bluuebunny/crossref_metadata_2025 huggingface dataset:
Access to Assisted Human Reproduction Services by Minority Groups
Authors: Daniels K.R. , Burn I.
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it addresses an important issue in contemporary society – namely the rights of access to modern assisted reproduction technology by women who are single, lesbian and/or postmenopausal.

Summary: This paper looks at the claims of lesbian and single women to have access to Assisted Human Reproduction (AHR) in New Zealand, discusses legislation, rulings and regulations, as well as the opinions of people who have been involved in this issue. These include clinics and health professionals who provide these services, ethics committees and other bodies, and public opinion. Some implications for policy development are also discussed.
Rectal Diclofenac Analgesia after Abdominal Hysterectomy
Authors: Scott Roger M. , Jennings Peter N.
Published: February 2008

Summary: Sixty‐two patients undergoing total abdominal hysterectomy with or without salpingo‐oophorectomy were randomly allocated to receive either 100 mg rectally of diclofenac (n=31) or a placebo (n=31) at the end of the operation and 12‐hourly for 72 hours postoperatively. The analgesic effect of the diclofenac was measured by a visual analogue scale pain score and morphine usage. Patients receiving diclofenac showed a morphine requirement of <50% of the patients receiving placebo (p<0.0001). There was no statistical evidence of any reduction in the incidence of nausea and vomiting with the use of diclofenac.
Rectal Bleeding: A Rare Complication of Abdominal Pregnancy
Authors: Saravanane C. , Smile S. Robinson , Chandra S. Sarath , Habeebullah S.
Published: February 2008

EDITORIAL COMMENT: We accepted this case report for publication not only because of its rare anecdotal interest, which is considerable, but also since it will warn readers that rectal bleeding in pregnancy may result from an abdominal pregnancy. It is strange that the ultrasonograph seems not to have identified the calcification as a fetus although we are not told that the latter was macerated or misshapen. The editor has never seen or heard of an ectopic pregnancy causing rectal erosion and bleeding although he has reported a primary abdominal pregnancy in which the placenta was implanted on the peritoneum of the pouch of Douglas posteriorly (A); this woman presented at 23 weeks' gestation when retroplacental haemorrhage resulted in a haematoma that bulged into the vagina causing acute urinary retention. One wonders why the placenta did not erode the anterior rectal wall in this more advanced case of primary placental implantment in the pouch of Douglas.

Summary: A rare case of abdominal pregnancy, causing massive rectal bleeding due to invasion of the rectal wall by the placenta, is reported.
Effects of Intrapartum Hydrotherapy on Labour Related Parameters
Authors: Aird Ian A. , Luckas Murray J.M. , Buckett William M. , Bousfield Peter
Published: February 2008

EDITORIAL COMMENT": We accepted this paper for publication because there is a lot of anecdotal discussion about water birth in obstetric practice but very few studies where the labours have been scientifically appraised and an attempt made to compare them with another group of patients. This paper attempts to make such a comparison and provides information which should interest all obstetricians and midwives. It is difficult to imagine how there could ever be a controlled trial on the usefulness of waterbirth compared with other methods of delivery. As the authors point out, there are so many advocates for waterbirth in the United Kingdom that compilation of scientific information and its publication must be encouraged. This study is small and we would encourage those who practise waterbirths to at least present an audit of the complications both maternal and fetal that occur with this method of delivery.

Summary: The use of birthing pools during labour is increasing in the United Kingdom. This is without good scientific evidence of their efficacy or safety. To further investigate the value and safety of intrapartum hydrotherapy, an historical cohort study was performed in a District General Hospital in Liverpool. The study group consisted of 100 women of low obstetric risk who used the birthing pool at some stage during their labours and the control group consisted of 100 women who were matched in terms of age, parity and obstetric history but laboured and delivered in air. The main outcome measures were operative delivery rates, duration of labour, analgesic requirements, perineal trauma and Apgar scores at 1 and 5 minutes. The results showed that nulliparas who used the birthing pool had significantly reduced operative delivery rates, a shorter second stage of labour, reduced analgesic requirements and a lower incidence of perineal trauma. In multiparas there were significant reductions in analgesic requirements.
Transient Osteoporosis of the Hip in Pregnancy
Authors: Siva Sashi , Roach Vijay
Published: February 2008

Summary: Transient osteoporosis of the hip (TOH) is an uncommon condition. This painful regional osteoporosis affects previously healthy women in the third trimester of pregnancy. It is characterized by pain in the affected hip and pronounced osteopenia of the femoral head and neck. It has a relatively short clinical course (average 6 months) and a predictably benign prognosis. Complete clinical and radiological recovery is the rule. The diagnosis is one of exclusion. The cause of the osteopenia is not known, although various aetiological factors have been implicated. A case of TOH occurring in the third trimester of pregnancy with complete recovery within 6 months postpartum is presented.
Changes in Folate Supplementation, and in Serum and Red Cell Folate Levels in Antenatal Patients Over the Course of a Health Promotion Project for the Prevention of Neural Tube Defects
Authors: MBBS Carol Bowerl , BSc Simon Knowlesl , MSc Darryl Nicol
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it presents useful information concerning folate intake in a community and the impact a health promotion project can have in changing folate supplementation in women before 20 weeks gestation. This study did not attempt to evaluate whether or not the health promotion project increased prepregnancy supplementation of folate by dietary intake or specific prescription of folic acid. However, the takeaway message seems to be that even in the final phase of the study, 85% of the 72 women investigated were not taking folic acid supplements before pregnancy. This finding is in keeping with data reported from other centres. Because pregnancy is not planned in about 40% of instances (reference 11 of this paper), and since the neural tube closes by the end of the 6th week from the last menstrual period, it seems that the incontestable conclusion from the data presented and discussed in this paper, is that a policy of folate fortification of food as recommended by the National Health and Medical Research Council of Australia, should be implemented.

Summary: We assessed the use of folic acid supplements and changes in serum and red cell folate levels in pregnancy over the course of a healui promotion project in Western Australia by 4 cross‐sectional studies of women attending a public antenatal outpatient clinic in 1992 (before the launch of the health promotion project), 1993, 1994, and 1995. A short questionnaire was completed and blood taken for estimation of serum and red cell folate. There was an increase in the proportion of women taking folic acid supplements in the first trimester (51.9% in the final phase) and before pregnancy (15% in the final phase of the study), and no change in the proportion taking other vitamin supplements. Serum and red cell folate levels increased significantly over the study period in both women taking and not taking folic acid supplements. The proportion of women who had seen the pamphlet used in die health promotion project rose to 35.4% in die third phase, and fell to 27.8% in the final phase. Coincident with the health promotion project, there was an increase in folate status in early pregnancy. However, most women were not taking folic acid supplements before they became pregnant and, hence, may not have had sufficient folate at the time of normal neural tube closure.
Predominance of a Maternal History of Diabetes for Patients with Non‐insulin‐independent Diabetes Mellitus. Implications for the Intrauterine Transmission of Diabetes
Authors: Mosesl R. , Rodda M. , Griffiths R.
Published: February 2008

Summary: In Europid populations, patients with non‐insulin‐dependent diabetes mellitus (NIDDM) are more than twice as likely to have a mother than a father with diabetes. We have examined this aspect in an Australian population. For this purpose records of 1,000 consecutive patients with NIDDM were reviewed. A history of diabetes was present in 193 mothers (19.3%) and in only 86 fathers (8.6%) (p<0.0001). The predominance of a maternal history of diabetes in patients with NIDDM is suggestive of a maternal transmission of this disorder. This metabolic tendency may develop due to an adverse intrauterine environment in women with undiagnosed gestational diabetes mellitus.
High‐Dose‐Rate Brachytherapy in the Management of Carcinoma of the Cervix: An 8‐year Australian Experience
Authors: MacLeod Craig , Fowler Alan , Dalrymple Chris , D'Costa Ieta , Firth Ian , Atkinson Ken , Elliot Peter , Carter Jonathan
Published: February 2008

Summary: High‐dose‐rate brachytherapy was introduced at this hospital for the treatment of gynaecological malignancy in 1985. A retrospective analysis was performed of 103 patients with cervix cancer treated with this technique from 1985 to June, 1993. The patients were analyzed for treatment parameters, response, survival, relapse and toxicity. Five‐year survival was 78% for Stage 1B, 72% for Stage 2A, 42% for Stage 2B and 29% for Stage 3B. The severe late toxicity rate was 4.9%. These results are similar to reported international series that have used either low‐dose‐rate or high‐dose‐rate brachytherapy.
Colour and Pulsed Doppler Examination in the Diagnosis of Uterine Arteriovenous Malformation
Authors: Meagher Simon E. , Tregaskis‐Lye Linda , Hill David , FRCP Denys Fortune
Published: February 2008

EDITORIAL COMMENT: We accepted this case report because it makes the point that transvaginal colour and pulsed Doppler examination facilitates the diagnosis of arteriovenous malformation in the uterus, which would allow more conservative curative therapy of heavy uterine haemorrhage, when indicated by the patient's requirements, than was adopted in this case.
The Sign of Stress Incontinence ‐ Should We Believe What We See?
Authors: Carey Marcus P. , Dwyer Peter L. , Glenning Peter P.
Published: February 2008

EDITORIAL COMMENT: This paper provides information about the reliability of clinical symptoms and signs of urinary stress incontinence in comparison with the final diagnosis arrived at with the combination of multichannel cystometrography and urethral pressure profilometry. While these specialized investigations do provide more detailed information about bladder and urethral function than is available clinically, no published research supports a need for cystometric testing in routine or basic‐evaluation of urinary incontinence. The Agency for Health Care Policy and Research in a review of the management of urinary incontinence in adults (A) does not recommend urodynamic investigation in women with stress incontinence prior to initial surgery if there are no complicating factors, the postvoiding volume is normal and the stress incontinence is associated with bladder neck hypermobility and is nonrecurrent. This study has shown that urodynamic investigation identified a large proportion of women with urinary symptoms who in addition to true stress incontinence have other urinary problems that warrant conservative management. However, conservative treatment can also be successful in women with genuine stress incontinence as the only urodynamic abnormality. Moreover, surgical treatment maybe unsuccessful when the only urinary problem is genuine stress incontinence, and successful in women with additional urodynamic problems to that of genuine stress incontinence. It remains a difficult clinical problem to decide when surgery is indicated in women with mixed urinary symptoms and/or urodynamic findings of dual pathology.

Fantl JA, Newman DK, Colling J et al. Urinary incontinence in adults: acute and chronic management. Clinical Practice Guidelines No. 2, 1996 Update. Rockville MD: U.S. Department of Health and Human Services, Public Health Agency. Agency for Health Care Policy and Research. AHCPR Publication No. 96–0682. March 1996.

Summary: The accuracy of the clinical sign of stress incontinence in the diagnosis of genuine stress incontinence (GSI) was evaluated in 863 (consecutive) women. 779 of whom were referred with the symptom of urinary incontinence. Subjects were assessed clinically and urodynamically by the one clinician (PLD). The positive and negative predictive values of the clinical sign of stress incontinence for a diagnosis of GSI were 91% and 50% respectively. Of the 569 women with GSI. 335 (59%) had GSI as their sole diagnosis and 234 (41%) had an additional urodynamic diagnosis The clinical sign of stress incontinence when present was a reliable guide to a final diagnosis of GSI. Clinical assessment of incontinent women requires the back‐up of urodynamic studies in order to make an accurate diagnosis.
Vaginal Electrostimulation for the Treatment of Genuine Stress Incontinence
Authors: Wilson P.D. , George M. , Imrie J.J.
Published: February 2008

Summary: The value of vaginal electrostimulation for genuine stress incontinence was evaluated in 30 women with this condition. Subjective and objective measurements were made before and after 3 and 15 months of treatment using urinary diaries, perineometry and pad tests. After 3 months use, 21 women (70%) reported a subjective improvement, but this had fallen to 9 (30%) by 15 months. There were significant reductions in the numbers of daily incontinent episodes and pad/pant changes and significant increases in the perineometry readings at both 3 and 15 months. There were no side‐effects observed with electrostimulator use, but 1 patient withdrew due to a dislike of the method of treatment. Vaginal electrostimulation would seem to be a simple and well tolerated means of managing genuine stress incontinence in a selected group of women.
Bleeding Associated with Vaginal Hysterectomy
Authors: Wood Carl , Maher Peter , Hill David
Published: February 2008

Summary: The increased use of blood transfusion, ultrasound evidence of postsurgical haematoma, the frequency of postoperative febrile morbidity of unknown cause and reports of these complications in large series which contain both abdominal and vaginal hysterectomy over the last 25 years, suggests that bleeding may be more common after vaginal hysterectomy. We performed laparoscopy routinely after vaginal hysterectomy in 50 patients. The frequency of bleeding was 48%, consistent with other studies ranging from 30 to 98%. Arterial bleeding from a branch of the uterine or vaginal artery occurred in 20%. The frequency of bleeding was not related to uterine size, ranging from normal to that equivalent in size to that of a pregnancy of 18 weeks' gestation. The most common site of bleeding was the vaginal vault. Liberal definitions of haemorrhage, possible emphasis in speed in performing hysterectomy, and difficulty in visualizing and ligating major and minor blood vessels, may have contributed to the increased frequency of bleeding reported after vaginal hysterectomy. Haemostasis is more easily obtained at laparoscopic surgery because of magnification, close inspection, routine use of suction irrigation and bipolar electrocoagulation. Routine laparoscopy at the completion of vaginal hysterectomy is recommended. New and improved methods of vessel closure are also required. Attitudes to haemorrhage during hysterectomy require change to further reduce the use of blood transfusion.
Serial Transvaginal Ultrasonography Following McDonald Cerclage and Repeat Suture Insertion
Authors: Fox Robert , Holmes Robert , James Mark , Tuohy Jeremy , Wardle Peter
Published: February 2008

Summary: The aim of this study was to explore the hypothesis that serial transvaginal ultrasonography identifies early evidence of suture failure and that repeat cerclage delays delivery. We undertook a review of our policy of transvaginal ultrasonographic cervical surveillance after McDonald cerclage and of repeat suture insertion if persistent cervical effacement developed. Data from 26 pregnancies in 26 women are analyzed. The women had had a total of 57 mid‐trimester miscarriages with a median of 2 (1–6) mid‐trimester losses per woman. Twelve (46%) of the 26 women developed cervical changes at scan and underwent repeat cerclage. All 14 women who had a single suture inserted progressed to live births but 1 of the 13 women who had repeat cerclage had a mid‐trimester miscarriage (p>0.05). The median gestation at delivery for the women who had repeat cerclage was 35 (22–39) weeks compared with 38 (36–40) weeks for those who had a single suture (p>0.05). The median interval from the detection of cervical changes at scan to delivery was 13 (4–19) weeks. Serial transvaginal ultrasonography after cervical cerclage identifies a group of women who are more likely to deliver preterm, and provides an opportunity for intervention (repeat cerclage) which appears to delay delivery by an average of 7 weeks.
Antenatal True Umbilical Cord Knot Leading to Fetal Demise
Authors: Eizenberg David
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because cord problems should interest readers and it is generally accepted, as the author notes, that a true knot is seldom a cause of death before the onset of labour in contradistinction to entanglement of the cord around the baby's limbs and body. As far as the Editor is aware, diminished or absence of fetal movements has never been shown cardiotocographically to be caused by a true knot with successful delivery of the fetus although one can imagine that this could occur. It is interesting to speculate, as the author has done, concerning how a true knot tightens when the umbilical cord is of normal length. In Chew's (A) paper the cardiotocographic findings were analyzed in 2,601 women who reported diminished fetal movements and there was no example of a knotted cord in any of the 21 perinatal deaths or in any of the 24 infants who had loss of baseline variation and type 2 decelerations, which was regarded as evidence of critical fetal reserve. A Medline search identified a case where a sinusoidal fetal heart rate pattern and moderate fetal hypoxia was associated with a true knot of the cord (B). Another study of 12 pregnancies in which fetal distress and death resulted from umbilical cord abnormalities included 8 where the patients had a history of decreased fetal movements, and where nonstress cardiotocography was abnormal (C). These authors concluded that antepartum fetal deaths due to umbilical cord abnormalities are still difficult to prevent, as it is often impossible to detect distress in time for appropriate intervention. Prompt action to deliver the baby after an abnormal cardiotocograph appears to be a necessary step to prevent such deaths, yet even this failed in Case 2 reported in this paper. These 2 cases may inspire us to keep looking. One can imagine that the fetus may have been saved in Case 1 had the patient reported change in fetal movements earlier.

Chew FTK, Beischer NA. Antepartum cardiotocographic surveillance of patients with diminished fetal movements. Aust NZ J Obstet Gynaecol 1992; 32: 107–113.

Goldstein I, Timor‐Tritsch IE, Zaidise I, Divon M, Paloi E. Sinusoidal pattern together with signs of moderate fetal hypoxia associated with a true knot of cord. Eur J Obstet Gynecol reprod Biol 1981; 11: 221–225.

Ghosh A, Woo JS, MacHenry C, Wan CW, O'Hoy KM, Ma HK. Fetal loss from umbilical cord abnormalities: a difficult case for prevention. Eur J Obstet Gynecol Reprod Biol 1984; 18: 183–198.
Haemoperitoneum Due to Cornual Endometriosis During Pregnancy Resulting in Intrauterine Death
Authors: Leung Wing Cheong , Leung Tsin Wah , Lam Yung Hang
Published: February 2008

EDITORIAL COMMENT: We accepted this case report for publication not only because of the rarity of an acute haemoperitoneum causing intrauterine fetal death in late pregnancy, but also because of the cause of the haemorrhage. There are cases where the cause of a haemoperitoneum is never found and indeed, when the editor was a resident medical officer at the Royal Women's Hospital, Melbourne, such a case resulted in a maternal death; this woman died during repeat laparotomy and possibly the source of the bleeding was a ruptured vein over the uterosacral ligament. One reviewer of this paper commented that the source of bleeding may have been an area of ectopic decidua formation rather than endometriosis. Ectopic decidua is frequently seen at Caesarean section involving the peritoneum of the uterus and broad ligaments. Occasionally it occurs outside the pelvis and when located in the renal pelvis can cause haematuria, sufficient in the case reported by Bettinger to result in nephrectomy to control the bleeding(A). Ectopic decidua is not biopsied at Caesarean section because of the risk of haemorrhage and is possibly best studied histologically in Caesarean hysterectomy specimens.

(A) Bettinger HF. Ectopic decidua in the renal pelvis. J Path Bact 1949; 59: 686–687.
Perioperative Documentation: Are We Doing Enough?
Authors: Roach Vijay J. , Lau T.K. , Kee Warwick D. Ngan , Wormald Peter J.
Published: February 2008

Summary: We performed a retrospective analysis to assess the content and accuracy of operative and anaesthetic records for Caesarean section in a large unit. The obstetric record was considered adequate if it included patient identification, participating doctors, operative date, title, details and findings and a signature. The anaesthetic record was evaluated by The Australian and New Zealand College of Anaesthetists guidelines. We analysed 104 operative and 101 anaesthetic records. There was inadequate identification in 17 (16.3%) of the operative records. Documentation of a previous scar or the presence or absence of intraabdominal adhesions was incomplete in 22 of the 35 patients (63%) with a previous laparotomy. Sixty per cent of records had incomplete skin closure information. Common anaesthetic record deficiencies were patient position, patient airway, investigation results and postoperative plan. Our findings identified deficiencies that could lead to inadequate medical care and indicate the need for improved standards of perioperative records.
Blood Pressure Measurement in Pregnancy: A survey of methods used in teaching hospitals in South Australia
Authors: Duggan P.M. , Miller J.
Published: February 2008

Summary: A voluntary, anonymous 10‐point multiple choice questionnaire was used to assess variability in methods used to measure blood pressure in pregnancy in 5 South Australian teaching hospitals. Medical and midwifery staff working in maternity units attached to teaching hospitals in South Australia were asked to complete a survey of their current practice related to the measurement of blood pressure in pregnant women; 213 replies were received from 440 surveyed (48% response rate). There was a lack of standardization of practice for: positioning of the patient, use of the 4th or 5th Korotkoff sound for diastolic blood pressure, cuff selection, rounding of the measurement, selection of the left or right arm, and period of premeasurement resting. Systematic errors averaging 10–15 mmHg can be expected in measurement of blood pressure in pregnancy due to failure of standardization of method. There is a need for standardization of method which is not being met by present methods of staff training in teaching hospitals.
The Effects of Human Amniotic Membrane and Fibrin Sealant in the Prevention of Postoperative Adhesion Formation in the Rabbit Ovary Model
Authors: Özeren Semih , Çorakci Aydin , Erk Ahmet , Yücesoy Gulseren , Yücesoy Izzet , Karabacak Onur
Published: February 2008

Summary: The study group consisted of 29 female, white New Zealand rabbits. The rabbits were randomized into 3 groups and a midline laparotomy was performed in order to make a 4–5 mm long lesion using a scalpel in both ovaries. In Group 1, both of the ovaries were left uncovered. In Group 2, the right ovaries were covered by human amniotic membrane graft. In Group 3, 0.1–0.2 mL of Tisseel solution was applied to the lesion in the right ovaries. No medication was applied to the left ovaries in any of the groups and thus this ovary acted as an individual control. After 2 weeks the adhesion scores were graded by relaparotomy in a blind manner. Fibrin sealant showed a significant reduction in postoperative adhesion formation compared with the amniotic membrane graft and control groups (p<0.001). Therefore, it can be concluded that fibrin sealant can be used as an adjuvant during reproductive surgery.
Strangulation of the Small Intestine: A Late Complication of Ventrosuspension
Authors: Portmann C. , Goh J. , Teh J.
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication to remind readers that small bowel obstruction can be a late complication of Ventrosuspension, and that as stated in the discussion, gynaecological surgery is responsible for a large proportion of cases of bowel obstruction requiring surgery in females. This case reminded the editor of an elderly woman seen a few years ago with postmenopausal bleeding which persisted after curettage had revealed no abnormality and no curettings. At laparotomy for hysterectomy it was found that the woman had had a previous ventrofixation and her elevated enlarged uterus attached to the anterior abdominal wall contained a huge malignant polyp; the previous curettage had been performed in the elongated cervix and lower uterine segment. Ultrasonography would have recognized this endometrial mass. The reviewer of this paper noted that a plain supine and erect abdominal X‐ray should be performed when bowel obstruction is a possible diagnosis and may have assisted the management of this woman by showing distended bowel loops with fluid levels; it would seem that in this case the ultrasound findings of fluid filled loops of bowel did not warrant immediate surgery.

Summary: A case of strangulation of the small intestine as a late complication of Ventrosuspension is presented and discussed.
Assessment and Management of Female Urinary Incontinence ‐ a Survey of Current Practice
Authors: Duggan P.M. , Arnold E.P.
Published: February 2008

Summary: A survey of conference delegates attending the Urogynaecology Day at the 1997 Annual Scientific Meeting of the Royal Australasian College of Surgeons indicated that practitioners are inconsistent in their approach to the use of preoperative urodynamics evaluation for women with stress incontinence and disagree about the significance of the low pressure urethra.
Diagnosis and Treatment of Cervical Intraepithelial Neoplasia in a Single Visit
Authors: Das S.S. , Elias A.H.
Published: February 2008

EDITORIAL COMMENT— ‐Peter T. Grant, FRCS (Ed), FRACOG, CGO Gynaecological Oncologist, Gynaecological Cancer Centre, Royal Hospital for Women, New South Wales

We evaluated the diagnostic and therapeutic efficacy of large loop excision of the transformation zone (LLETZ) performed in the first visit (see and treat policy) as compared to LLETZ treatment performed as an interval procedure. Data of 248 patients were analyzed of which 206 patients had LLETZ. Two thirds of the procedures were performed at the first visit. Of all the women who had the ‘see and treat policy’ 94.9% were diagnosed to have cervical intraepithelial neoplasia (CIN) on histology compared to 90.8% in the interval treatment group. A total of 3 (1.4%) patients were detected to have microinvasive carcinoma. There was no difference in the immediate postoperative complication rate, overtreatment rate and need of repeat treatment in both the groups. Single visit colposcopy and loop treatment is a safe and effective option for treatment of cervical epithelial abnormalities. The experience of the colposcopist is very important.
Pregnancy and Congenital Heart Disease ‐ Maternal and Fetal Outcome
Authors: Sawhney H. , Suri V. , Vasishta K. , Gupta N. , Devi K. , Grover A.
Published: February 2008

Summary: Two hundred and seventy five pregnancies in patients with congenital heart disease during 1980–1996 were analyzed retrospectively. Maternal and perinatal outcome was compared in 251 pregnancies of women with acyanotic and 24 pregnancies of women with cyanotic heart disease. Congenital heart disease was diagnosed during the index pregnancy in 26.1% of patients and the majority (88.4%) were in NYHA classes 1 and 2. Atrial septal defect (27.7%) was the most common lesion in women with acyanotic heart disease and the majority with cyanotic heart disease had Eisenmenger syndrome, 13 of 21 (61.9%). Sixty pregnancies occurred in patients with surgically corrected lesions (acyanotic, 56; cyanotic, 4). The incidences of abortions (8.3%), stillbirths (13.6%) and small for gestational age (SGA) (36.4%) were higher in cyanotic heart disease compared to acyanotic heart disease (stillbirth, 0.8%; SGA, 6.9%). There was a statistically significant difference in mean maternal age, mean gestational age and mean birth‐weight in the surgically corrected and noncorrected lesions in both acyanotic and cyanotic heart disease. There was 1 maternal death in a woman with Eisenmenger syndrome.
Maternal and Umbilical Cord Serum Zidovudine Levels in Human Immunodeficiency Virus Infection
Authors: Phuapradit Winit , Sirinavin Sayomporn , Taneepanichskul Surasak , Chaovavanich Achara , Wiratchai Amompun , Sunthornkachit Rujanee , Puchaiwatanon Orawan
Published: February 2008

EDITORIAL COMMENT: Because of the low prevalence rate for HIV in Australian antenatal populations and lack of a national or state policy for offering routine HIV testing in pregnancy, we have relied on our colleagues from Thailand to provide readers with information concerning treatment of pregnant women known to be HIV positive. Readers are referred to the January 24, 1998 issue of the British Medical Journal which contains 7 papers concerning HIV infection in pregnancy and neonates. The editorial by Danielle Mercey ‘Antenatal HIV testing. Has been done badly in Britain and needs to improve’ (A) should interest readers since HIV testing has been sufficiently performed in the United Kingdom to provide the information that in 1996 only 15% of previously unrecognized HIV infections were diagnosed in pregnancy. The prevalence in tested women in London increased 6‐fold from 0.03% in 1988 to 0.191% in 1996; for the rest of the United Kingdom the comparable percentages in tested women were 0.005% and 0.016% (B). For comparison, as noted in this paper, the prevalence rate of HIV positive mothers in Thailand was 2% in 1993, or more than 10 times greater than in London in 1996 and 125 times greater than in the rest of the United Kingdom. Tourists with sex adventures in mind should be aware of these facts when planning their itinerary for overseas tours. Obstetricians in Australia should heed the statement that ‘The advantages of ascertaining a pregnant woman's HIV positive status before delivery are clear’: transmission to the baby can be roughly halved by avoiding breastfeeding and reduced by a further two‐thirds by the administration of zidovudine (A).

(A) Mercey D. Antenatal HIV testing. BMJ 1998; 316: 241–242.

(B) Nicoll A, McGarrigle C, Brady AR et al. Epidemiology and detection of HIV‐1 among pregnant women in the United Kingdom: results from national surveillance 1988–1996. BMJ 1988; 316: 253–258.

Summary: The aim of this study was to determine the maternal and umbilical cord serum ZDV levels at delivery in HIV‐1 infected parturients treated with a short‐course ZDV regimens in late pregnancy and labour. Serum ZDV and its metabolite were measured by high‐performance liquid chromatography. Concentrations of ZDV and its metabolite in umbilical cord blood appeared similar to maternal concentrations. There was a significant positive correlation between serum ZDV and its metabolite in maternal and umbilical cord concentrations. At delivery, maintenance of optimal virustatic ZDV concentration with oral antenatal and oral intermittent intrapartum ZDV dosage regimen can be achieved in only 53% of cases. The regimens used in this study were useful but not as effective as the ACTG 076 regimen with an intravenous dose intrapartum plus the oral administration to the infants for 6 weeks.
Massive Mature Solid Teratoma of the Ovary with Gliomatosis Peritonei
Authors: Nanda Smiti , Kalra Bharti , Arora B. , Singh Subedar
Published: February 2008

EDITORIAL COMMENT: : We accepted this and the following case report for publication because they illustrate problems that may be associated with spontaneous or surgical spillage of contents of a cystic teratoma into the peritoneal cavity. The oncologist who reviewed this manuscript suggested that the editorial subcommittee publishes a statement that women with a large abdominal mass are unlikely to have their management altered by CT scan or MRI investigations although ultrasonography has usually been arranged by the referring practitioner. These women require prompt laparotomy, although chest X‐ray should be performed preoperatively to exclude metastatic disease. Diagnostic paracentesis which is often performed in women with abdominal masses, as in this patient, is potentially harmful and unnecessary in a patient fit and willing for surgery. Although most gynaecologists attempt to remove a cystic ovarian carcinoma intact, the literature is inconclusive about the risk of recurrence of a Stage 1 ovarian carcinoma if spillage of cyst contents occurs during surgery (A, B). It was also noted by the oncologist reviewer that most large solid teratomas are malignant and that a tumour of this size should be extensively sampled by the pathologist before a diagnosis of benign teratoma is made. Clinically, a large ovarian tumour can seem solid when it is cystic, and may also be mistaken for ascites as apparently was so in the patient reported here.

(A) Sainz de la Cuesta R, Goff BA, Fuller AF, Nikrui N, Eichhorn JH, Rice LW. Prognostic importance of intraoperative rupture of malignant ovarian epithelial neoplasms. Obstet Gynecol 1994; 84: 1–7.

(B) Sevelda P, Dittrich C, Salzer H. Prognostic value of the rupture of the capsule in Stage 1 epithelial ovarian carcinoma. Gynecol Oncol 1989; 35: 321–322.

Summary: Glial implants on peritoneum and omentum may occur with mature solid teratoma of the ovary (gliomatosis peritonei). The case of a 17‐year‐old girl is presented, who had a massive solid ovarian teratoma with glial implants on visceral peritoneum and omentum. The massive size of the tumour posed difficulty in diagnosis. CT demonstrated a large teratoma. At laparotomy, the seedlings were initially thought to be evidence of malignancy and hysterectomy was offered which was refused by the parents. Oophorectomy was performed and the benign nature of the tumour and implants was seen on histopathology. It is important to recognize the benign nature of glial seedlings in such cases to avoid unnecessary extensive surgery.
Sacculation and Retroversion of the Gravid Uterus in the Third Trimester
Authors: Dietz H.P. , Teare A.J. , Wilson P.D.
Published: February 2008

EDITORIAL COMMENT: We accepted this case report of persistent retroversion of the uterus into the third trimester because of its rarity, good documentation and because the clinical details of the distortion of uterine and pelvic anatomy should interest readers. Generally it is considered that such cases are examples of anterior sacculation of the uterus which would seem to account for the features shown in figures 2 and 4. However the authors tell us that figure 3 shows the placenta within posterior sacculation of the uterine wall. Figure 4 shows the uterine fundus perched above a distended lower uterine segment reminiscent of what is seen in an advanced case of cervical pregnancy. In other words there seems to have been both anterior and posterior sacculation of the lower uterine segment. The editorial committee agrees that the authors were wise to anticipate profuse haemorrhage at Caesarean section. We also give them full marks for proper interpretation of the ultrasono graph and MRI allowing a correct diagnosis before laparotomy, with appropriate placement of the lower uterine incision to allow safe breech delivery of the fetus.
Primary Genital Non‐Hodgkin Lymphoma
Authors: Sungurtekin Ümit , Lacin Selman , Ayhan Semin
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication because it is interesting for readers to know that the uterus and/or ovaries can be the site of primary non‐Hodgkin lymphoma or the site where involvement of the disease causes presentation. One reviewer commented on the fact that clinical evidence of operability may be more likely to be misleading in cases of lymphoma than carcinoma. Certainly this case report indicates that clinically there was no evidence of extension of the tumour to the pelvic wall, but the fact that subtotal hysterectomy was necessary seems to indicate otherwise. Some years ago a patient in her thirties was operated on by the editor together with oncologist Peter Grant because she was in renal failure with a pelvic mass due to a lymphoma. She previously had had a generalized abdominal tumour which responded to irradiation with her pelvis shielded which accounted for the residual disease in the pelvis. This patient had an enlarged uterus of limited mobility, but it was thought that a total hysterectomy could be performed. This was found not to be so and a subtotal hysterectomy was performed as in the patient described in this case report. This woman survived for 4 years with a ureteric splint and repeated courses of chemotherapy.

Summary: Although genital lymphoma either being an initial manifestation of occult nodal disease or secondary involvement is not uncommon, extranodal lymphoma originating primarily from the genitalia is quite rare. Here, we report a new case of primary genital lymphoma involving the uterus and ovaries, but not the Fallopian tubes. We also wish to emphasize that misdiagnosis of genital lymphoma, either clinically or histologically can occur.
Recurrence of Gestational Diabetes
Authors: Foster‐Powell Kaye A. , MDAA Diet , Cheung N. Wah
Published: February 2008

Summary: We conducted a retrospective review of 540 women with gestational diabetes managed by our Service between 1990 and 1996. The aim was to determine the recurrence rate of gestational diabetes and the factors associated with recurrence. Of 117 women who had a subsequent pregnancy, 82 (70%) had a recurrence of gestational diabetes according to criteria where the fasting glucose value ≥ 5.5 and/or 1 hour ≥10.0 and/or 2‐hour ≥8.0 mmol/L after a 75 g oral glucose load. The recurrence rate was 62.4% (58), using the criteria of the Australian Diabetes in Pregnancy Society (ADIPS). Older age in both the index and subsequent pregnancy and insulin requirement during the index pregnancy were the strongest predictors for recurrence of gestational diabetes. Non‐English speaking country of birth, higher diagnostic glucose tolerance test (GTT) levels, greater prepregnancy BMI and weight gain between pregnancies were also associated with recurrence.
Cervicovaginal Fetal Fibronectin Testing in Threatened Preterm Labour — Translating Research Findings into Clinical Practice
Authors: Chuileannain Fiona Ni , Bell Robin , Brennecke Shaun
Published: February 2008

Summary: A retrospective audit was undertaken involving 70 women with a singleton pregnancy who attended hospital with symptoms of threatened preterm labour prior to 34 weeks' gestation and who had a bedside fetal fibronectin (FFN) Membrane Immunoassay Kit Test (Adeza Biomedical) performed. The aim of the study was to determine if the results of the FFN test when used in routine clinical practice would be similar to those of a previous research study (1) that was performed at the same centre, and whether or not knowledge of the result of the FFN test might influence clinical management. The audit revealed that the sensitivity of the FFN test in the prediction of delivery prior to 34 weeks' gestation was 90%, the specificity was 82%, whilst the positive and negative predictive values were 45% and 98% respectively. These results were very similar to those of the previous, blinded research study. Compared to women with a negative FFN test, more women with a positive FFN test received corticosteroids (100% versus 71%, p = 0.02) and tocolysis (35% versus 12%, p = 0.04) and more remained in hospital longer than 24 hours (85% versus 56%, p=0.1).
Interstitial Ectopic Pregnancy—Management with Laparoscopically‐guided Local Methotrexate Infiltration
Authors: Wilkinson Chris , Petrucco Oswald , Pachulicz Maureen , Furness Margaret
Published: February 2008

EDITORIAL COMMENT: This issue of the journal contains 2 case reports of interstitial ectopic pregnancies, both treated by injection of methotrexate, by intramuscular injection in one case, and by laparoscopically‐guided injection into the ectopic pregnancy mass in the other. The methods were not equally successful. Parker and colleagues reviewed the published data and concluded that single‐dose intramuscular methotrexate for treatment of ectopic pregnancy is associated with a high failure rate, and serious complications have occurred (11). The authors of this report advocate the use of laparoscopically‐guided local methotrexate infiltration. The selection of which cases of ectopic pregnancy warrant this regimen is not yet established in the editor's opinion. Ironically one of the reviewers of this case report, selected because of his known experience with ultrasonographically‐guided direct local methotrexate injection into early tubal ectopic pregnancies, stated that, because of the risk of causing haemorrhage, that he had preferred methotrexate by intramuscular injection in 2 women with interstitial ectopic pregnancies, who then, at a later date, had excision of the ectopic pregnancies performed laparoscopically.

Summary: This case describes the use of ultrasound to diagnose an interstitial ectopic pregnancy and the subsequent management and ultrasound follow‐up. Interstitial pregnancy is a rare but potentially life‐threatening complication of pregnancy. Management options depend upon the timing of diagnosis, and the desire for maintenance of fertility. Methotrexate injection, under ultrasonographic or laparoscopic guidance, seems to be the management of choice when the ectopic is diagnosed at an early stage.
Recurrent Interstitial Pregnancy
Authors: Sungurtekin Ümit , Uyar Yildiz
Published: February 2008

Summary: As a rare form of ectopic pregnancy, interstitial pregnancy threatens the future fertility of the patient. Methods of management include observation only, medical treatment with methotrexate either systemically or locally, or surgery either with laparotomy or laparoscopy. We present the case of a woman with recurrent interstitial pregnancy. Treatment with methotrexate was successful in her first interstitial pregnancy, however the second necessitated laparotomy. Selection of patients for treatment with methotrexate and the importance of subsequent tubal investigation are emphasized.
Obstructed Labour Due to a Vesical Calculus
Authors: Rai Lavanya , Ramesh K.
Published: February 2008

EDITORIAL COMMENT: We accepted this short case report because although the condition is rare it is appropriate for obstetricians to know that a vesical calculus can cause obstructed labour as in this primipara.
Microinvasive Adenocarcinoma of the Cervix
Authors: Nicklin J.L. , Perrin L.C. , Crandon A.J. , Ward B.G.
Published: February 2008

Summary: We evaluated the management of patients with microinvasive adenocarcinoma of the cervix (MIAC), in particular, to determine the place of conservative surgery, and determine if the FIGO classification for MIAC is valid and equivalent to the classification as it applies to microinvasive squamous cancer. A review was undertaken of the database of the Queensland Centre for Gynaecological Cancer (QCGC) from January, 1986 to October, 1998. The records of all patients recorded as having MIAC were retrieved. Microinvasion was defined according to the 1995 FIGO classification as a depth of invasion of no greater than 5 mm and a horizontal dimension of no greater than 7 mm. 30 patients were found to have been treated for MIAC. The vast majority (29) were asymptomatic, disease being discovered at the time of routine Papanicolaou smear. There was a 43% incidence of coexisting squamous intraepithelial neoplasia. Multifocal disease was found in 17% of patients and lymph‐vascular positivity in 7%. Eighteen patients were treated with radical surgery and 13 with conservative surgery. There were no recurrences over a follow‐up interval of 3–116 months. Of the 18 patients treated with radical surgery, none was found to have occult microscopic disease in the parametria or nodal metastases. A total of 27 ovaries were removed, all of which were free of disease. In this small study, MIAC appears to behave in a manner similar to the squamous equivalent. The results provide some justification for the FIGO classification of a microinvasive glandular neoplasm of the cervix. There is some support for a role for conservative surgery in managing this condition, but there is insufficient worldwide experience to make definitive recommendations.
Vaginal Reconstruction in the Fibrotic Pelvis
Authors: FRANZCOG Simon E. Hyde , MD Neville F. Hacker
Published: February 2008

Summary: Vaginal reconstruction was performed in 7 patients who had developed vaginal stenosis as a result of extensive pelvic fibrosis following either pelvic irradiation (6 patients) or multiple vaginal procedures (1 patient). Six patients received split thickness skin grafts and 1 patient received an amnion graft in the creation of the neovagina. Five patients achieved a satisfactory final result. All of these patients were sexually active and described adequate sexual function. There was no serious morbidity associated with these procedures. Safe and successful vaginal reconstruction can be performed in a patient with a fibrotic pelvis.
Comparison of Epidural and General Anaesthesia for Elective Caesarean Delivery According to the Effects on Apgar Scores and Acid‐Base Status
Authors: Şendaǧ Fatih , Terek C§an , Öztekin Kemal , Saǧol Sermet , Asena Uçar
Published: February 2008

Summary: The objective of this study was to determine the effects of lumbar epidural anaesthesia on the Apgar score and acid‐base status of the newborn. Umbilical artery blood gases were obtained in 85 singleton, term, uncomplicated pregnancies delivered by elective Caesarean section. The umbilical artery blood pH, PaCO2, PaO2 and HCO3 values and Apgar scores (1 and 5 minutes) were compared between lumbar epidural and general anaesthesia groups. General anaesthesia was used in 45 (52.9%) women and lumbar epidural anaesthesia in 40 (47.1%). Only 2 of the newborns exposed to epidural anaesthesia had umbilical artery blood pH values 7.19 or less. The mean umbilical artery blood pH was found to be significantly lower in the newborns exposed to lumbar epidural anaesthesia (p = 0.011). None of the newborns in the 2 groups were severely depressed (Apgar scores less than 4). The mean umbilical artery blood PaCO2, PaO2 and HCO3 values did not show any significant difference between the groups. In conclusion, lumbar epidural anaesthesia is associated with lower umbilical artery blood pH values, occasionally with severe fetal acidaemia.