bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Paraaortic Lymphadenectomy on 5‐Year Survival in Early Stage Cervical Cancer
Authors: Ayhan Ali , Tuncer Z. Selcuk , Ayhan Ayse 
Published: February 2008

EDITORIAL COMMENT: In this study, there was no statistical difference in survival between the 137patients who underwent pelvic and paraaortie lymphadenectomy and the 141 who had pelvic lymphadnectomy alone at the time of radical hysterectomy. However, since the 2 groups were not randomized, and since all patients with positive paraaortie lymph nodes had extended field radiotherapy plus chemotherapy, it was not possible to evaluate if paraaortie lymphadenectomy conferred a survival benefit. The authors consider that paraaortie lymphadenectomy is an essential part of surgical staging in patients with early cervical cancer for the purpose of prognosis, but its effect on survival for the small proportion with involved paraaortie nodes remains unclear.Summary: This study includes 278 patients with Stages 1 and 2 cervical cancer subjected to type 3 hysterectomy and lymphadenectomy. The incidence of lymph node metastasis and effect of paraaortie lymphadenectomy on 5‐year survival were evaluated. The overall incidences of pelvic and paraaortie lymph node involvement were 24.1% and 8.0%, respectively. The overall 5‐year survival rate was 83.8%. The 5‐year survival of patients subjected to both pelvic and paraaortie lymphadenectomy was found to be 84.6%; the figure was 80.9% for patients subjected to only pelvic lymphadenectomy. No statistical difference in survival was found between patients with and without paraaortie lymphadenectomy.
Symphysiotomy for the Trapped Aftercoming Parts of the Breech: A Review of the Literature and a Plea for Its Use
Authors: Menticoglou Savas M. 
Published: February 2008

EDITORIAL COMMENT: This is a scholarly clinical essay and we commend it to readers even if they feel symphysiotomy is not an option in their armamentarium — it will at the very least provide an excellent revision of the possible mechanisms of difficult breech extraction. This paper is a masterpiece with the right amount of repetition to make its central point.Summary: The most dreaded complication of vaginal breech delivery is entrapment of the aftercoming head. When this is due to disproportion, persistent attempts at vaginal extraction are likely to result in a dead or damaged baby. A largely unknown solution in this desperate predicament is to surgically enlarge the pelvis by means of a symphysiotomy. A review of the literature shows that symphysiotomy performed to free the trapped aftercoming head will save at least 80% of babies if the procedure is performed without delay. Every obstetrician should be prepared to perform a symphysiotomy if the aftercoming head is trapped.
Correlation of Umbilical Cord Whole Blood Viscosity and the Presence of Fetal Distress at Birth: A Mathematical Modelling Study
Authors: Umapathysivam K. , Haskard K. A. , Meffin E. , Jones W. R. 
Published: February 2008

Summary: This study was designed to investigate the relationship between umbilical cord blood viscosity and clinical parameters such as maternal parity, maternal smoking, mode of delivery, sex of infant and the incidence of fetal distress at birth using mathematical modelling.The results demonstrated vaginal delivery, male infants, infants of primigravidas and low cord whole blood viscosity at a high shear rate were co‐variables and were associated with an increased incidence of fetal distress and low Apgar scores.
An Investigation of the Maternal Antecedents of Perinatal Mortality in 2 Large Teaching Hospitals
Authors: Forbes Kevin L. , King James F. 
Published: February 2008

EDITORIAL COMMENT: We wish to endorse the conclusions in this paper, namely that perinatal deaths should be classified by antecedent clinical parameters, since strategies of prevention are then more likely to be enunciated and evaluated. Spontaneous preterm labour, fetal malformations and intrauterine growth retardation are well recognised as the 3 main causes of perinatal mortality. However, the view expressed in this paper that unexplained intrauterine death is an important category, worthy of special attention, requires emphasis, even although such deaths occur in only 1 in 1,000 pregnancies (la). We consider that for inclusion in this group there should be a maturity (36 or more weeks' gestation) or birth‐weight limit (≥ 2,500 g), since prenatal investigation is more likely to reap a reward if there is focus upon salvageable infants. Ia. Beischer N A, DeGaris C N, Unexplained Intrauterine Death near Term. Aust NZ J Obstet Gynaecol 1986; 26: 99–101.Summary: Perinatal mortality reviews are a form of quality assurance, and the classification of perinatal mortality would be most useful if it assisted in strategies for prevention. Whilst the value of clinicopathological (autopsy) and separate neonatal classifications is recognized, the Whitfield classification, modified for Australian conditions and applied to 393 cases, clearly identified the major obstetric problems leading to perinatal death, and may therefore contribute to continuing improvement in prenatal care.
Conception in the Resistant Ovary Syndrome Occurring during Hormone Replacement Therapy: A Report of 2 Cases
Authors: Jequier Anne M. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication as it provides readers with a useful account of the resistant ovary syndrome and information comparing the doses of hormones in the oral contraceptive pill and hormone replacement therapy.ABSTRACT Two patients with resistant ovary syndrome are described. Both patients conceived while on hormone replacement therapy. Both women were taking the phasic preparation containing mestranol and norethisterone known as ‘Menophase’ (Syntex Pharmaceuticals Ltd). The possible mechanism of action of this type of hormone preparation in the induction of ovulation in patients with resistant ovary syndrome is discussed.
The Short‐term Outcome of Singleton Infants Delivered Before 28 Weeks' Gestation
Authors: Nicholl Michael C. , Giles Warwick B. 
Published: February 2008

EDITORIAL COMMENT: : This and the following paper present the survival rates and incidence of major impairment in infants who survive birth before 28 weeks' gestation in singleton and multiple pregnancies. Readers should consider the authors' careful words that period of gestation rather than estimation of birth‐weight is the parameter obstetricians should rely on when judging whether or not Caesarean section is indicated for a fetal indication; for singleton pregnancies the rubicon is 26 weeks' gestation. The authors consider that their findings lend further support for routine pregnancy ultrasound screening to confirm gestational age since the occurrence of problems in the second trimester can seldom be predicted.Summary: : The short‐term outcome of 271 singleton infants born at Westmead Hospital between 20 and 28 weeks' gestation, during a 5‐year period are reported. The earliest gestation at which there was a survivor was 23 weeks. Survival rates from 23‐23+6 weeks to 27‐27+6 weeks, excluding congenital abnormalities, were 8.3% to 77.5% respectively. Overall 21.9% of deaths occurred in the delivery suite, 63.4% in the neonatal period, 3.7% in the postneonatal period in hospital and a further 11% after discharge from hospital. Of survivors at 12 months, 18.8% were judged to have a major impairment.
Group B Streptococcus (GBS) and Neonatal Infections: The Case for Intrapartum Chemoprophylaxis
Authors: Garland Suzanne M. , Fliegner John R. 
Published: February 2008

EDITORIAL COMMENT: This paper presents important information concerning improvement in neonatal mortality and morbidity rates of infants born to mothers who are carriers of Group B streptococci by use of intrapartum penicillin treatment of these colonized women. These data indicate that to be effective chemotherapy must be given to the mother before delivery to minimize the risk of significant infection in the infant. Implementation of the protocol described in this paper could achieve significant improvement of neonatal results, but would not prevent stillbirths due to this infection. We still require introduction of a rapid sensitive antigen test for detection of GBS carrier status in early labour to identify those at risk patients who merit chemoprophylaxis ‐such a test could also be used to quickly identify GBS carrier status in patients with premature rupture of membranes where intrauterine infection may become established before the onset of labour. Summary: : At the Royal Women's Hospital, Melbourne over an 8‐year period (1981–1988) all public antenatal patients were screened at 32 weeks' gestation for group B streptococcus (GBS). In a total of 30,197 livebirths there were no early onset neonatal GBS infections in infants of treated asymptomatic carrier mothers. By contrast there were 27 infections with 8 deaths in an unscreened control group of private patients (total livebirths 26,915).It is recommended that GBS screening occur antenatally at 28 weeks and that intrapartum chemoprophylaxis be offered at least to those carriers with obstetric risk factors.
THE AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY
Authors: Beisdiei Norman , Brown James , Parkinson Patricia , Walstab Janei 
Published: February 2008

Summary: During the years 1971–1984 urinary oestriol excretion was tested in 51,427 patients (group 1). One or more low oestriol value was found in 10.7% of patients; in this group the stillbirth rate was 6.8 times higher, the neonatal death rate 3.8 times higher, and fetal growth retardation rate 3.5 times higher than in patients with normal oestriol values (all p 0.00001).During the years 1985–1989 a further 20,635 patients were tested (group 2) and 7.6% had one or more low oestriol value. The perinatal mortality rate in patients with normal oestriol excretion fell from 0.8% in group 1 to 0.5% in group 2 (p< 0.005), and in patients with low oestriol excretion from 4.2% in group 1 to 2.4% in group 2 (p 0.002). However, patients in group 2 with low oestriol values still had significantly unfavourable results, compared to those with normal oestriol values ‐ stillbirth rate 3.3 times higher, neonatal death rate 4.6 times higher, and fetal growth retardation rate 3.2 times higher (all p < 0.00001).Intravenous dextrose and aminoacid infusions were given to 967 patients who had persistently low oestriol values in spite of rest in hospital, in an attempt to correct fetoplacental function; the perinatal mortality rate was 0.9% in the 660 (68.3%) who responded favourably, and 9.8% in the 307 (31.7%) who did not respond (p<0.0001).Although perinatal results have improved, fetal growth retardation and the risk of perinatal death are still identified by urinary oestriol estimation.
Trends in Contraception and Sterilization in Australia
Authors: Santow Gigi 
Published: February 2008

EDITORIAL COMMENT: The purpose of this comment is to encourage readers to give this paper the close attention it deserves ‐ the summary is too modest, and the important information in the tables may be overlooked if readers do not study them in conjunction with the text. It is noteworthy that of women aged 40–44 years in 1986, 35% had had a tubal ligation, another 11% had had a hysterectomy and a further 16% of these women had partners who had undergone vasectomy. In these data, which were collected in 1986, the condom made a miserable showing as a contraceptive, but as noted by the author ‘this is not to say that coitus‐related methods may not gain some support if the motivation for their use is not entirely contraceptive ‐ sexually transmitted diseases in general and AIDS in particular’. Enquiry of the manufacturers surprised the editor by revealing that total sales of condoms in Australia (2 per person per year or 34 million per year) have increased only about 50% in the last 10 years. This is in accord with the data in this paper and indicates that there has been little change since 1986.Summary: Life‐history data collected in a national survey of women in 1986 are used to derive the first national estimates of trends in contraception and sterilization in Australia over the last 30 years. The pill rapidly became the method of choice after its release in 1961. The intrauterine device, the other truly modern method, has never attained the same popularity. The move toward sterilization dates from the early 1970s and has been so complete that women of 35 or older are now more likely to be protected by a ligation or laparoscopic sterilization than by the pill or, indeed, by all other methods combined. Unmarried women are now indistinguishable from married women on the basis of their use of contraception, and childless married women are now more likely to be using a reversible method than married women with children.
Intractable Postpartum Haemorrhage Managed by Angiographic Embolization: Case Report and Review
Authors: Duggan P. M. , Jamieson M. G. , Wattie W. J. 
Published: February 2008

EDITORIAL COMMENT: We accepted this case report because it gives a comprehensive review of a technique that should be available in all major centres although not in obstetric institutions unless affiliated with a general surgical hospital. Table I shows that angiographic embolization was successful in most cases reported in the literature but so too is ‘return to theatre’ surgery even if the patient requires more than one such journey. The case reported here was one of secondary postpartum haemorrhage. The technique of embolization is less likely to be suitable in a case of continuing primary postpartum haemorrhage after Caesarean section or Caesarean hysterectomy although this would depend upon the circumstances of the previous surgery and whether or not resuscitation and control of coagulation failure had been problems. Also a patient who has a haemoperitoneum requires reoperation; moreover, it is sometimes difficult to know whether there is a haemoperitoneum or not in these patients and this is often the case when there is a postoperative problem. The authors make the important point that bilateral internal iliac artery ligation may not control haemorrhage even from the region of the vaginal vault, a comment referred to previously in this journal This paper gives a comprehensive review of the literature on this subject and should interest many readers.

Return to theatre ‐ experience at the Mercy Maternity Hospital, Melbourne 1971–1982. Aust NZ Obstet Gynaecol 1985; 25: 159.
Internal iliac and ovarian artery ligation in the control of pelvic haemorrhage. Aust NZ Obstet Gynaecol 1989; 29: 22.

Summary: A case of intractable postpartum haemorrhage successfully managed by angiographic embolization is presented. The literature concerning angiographic embolization and internal iliac artery ligation is reviewed. Angiographic embolization is a superior method to internal iliac artery ligation in appropriately selected cases of obstetric haemorrhage, and may also be used successfully in cases where internal iliac ligation and/or hysterectomy has failed to control pelvic haemorrhage. Angiographic embolization is a potentially life‐ and fertility‐saving procedure.
Expression of Tumour Markers CA125, CASA and OSA in Minimal/Mild Endometriosis
Authors: Ward Bruce G. , McGuckin Michael A. , Ramm Louise , Forbes Kevin L. 
Published: February 2008

EDITORIAL COMMENT: This study confirms most of the findings reported by Fraser et alA in their study of serum CA‐12S levels in women with endometriosis before and after medical therapy. Both studies showed that serum CA‐125 levels were suppressed during treatment but tended to rise after treatment even in women in whom the disease had not recurred. There is an extensive literature concerning the use of serum CA‐125 as a marker of recurrence or persistence of ovarian carcinoma after treatment; it would seem that the assay is of limited value and does not for example replace the need for second look laparotomy by identification of women with residual disease requiring further chemotherapy. It is difficult to judge how troublesome raised serum CA‐125 levels due to endometriosis are to oncologists ‐ how many of their patients with ovarian cancer still have functioning ovarian tissue? We accepted this paper for publication because the authors have 2 new serum tumour markers, which apparently are superior to CA‐125 in detecting small volume ovarian cancer, and yet, as this study shows, do not show elevated levels in patients with mild endometriosis. As stated in a previous editorial comment* we require a marker for ovarian cancer that is cheap enough to apply as a screening test to identify asymptomatic lesions ‐ to be useful it must be cheaper than vaginal ultrasonography; we look forward to the results of the authors' study using these markers to screen 10,000 asymptomatic women for malignant disease; presumably this paper indicates that such a study could include premenopausal patients since the 2 markers are not tricked by endometriosis in the 23 cases reported here.

Fraser IS, McCarron G, Markham R. Serum CA‐125 levels in women with endometriosis. Aust NZ J Obstet Gynaecol 1989; 29: 416–420.
Ward BG, McGuckin MA, Hurst TG, Khoo SK. Expression of multiple tumour markers in serum from patients with ovarian carcinoma and healthy women. Aust NZ J Obstet Gynaecol 1989; 29: 340–345.

Summary: Ovarian cancer associated antigens CA125, CASA and OSA were measured in serum from 23 patients with mild endometriosis before, during and after medical therapy. Pretreatment CA125 levels were elevated above 35/ml in 4 (17%), and above 25/j/ml in 7 (30%) patients. Mean CA125 levels decreased during treatment, but in only 10 patients did levels reflect disease response. There was no correlation between CA125 levels and disease severity as measured by modified American Fertility Society Scoring. Neither CASA nor OSA were detected in these women.
Caesarean Section Rates, Australia 1986: Variations at State and Small Area Level
Authors: Renwick Manoa Y. 
Published: February 2008

EDITORIAL COMMENT: This paper presents important data regarding Caesarean section rates in the various Australian States and Territories according to metropolitan or nonmetropolitan area and whether or not the patient was medically insured or was a private patient. The different rates between the States are less than the differences between insured and uninsured patients. High Caesarean section rates increase the hospital costs of obstetric practice although it should be noted that the average number of days in hospital in Australia, after either vaginal or Caesarean delivery are about double that in the United States of America, where the Caesarean section rate exceeds Australia's ‐ but then the Caesarean section rate in China exceeds America's by a similar margin to that which the USA's rate exceeds that in Australia! What are the reasons for the very high Caesarean section rate in this nation where most women have only one confinement? Surely what needs to be settled is whether these higher Caesarean section rates are necessary ‐are we practising good medicine? Does the alarming increase in the Medical Defence Association rates for obstetricians contribute to defensive medicine and earlier decision to perform Caesarean section and satisfy the woman and her partner when the going gets tough in labour. It may be noted that 47% of all patients' claims against doctors in Victoria involve obstetricians. Patients expectations of a favourable outcome for mother and child are increasing, especially as the new technology is viewed as a guarantee of normality. Readers are referred to previous papers and comments on this subject.Summary: The first national study of Caesarean section rates was made possible by combining 1986 data from hospital morbidity collections and medicare claims. Rates per 100 births, based on the area of usual residence of the mother, were calculated for statistical local areas, which were aggregated to statistical subdivisions, statistical divisions and States.The rate for mainland Australia was 16.9% (Tasmania could not be included). Variations in rates were of the order of one and a half‐ to two‐fold. The highest rates were found in Canberra and central Brisbane (26.3% and 25.4% respectively). The rates for Northern Territory, South Australia, and Queensland were higher than those for other States.There were few consistent patterns in the variations. Generally rates were highest in the State capital cities and for insured women. This suggests an association with the supply of obstetricians and with demand factors such as the expectations of obstetricians and consumers.
A Survey of Women Undergoing a Pelvic Examination
Authors: Vella Paul V. 
Published: February 2008

Summary: This study attempts to evaluate patients' satisfaction with certain aspects of a first visit antenatal or gynaecological consultation and the reaction to and preferences during a pelvic examination.Embarrassment and apprehension were emotions experienced by at least half those surveyed and the speculum examination was uncomfortable to more women than the bimanual examination.However, less than 10% found the pelvic examination worse than they had anticipated.