bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recurrence of Pelvic Abscess Associated with a Detached Filshie Clip
Authors: Robson Stephen , Kerin John 
Published: February 2008

EDITORIAL COMMENT": We accepted this case for publication to inform readers of the possibility of a pelvic abscess occurring associated with a clip on the Fallopian tube. A case of multiple pelvic abscesses due to actinomycosis was recently reported in this journal (A) that showed some similarities to the case here described. It is agreed that pelvic abscesses associated with a foreign body require removal of the foreign body but the reviewer of this paper also cautioned that recurrent pelvic abscesses may cause chronic pelvic inflammatory disease which requires further surgery such as hysterectomy and salpingo‐oophorectomy. It is too early to conclude that this woman is cured of the pelvic infection.(A) Garland SM, Rawling D. Pelvic actinomycosis in association with an intrauterine device. Aust NZ J Obstet Gynaecol 1993; 33: 96–98.
Standard Parameters of Preeclampsia: Can the Clinician Depend Upon Them to Reliably Identify the Patient with the HELLP Syndrome?
Authors: Magann Everett F. , Chauhan Suneet P. , Naef Robert W. , Blake Pamela G. , Morrison John C. , Jr James N. Martin 
Published: February 2008

EDITORIAL COMMENT: We accepted the following 3 gapers concerned with the HELLPsyndmme (haemolysis, elwated liver enzymes and low platelets) becuuse a series of 454 cases merits attention and we asked the authors to explain how they gathered such a large series. It has been standard teaching to recommend delivery of the patient with swere preeclampsia, more or less irrespective of the period of gestation. At times this ruling is not followed when the baby is judged to be immature. There is also the question of whether betamethasone thempy should be used when these women are treated conservatively. Readers should note that the authors are not recommending comernative management of women with severe preeelampsia and the HELLPsyndrome. TWO of these 3 paperspresent results in 270f the 427patients (6.3 %)given corticosteriods when it was judged pmper practice to allow conservative management for a few days.Our senior miewer from the Royal Women's Hospitai, Melbourne, calculated that in our community we would need about 225,000pregnancies to obtain 454 cases of the HELLPsyndrome (preeclampsia 2% and the HELLPsyndmme in 10% of these). ‘The syndrome described is really one of thrornbocytopenia and hyperuricaemia. The authors do not define their criteria for haemolysis or elevated liver enzymes. The value of classijication of the severity of the HELLP syndmme on the basis of the platelet count is questioned since the worst prognosis in these cases is when there is consumptive eoagulopathy, microhaemangiopathic anaemia and epigastric pain in association with impaired liver function’.The senior author was asked to explain the source of the series and the clussification of severity of the condition and he provided the following:
Elevated Serum Alpha Fetoprotein and Normal Liquor Alpha Fetoprotein Values in Association with an Abdominal Pregnancy
Authors: Jackson Simon , Hollingworth Tony , Macpherson Marion 
Published: February 2008

Summary: A case report is described in which abdominal pregnancy was misdiagnosed by ultrasound scanning as a pregnancy within a horn of a bicornuate uterus. Two serum alpha fetoprotein (SAFP) results were greatly elevated and an amniocentesis was performed, the liquor alpha fetoprotein (LAFP) and karyotype were normal. Elective Caesarean section was performed at 38 weeks for a persistent transverse lie and an abdominal pregnancy was found. The outcome was excellent for both the mother and child.This is the first reported case of amniocentesis and measurement of LAFP in an abdominal pregnancy and confirms abdominal pregnancy as a rare cause of an elevated SAFP.
Folliculogenesis ‐ The Natural Way
Authors: Cooke I. D. , Lenton E. A. 
Published: February 2008

Summary: Natural cycle IVF (NIVF) arose from a wish to understand intrafollicular events in couples with unexplained infertility. Single follicle aspiration required unusual technical skill and a precise understanding of the endocrinology in the ostensibly normal cycle. The application of NIVF to all candidates for assisted conception resulted in a low delivery rate. However once data had accumulated it became apparent that age, follicular phase FSH concentrations and other endocrine abnormalities were associated with high failure rates. The concept of using NIVF as a preliminary screening cycle arose. By early elimination of some candidates and selective inclusion of others a highly cost effective regime can be developed. Taking delivery rates into account the cost per maternity is only half that of stimulated IVF. Using clear cut algorithms for the investigation of different categories of infertility the place of NIVF can be defined.Current UK discussions relate to exclusions from access to IVF. Biological exclusions such as age could further enhance the cost effectiveness of NIVF. When NIVF can contribute to at least 50% of cycles in an assisted conception programme it has the potential to have a major economic impact.
Folliculogenesis ‐ The Stimulated Way
Authors: Pepperell Roger J. 
Published: February 2008

Summary: The initial techniques of stimulating follicular development in the anovulatory woman involved the use of human pituitary gonadotropin (hPG) and thus replaced the function of the pituitary gland. Despite extreme care with administration of hPG and extensive monitoring to assess the ovarian response, ovarian hyperstimulation and multiple pregnancy were common. Less expensive and easier methods of treatment soon followed with oral clomiphene citrate (early 1960s), oral bromocriptine (early 1970s) and pulsatile gonadotrophin‐releasing hormone (late 1970s) being used. Currently all of these methods, alone or in combination, are employed and successful ovulation induction (except in women with elevated FSH levels) can now virtually be guaranteed.Controlled ovarian hyperstimulation, just the outcome one was attempting to avoid in the treatment of anovulatory women, has become the treatment of choice for women having in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT). The extra oocytes produced by this treatment results in more embryos being available for transfer and/or freezing and improves the overall pregnancy rate. The concurrent use of gonadotrophin‐releasing hormone agonists (GnRH‐a) has resulted in more mature oocytes being developed, less cancelled cycles for a spontaneous midcycle LH surge, and allowed even more embryos to be produced thereby increasing the pregnancy rate further to the current expected 20% per cycle commenced. As techniques are further modified, adverse effects of elevated LH levels on pregnancy and take home baby rates should be able to be overcome, and oocyte freezing and long‐term storage should become a possibility.The latest advance in treatment has been the production of pure FSH by a recombinant technique, thereby allowing anovulatory or ovulatory women to be given the pure hormone rather than one contaminated with significant amounts of LH. Normal follicular development, as assessed ultrasonically, has been observed during such treatment cycles despite the fact the oestradiol levels are low.
Vaccination for Contraception
Authors: Jones Warren R. 
Published: February 2008

Summary: Vaccination for birth control has several advantages over currently available methods of family planning and should prove an attractive addition to the contraceptive armamentarium both in developing countries and in a developed country such as Australia. Concerns have been voiced by consumer health advocates that vaccines, like other long acting contraceptive methods, may be abused by health authorities in developing countries and by their use in vulnerable groups such as aborigines in our own country. These concerns need to be recognised and addressed. More difficult to accomodate are the anxieties expressed by feminist groups about the ‘loss of control’ and ‘lack of body awareness’ inherent in a method, such as a vaccine, that is relatively easily administered and has no overt side effects. There is no evidence that these concerns are shared by women in general.The antifertility vaccine that will most likely be applied first in family planning programmes is one directed against the pregnancy hormone hCG. A WHO vaccine directed against the C‐terminal peptide of beta‐hCG provokes a specific and safe immune response and will enter Phase 2 trials in Sweden this year. Subsequent developments with this vaccine will include the replacement of the current emulsion vehicle by a delivery system based on biodegradeable microspheres which will give a more sustained antigen release and duration of effectiveness.
Prostaglandin E2, Fetal Maturation and Ovine Parturition
Authors: Young I. R. , Thorburn G. D. 
Published: February 2008

Summary: The major source of PGE2 in ovine pregnancy is the placenta, with secretion occurring bidirectionally into fetal and maternal circulations. The placental output of PGE2 appears to increase when demand on placental function is increased, suggesting that the normally observed increase in its concentration towards term is driven by the growing demands of the fetus. The fetal pituitary is also involved in the control of PGE2 synthesis. PGE2 has potent stimulatory actions on the fetal pituitary to increase both the absolute concentration and the bioactive fraction of ACTH‐containing peptides in the fetal circulation. It also directly stimulates glucocorticoid secretion from the fetal adrenal gland.We propose that PGE2 provides a tonic stimulation of the fetal HPA axis in late gestation, contributing to phenomena such as the apparent insensitivity of the pituitary to Cortisol feedback and the increasing sensitivity of the fetal adrenal. Because of its apparent responsiveness to placental workload, it may transduce stimuli from the placenta and transmit them to the fetal HPA axis, giving a possible biochemical basis to the empirically observed correlation between fetal metabolic demand and gestation length.
Computerization of Obstetric Antenatal Histories
Authors: Kohlenberg Christopher F. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it explains the basic facts of life concerning computerization of obstetric antenatal histories. The editorial committee is convinced that such a system should now be introduced into all obstetric hospitals at least for the purposes of prompt production of a discharge summary and letter to the referring practitioner. This system is easily adapted to the coding requirements for clinical audit and Diagnostic Related Group (DRG) coding now required for funding of Public Hospitals in Victoria. We encourage all readers to seek more information about these systems and to request that the administrators in the hospitals where they work at least introduce them for generation of discharge summaries and letters. The rest will follow.Summary: Computers have existed for over 40 years. Their evolution has transformed them from being merely big calculators into versatile user‐friendly machines with the possibility to interact with the operator.Within their clinical capacity one of their main benefits is within the area of quality assurance. When applied in an appropriate way in obstetrics, they can actually lead to improved antenatal care. This can be achieved through obtaining a more standardized and comprehensive patient history and the use of management suggestions, made by the computer, in response to specific items in the patient history. These suggestions are titled ‘action prompts’. Other quality assurance advantages exist within the areas of legibility and availability of individual patient files, while within a general setting they lend themselves easily to research and education.All these advantages will make computer generated antenatal histories and summaries more likely to be widely implemented in the future.
Home Deliveries and Third Stage Complications
Authors: Sawhney Harjeet , Gopalan Sarala 
Published: February 2008

EDITORIAL COMMENT: We have accepted this paper for publication not only because it tells us about the conditions under which obstetrics is practised in a very large proportion of the world's population but because, by implication, it reminds us of the importance of careful management of the third stage of labour. We learn from this paper that approximately 80% of parturients in India are cared for by an untrained birth attendant and that oxytocic agents are not available or used routinely at delivery. One can only wonder at how many maternal deaths occur in patients who are never referred to hospital. As far as the editorial subcommittee of the Journal is aware the national maternal mortality rates are not available for India and hospital figures are quoted when the proportion due to various complications are discussed. This paper does not allow comparison of third stage complications in home deliveries and hospital deliveries because the 122 cases referred to in this paper come from a population whose size is unknown. It is salutary to note from table 1 that in 13% (16 of 123) of cases the baby had been stillborn. The high incidence of uterine inversion in this series no doubt is explained by attempts at removal of a retained placenta without the use of oxytocic agents. There is a message here for us all ‐ in developed and in developing countries. The third stage of labour is a killer and requires routine management with an oxytocic drug used appropriately.Summary: Women with third stage complications following home deliveries admitted as emergencies to a referral hospital are discussed. Retained placenta constituted 68% (83 of 122) of emergencies. Primary and secondary postpartum haemorrhage was seen in 16.4% and 15.6% respectively. There was a considerable delay in referral and 31.4% patients were admitted in shock. Two patients required prolonged hospitalization. Training of traditional birth attendants in management of the third stage of labour will reduce these complications in the developing countries where approximately 80% of all births are managed by these untrained personnel who conduct deliveries at home.
Genital Mycoplasmas in Pregnancy and Obstetric Outcome
Authors: Chua S. , Arulkumaran S. , Chow C. , Leong W.P. , Kumarasinghe G. , Kuah B.G. , Ratnam S. S. 
Published: February 2008

Summary: This prospective study was conducted to determine the incidence of genital mycoplasma carriage in an antenatal pregnant population in Singapore, and to study the association of genital mycoplasma with preterm labour, prelabour rupture of membranes (PROM) and low birth‐weight babies.Genital mycoplasma was isolated in 26.3% of 312 pregnant women. The carrier rate was twice as high in women between 28 and 34 weeks (37.9%) compared with women at <28 weeks (23.8%) (p <0.05). In the individual women, the carriage of genital mycoplasmas was not persistent throughout pregnancy even without treatment, and a negative swab did not exclude colonization later on in pregnancy.Our study does not support an association between genital tract colonization with genital mycoplasmas (Mycoplasma hominis or Ureaplasma urealyticum) and prematurity (8.5% in carriers compared with 8.3% in noncarriers), PROM (3.7% in carriers compared with 4.8% in noncarriers) or low birth‐weight babies (2.4% in carriers compared with 5.6% in noncarriers).
Electrosurgical Principles and Problems
Authors: Cooper Michael 
Published: February 2008

EDITORIAL COMMENT: We have not previously published information concerning electrosurgical principles applicable to the instrumentation now widely used in gynaecological practice. This is our beginning. The information presented should, at the very least, warn surgeons, especially those using electrosurgery in combination with laparoscopy, that a thorough understanding of these principles should be mastered before surgical training in these techniques is commenced.Summary: Major technological advances in electrosurgical generator equipment have reduced many of the problems associated with early generation equipment. The appropriate use of cutting or coagulation waveforms and an understanding of electrosurgical principles will enhance performance and further reduce operative risk.
Replacement of Abdominal Hysterectomy by the Laparovaginal Technique – Its Success and Limitations
Authors: Wood Carl , Maher Peter , Hill David 
Published: February 2008

Summary: The objective of this study was to study the effect of replacing of most abdominal hysterectomies with the laparovaginal technique. Three gynaecologists trained in advanced operative laparoscopy performed 160 laparovaginal, open and vaginal hysterectomies in 3 private hospitals in Melbourne.One hundred and twenty seven (79.4%) of hysterectomies were laparovaginal, 16 (10.0%) were open and 17 (10.7%) were vaginal. The distribution of technique was similar for the 3 surgeons.The high incidence of laparovaginal hysterectomy was partly due to the ability to remove uteri up to the size of a 16‐week pregnancy, to divide severe pelvic adhesions and to perform recto‐vaginal excisional surgery in severe endometriosis. Abdominal hysterectomy was preferred for patients with uteri larger than a 16‐week pregnant size, tough intestinal adhesions, multiple pelvic pathology requiring prolonged surgery or with excessive obesity.The infrequent use of vaginal hysterectomy was related to the low occurrence of vaginal prolapse, the routine use of endometrial ablation for the treatment of menorrhagia resistant to drug therapy in uteri less than 10 cm, and the preference for laparoscopic rather than vaginal removal of the ovaries.The considered advantages of laparovaginal hysterectomy compared to abdominal hysterectomy were the reduced time in hospital and reduced convalescence.The cost of laparovaginal hysterectomy in the present study is 600–700 higher than abdominal hysterectomy. The cost may be reduced by decreased use of disposable equipment or by earlier discharge of patients from hospital. Gasless laparoscopy facilitating a combined abdominal and vaginal technique using 2 surgeons may further reduce operating time. Laparovaginal hysterectomy is capable of replacing most open procedures. Its future may depend upon the ability to reduce the operating time to be comparable to that of abdominal hysterectomy and to maintain similar costs. Vaginal hysterectomy is a suitable alternative to laparovaginal hysterectomy for surgeons skilled with this technique.
Splenic Artery Aneurysm in Pregnancy
Authors: Wiegand M.H. , Smith D. , Bowman M. , Delbridge L.W. , Lucas P. , Roche J. 
Published: February 2008

EDITORIAL COMMENT: We accepted this rather detailed case report for publication because of the special relationship of rupture of splenic artery aneurysms with pregnancy. It is wise for obstetricians to know that this condition is an important uncommon cause of abdominal pain and collapse during pregnancy, labour or the puerperium.Summary: Rupture of a splenic artery aneurysm during pregnancy or delivery is a rare event. Only 99 cases have been reported. There is significant risk to mother and fetus. This paper describes a splenic artery aneurysm rupture with a concomitant unruptured hepatic artery aneurysm and coincidental partial placental abruption with fetal death at 22 weeks' gestation. Splenectomy was performed to achieve haemostasis. Nonsurgical treatment by embolization of the hepatic artery aneurysm was performed after a routine postoperative computed tomogram (CT) and angiogram revealed the lesion. CT screening of high‐risk patients and ultrasound/pulsed Doppler screening of pregnant women with unexplained abdominal pain might be an important precaution in the avoidance of obstetric catastrophies.
Why Do Aboriginal Newborns Weigh Less? Gestational Age at Delivery: Estimation, Distribution and Determinants
Authors: Blair Eve , Morich Patricia , Stanley Fiona 
Published: February 2008

Summary: We reviewed birth records pertaining to 1,301 Western Australian singleton Aboriginal pregnancies dated before 24 weeks by ultrasound fetometry using Caucasian standards.We compared i) ultrasound‐ and LMP‐derived estimates of age at delivery for 323 pregnancies with available last menstrual period (LMP) dates and ii) distributions of ultrasound‐estimated age at delivery for full‐blood with part‐blood Aboriginal neonates and with statutorily collected estimates for Caucasian neonates. We investigated determinants of age at delivery for Aboriginal neonates.Ultrasound‐derived estimates of gestational age for Aboriginal pregnancies were statistically but not clinically significantly shorter than estimates derived from LMP dates claimed to be certain: mean difference = 0.4 weeks (95% 0:0.09‐0.71). Aboriginal gestations were shorter than Caucasians' by 2 weeks (median) or 1 week (mode). Some shortening of gestation was accounted for by antepartum haemorrhage, congenital anomaly, history of syphilis, diabetes, hypertensive disease and inductions before 40 weeks without recorded medical complication but not by full‐blood (relative to part‐blood) Aboriginality.We conclude that Caucasian fetometry standards gave gestational estimates acceptably close to those derived from certain menstrual dates for dating scan before 24 weeks. Aboriginal gestations tended to be shorter than Caucasian gestations but since factors recorded in the medical record accounted for little of this difference, socioeconomic factors may be partly responsible.
Postnatal Depression: A South Australian Prospective Survey
Authors: Stamp Georgina E. , Crowther Caroline A. 
Published: February 2008

Summary: The purpose of this study was to determine the prevalence of postnatal depression (PND) and to assess self‐esteem in the early postnatal period and at 6 weeks postpartum and PND at 6 months postpartum.Women giving birth to term babies over a 6‐month period, completed an Edinburgh postnatal depression scale (EPDS) and a Rosenberg self‐esteem scale in hospital, at 6 weeks postpartum and an EPDS only at 6 months postpartum. A total of 235 women participated in the study of which 222 (95%) returned their questionnaire at 6 weeks postpartum and 192 (82%) at 6 months postpartum. Characteristics of the women and their pregnancy outcome are presented.The EPDS identified a depressed mood in 9% of women in hospital and at 6 weeks postpartum (95% CI 5.3%‐12.8%). At 6 months this had increased to 10% (95% CI 7.8%‐12.2%). Postnatal depression was significantly correlated with low self‐esteem in hospital and at 6 weeks postpartum.