bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endocrinology of Ovarian Stimulation for In Vitro Fertilization
Authors: Kerin J. F. , Warnes G. M. , Quinn P. , Kirby C. , Godfrey B. , Cox L. W. 
Published: February 2008

Summary: Understanding of the endocrinology of in vitro fertilization has advanced rapidly in the past 5 years. Despite a multitude of ovarian stimulation regimens a particular regimen has not demonstrated a marked superiority. In principle the achievement of high FSH levels during the early follicular phase to recruit a maximum number of follicles with a tolerable degree of asynchrony for final maturation is confined to a limited time span or ‘FSH window’ of about 3 to 4 days before negative E2 feedback induces below‐threshold FSH levels, thereby condemning all subsequent follicles in that cycle to atresia. It appears that one can widen and/or amplify the ‘FSH window’ too far from gross hyperstimulation resulting in the recruitment of many follicles with an intolerable degree of asynchrony. This may lead to a defective endocrine environment for the oocytes contained within these follicles or an abnormal luteal environment and an increased frequency of fertilization, cleavage and implantation failure.Whichever regimen is used, the stimulation should ideally be sufficient to promote the development of at least 3 follicles beyond 18mm diameter at the time of OPU. This can be expected to result in at least 2 embryos to be available for transfer. Monitoring of follicular response by a combination of E2 and ultrasonic parameters is recommended so that the administration of HCG is given close to the anticipated endogenous rise of LH. This can be achieved by detecting a reduction in the rate of E2 rise (to plateau). A plateau in E2 in the absence of follicles of preovular diameter (e.g. < 18mm) may be followed by a secondary acceleration phase and associated follicle growth. Timing of OPU from the start of the LH surge tends to result in embryos which give rise to a higher pregnancy rate. This natural timing of OPU may give the recruited follicles time to achieve their maximum potential by correction of asynchrony and development of better oocytes. Permitting the natural mid‐cycle events to occur may also minimize disruption of the critical follicular to luteal phase transition period. Luteal phase deficiencies as detected hormonally do not appear to be a feature of either moderate Clomid or Clomid+HMG stimulation regimens, provided women with disordered follicular phase endocrine responses are identified and not subjected to laparoscopy. Luteal phase plasma progesterone concentrations in the conceptual cycles begin to diverge from the nonconceptual groups by day +5 after OPU and become significantly higher by day +10. This difference is likely to be a result of successful implantation rather than an intrinsic luteal defect in the nonconceptual cycles.
Intravenous Labetalol and Intravenous Diazoxide in Severe Hypertension Complicating Pregnancy
Authors: Michael C. A. 
Published: February 2008

Summary: The results of a prospective trial to evaluate the use of diazoxide and labetalol given intravenously in the management of severe hypertensive disease in pregnancy are presented.Both drugs had an efficient hypotensive action. The reduction in blood pressure in the labetalol group was better controlled and this may be a factor influencing perinatal outcome.Because of the freedom of maternal and fetal side‐effects, labetalol given by intravenous infusion is a more appropriate drug for use in the management of hypertensive crises occurring in pregnancy and labour.
The Realities of Screening for the Small for Dates Fetus Using Ultrasound Measurement
Authors: Duff G. B. 
Published: February 2008

EDITORIAL COMMENT: This study stresses that only a proportion of small for dates fetuses suffer intrauterine starvation, and questions the value of routine screening with ultrasound for their indentification. We agree that not all small for dates fetuses are at risk, and on the other hand, many at risk of intrauterine hypoxia and death are not by definition growth retarded. To recognize and treat the fetus with intrauterine starvation, tests for fetoplacental function (oestriol assay, cardiotocography) are necessary and are complementary to, not competitive with, ultrasonography.Summary: Screening for the small for dates fetus using ultrasound measurement of the fetal abdominal circumference resulted in a significantly increased rate of diagnosis compared with clinical examination. However, when the perinatal mortality and morbidity amongst infants with a birthweight less than the 10th percentile for gestation in the screened group was compared with that of similar infants in a nonscreened groups who attended the same antenatal clinic but who either booked or were referred late, there was no significant difference.
Meconium Aspiration — Role of Obstetric Factors and Suction
Authors: Benny Peter S. , Malani Seleima , Hoby Mark A. , Hutton John D. 
Published: February 2008

Summary: Meconium aspiration occurred in 66 of 120 infants with meconiumstained liquor admitted to a Neonatal Unit. Four of the 66 infants died, whilst 17 others required ventilatory support. Meconium aspiration syndrome, especially when severe, was more likely if the mother was a smoker, hypertensive, anaemic, Maori or the pregnancy was greater than 42 weeks' gestation. Meconium aspiration was also associated with thick meconium, prolonged labour, late fetal heart decelerations and inadequate suctioning of the airway at birth.Although meconium‐stained liquor is a common occurrence in labour, a bad neonatal outcome will only be obviated by vigilant intrapartum care and active suctioning of the infant's airway at birth. Once aspiration has occurred, intensive treatment is often required and sometimes fails.
Maternal Narcotic Addiction: Pregnancy Outcome in Patients Managed by a Specialized Drug‐Dependency Antenatal Clinic
Authors: Ellwood David A. , Sutherland Paul , Kent Chester , O'Connor Michael 
Published: February 2008

EDITORIAL COMMENT: The obstetrician's concerns regarding maternal narcotic addiction in pregnancy are ft) difficulties in recognition (ii) results of management in pregnancy and (iii) the long‐term results for mother and child — we leave to our politicians and police the problems of prevention of drug trafficking and the socioeconomic ills on which the trade flourishes! This paper reports a relatively large experience, confirming that pregnancy results are satisfactory, although there are increased incidences of prematurity and fetal growth retardation. The problems of diagnosis and long‐term follow‐up remain.The cost‐effectiveness of the numerous available antenatal screening tests is an important consideration, since together with clinical findings they provide the basis of antenatal care. Should urinary drug screening be added to the list below, which is considered by the editor to be appropriate for Australasia? Can we believe paediatric claims that babies of unrecognized addicts never escape detection after birth because of their withdrawal symptoms? The authors of this paper on questioning have stated that ‘not all babies born to our patients went through a classical withdrawal and there are certainly some who would escape detection unless a formalized abstinence scoring chart is used’ Another problem that has tested at least I Australian ethics subcommittee is whether or not urinary drug screening in pregnancy is ethical without the informed consent of the patient!Summary: A retrospective analysis has been made of the outcome of pregnancy in 174 women abusing narcotics, managed by a specialist team from a drug‐dependency antenatal clinic. These women were cared for through 182 pregnancies of greater than 20 weeks' gestation, resulting in 183 live and 5 stillbirths. The majority of patients were enrolled in a methadone programme and stabilized on the drug before the third trimester.The group was characterized by a high prevalence of previous obstetric and medical problems. The most common antenatal complications were preterm labour (24%) and anaemia (12%). Preterm delivery and small‐for‐gestational‐age each occurred in a quarter of pregnancies. The mean birth‐weight for the group was 2.746g ± 721g; mean ± S.D. Eight perinatal deaths occurred (5 stillbirths, 3 neonatal deaths). giving a perinatal mortality rate of 43/1,000.The data on narcotic abusers have been compared with similar data obtained from randomly selected public antenatal clinic patients who delivered during the same period.
Acute Fatty Liver of Pregnancy: Clinical Features and Diagnosis
Authors: Purdie Jane M. , Walters B. N. J. 
Published: February 2008

EDITORIAL COMMENT: This paper emphasizes the importance of early diagnosis of acute fatty liver of pregnancy and prompt delivery of the patient. When the clinical picture has similarities with severe preeclampsia the patient also needs immediate delivery. The associated feature of polydipsia reported here is an important observation and the writer of this review can recall a severely ill patient in labour in 1960 in whom the consulting physician diagnosed ‘temporary diabetes insipidus in labour’. If these patients do come to Caesarean section (for acute fetal distress or because the condition of the mother is serious or deteriorating rapidly) the problems of blood coagulation failure must be anticipated.Summary: Five cases of acute fatty liver of pregnancy are described. These are the only recognized cases of this disorder occurring in a 2 year period in Western Australia. Clinical and laboratory features are presented. There was no maternal death. Of the six babies, there were three intrauterine deaths, including the only set of twins. All the babies were male.Vomiting in the third trimester was the chief presenting feature in all cases, often accompanied by a systemic illness with malaise and tiredness. Extreme polydipsia was noted as a prominent symptom in all cases. The combination of moderately abnormal liver function tests, extreme leucocytosis with other blood film abnormalities, hypoglycaemia, impaired renal function, coagulopathy and gross elevation of uric acid level is regarded as highly suggestive of the diagnosis. Features of a preeclamptic illness were present in several cases.Three of the patients have since had uneventful pregnancies.The constellation of clinical and laboratory features is sufficiently characteristic to allow accurate clinical diagnosis in most cases of this disorder. The chances of both maternal and fetal survival are enhanced by early diagnosis allowing intervention in the form of prompt delivery of the infant.
Adenomyosis Uteri: A Study of 416 Cases
Authors: Raju Gangaraju C. , Naraynsingh V. , Woo J. , Jankey N. 
Published: February 2008

EDITORIAL COMMENT: This essay on adenomyosis confirms that the patient is usually a multipara with menorrhagia and uterine enlargement, often with associated fibromyomas — this sentence also describes the type of patient coming to hysterectomy whose uterus does not show the histological features of adenomyosis. It would be interesting to see these clinical features documented in a prospective series to test the strength of the correlation between adenomyosis and menorrhagia with regular uterine enlargement. The editor was interested to note the absence of uterine tenderness and low incidence (10%) of dyspareunia in this series, since his clinical impression is that the multipara with menorrhagia and uterine enlargement often has a tender uterus which in the hands of the pathologist shows evidence of adenomyosis. Perhaps an interested reader will examine this impression scientifically!Summary: Adenomyosis was noted in 16% of 2,616 consecutive hysterectomy specimens examined during a 7‐year period. Multiparas between the ages of 30 and 50 years were most commonly affected. Abnormal uterine bleeding was the common symptom. Myohyperplasia and leiomyomas were the usual associated lesions. Adenomyosis uteri was seen equally in women of African, Indian and mixed races in this West Indian population.
Can The Fetus Cause Plaeental Separation?
Authors: Eden John 
Published: February 2008

EDITORIAL COMMENT: Many years ago Dame Kate Campbell told us that she believed the long fingernails of the postterm fetus was the possible cause of trauma to membranes and decidua permitting entry of amniotic fluid into the maternal circulation when this complication occurred before the onset of labour. The case notes and figure 1 in this paper suggest that the fetus can cause plaeental trauma by kicking!Summary: Two cases of painless antepartum haemorrhage are presented, in which it would seem the likely explanation was fetal trauma to the plaeental edge. The value of an immediate ultrasound scan is emphasized.
Ethinyl Oestradiol and D‐Norgestrel is an Effective Emergency Postcoital Contraceptive: A Report of its Use in 1,200 Patients in a Family Planning Clinic
Authors: Bagshaw Susan N. , Edwards Diana , Tucker Alison K. 
Published: February 2008

Summary: We describe a prospective study of 1,200 patients using the Yuzpe regimen of hormonal postcoital contraception.There was an 85% follow‐up rate, and of the 1,015 patients followed there were 13 pregnancies, giving a pregnancy rate of 1.3%. The number of expected pregnancies at mid‐cycle was reduced by 83%; 12 of the 13 pregnancies went on to abortion. The patients were young: 86% were under 25, and 10% were under 15. The most frequent reason for presentation was that no contraception had been used (57%). All patients received an antiemetic; 57% experienced no side‐effects, 28% had some nausea and 9.6% some vomiting.
An Evaluation of Transcutaneous Electrical Nerve Stimulation for Pain Relief in Labour
Authors: Thomas I. L. , Tyle V. , Webster J. , Neilson A. 
Published: February 2008

EDITORIAL COMMENT: It is undeniable that fashion determines details of management in obstetric practice e.g. techniques of antenatal preparation, place of birth, position at birth. Methods of pain relief in labour have also varied, but in recent years the trend has been towards an increased use of epidural analgesia on the one hand, and a wish to avoid conventional methods of analgesia altogether on the other! It is against this background that transcutaneous electrical nerve stimulation (TENS) has been introduced into labour wards in many hospitals. This careful, large study tackles the difficult task of critical appraisal of patients' perception of pain in labour and its influence by TENS. The authors have shown that although the method does no harm, it probably does little good and they do not advocate its widespread introduction for routine use in labour.Summary: The effectiveness of transcutaneous nerve stimulation (TENS) for pain relief in labour was evaluated by randomizing 280 patients in early labour into 2 groups. Inoperative sham machines were applied to patients in the control group and active units to those in the test group. Neither patients nor attending labour ward staff were aware of which group the patient was in. The intensity of low back pain and abdominal pain was assessed by the patient each hour on a visual analogue pain scale. Each patient served as her own control by switching off the machine for 2 contractions every hour and then recording the intensity of pain. The amount of conventional analgesia each patient received was recorded by labour ward staff.There was no difference in the intensity of pain recorded by each group. Nor was there any difference between the 2 groups in the change of pain experienced when the machine was switched off. Moreover there was no difference in the amount of other analgesia required. Some differences were found when those with little low back pain were excluded from the study.We conclude that TENS is ineffective as a routine method of pain relief in labour. It is likely to benefit only those with severe back pain and then only to a modest degree.
Post‐Caesarean Wound Infection: A Review of the Risk Factors.
Authors: Webster Joan 
Published: February 2008

EDITORIAL COMMENT: This paper presents a careful appraisal of infection rates after Caesarean section in a teaching hospital. The overall infection rate was 9.4% which seems low in view of the fact that the criteria for infection were unusually strict although these did not include pyrexia; in 2.4% of patients the infection was deep with drainage of purulent material. Wound sepsis is important because of patient morbidity and cost, hospitalization being increased in this series by 2 days when wounds became infected. Such studies are difficult, because antibiotics are used widely (39% in this study) and even in those with more severe degrees of pyrexia (above 38d̀ C on 2 or more occasions), 74% of patients in this series had no evidence of wound infection. Another problem inevitable in such a study is that there is no record of wound problems after the patient was discharged from hospital. It would be helpful to know if the patients who develop stitch abscesses or breakdown of the wound after discharge from hospital are those who receive prophylactic antibiotics or antibiotic therapy because of pyrexia. In many hospitals it is common practice for the surgeon to give antibiotic therapy if the patient develops pyrexia; usually bacteriological studies are not performed in such patients since there is no discharge to culture. It is also difficult to know how to interpret the bacteriological findings in the 28% of patients whose troublesome wounds were cultured.Summary: In a prospective study of 1,546 patients delivered by Caesarean section a wound infection developed in 146 (9.4%); the rate was significantly higher in clinic patients (15.8%) compared with private patients (6.0%). Elective operations resulted in a lower incidence of wound infection (7.9%) than emergency operations (12.3%). Other factors significantly associated with postoperative wound infection were: the number of vaginal examinations before surgery (p<0.05), duration of operation (p< 0.005), vertical skin incision (p<0.05) and category of surgeon (p<0.001). In 56 patients for whom a past history was available, there was a record of a wound infection in 31 (55%). Clinic patients were over‐represented in all situations predisposing to wound infection.
A Controlled Trial on Wound Drainage in Caesarean Section
Authors: Loong Richard L. C. , Rogers Michael S. , Chang Allan M. Z. 
Published: February 2008

Summary: A randomized controlled trial was carried out to investigate the influence of drainage on wound infection following Caesarean section.The incidence of clinical wound infection was significantly reduced if a Redivac suction drain was placed beneath the rectus sheath. Subcutaneous corrugated drains were found to offer no advantage.Three different degrees of postoperative pyrexia are examined for their predictive value for the development of wound sepsis.The influence of duration of amnion rupture and the number of vaginal examinations in labour on the postoperative incidence of wound infection and pyrexia are examined.
Stillbirths in Western Australia 1980–1983: Influence of Race, Residence and Place of Birth
Authors: Alessandri Louisa M. , Stanley Fiona J. , Waddell Vivienne P. , Newnham John 
Published: February 2008

EDITORIAL COMMENT: The stillbirth rate in Western Australia for infants with birth‐weights of at least 1,000 g is commendably low at only 4.91 per 1,000 births. The authors' analysis shows that stillbirths of unknown cause are the largest group (table 3), and most of these occur at term, but before labour (table 2b). We respectfully disagree with the authors' comment that because these deaths are of unknown cause, that few are potentially avoidable/preventable by better obstetric care. The table below shows the neonatal death and stillbirth rates for Victoria for infants with birth‐weight of 1,000 g or more. Although the death rates have not reduced significantly in the past 2 years we believe that further improvement is possible; even if the stillbirth rates in Western Australia for 1984, 1985 and 1986 are the same as for 1983, we should not be prepared to accept that the limits of current obstetric care to favourably influence stillbirth rates have been reached. It should be stressed that this large group of stillbirths of ‘unknown cause’ occur in potentially salvageable infants who are mature and not malformed. The research required to prevent a significant proportion of these deaths may be no more than routine testing of glucose tolerance to diagnose all cases of gestational diabetes.Summary: All stillbirths in Western Australia from 1980–83 weighing 1,000 g and over were identified from perinatal death certificates, and their causes and demographic correlates described.The stillbirth rate was 4.91 per 1,000 total births; nearly 65% were antepartum, 25% intrapartum and in 10% the time of death was unknown. The cause of death of most stillbirths was unknown (52%) or associated with lethal congenital malformations (13%), antepartum haemorrhage (12%) or maternal hypertension (8%).Whilst Aboriginal women had much higher stillbirth rates (10.80) than non‐Aboriginal women (4.57), their patterns of time and causes of death were similar. Both antepartum and intrapartum stillbirth rates were much higher at low birth‐weights and low gestational ages in both racial groups.Women living in rural areas who delivered in the metropolitan area had much higher antepartum (11.02) and intrapartum (3.31) stillbirth rates than either rural women delivering in rural areas (1.89 and 1.34) or metropolitan women delivering in the metropolitan area (2.72, 0.98). This reflects the transfer of rural high risk pregnant women or those with fetal death in utero, for delivery in metropolitan specialist hospitals.