bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Maternal Cardiac Disease on Perinatal Outcome
Authors: Jindal U.N. , Dhall G.I. , Vasishta K. , Dhall K. , Wahi P.L.
Published: February 2008

EDITORIAL COMMENT: In Australia cardiac disease is a well recognized cause of maternal death, but the incidence is so low that it is seldom considered as a cause of perinatal mortality or morbidity. In the 7 triennia from 1964–1966 to 1981–1984 cardiac disease accounted for an increasing proportion of maternal deaths in Australia — 4.2% of 275, 4.2% of 237, 8.0% of 244, 8.6% of 137, 8.8% of 106, 7.0% of 98 and 10.6% of 94 respectively. The incidence of cardiac disease in pregnancy is much higher in developing countries and in those where rheumatic carditis is common (Ireland, Malaysia, India). At the Mercy Maternity Hospital, Melbourne, 1971–1983, there were 56,842 confinements and 209 patients (0.4%) had cardiac disease; the perinatal mortality (20 weeks and beyond) was 19.1 per 1,000. These figures are in sharp contrast to those quoted in this paper from the Postgraduate Institute in Chandigarh, India, where the incidence of cardiac disease was 1.4% (223 of 15,664) and the perinatal mortality rate (28 weeks and beyond) 67.2 per 1,000. The authors present convincing evidence that cardiac disease is associated with fetal growth retardation and prematurity.

Summary: Perinatal outcome of 223 pregnancies complicated by maternal cardiac disease, over a 5‐year period has been studied. Mean birth‐weights of these babies were compared to the Institute's reference neonatal weight curves at different periods of gestation and found lower than the reference. The mean difference of 150 g was statistically significant. The incidence of prematurity, small for gestational age and perinatal mortality was analyzed according to the risk factors i.e. type, duration and severity of symptoms. The perinatal outcome was directly proportional to the severity of symptoms, irrespective of the type and duration of heart disease.
The ‘Forgotten’ Intrauterine Device; an Unusual Cause of Infertility
Authors: Leeton John , Buttery Beresford
Published: February 2008

EDITORIAL COMMENT: The title of this case report underestimates the message it contains.
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

Summary: 9,208 patients who received antenatal care and underwent delivery at a teaching hospital in Hong Kong during 1984 and 1985 were divided into 3 groups of high, normal and low prepregnancy ponderal index. The characteristics of each group were analysed using a computer database. Statistically significant differences were found between the groups. Parturients with high ponderal indices tended to be older, of higher parity, had heavier babies and had increased incidences of gestational diabetes, prolonged gestation, induction of labour, failed induction, Caesarean section and puerperal pyrexia. Parturients with low ponderal indices had an increased incidence of intrapartum fetal distress and instrumental vaginal delivery. These results indicate that the maternal ponderal index in Chinese parturients is a useful indicator of at risk pregnancies.
Maternal Features of Obstetric Cholestasis: 20 Years Experience at King George V Hospital
Authors: Fisk Nicholas M. , Bye William B. , Storey G. N. Bruce
Published: February 2008

Summary: Between 1965 and 1984, 139 pregnancies in 125 women were complicated by obstetric cholestasis (OC). Prevalence increased from 0.1% in the first 10‐year period to 0.2% in the second (p< 0.001), following recognition of the adverse fetal risks of this condition. Perinatal data from both series, 1965–1974 and 1975–1984 have previously been published. Mothers in the latter series were more likely to be of Anglosaxon than Mediterranean origin (p< 0.001) and did not have underlying haemolytic conditions. Diagnostic criteria changed considerably over the 20 years, such that liver biopsy was no longer needed, gastroenterological consultation was sought less frequently (p< 0.001) and newer diagnostic criteria of increased bile acids with negative hepatitis serology were increasingly employed. Biochemical data were broadly similar in the 2 groups. An understanding of the clinical and laboratory features of this disease facilitates early diagnosis, which is imperative if intensive fetal surveillance is to reduce the high stillbirth rate in OC.
Vasa Praevia: Another Cause for Concern in In Vitro Fertilization Pregnancies
Authors: Burton G. , Saunders D. M.
Published: February 2008

Summary: A case is reported of the velamentous insertion of the umbilical cord into the membranes of the placenta, unsuspected until delivery, in an in vitro fertilization pregnancy. Abnormal placental development adds a new dimension of risk to these pregnancies.

The Australian Register of in vitro fertilization (IVF) pregnancies has shown (1) an increase in perinatal mortality rates but there are many possible causes for such an increase. A recent report (2) has suggested a higher incidence of velamentous and marginal insertions of the umbilical cord in IVF pregnancies.

We wish to report a case of marked velamentous insertion of the cord which was associated with an uncomplicated vaginal delivery, but highlights the possible increased risks of vasa praevia in IVF pregnancies.
Fetal Renal Vein Thrombosis
Authors: Furness Margaret E. , Rajadurai Samuel , Haslam Ross R. , Weckert Roger C. , O'Loughlin John A.
Published: February 2008

Summary: Two cases of fetal renal vein thrombosis, diagnosed via maternal ultrasound scan are presented. One was associated with severe placental dysfunction and demonstrated haematuria and renal failure which resolved on day 10. The other followed an antepartum haemorrhage and resolved before the baby was born. The ultrasound showed, as transient findings, unilateral renal enlargement, thrombus protruding into the inferior vena cava, and mild fetal ascites. We suggest that fetal renal vein thrombosis may be more common than previously suspected, and warrants close monitoring of fetal well‐being. Delivery should be considered if there is other evidence of fetal compromise, if the amount of peritoneal fluid suggests substantial haemorrhage, or if there is propagating thrombus in the inferior vena cava.
Congenital Hydrocephalus Secondary To Prenatal Intracranial Haemorrhage
Authors: Gunn Tania R , Mora J Dermot , Becroft David M O
Published: February 2008

Summary: A high incidence of intracranial haemorrhage in utero of uncertain aetiology has been previously identified as an important cause of stillbirth in infants of immigrant Pacific Islanders in New Zealand. Congenital hydrocephalus is now described as a consequence of intracranial haemorrhage in 2 stillborn Pacific Islander infants. A large intracerebral haemorrhage, hydrocephalus and hydrops in one infant was first recognized prenatally by ultrasonography and caused intrauterine death at 26 weeks' gestation. Severe hydrocephalus in the other infant was first identified just before labour at term but the pathological findings were of old intraventricular haemorrage with narrowing of the aqueduct of Sylvius as a reaction to the haemorrhage. Prior intracranial haemorrhage may be the cause of an increased incidence of hydrocephalus in Pacific Islander stillbirths and of some otherwise unexplained cases of congential hydrocephalus in other races.
The Value of Amnioscopy in Surveillance of Postdate Pregnancy
Authors: Levran D. , Shoham Z. , Geranek M. , Greenwald M. , Mashiach S.
Published: February 2008

Summary: The accuracy and reliability of amnioscopy in detecting the presence of meconium in amniotic fluid and in predicting fetal distress were evaluated in 289 postdate pregnancies. Meconium‐stained amniotic fluid tended to be associated with complications of pregnancy such as ABO incompatibility (p<0.05), the need for operative delivery (p<0.02), and fetal distress at birth (p<0.05). Amnioscopy failed to detect the presence of meconium antenatally in most cases (57%), and positive amnioscopy for meconium was unrelated to the incidence of fetal distress. When meconium was present, induction of labour was ineffective in reducing the incidence of fetal distress. Amnioscopy is not recommended for the monitoring of postdate pregnancies.
Primary Postpartum Haemorrhage in Tasmania 1982–1986
Authors: Allen D. G. , Correy J. F. , Marsden D. E.
Published: February 2008

EDITORIAL COMMENT: This paper provides valuable statistics regarding the most common life‐threatening complication that occurs in the delivery room. The overall incidence of primary postpartum haemorrhage (PPH) was 7.2%, and the rate was significantly higher after either instrumental delivery (13.7%) or Caesarean section (15.4%), than after normal vaginal delivery (3.9%). This paper does not discuss the influence of episiotomy or retained placenta, and the authors do not tell us the method of management of the third stage of labour which they favour. Blood transfusion statistics are not quoted but the high incidence of PPH associated with Caesarean section, antepartum haemorrhage and multiple pregnancy, suggest that it is prudent to cross‐match blood in patients with these complications.

In one hospital series of 15,860 deliveries (1) the incidence of PPH was 3.7% (excluding Caesarean sections unless blood loss exceeded 600 ml after the operation), and 1 in 3 patients with this complication received a blood transfusion, and 1 in 200 required hysterectomy. In this series there were 2,305 Caesarean sections and in these patients the blood transfusion rate was 8.3%, and 1 in 100 required hysterectomy.

Postpartum haemorrhage and Caesarean section share a special association because, if blood loss is measured accurately at operation, the mean volume (± SD) is 1,290 ± 240 ml for first Caesarean section and 1,012 ± 380 ml for repeat operations (2). The presence of an episiotomy or perineal tear is also important, in terms of average blood loss, in patients delivered vaginally; Paull and Ratten (3) reported that, in both nulliparas and multiparas, the amount of blood loss more than doubled in patients with a sutured tear or episiotomy in comparison with those with an intact perineum.

Estimation of blood loss at delivery is difficult, especially at Caesarean section. Because of this it is wise to perform a haemoglobin estimation in the puerperium — the results are often a surprise! It is the editor's practice to advise all patients to continue iron tablets for 3 months after delivery to minimize the risk of postpartum anaemia.

Summary: Primary postpartum haemorrhage remains a significant problem in modern obstetric practice. The incidence and factors associated with postpartum haemorrhage in Tasmania over a 5‐year period were studied. The mode of delivery, anaesthesia, birth‐weight, induction and augmentation of labour, multiple pregnancy, antepartum haemorrhage and hypertension were found to be important factors. The incidence of retained placenta was not considered in this study.
The Reliability of a Cytological Prediction of Cervical Adenocarcinoma In Situ
Authors: Laverty Colin R. , Farnsworth Annabelle , Thurloe Julia , Bowditch Ronald
Published: February 2008

EDITORIAL COMMENT: The entity of cervical adenocarcinoma in situ will be new to many readers. This careful large study established that cytological prediction of adenocarcinoma in situ of the cervix is a very meaningful finding, with a false positive rate of only 2% i.e. 1 of 47 patients having adequate investigation; the other 46 patients having in situ (28) or invasive (18) carcinomas. The authors have justified their conclusion that a cytological report of adenocarcinoma in situ of the cervix merits further investigation by cone biopsy. The appropriate management of very early or minimal microinvasive adenocarcinoma discovered at conization performed following a cytological prediction of adenocarcinoma in situ remains controversial, until such time as long term follow‐up of a series of such patients is reported.

Summary: A spectrum of changes precedes clinical invasive adenocarcinoma of the cervix. Cytological and histological criteria for the diagnosis of adenocarcinoma in situ (ACIS) are becoming more clearly defined. A 5‐year prospective study was undertaken to test the accuracy of a cytological prediction of ACIS.

From a total of 290,000 cervical smears 54 predictions of ACIS were made: 33 (61%) alone and 21 (39%) with associated squamous carcinoma in situ (SCIS). The rate of reporting ACIS was compared to the rates for intraepithelial and invasive squamous lesions and for frank invasive adenocarcinoma. The findings suggest that ACIS is being underdiagnosed.

Forty‐seven patients were adequately investigated; 46 had intraepithelial or invasive malignancy. There were 10 cases of ACIS, 10 ACIS with SCIS, 9 microinvasive adenocarcinoma, 5 invasive adenocarcinoma, 2 microinvasive adenosquamous carcinomas, 1 invasive adenosquamous carcinoma, 8 SCIS and 1 endometrial carcinoma. There was one true false positive report. Thus cervical glandular neoplasia was confirmed in 37 patients (79%), 13 of these having adenosquamous tumours.

Because 98% of patients had in situ or invasive malignancy and because 36% of cases were invasive (though mostly microinvasive) prompt investigation, by cone biopsy, must follow a cytological report of ACIS.
The Role of Second‐Look Laparotomy in the Management of Patients with Ovarian Carcinoma
Authors: Rome Robert M. , Fortune Denys W.
Published: February 2008

Summary: Second‐look laparotomy has been performed on 76 patients with ovarian carcinoma each of whom was clinically free of tumour after completing a programme of postoperative chemotherapy (60 patients), pelvic radiotherapy followed by chemotherapy (14 patients) or observation (2 patients). The initial stage, bulk of residual tumour, completion of hysterectomy and bilateral salpingo‐oophorectomy and an interval of 11 months or more between diagnosis and second‐look surgery were all significantly (p<.05) associated with negative findings. Recurrences occurred after a negative operation in 10 of 42 (23.8%) patients and were more frequent amongst patients with grade 3 tumours (p = .03). Macroscopic cancer was found in 23 (30.3%) patients and microscopic cancer in 11 (14.8%) patients. Survival was related to the surgical findings and to the amount of residual tumour at the conclusion of the second‐look operation. Survival of patients with no macroscopic residue (those found to have microscopic tumour and those who had complete excision of macroscopic tumour) was significantly longer than that of patients with macroscopic residue (median survival 38.2 versus 19.0 months, p= .01). These results suggest that benefit from second‐look laparotomy is confined to patients with microscopic or totally resectable tumour for whom second‐line therapy may still be curative.
Clomiphene C itrate and Ovarian Resistance
Authors: McKenna K. Mark , Evans James H.
Published: February 2008

Summary: An uncommon association between clomiphene citrate and the development of ovarian resistance to gonadotrophins is described. We advise against the use of clomiphene in the rare patient with the resistant ovary syndrome, and advise caution in any patient who exhibits a decreasing oestrogen response to clomiphene ovulation induction.
Papillomavirus Infection of the Female Genital Tract Before and After Treatment: A Cytological, Colposcopic and Histological Study*
Authors: Merkur Harry , Baird Phillip J.
Published: February 2008

EDITORIAL COMMENT: All practitioners and many members of the public are becoming increasingly concerned about papillomavirus infection of the genital tract, in men and women, because of its apparent escalating prevalence, and its relationship to the development of invasive cancer. It is difficult to suppress fear that the HIV‐1 virus that causes AIDS will ultimately spread through the community in a similar manner. The authors have studied 135 patients with an abnormal Papanicolaou smear and reported the colposcopic and histological findings after a follow‐up for 12 months. The takeaway message is that HPV infection persists in spite of treatment; at the initial investigation 114 of the 135 women had colposcopic evidence of HPV ± CIN and 99 showed histological evidence of these lesions (tables 4 and 5); at follow‐up colposcopy 108 women still had evidence of HPV ± CIN (table 6). The enormous difference in the proportion of patients with HPV7CIN rather than HPV alone in 1986 compared with the 2 previous years (table 8) indicates either a rapid change in the disease, or in its interpretation by colposcopists and pathologists. The absence of invasive cancer on follow‐up is not reassuring after only 12 months' surveillance. In the authors' series the most recent follow‐up experience is that colposcopy showed persistence of HPV infection in 87% of patients who originally presented because of an abnormal Papanicolaou smear (table 7).

Summary: Papillomavirus infection (HPV) of the female genital tract is now recognized as a major risk factor for the development of neoplasia. With the combined investigative modalities of cytology, colposcopy and histopathology, it is clear that precancerous changes and HPV are closely associated. The differentiation of innocent HPV infection from progressive premalignant disease is not clear‐cut in all situations. Despite various treatment modalities, close follow‐up of these patients by cytology, colposcopy and histology reveals the presence of persistent genital tract infection by HPV.
Cervical Cancer in South Australia: Trends in Incidence, Mortality and Case Survival
Authors: Bonett Anton , Davy Margaret , Roder David
Published: February 2008

Summary: Approximately 90% of cervical cancers are considered preventable through regular screening and the treatment of precursor lesions, but fewer than 20% of South Australian women were found to have been screened in 1984.

Data from the State Cancer Registry have shown an increase in cervical cancer incidence of approximately 80% in women under 50 years of age in the 9‐year period to 1986, but a decrease of about 25% in older women. Mortality data have shown similar patterns by age, although the increase in younger women tended to extend to an older age.

Case survival was unchanged between the diagnostic periods 1977–1981 and 1982–1987 and there was little change in the proportion of cases that were adeno‐carcinomas.
The Sodoeconomic Status of Women Attending a New Zealand Colposcopy Clinic
Authors: Chang Alexander R.
Published: February 2008

Summary: An analysis of a group of predominantly Caucasian women with cervical intraepithelial neoplasia grade 3 lesions seen at the Dunedin Hospital Colposcopy Clinic during a period when it was the only colposcopic service in the region, showed that patients in the lowest socioeconomic class, as judged by two parameters unique in New Zealand were overrepresented. This finding is in agreement with the social class gradient for cervical cancer and precursor lesions observed in other countries. Poverty, more liberal sexual activity and smoking may be factors in the genesis of cervical neoplasia amongst the women studied. In providing cervical smear facilities for at‐risk women, special provision should be made for women in the lowest social stratum.
Screening for Gestational Diabetes in a Teaching Hospital in Saudi Arabia
Authors: Khwaja Suraiya S. , Al‐Suleiman Suleiman A. , Al‐Sibai M. Hisham
Published: February 2008

EDITORIAL COMMENT: It is difficult to compare the incidence of gestational diabetes in different communities unless the same methods of testing are used, and the same criteria for gestational diabetes adopted. In this paper from Saudi Arabia the authors used the same methodology and definitions as did El‐Shafei and Colleagues in the preceding paper in this issue of the journal, comparing the incidence and severity of gestational diabetes in Bahrain and Melbourne. However, it should be noted that Khwaja and colleagues estimated glucose in venous plasma whereas the other study used capillary plasma which has a higher glucose value — this probably accounts for the relatively small number of milder cases of gestational diabetes in the Saudi series.

Summary: This study was undertaken to determine the incidence and severity of gestational diabetes in our hospital population which is predominantly Arab; 455 consecutive patients were screened by a 3‐hour glucose tolerance test in the third trimester of pregnancy. The overall incidence of gestational diabetes was found to be 11% and the incidence increased with increasing maternal age, parity and weight. A high prevalence of more severe degrees of gestational diabetes was noted among the Arabs. Glucose intolerance was observed in 2 patients in the absence of any risk factor. The most common high risk factor in patients found to have gestational diabetes was maternal age of 30 years or more.
Sarcomas of the Uterine Cervix
Authors: Zhong‐ying Weng , Bin‐yan Yang
Published: February 2008

EDITORIAL COMMENT: Rarely is this journal offered a paper from China, let alone one presenting 8 cases of primary sarcoma of the cervix. Readers will be interested in the presentation, pathology and different modes of treatment in these 8 patients, 5 of whom are long‐term survivors. In the 17 years, 1971–1988, only 1 such patient has been treated at the Mercy Maternity Hospital, Melbourne: a 14‐year‐old girl who presented with a 4‐month history of bloodstained vaginal discharge. Biopsy of the necrotic mass distending the upper vagina showed an embryonal rhabdomyosarcoma (sarcoma botryoides). She is alive and well 10 years after radical hysterectomy with preservation of the ovaries (figure I A), although 15 months after hysterectomy, excisional biopsy of an anterior vaginal wall nodule showed histological features similar to those of the primary tumour. (Case report courtesy of Mr Ian Maclsaac).
Absorption of a First Trimester Fetus
Authors: White Bernadette , Beischer Norman
Published: February 2008

Summary: A case of an 8‐week fetus with ultrasound demonstrated heart beat, which was absorbed completely prior to abortion at 11 weeks' gestation, is reported.
A Case of Intrapartum Fetal Arrhythmia Creating Difficulties in Cardiotocograph Interpretation
Authors: Gray J.
Published: February 2008

EDITORIAL COMMENT: We have accepted this case for publication to show readers a problem that can occur with the interpretation of a cardiotocograph when the fetus had cardiac arrhythmia. The pattern shown in the 3 figures is an artifact caused by the machine being unable to trace a heart rate that is changing and is irregular. The Hewlett Packard fetal monitor registers the fetal heart rate only if the impulses (fetal heart rate) come in an orderly sequence. Should there be a break in the sequence, the monitor will reject it and then ‘scan’ the range for new sequential impulses — hence the broad dark tracing between 80–140 beats/minute when the irregular auscultated heart rate was 105 beats/minute. Later on when the irregular fetal heart rate rose to 140 beats/minute, the scanning range broadened to between 80–200 beats/minute. In such cases the clinician should rely on clinical auscultation of the fetal heart rate and other signs of distress such as the presence ofmeconium or fetal scalp blood sampling if this is available.
Elective Caesarean Hysterectomy. Indications and Outcome: A 17‐Year Experience of 140 Cases
Authors: Bukovsky Ian , Schneider David F. , Langer Rami , Arieli Shlomo , Caspi Eliahu
Published: February 2008

EDITORIAL COMMENT: Elective Caesarean hysterectomy for sterilization alone or for sterilization when there is other gynaecological pathology present (fibromyomas, menorrhagia) is not widely practised in Australia in so far as this editor is aware. This is quite different from results of practice reported from the United States of America or, as this paper reports, in Israel. This paper reports remarkably good results that justify the authors' practice of performing more than 5 Caesarean hysterectomies electively for every 1 performed as an emergency procedure (140 versus 26). It is not always easy to decide when a Caesarean Hysterectomy is elective; if the patient has many children and especially if she has had several Caesarean sections, then ‘difficulty with haemostasis’ or ‘a defective lower segment scar’ can become an ‘indication’ for emergency Caesarean hysterectomy. In this series the total incidence of Caesarean hysterectomy was 1 in 396 confinements (166 in 65,723); the incidence was 1 in 470 for elective and I in 2,528 confinements for emergency Caesarean hysterectomy. For perspective and contrast, readers are referred to Emergency Hysterectomy in Obstetrics ‐ a Review of 117 Cases A l‐Sibai MH, Rahman J, Butalack F. Aust NZ J Obstet Gynaecol 1987; 27:180–184. Table 1 below shows the total experience of Caesarean hysterectomy at the Mercy Maternity Hospital, Melbourne, where religious considerations preclude the practice of sterilization procedures. It is seen that the operation was performed 1 in 1,098 confinements and that in 70% of cases (46 of 66) the patient had had a previous Caesarean section. This table shows little change in the indications for Caesarean hysterectomy in the 16 years reviewed, apart from the remarkable increase in the incidence of placenta praevia accreta, an increase that cannot adequately be explained by the increasing Caesarean section rate.

Summary: In an earlier report of 86 elective Caesarean hysterectomies (1970–1979) we showed that the operation was associated with few complications but a high blood transfusion rate.

In this paper we report an extended series comprised of 140 cases (1970–1986), and compare results of the 1970's series with that of the 1980's. The operative and postoperative complications were minimal during the entire period. The blood transfusion rate which was 64% in 86 cases of the 1970–1979 period decreased to 17% in 54 cases of the 1980–1986. Our results show that Caesarean hysterectomy is a safe procedure with some long‐term advantages; therefore this option should be discussed with women who ask for tubal sterilization at the time of Caesarean section.
Mid‐trimester Abortion by Extraamniotic Emcredil Versus Normal Saline
Authors: Zauva B.L. , Gupta I. , Dhall G.I.
Published: February 2008

EDITORIAL COMMENT: Midtrimester abortion using hypertonic saline (20% sodium chloride) was used extensively in the I950's‐1960's and was abandoned because of maternal deaths associated with seizures, hypernatraemia and coagulation failure, presumably due to accidental intravenous injection of the solution (or its rapid absorption into the intravascular space) resulting in cerebral infarction or haemorrhage (1,2). Intraamniotic instillation of 20% NaCl or 50% glucose was advocated as late as 1966–1969 for induction of labour in cases of intrauterine death, missed abortion, or therapeutic abortion beyond 14 weeks' gestation (3,4). It should be emphasized that normal saline (0.9% sodium chloride) is a physiological, isotonic solution which should have no such ill‐effects. It is always difficult to judge 2 solutions such as described in this paper when the regimens are complicated by use of Syntocinon infusion, which was commenced in both study groups 2 hours after extraamniotic instillation of the 2 solutions whose abortificient actions were being compared. Nonetheless the authors achieved acceptable results with the normal saline‐Syntocinon regimen described here, which justify continued evaluation of the method in a larger series of patients. Second trimester abortion is unfortunately necessary in modern obstetrics and the great variation of published methods indicate that none is entirely satisfactory.

Summary: Data is presented for 40 mid‐trimester abortions, induced by 0.1% Emcredil (Group 1 — 20 cases) and normal saline (Group 2 — 20 cases) by instillation in the extraamniotic space. It was observed that the 2 groups were comparable for age, parity and period of gestation. The mean induction‐abortion interval was 18 hours 9 minutes in Group 1 and 19 hours 19 minutes in Group 2. Abortion was complete in 45% and 65% in Group 1 and Group 2, respectively. With a cutoff time of 30 hours, there were 3 failures, 1 in Group 1 and 2 in Group 2. The induction‐abortion interval was significantly less in the more advanced pregnancies in the saline group. There was no complication in either of the 2 groups. It is hypothesized that normal saline also acts by damage of the decidual cells with liberation of pro‐staglandins locally. Also since normal saline is a cheap and easily available commodity with no contraindication for its use and no side‐effects, it seems to hold a lot of promise for induction of mid‐trimester abortion.
When Do Perinatal Deaths in Multiple Pregnancies Occur?
Authors: Fliegner John R. H.
Published: February 2008

EDITORIAL COMMENT: Dr R T O'Shea recently reported in this journal that ‘if bed‐rest in hospital is to be implemented as a possible means of improving perinatal outcome in twin pregnancy it needs to be effected between 21 and 28 weeks' gestation’ (Twin Pregnancy: Prematurity and Perinatal Mortality. Aust NZ J Obstet Gynaecol 1986;26:165). Dr Fliegner now provides us with supporting data from Victoria. Our main editorial comment remains that ‘a practical compromise could be for patients with multiple pregnancy to be rested in hospital for 2–3 days every 2–4 weeks from 20 weeks' gestation until the dangers of prematurity are past’. The problem of fetal growth retardation is another matter. Use of ultrasonography to detect discordant fetal growth and cardiotocography to detect fetal hypoxia in the last 4–6 weeks of pregnancy are an alternative to routine induction of labour at 38 weeks' gestation. As far as the editor is aware there is no published report of a controlled trial of elective induction of labour in twin pregnancy, and whether or not am‐niotomy is as effective as in singleton pregnancies; the 15% incidence of breech presentation of the first twin is another problem!

Summary: Perinatal mortality for multiple pregnancy remains at least 5 times the rate for singleton births. The major causes are neonatal deaths due to gross immaturity before 30 weeks' gestation, and stillbirths due to intrauterine growth retardation at all gestations, but especially after 32 weeks. Sixty four per cent of perinatal losses before 30 weeks' gestation occur before 26 weeks, highlighting the need to commence prophylactic measures earlier than usually recommended. The perinatal mortality in infants in multiple births weighing more than 2,500g is the same as that of singletons, but is 10 times this rate in multiple births weighing between 500g and 2,500g. Because the stillbirth rate in twins proceeding beyond 38 weeks' gestation is 3 times that of singleton births, elective termination of pregnancy is recommended if spontaneous labour has not occurred by this time.
The Influence of In‐Utero Transfer on Perinatal Mortality in a Tertiary Care Centre
Authors: Wittekind Carola A. , Arnold John D. , Leslie Garth I.
Published: February 2008

EDITORIAL COMMENT: It is often questioned at State Stillbirth and Neonatal Death Committees if deaths with avoidable factors occurred in country, peripheral or tertiary centres, and whether or not the attending practitioner was a general practitioner, specialist in training, or consultant obstetrician. This paper analyses the proportion of perinatal deaths in a tertiary centre occurring in nonbooked patients — i.e. in utero transfers expectedly these patients had a high perinatal mortality rate (152 per 1,000 livebirths), and in this study accounted for 39% of all perinatal deaths. In this study the perinatal mortality for booked patients was 10.8 per 1,000 births which was less than the overall State result although the hospital population would presumably have included a relatively high proportion of high risk pregnancies. These results are excellent and important e.g. for comparison, at the Mercy Maternity Hospital, Melbourne for the triennium 1984–1986 the perinatal mortality in 15,150 booked patients was 13.3 per 1,000; there were 508 nonbooked patients (3.2%) and they provided 30.6% (90 of 294) of all perinatal deaths. Perinatal deaths may have avoidable factors due to problems in management performed in teaching hospitals and this can occur in booked or nonbooked patients. Therefore scrutiny of the causes of perinatal death is essential in both booked and nonbooked cases although the latter, largely because of prematurity, will be associated with very high mortality rates.

Summary: From March 1, 1986 through February 28, 1989 inclusive there was a total of 8,319 births with a birth‐weight of 500 g or more at Royal North Shore Hospital (RNS). Three hundred and sixty one births (4.3%) resulted from in‐utero transfer of high risk pregnancies (IUT); the remainder were booked at RNS. There were 141 perinatal deaths of which 55 (39%) occurred in infants transferred in‐utero.
An Evaluation of Cervical Smears Consisting of Spatula and Cytobrush Samples
Authors: Chang Alexander R
Published: February 2008

Summary: Analysis of 100 paired spatula and Cytobrush cervical smear samples taken and evaluated by one person showed that the combined smear was excellent for sampling the transformation zone and for detecting lesions. However, care in obtaining and evaluating smears are still vital if false‐negative smears are to be eliminated. The greater use of the 2‐sample smear is advocated.
Advanced Extrauterine Pregnancy Mimicking Intra‐Uterine Fetal Death: Case Reports
Authors: Glew S.S. , Sivanesaratnam V.
Published: February 2008

Summary: Two cases of late second trimester extrauterine pregnancy are presented — intraabdominal pregnancy in one and an ampullary pregnancy in another. In the former the diagnosis was made only after attempts at induction of labour for fetal death with prostaglandins failed and in the latter only at laparotomy. The diagnostic and surgical problems encountered are discussed.
New Zealand Obstetricians' Management of Hypertension in Pregnancy A Questionnaire Survey
Authors: Hutton John D. , Kee Digby G. Ngan , Wilcox Frank L.
Published: February 2008

Summary: A questionnaire about the management of hypertension in pregnancy was sent to the 150 members of the Royal New Zealand College of Obstetricians and Gynaecologists. Sixty five out of a total of 77 replies were suitable for analysis. There was a wide variation in the criteria for diagnosis and the outpatient and inpatient investigation and treatment. The commonest drugs prescribed in imminent eclampsia were hydralazine as an anti‐hypertensive, and diazepam or phenytoin as anticonvulsants. All clinicians practised aggressive management with induction of delivery if significant proteinuria complicated hypertension in pregnancy. Gluco‐corticoid therapy for the premature induction of fetal lung maturity in mothers and severe hypertension was considered beneficial by some, yet contraindicated by others.
Place of Second‐look Laparotomy After 18 Courses of Chemotherapy in Epithelial Ovarian Cancer
Authors: Ngan Hextan Y.S. , VVong L.C. , Ma H.K.
Published: February 2008

Summary: Thirty‐two patients with epithelial carcinoma of the ovary underwent a second‐look laparotomy after the completion of an average of 18 courses of adjuvant chemotherapy. Nine patients (28%) were found to have persistent disease. This low‐rate of positive second‐look laparotomy is probably because these patients received chemotherapy for 18 months and in those patients whose tumour did not respond to the medication, the disease would progress and the patient died without becoming a candidate for laparotomy.

There was no stage 1c patient whose second‐look laparotomy was positive and the need for second‐look laparotomy is questionable in such patients. Stage 111/ IV patients and patients with recurrence had a significantly higher positive second‐look laparotomy rate than stage Ic/II patients, 44% and 7% respectively. In the present group of patients with positive tumour at second‐look laparotomy, 33% responded to further debulking operation and chemotherapy and remained disease free 15–33 months after completion of their second line chemotherapy treatment. For second‐look laparotomy to be of maximum benefit to the patient, we recommend that it be performed after 12 courses of chemotherapy.
Peritoneal Washing Cytology: A Retrospective Analysis of 175 Gynaecological Patients
Authors: Lowe Elana , McKenna H.
Published: February 2008

Summary: Accurate staging is the basis for optimal therapy in the management of the gynaecological cancer patient and, in recent years, peritoneal washings are one of the techniques used to determine this, both at the initial and subsequent lapa‐rotomies.

Two hundred and four peritoneal washes were obtained from 175 patients during a 5‐year period. Fifteen cases of histologically proven intraperitoneal tumour were confirmed in 11 cases by peritoneal cytology at initial operation, a sensitivity of 73%. At second‐look laparotomy, 3 of 9 histologically proven malignancies were confirmed by cytology, a sensitivity of 33%. One false positive diagnosis was made in the series.

Prodecures to avoid both false‐positive and false‐negative diagnoses by the clinician and the laboratory are discussed, and a review of the literature is provided.
The Prevalence of Polycystic Ovaries in Thin Oligomenorrhoeic, Anovulatory Women
Authors: Eden John A. , Place Jan
Published: February 2008

Summary: Seventeen thin ojigomenorrhoeic, anovulatory women were investigated with high resolution ovarian ultrasound, laparoscopy and biochemical parameters. Nine (53%) had ultrasound, laparoscopic and biochemical evidence of polycystic ovaries (PCO), 2 (12%) had multicystic ovaries (MCO) and 6 (35%) had morphologically normal ovaries. Three patients had biochemical evidence of thyroid disease and one patient had elevated gonadotrophins. Overall, 12 (71%) of these thin oligomenorrhoeic women had an explanation in addition to their low body mass to explain their menstrual disorder.
Combined Intrauterine and Tubal Ectopic Pregnancy
Authors: Wong W.S. Felix , Mao Kenneth
Published: February 2008

EDITORIAL COMMENT: The Reports of Maternal Deaths in Australia for the 4 triennia 1973–1984 have shown that ectopic pregnancy (17 cases) ranks second only to primary postpartum haemorrhage (28 cases), ahead of rupture of the uterus (14 cases), placenta praevia (8 cases) and abmptio placentae (6 cases) as a cause of maternal death associated with haemorrhage — most commonly the intraperi‐toneal haemorrhage was undiagnosed with the patient dying at home or in transit to hospital. There are many reports that the incidence of ectopic pregnancy is increasing and the condition has a special relationship with in vitro fertilization and embryo transfer. The 2 cases of combined intrauterine and tubal ectopic pregnancies reported here are more than anecdotal; both were initially undiagnosed because of the known presence of an intrauterine pregnancy. The authors provide a useful discussion of the rules to keep in mind for early diagnosis of this potentially dangerous condition.
Pulsatile Ovarian Fossa Ectopic and the ‘Morning After’ Pill
Authors: Paraskevaides E. C. , Daw E.
Published: February 2008

EDITORIAL COMMENT: This case report was accepted for publication mainly to remind readers that withdrawal haemorrhage does not exclude pregnancy, in‐trauterine or extrauterine, when ‘morning after’ pills are prescribed. These patients also require an appropriately‐timed HCG assay, oestrogen and/or progesterone assay or ultrasonography. The pulsatile nature of this ectopic gestation, whether ovarian or primary peritoneal, is unusual. Conjecture on aetiology is unwarranted without knowledge of the time in the menstrual cycle that morning after pills were taken.
Outcome of Pregnancies Complicated by Epilepsy in Tasmania 1981–1988
Authors: Sonneveld S. W. , Correy J. F.
Published: February 2008

EDITORIAL COMMENT: Epilepsy and asthma are the neglected major medical diseases of pregnancy challenging in importance (prevalence, maternal and perinatal mortality and morbidity) essential hypertension, chronic renal disease and diabetes. This issue contains 2 complementary papers on epilepsy and pregnancy: the large Tasmanian community series confirms the significant increase in fetal abnormalities and other pregnancy complications; the South Australian teaching hospital series confirms the association with fetal malformations and antenatal complications and also discusses the medical management of epilepsy in pregnancy and how the 2 conditions influence each other.

Summary: Epilepsy in pregnancy is associated with an adverse pregnancy outcome. In 347 pregnancies in an 8‐year retrospective study of all private and public patients in Tasmania from 1981 to 1988, epilepsy was found to be associated with an increased risk of hypertension (21%), antepartum haemorrhage (4.9%), postpartum haemorrhage (11.2%), fetal abnormality (3.5%) and perinatal mortality (2.3%).
Correlation between Human Placental Lactogen Levels and Glucose Metabolism in Pregnant Women with Intrauterine Growth Retardation
Authors: Bagga Rashmi , Vasishta Kala , Majumdar S. , Garg S. K.
Published: February 2008

Summary: Twenty pregnant women with fetal growth retardation and 20 pregnant women with appropriate for gestational age fetuses (controls) were recruited after the 28th week of gestation. Samples were collected for estimation of serum insulin and human placental lactogen (HPL) levels in the fasting state and a glucose tolerance test was carried out on all the subjects. The results showed the glucose and HPL levels to be significantly lower in the fetal growth retardation group compared to controls. There were no differences in the fasting serum insulin levels in the 2 groups. Fetal growth retardation appears to be linked with the absence of development of the physiological ‘diabetogenic’ state in the second half of pregnancy. This maternal hypoglycaemic state is associated with low HPL levels and not with raised maternal insulin levels as measured in the fasting state.
Syringoma ‐ An Unusual Cause of Pruritus Vulvae
Authors: Carter Jonathan , Elliott Peter
Published: February 2008

Summary: A case of syringoma of the vulva causing severe vulval pruritus is presented. The patient was thought to have either vulval dystrophy or nonspecific inflammation. Unexpectantly the diagnosis of syringoma was made on pathological examination of biopsy specimens. This unusual case is presented as the presenting symptoms and macroscopic appearance was atypical for syringoma.
Primary Amenorrhoea in a Triple X Female
Authors: Itu Mohapatra , Neelam Taneja , Ammini A.C. , Kucheria K.
Published: February 2008

Summary: The incidence of trisomy X in the newborn population is estimated to be 1 in 1,000 liveborn females. Most of them have normal physical appearance and puberty. Therefore, the reported number of triple X females in the literature is low. We herein report one patient with triple X chromosomes, primary amenorrhoea and normal intelligence. Steroid hormonal levels, clinical and ultrasound findings were suggestive of ovarian failure/gonadal dysgenesis. This case emphasizes the need for chromosomal analysis in women presenting with premature ovarian failure leading to primary or secondary amenorrhoea.
In‐Vitro Fertilization: A Neonatal Paediatrician's Perspective
Authors: Doyle Lex W.
Published: February 2008

EDITORIAL COMMENT: This thoughtful essay has no summary; we provide this comment to make sure readers do not miss the ‘conclusion’ or the important audit of the clinical results achieved at the Royal Women's Hospital Intensive Care nursery, 1986–1988. Neonatal paediatricians are not the only ones who question modern obstetric practice — there is often debate at stillbirth and neonatal death committees of the Consultative Council on Obstetric and Paediatric Mortality and Morbidity attended by the editor as to the wisdom of many Caesarean sections performed at or before 26 weeks' gestation because of severe preeclampsia or severe fetal compromise — unfortunately many of these women require a classical Caesarean section because the lower segment is poorly developed. Of course there is no good news at mortality meetings and one must turn to the data from the perinatal units to see the overall survival rates for early deliveries. In Victoria in 1987, the perinatal mortality rate for infants with birth‐weight 500 g or above was 11.0 per 1,000 births (677 of 61,090), the neonatal death rate being 4.7per 1,000. However, the perinatal mortality rate was 738 per 1,000 births in the group of 294 infants with birth‐weight 500–999 g. In 1987 there were 46 deliveries by Caesarean section before 28 weeks' gestation and the results were 5 stillbirths, 14 neonatal deaths and 27 survivors. Results of intensive care of extremely low birth‐weight infants would suggest that the current Caesarean section rate in high risk pregnancies before 28 weeks' gestation should not be extended. One has only to read our newspapers to learn the problems of provision of resources for intensive care — individual parents and their paediatrician may press for increased availability of the new technology for any liveborn infant but there is a limit to what the State can afford — it could be argued that the neonatal intensive care facilities currently available in Australia are adequate.
Depo Provera: A Profile of Current Users
Authors: Jarman Heather , Kovacs Gabor T. , Westcott Mary
Published: February 2008

Summary:This retrospective study reviewed the current users of Depo‐Medroxy‐Progesterone‐Acetate (Depo‐Provera) from April to June, 1987, within the Family Planning Association of Victoria's Richmond Clinic. The profile that emerged from the study showed the clients were of average intelligence, well informed, had tried other methods of contraception, had a high number of unplanned pregnancies and chose to use Depo‐Provera as other methods of contraception were unsuitable.
The Antiprogesterone Steroid, RU 486 (Mifepristone)
Authors: Permezel M.
Published: February 2008

Summary: RU 486 (Mifepristone) represents a major development in the field of hormone antagonists as the first effective antiprogestogen. A number of therapeutic roles for the drug are envisaged. It is already being used extensively around the world for the procurement of first trimester abortion — particularly in combination with prostaglandins. It also has been shown to be effective as a cervical ripening agent and for the induction of labour. Initial human studies have involved nonviable pregnancies and more work is needed in animal models before the drug can be deemed safe for use in viable human pregnancies in the third trimester.