cell tumours (24.8%). Ten patients (9.9%) presented with torsion. Only 3 (3%) cases of Burkitt lymphoma were recorded (3%); the series included 1 case of primary non‐gestational choriocarcinoma of the ovary in an 11‐year‐old premenarchal girl.
Phase II Study of Mitoxantrone in Advanced or Metastatic Endometrial Carcinoma
Authors: Boadle D. J. , Tattersall M. H. N.
Published: February 2008

Summary: Mitoxantrone was administered to 12 patients with advanced or recurrent endometrial carcinoma of whom only I had received prior chemotherapy (chlorambucil). The drug was given every 21 days, the initial dose of either 12mg/m1 or 14mg/m1 being decided by the patient's age, timing of prior radiotherapy, tolerance of prior chemotherapy and baseline haematological parameters. One partial response was observed in the 11 patients evaluable for assessment of response. Mitoxantrone was well tolerated with the major toxicity being myelosuppression, particularly granulocytopenia. With the observed response rate of 9%, we conclude that mitoxantrone does not have significant activity in endometrial carcinoma.
Acute Fatty Liver of Pregnancy: Clinical Features and Diagnosis
Authors: Purdie Jane M. , Walters B. N. J.
Published: February 2008

EDITORIAL COMMENT: This paper emphasizes the importance of early diagnosis of acute fatty liver of pregnancy and prompt delivery of the patient. When the clinical picture has similarities with severe preeclampsia the patient also needs immediate delivery. The associated feature of polydipsia reported here is an important observation and the writer of this review can recall a severely ill patient in labour in 1960 in whom the consulting physician diagnosed ‘temporary diabetes insipidus in labour’. If these patients do come to Caesarean section (for acute fetal distress or because the condition of the mother is serious or deteriorating rapidly) the problems of blood coagulation failure must be anticipated.

Summary: Five cases of acute fatty liver of pregnancy are described. These are the only recognized cases of this disorder occurring in a 2 year period in Western Australia. Clinical and laboratory features are presented. There was no maternal death. Of the six babies, there were three intrauterine deaths, including the only set of twins. All the babies were male.

Vomiting in the third trimester was the chief presenting feature in all cases, often accompanied by a systemic illness with malaise and tiredness. Extreme polydipsia was noted as a prominent symptom in all cases. The combination of moderately abnormal liver function tests, extreme leucocytosis with other blood film abnormalities, hypoglycaemia, impaired renal function, coagulopathy and gross elevation of uric acid level is regarded as highly suggestive of the diagnosis. Features of a preeclamptic illness were present in several cases.

Three of the patients have since had uneventful pregnancies.

The constellation of clinical and laboratory features is sufficiently characteristic to allow accurate clinical diagnosis in most cases of this disorder. The chances of both maternal and fetal survival are enhanced by early diagnosis allowing intervention in the form of prompt delivery of the infant.
Adenomyosis Uteri: A Study of 416 Cases
Authors: Raju Gangaraju C. , Naraynsingh V. , Woo J. , Jankey N.
Published: February 2008

EDITORIAL COMMENT: This essay on adenomyosis confirms that the patient is usually a multipara with menorrhagia and uterine enlargement, often with associated fibromyomas — this sentence also describes the type of patient coming to hysterectomy whose uterus does not show the histological features of adenomyosis. It would be interesting to see these clinical features documented in a prospective series to test the strength of the correlation between adenomyosis and menorrhagia with regular uterine enlargement. The editor was interested to note the absence of uterine tenderness and low incidence (10%) of dyspareunia in this series, since his clinical impression is that the multipara with menorrhagia and uterine enlargement often has a tender uterus which in the hands of the pathologist shows evidence of adenomyosis. Perhaps an interested reader will examine this impression scientifically!

Summary: Adenomyosis was noted in 16% of 2,616 consecutive hysterectomy specimens examined during a 7‐year period. Multiparas between the ages of 30 and 50 years were most commonly affected. Abnormal uterine bleeding was the common symptom. Myohyperplasia and leiomyomas were the usual associated lesions. Adenomyosis uteri was seen equally in women of African, Indian and mixed races in this West Indian population.
Can The Fetus Cause Plaeental Separation?
Authors: Eden John
Published: February 2008

EDITORIAL COMMENT: Many years ago Dame Kate Campbell told us that she believed the long fingernails of the postterm fetus was the possible cause of trauma to membranes and decidua permitting entry of amniotic fluid into the maternal circulation when this complication occurred before the onset of labour. The case notes and figure 1 in this paper suggest that the fetus can cause plaeental trauma by kicking!

Summary: Two cases of painless antepartum haemorrhage are presented, in which it would seem the likely explanation was fetal trauma to the plaeental edge. The value of an immediate ultrasound scan is emphasized.
Ethinyl Oestradiol and D‐Norgestrel is an Effective Emergency Postcoital Contraceptive: A Report of its Use in 1,200 Patients in a Family Planning Clinic
Authors: Bagshaw Susan N. , Edwards Diana , Tucker Alison K.
Published: February 2008

Summary: We describe a prospective study of 1,200 patients using the Yuzpe regimen of hormonal postcoital contraception.

There was an 85% follow‐up rate, and of the 1,015 patients followed there were 13 pregnancies, giving a pregnancy rate of 1.3%. The number of expected pregnancies at mid‐cycle was reduced by 83%; 12 of the 13 pregnancies went on to abortion. The patients were young: 86% were under 25, and 10% were under 15. The most frequent reason for presentation was that no contraception had been used (57%). All patients received an antiemetic; 57% experienced no side‐effects, 28% had some nausea and 9.6% some vomiting.
Giant Cervical Polyp Due to a Foreign Body in a ‘Virgin’
Authors: Aridogan Nihat , Cetin M. Turan , Kadayifci Oktay , Atay Yilmaz , Bisak Ufuk
Published: February 2008

Summary: A 17‐year‐old virgin who had a giant cervical polyp which had developed through a foreign body and protruded out of the hymen was evaluated; the aetiological significance of the foreign body in the formation of the cervical polyp is discussed.
Obstetric Complications Among Chinese Parturients with Extreme Prepregnancy Ponderal Indices
Authors: Duthie S. J. , Li D. F. H. , To W. K. , Ma H. K.
Published: February 2008

EDITORIAL COMMENT: This paper reports that a high maternal ponderal index indicates at risk pregnancies in a Chinese population. The increased incidence of gestational diabetes in patients with a high ponderal index provoked this editorial comment since the association between maternal weight and glucose tolerance in pregnancy is not clear cut. The use of ponderal indices rather than absolute weight has great merit since it also considers maternal height. Similarly fetal macrosomia is more properly defined as birth‐weight according to gestational age rather than as a particular birth‐weight, such as 4,000 g or 4,500 g which are commonly used criteria. This paper uses the 1964 criteria of O'Sullivan and Mahan for the diagnosis of gestational diabetes — 2 or more venous plasma glucose values above 5.8 mmol/l fasting, 10.6 at 1 hour, 9.2 at 2 hours and 8.1 mmol/l at 3 hours after a 100 g oral glucose challenge. The difficulty in interpreting the significance of the 13% incidence of gestational diabetes in the high ponderal index group is that glucose tolerance testing was presumably performed on indications and not as a routine in all patients in all 3 groups.
An Evaluation of Transcutaneous Electrical Nerve Stimulation for Pain Relief in Labour
Authors: Thomas I. L. , Tyle V. , Webster J. , Neilson A.
Published: February 2008

EDITORIAL COMMENT: It is undeniable that fashion determines details of management in obstetric practice e.g. techniques of antenatal preparation, place of birth, position at birth. Methods of pain relief in labour have also varied, but in recent years the trend has been towards an increased use of epidural analgesia on the one hand, and a wish to avoid conventional methods of analgesia altogether on the other! It is against this background that transcutaneous electrical nerve stimulation (TENS) has been introduced into labour wards in many hospitals. This careful, large study tackles the difficult task of critical appraisal of patients' perception of pain in labour and its influence by TENS. The authors have shown that although the method does no harm, it probably does little good and they do not advocate its widespread introduction for routine use in labour.

Summary: The effectiveness of transcutaneous nerve stimulation (TENS) for pain relief in labour was evaluated by randomizing 280 patients in early labour into 2 groups. Inoperative sham machines were applied to patients in the control group and active units to those in the test group. Neither patients nor attending labour ward staff were aware of which group the patient was in. The intensity of low back pain and abdominal pain was assessed by the patient each hour on a visual analogue pain scale. Each patient served as her own control by switching off the machine for 2 contractions every hour and then recording the intensity of pain. The amount of conventional analgesia each patient received was recorded by labour ward staff.

There was no difference in the intensity of pain recorded by each group. Nor was there any difference between the 2 groups in the change of pain experienced when the machine was switched off. Moreover there was no difference in the amount of other analgesia required. Some differences were found when those with little low back pain were excluded from the study.

We conclude that TENS is ineffective as a routine method of pain relief in labour. It is likely to benefit only those with severe back pain and then only to a modest degree.
Post‐Caesarean Wound Infection: A Review of the Risk Factors.
Authors: Webster Joan
Published: February 2008

EDITORIAL COMMENT: This paper presents a careful appraisal of infection rates after Caesarean section in a teaching hospital. The overall infection rate was 9.4% which seems low in view of the fact that the criteria for infection were unusually strict although these did not include pyrexia; in 2.4% of patients the infection was deep with drainage of purulent material. Wound sepsis is important because of patient morbidity and cost, hospitalization being increased in this series by 2 days when wounds became infected. Such studies are difficult, because antibiotics are used widely (39% in this study) and even in those with more severe degrees of pyrexia (above 38d̀ C on 2 or more occasions), 74% of patients in this series had no evidence of wound infection. Another problem inevitable in such a study is that there is no record of wound problems after the patient was discharged from hospital. It would be helpful to know if the patients who develop stitch abscesses or breakdown of the wound after discharge from hospital are those who receive prophylactic antibiotics or antibiotic therapy because of pyrexia. In many hospitals it is common practice for the surgeon to give antibiotic therapy if the patient develops pyrexia; usually bacteriological studies are not performed in such patients since there is no discharge to culture. It is also difficult to know how to interpret the bacteriological findings in the 28% of patients whose troublesome wounds were cultured.

Summary: In a prospective study of 1,546 patients delivered by Caesarean section a wound infection developed in 146 (9.4%); the rate was significantly higher in clinic patients (15.8%) compared with private patients (6.0%). Elective operations resulted in a lower incidence of wound infection (7.9%) than emergency operations (12.3%). Other factors significantly associated with postoperative wound infection were: the number of vaginal examinations before surgery (p<0.05), duration of operation (p< 0.005), vertical skin incision (p<0.05) and category of surgeon (p<0.001). In 56 patients for whom a past history was available, there was a record of a wound infection in 31 (55%). Clinic patients were over‐represented in all situations predisposing to wound infection.
Which is the Best Test to Detect the Polycystic Ovary?
Authors: Eden John A.
Published: February 2008

Summary: Laparoscopy was used to characterize the ovaries of a group of infertile women. Patients with polycystic ovaries (PCO) were compared with those with normal ovaries. A free androgen index (FAI) >4.5 was 100% specific and sensitive for detecting the PCO in a group of women with oligomenorrhoea. Overall, a biochemical ‘screen’ consisting of a luteinizing hormone (LH) level > 10 U/1, testosterone (T) >2.6nmol?/l, sex hormone binding globulin (SHBG) <31nmol/l or a FAI >4.5 was 89% sensitive and 98% specific for PCO, which is comparable with the reliability of ultrasound for detecting the PCO.
What are the Ultrasound and Biochemical Features of Impending Ovulation?
Authors: Eden John A , Place Jan , Carter Graham D. , Jones Julia , Alaghband‐Zadeh Jamshid , Pawson Michael E.
Published: February 2008

Summary: Thirty‐two ovulatory women had serial ultrasound measurements of uterine volume, endometrial thickness and leading follicular diameter compared with serum oestradiol, testosterone and sex‐hormone binding globulin. Follicular diameter, endometrial thickness and uterine volume were significantly correlated with serum oestradiol. The day before ovulation was characterized by maximal values for oestradiol, testosterone, luteinizing hormone, endometrial thickness, uterine volume and leading follicular diameter. Leading follicular diameter and endometrial thickness in particular, appear to be useful parameters to indicate impending ovulation.
Acute Renal Failure Due to Postpartum Haemolytic Uraemic Syndrome
Authors: Li Philip K.T. , Lai Fernand Mac‐Moune , Tarn John S.L. , Lai Kar Neng
Published: February 2008

Summary: A patient developed the haemolytic uraemic syndrome after an uncomplicated Caesarean section. Escherichia coli species producing verotoxin was not isolated from the stool and the verotoxin was not demonstrated in the renal biopsy. The patient recovered with supportive dialysis. The clinical features of 66 cases of postpartum haemolytic uraemic syndrome reported in the literature are reviewed.
A Controlled Trial on Wound Drainage in Caesarean Section
Authors: Loong Richard L. C. , Rogers Michael S. , Chang Allan M. Z.
Published: February 2008

Summary: A randomized controlled trial was carried out to investigate the influence of drainage on wound infection following Caesarean section.

The incidence of clinical wound infection was significantly reduced if a Redivac suction drain was placed beneath the rectus sheath. Subcutaneous corrugated drains were found to offer no advantage.

Three different degrees of postoperative pyrexia are examined for their predictive value for the development of wound sepsis.

The influence of duration of amnion rupture and the number of vaginal examinations in labour on the postoperative incidence of wound infection and pyrexia are examined.
Stillbirths in Western Australia 1980–1983: Influence of Race, Residence and Place of Birth
Authors: Alessandri Louisa M. , Stanley Fiona J. , Waddell Vivienne P. , Newnham John
Published: February 2008

EDITORIAL COMMENT: The stillbirth rate in Western Australia for infants with birth‐weights of at least 1,000 g is commendably low at only 4.91 per 1,000 births. The authors' analysis shows that stillbirths of unknown cause are the largest group (table 3), and most of these occur at term, but before labour (table 2b). We respectfully disagree with the authors' comment that because these deaths are of unknown cause, that few are potentially avoidable/preventable by better obstetric care. The table below shows the neonatal death and stillbirth rates for Victoria for infants with birth‐weight of 1,000 g or more. Although the death rates have not reduced significantly in the past 2 years we believe that further improvement is possible; even if the stillbirth rates in Western Australia for 1984, 1985 and 1986 are the same as for 1983, we should not be prepared to accept that the limits of current obstetric care to favourably influence stillbirth rates have been reached. It should be stressed that this large group of stillbirths of ‘unknown cause’ occur in potentially salvageable infants who are mature and not malformed. The research required to prevent a significant proportion of these deaths may be no more than routine testing of glucose tolerance to diagnose all cases of gestational diabetes.

Summary: All stillbirths in Western Australia from 1980–83 weighing 1,000 g and over were identified from perinatal death certificates, and their causes and demographic correlates described.

The stillbirth rate was 4.91 per 1,000 total births; nearly 65% were antepartum, 25% intrapartum and in 10% the time of death was unknown. The cause of death of most stillbirths was unknown (52%) or associated with lethal congenital malformations (13%), antepartum haemorrhage (12%) or maternal hypertension (8%).

Whilst Aboriginal women had much higher stillbirth rates (10.80) than non‐Aboriginal women (4.57), their patterns of time and causes of death were similar. Both antepartum and intrapartum stillbirth rates were much higher at low birth‐weights and low gestational ages in both racial groups.

Women living in rural areas who delivered in the metropolitan area had much higher antepartum (11.02) and intrapartum (3.31) stillbirth rates than either rural women delivering in rural areas (1.89 and 1.34) or metropolitan women delivering in the metropolitan area (2.72, 0.98). This reflects the transfer of rural high risk pregnant women or those with fetal death in utero, for delivery in metropolitan specialist hospitals.