bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fibroid Arising in a Mullerian Duct Remnant and Presenting as a Pelvic Mass in a Patient with Vaginal Agenesis: An Unusual Finding
Authors: Baker James , Buttini Melissa 
Published: February 2008

EDITORIAL COMMENT: We accepted this case because of its anecdotal interest and also to stress the message that a pelvic mass in a woman with known Mullerian tract anomalies merits an intravenous pyelogram to check on the presence and positions of kidneys and ureters before laparotomy is performed to remove the tumour. The histology report of the tumour gave the reviewer a moment of anxiety when ‘the duct‐like structure lined by tubal epithelium’ was described! Authors reply: The authors were well aware of the risk of pelvic kidney being involved. Unfortunately an adequate IVP was unable to be obtained in this particular centre. We improvised by identifying 2 kidneys in normal position by ultrasound scan.Summary: We report a case of vaginal agenesis associated with a large fibroid arising from a Müllerian duct remnant. Vaginal agenesis is rare and infrequently encountered by gynaecologists. Its association with a pelvic mass is even more uncommon, and a medline search by the authors has failed to uncover another reported case. We provide the clinical details of this case and discuss the differential diagnoses.
Indications for Blood Transfusion in Pregnancy With Sickle Cell Disease
Authors: El‐Shafei Affaf M. , Dhaliwal Jagjeevan Kaur , Sandhu Amarjeet Kaur , Al‐Sharqi Mona Rashid 
Published: February 2008

EDITORIAL COMMENT": These authors have previously reported the importance of sickle cell anaemia as a cause of maternal mortality in Bahrain (A). We have accepted this paper for publication although sickle cell anaemia is rare in Australia so that our readers can see the lesson learnt from this very large experience of 571 cases, namely that prophylactic blood transfusion is not indicated unless the haemoglobin value falls below 6 g/dL. We presume that all of these patients would require blood to be cross‐matched and available at delivery in case of postpartum haemorrhage.Summary: In order to assess the value of prophylactic blood transfusion in the management of pregnant patients with sickle cell disease, a study was conducted on 571 sickle cell disease pregnancies. These patients were divided into 2 groups, one with prophylactic transfusion and the other with restricted transfusion. In spite of the reduction in the incidence of blood transfusion the rate of preterm labour, intrauterine growth retardation, perinatal mortality and maternal mortality were similar in both groups.A restricted blood transfusion policy can be safely followed without compromising fetal or maternal well‐being with an additional benefit of reducing the incidence of transfusion related crises and other complications.
Invasive Cervical Cancer in Pregnancy
Authors: Allen David G. , Planner Robert S. , Tang Peter T. M. , Scurry James P. , Weerasir Tilak 
Published: February 2008

EDITORIAL COMMENT": Readers are advised to give this paper careful attention. It reports a large experience of treatment of invasive carcinoma of the cervix during pregnancy and within 1 year of confinement. The authors emphasize the importance of performing a Papanicolaou cervical smear on all pregnant patients and their results show that adequate investigation including cone biopsy of the cervix is possible during pregnancy and that in the vast majority of women, treatment of the disease is possible without compromise to fetal or maternal life or health. To appreciate this paper the tables must be studied closely. It is interesting that the incidence of the disease was only 1 in 4,419 pregnancies, especially when 11 of the 22 cases had microinvasive disease with a depth of invasion of 3 mm or less. The recommended method of delivery in women with microinvasive squamous carcinoma of the cervix who have had cone biopsy during pregnancy is still not clear‐cut. Certainly vaginal delivery is possible in these women as was shown in 4 patients in this series. Further follow‐up is required to confirm the safety of this finesse.Summary: Cervical cancer is the commonest malignancy which complicates pregnancy, but the management remains controversial. We reviewed our patients in an attempt to identify the best management options which resulted in long‐term survival for the mother and a live baby. The total number of pregnancies managed between January, 1981 and March, 1995 was obtained from the hospital records, and patients with invasive cervical cancer diagnosed during pregnancy or within 12 months of delivery were identified. The case records were reviewed. Between January, 1981 and March, 1995 there were 22 cases of cervical cancer diagnosed either during pregnancy or within 12 months postpartum. This gave an incidence of cervical cancer associated with pregnancy of 1 in 3,817 pregnancies or 0.26 per 1,000 pregnancies. Eleven patients had microinvasive disease. Nine were treated by cone biopsy and 2 by radical hysterectomy. Nine patients had Stage IB and 1 had Stage 2A disease and all were treated with radical hysterectomy. One patient had Stage 3B disease and was treated witfi radiotherapy and chemotherapy followed by simple hysterectomy. Fourteen patients delivered vaginally. Twenty of the 22 patients were delivered of live babies which survived. The patients have been followed from 1 month to 13 years with only 1 recurrence, and all 22 remain alive. We conclude that all pregnant women should have a Pap smear performed antenatally. Cone biopsy can be safely performed in pregnancy and may be adequate treatment for microinvasive squamous cell carcinomas. Treatment, including the timing of delivery, must be individualized, with the patient playing an important decisionmaking role.
Combined Chemotherapy in the Medical Management of Tlibal Pregnancy
Authors: Anandakumar C. , Choolani M. A. , Adaikan P. G. , Wong Y. C. , Gopal M. , Marshall B. , Ratnam S. S. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because the regimen for medical management of tubal pregnancy by the systemic route with such small doses of methotrexate and prostaglandin seems much simpler than laparoscopic injection into the tubal pregnancy. The authors have been cautious with the management of these patients keeping them in hospital for a week after therapy. If this period of hospitalization is necessary then it distracts from the value of the method. It is difficult to see why hospitalization is more necessary in patients treated systemically than those reported by other authors where the methotrexate was introduced into the gestation sac under ultrasound control.Summary: The medical management of early unruptured tubal ectopic pregnancies is gaining acceptance internationally as an alternative to surgical procedures. This method has been shown to be effective and safe in properly selected cases and with adequate supervision. Most of the work however has been done using either methotrexate or prostaglandins. The present study aimed to evaluate the efficacy of a combined therapeutic regimen. The efficacy was noted to be at least as good but with fewer side‐effects. The treatment was effective in 18 out of 19 cases of tubal pregnancies (94.7%). One patient complained of a gastritis which resolved with antacids. One patient experienced abdominal cramps and transient hypotension probably as a profound vagal response during tubal abortion. The median time to resolution varied directly with the initial serum beta HCG level at diagnosis. All patients who responded to die therapy described the experience as painless and viewed die treatment positively as it spared diem the need for surgery and its attendant anaestiietic risks. However, we strongly recommend caution and close supervision and to keep the patient in the hospital at least for the first week of dierapy.
Absence of Fetal Corpus Callosum Associated with Intrapartum Cardiotocographic Nonreacthity
Authors: Cincotta Robert , Brennecke Shaun 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it shows an interesting association between a cerebral malformation and abnormal cardio‐tocography. Chew and colleagues have previously reported that in series of patients with evidence of critical fetal reserve detected by antenatal cardiotocography the incidence of major fetal malformations ranged from 10–12%, a figure very similar to the major malformation rate of infants of women with prepregnancy diabetes delivered at the Mercy Hospital for Women 1971–1994 (47 of 392). These authors have recommended that when time permits ultrasonographic assessment of a fetus should be performed to seek evidence of major malformations when there is evidence of severe fetal compromise on antenatal cardiotocography. Nonetheless, most infants are not malformed when this type of cardiotocograph is seen, and it is also true that many infants with a major malformation may not show an abnormal cardiotocograph. This can also apply to cases with defects as severe as anencephalus. The association between a major cerebral abnormality and an abnormal cardiotocograph seen in this case is of interest but cannot be implied universally to the interpretation of abnormal cardiotocographs apart from suggesting the need to exclude malformation with ultrasonography.Authors'reply to editorial comment:Given the currently vexatious medicolegal climate in which obstetric care and paediatric neurological outcomes feature prominently, it is worthwhile to have on record a case such as this. Specifically, an implication of this report is that, whether or not there is any demonstrable anatomical cerebral abnormality, it remains possible that an abnormal intrapartum cardiotocograph may reflect abnormal paediatric neurological function which Caesarean delivery would not influence. Other means of assessing fetal well‐being in addition to cardiotocography are required to distinguish those cases that may benefit from interventional delivery from those that would not.
Incarcerated Procidentia: A Rare Complication of Carcinoma Cervix
Authors: Kriplani Alka , Relan Supriya , Kumar Lalit , Biswal B. M. , Rath G. K. 
Published: February 2008

EDITORIAL COMMENT: The word incarcerated is defined as imprisoned; in pregnancy an incarcerated uterus is one imprisoned in the pelvis usually as a result of retroversion with presentation caused by acute retention of urine due to obstruction of the urethra. Irreducible is a more appropriate term to apply to a procidentia than incarcerated in our opinion. Rarely a procidentia is truly irreducible although a longstanding prolapse with ulceration and oedema may at first seem to be irreducible until the enterocele is progressively replaced ‐ the inexperienced practitioner may fail to replace such a prolapse if an attempt is made to reduce the anterior wall first. The anterior vaginal wall prolapses first followed by the cervix then enterocele and rectocele, and correction requires the same technique in reverse; i.e. the posterior aspect of the mass must be reduced first to correct the enterocele before the cervix and cystocele can be replaced into the vagina as is performed prior to preparation for surgery or rarely, insertion of a pessary when surgery is refused by either the patient or the anaesthetist. The editor has seen only one woman with an irreducible procidentia and in this case it had been present for many years and was extremely keratinized. We accepted the present case for publication because of its rare anecdotal interest and the excuse it provided for reminding readers how to replace a huge prolapse. It may be noted that the term procidentia means prolapse (Latin procedure: to fall forward) but it is often used as being indicative of third degree or massive prolapse. It would have been of interest to know the renal function in this woman. The case also illustrates how radiation can shrink a tumour and allow subsequent revision of treatment options when the woman does not abscond.Summary: A rare case of a huge carcinoma of the cervix leading to sudden uterovaginal prolapse and incarcerated procidentia, in a postmenopausal woman is presented. The woman presented as an emergency with severe distress. The problem was successfully managed by reducing the uterovaginal prolapse under deep sedation and starting radiotherapy as an emergency procedure at the same sitting. The role of immediate radiotherapy in the management of such an emergency situation is discussed.
Removal of Fibromyomas by Laparoscopic Surgery After Preoperative GnRH Analogue ‐ An Alternative to Abdominal Hysterectomy or Myomectomy
Authors: Wood C. , Maher P. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it reports a reasonably large experience of dealing with symptomatic fibromyomas of considerable size in women who wished to avoid or reduce the risk of hysterectomy. It should be noted that the fibromyomas in these women were unsuitable for the technique of ‘myolysis ‘reported previously by the authors. Readers interested in this subject are referred to a recent publication of patients treated in Italy where a randomized trial concluded that laparoscopic myomectomy in comparison with laparotomy myomectomy has benefits of a shorter recovery time and less postoperative pain {A). In this series of 40 patients the authors excluded those with more than 4 fibromyomas requiring removal and those with the largest fibromyoma exceeding 6 cm in mean diameter (A). Mais V and colleagues. Laparoscopic versus abdominal myomectomy: A prospective, randomized trial to evaluate benefits in early outcome. Am J Obstet Gynecol 1996; 174: 654–658. It is of interest that in this series ‘to reduce the risk of short‐term myoma recurrence, no patient underwent medical treatment for ovarian suppression before the operation.Summary: Nineteen patients with fibromyomas who had been recommended to have a hysterectomy or abdominal myomectomy were referred as they wished to avoid a hysterectomy (14) or laparotomy incision for a myomectomy (5). Following administration of the GnRH analogue goserelin, laparoscopic surgery was performed on all these patients. Hysterectomy was avoided in all but 1 of the 14 patients and laparotomy myomectomy was avoided in 4 of the 5 patients recommended to have these procedures. The combination of a GnRH analogue and laparoscopic‐based surgery may be an acceptable alternative to both laparotomy myomectomy and hysterectomy in women with fibromyomas requiring surgery.
Pregnancy and Active Wegener Granulomatosis
Authors: Parnham Alan P. , Thatcher Geoffrey N. 
Published: February 2008

EDITORIAL COMMENT: We accepted this case report not only because readers could encounter a patient with Wegener granulomatosis, but also because the use of cyclophosphamide from 22 weeks gestation did not harm the fetus. We have asked the authors to provide readers with a 100–200 word summary of the aetiology, clinical features and complications of Wegener granulomatosis.Author's response: Wegener granulomatosis is a systemic necrotizing granulomatous vasculitis of unknown aetiology with a predilection for the kidney and upper respiratory tract, especially the nose and sinuses. It classically causes acute renal failure, epistaxis, and pulmonary haemorrhage. It can however affect any organ and untreated has an 82% 1‐year mortality. It can occur at any age but is more common in elderly patients. It is very strongly associated with cytoplasmic antineutrophil cytoplasmic antibody (cANCA) which is directed against a serine proteinase 3 antigen and can be used to follow the course of the disease. Unless the patient has very localized disease, treatment always involves cyclophosphamide and high dose steroids ± plasmapheresis to obtain remission. This would then be followed by a prolonged course of azathioprine and steroid treatment.
Intrauterine Retention of Fetal Bone
Authors: Chan Norman S.T. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication although the February issue of our Journal contained a similar case (Bellingham FR. Endometrial bone formation. Aust NZ J Obstet Gynaecol 1996; 36: 109–110) because this paper gives a very careful complete review of the literature on the subject and discusses the pathology of ectopic bone formation within the uterus.Summary: A case of secondary infertility, dysmenorrhoea and menorrhagia due to retained fetal bone is presented. Retained fetal bones should be considered in all patients with infertility, dysfunctional uterine bleeding, dysmenorrhoea or other symptoms dating from a pregnancy or pregnancy termination. Ultrasound is an excellent modality for evaluating these patients. Ultrasound is also very useful for the follow‐up of patients after surgical removal of the bony fragments. Some bony fragments may be embedded in the endometrium or myometrium and may not be identified at curettage. Hysteroscopy is valuable in both establishing the diagnosis and the removal of bony fragments. A crucial aspect of the procedure involves re‐introduction of the hysteroscope to document that the cavity is clear after attempts at bone removal are complete. After removal of bony fragments, restoration of fertility and improvement of symptoms are expected.
The Effect of Intraumbilical Oxytocin on the Third Stage of Labour
Authors: Özcan Tülin , Sahin Güler , Senöz Selim 
Published: February 2008

SummaryThe umbilical vein administration of oxytocin in saline was compared with umbilical vein saline alone and the traditional management of the third stage of labour. Seventy‐two women were randomized to 3 groups. Group 1 received intraumbilical 20 IU of oxytocin diluted to 40 mL with saline. Group 2 received intraumbilical vein 40 mL of saline while subjects in group 3 were managed according to the standard protocol without any intraumbilical injection. No significant differences were found in terms of the length of the third stage, the blood loss in the third stage and postpartum haematocrit differences among the 3 groups. The administration of diluted oxytocin or saline do not seem to have any superiority to the traditional management of the third stage of labour.
Sharing Antenatal Care: Client Satisfaction and Use of the ‘Patient‐held Record’
Authors: Webster J. , Forbes K. , Foster S. , Thomas I. , Griffin A. , Timms H. 
Published: February 2008

SummaryTwo hundred women (148 shared care patients and 52 clinic patients) completed a questionnaire about care received during pregnancy and the use of a patient‐held record. Women receiving shared care reported higher levels of satisfaction with their care than clinic patients (p<0.0001). Thirty‐six percent of the women in shared care forgot to take their record to an appointment on at least 1 occasion. During the pregnancy, over half of the respondents in both groups made contact with the hospital for reasons other than for their regular visit. For both groups, convenience was the most frequently reported reason for choosing their model of care. Other important issues for shared care patients were that the service was more personal and more information was provided. Among clinic patients, safety and quality of care were identified as important. Problems involved with the patient holding the only complete pregnancy record are discussed.
National Trends in Gynaecological Endoscopic Surgery
Authors: Molloy David , Crosdale Sue 
Published: February 2008

SummaryEndoscopic or minimal access surgery promises less postoperative pain and decreased hospitalization. It is also a more reliable diagnostic tool than some conventional diagnostic procedures. The Medicare database was analyzed over 4 sequential financial years (1991–1992 to 1994–1995) to assess trends in utilization of endoscopic procedures in the private sector. Hysteroscopy is slowly replacing dilatation and curettage as a diagnostic procedure. Endometrial ablations are decreasing. A higher proportion of adnexal procedures and ectopic pregnancies are being managed endoscopically. Laparoscopically‐assisted hysterectomies are slowly increasing. However data from the last 2 financial years suggests that the trend to endoscopic procedures is stalling with laparotomy still being extensively used. This may indicate an increased need for education and workshops by responsible organizations to extend the potential benefits of endoscopic surgery to more patients.
Combination of Vaginal Ultrasonography and Pipelle Sampling in the Diagnosis of Endometrial Disease
Authors: Kayak Zehra , Ceyhan Nejat , Pekin Sakip 
Published: February 2008

SummaryIn this article, we aimed to investigate the value of Pipelle endometrial sampling with and without sonographic measurement of endometrial thickness in the diagnosis of endometrial disease. We studied prospectively 78 patients scheduled for dilatation and curettage in order to evaluate abnormal uterine bleeding. Sonographic measurement of the endometrial thickness and endometrial sampling with the Pipelle were performed before the curettage. The accuracy of ultrasonography and the Pipelle sampling was measured against the final diagnosis. In 68 cases (87.1%), the endometrial histological results of curettage agreed with those of the Pipelle sampling. Pipelle endometrial sampling had a sensitivity of 73% and a specificity of 100% for endometrial disease. The use of ultrasonography increased the sensitivity of the Pipelle aspiration from 73% to 90%.
Inappropriate ADH Secretion Due to Immature Ovarian Teratoma
Authors: Lam S.K. , Cheung L.P. 
Published: February 2008

SummaryInappropriate antidiuretic hormone secretion syndrome (IADHS) is usually associated with postoperative pain, stress, chest infection, drugs or carcinoma. It is rarely found in patients with gynaecological malignancy. IADHS was found in a 17‐year‐old girl with an immature ovarian teratoma. Hyponatraemia was persistent and did not respond to fluid restriction therapy before the operation. The plasma sodium level however returned to normal after the removal of the tumour. This is the first reported case of IADHS due to an immature ovarian teratoma or germ cell tumour.
Outcomes of Induced Labour
Authors: Robson Stephen , Pridmore Brian , Dodd Jodie 
Published: February 2008

EDITORIAL COMMENT: This observational study makes the valuable point that the outcomes of labour and delivery where labour was induced for nonmedical indications, were comparable for the outcomes of spontaneous labour. As the authors point out this challenges the premise of the RACOG Obstetric Indicator which suggests that induction of labour for ‘nondefined’ indications should be kept to a minimum. This implies that labour can properly be induced for ‘social’ indications without concern for increasing the rate of birth complications. However, as the authors point out, this conclusion requires further testing in a prospective study where the state of the cervix is evaluated.Summary: We report a review of maternal and neonatal outcomes of labour in 1,405 pregnancies managed during a 12‐month period. This included all singleton pregnancies of greater than 20 weeks' gestation, excluding women antenatally assigned for Caesarean delivery. Labour was induced in 313 cases (22.3%), and records were available for review in 311 of these. We classified the indications for induction according to the Australian Council of Healthcare Standards (ACHS) / RACOG list of ‘defined’ indications in Obstetric Clinical Indicator number 1. In 165 cases (53.7%) labour was induced for defined indications. There was no significant difference in the rates of instrumental vaginal delivery, Caesarean delivery or adverse neonatal outcome (admission to neonatal nursery in the first 24 hours of life; 5 minute Apgar score of <7) between women who laboured spontaneously and those induced for ‘nondefined’ indications. However, labours induced for ‘defined’ indications had a significantly increased rate of these outcomes.