bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abruptio Placentae at The University of Nigeria Teaching Hospital, Enugu: A 3‐Year Study
Authors: Ozumba Benjamin C. 
Published: February 2008

EDITORIAL COMMENT: This paper will remind readers about the clinical problems of abruptio placentae that accounts for about 20% of perinatal deaths and can threaten maternal life, usually by haemorrhage associated with blood coagulation failure. In the author's hospital in Nigeria which serves a population of 4 million, the incidence of abruption was 0.4% (81 of 81,215 confinements). This low incidence is partly accounted for by the strict clinical criteria for diagnosis (abdominal pain 85%, tenderness 88%) which in turn explained the high incidence of blood transfusion (93%) and high perinatal mortality rate (58%). These results are similar to those reported from the Maternity Hospital, University of Cape Town, 1986, where the incidence of abruption was 0.6% (149 of 25,402) and the perinatal mortality rate 55%. The incidence reported from the National Maternity Hospital, Dublin, 1986, was 0.3% (22 of 7,823) with a perinatal mortality rate of 59%, although blood transfusion was required in only 23% of patients. The prize for perinatal mortality associated with placenta! abruption must belong to Hong Kong — in the Queen Mary and Tsan Yuk Hospitals, 1983, the incidence of abruptio placentae was 0.3% and the associated perinatal mortality rate was 5%. It would seem that not only do the Chinese have low incidences of prematurity, fetal malformations and multiple pregnancy, but also fewer cases of severe abruption. At the Mercy Maternity hospital, Melbourne, there is a much higher incidence of abruption but here the diagnostic criterion is evidence of an old retroplacental clot at delivery — the incidence in this hospital, 1984–1986, was 2.2% (337 of 15,658) with a perinatal mortality rate of 15% and a blood transfusion rate of 17%. In the Melbourne series disseminated intravascular coagulopathy occurred in 1% of patients with abruption whereas in the author's series the incidence was 11%. The author concludes that good antenatal and intrapartum care minimizes the maternal and fetal hazards of placenta! abruption; he also gives the good advice that coagulation failure must be ruled out before embarking on Caesarean section in these patients.Summary: A total of 81 cases of abruptio placentae treated in a 3‐year period at the University of Nigeria Teaching Hospital, Enugu is reported. The incidence of 0.44% found in the study is low when compared to reports from Europe. The outstanding clinical features were high parity, low incidence of renal failure, hypertension and proteinuria. The perinatal mortality of 58% is quite high while 2 mothers who were referred to the Teaching Hospital in poor condition died. Management was by rapid and adequate resuscitation by blood transfusion and delivery as soon as the diagnosis was made. The absence of maternal mortality amongst mothers who received antenatal care at the University Teaching Hospital emphasizes the need for adequate antenatal and intrapartum care in order to eliminate the complications of this obstetrical enigma.
Labour Induction with Low Dose PGE2 Vaginal Gel: Result of an Australian Multicentre Randomized Trial*
Authors: MacLennan Alastair , Fraser Ian , Jakubowicz Diana , Murray‐Arthur Frederick , Quinn Michael , Trudinger Brian 
Published: February 2008

Summary: An open‐label, parallel, randomized study was conducted in 6 Australian hospitals involving 320 women near term who required induction of labour. Labour induction with 1 or 2mg of PGE2 in a vaginal triacetin gel repeated if necessary at 6 hours was compared to induction by amniotomy and intravenous oxytocin.Analysis of the 2 groups confirmed matching with regards demographic and clinical data. A significantly longer and more variable mean induction to onset of established labour interval was recorded in the PGE2 group (6.7 ±4.8 versus 2.0± 1.1 hours. (p<0.001). The mean period of established labour was also longer (8.1 versus 6.0 hours, p<0.001) in the PGE2 group. However, 48% of PGE2 treated patients versus 29% oxytocin treated patients (p<0.01) were recorded as not experiencing strong contractions. Twelve hours after induction 65% of the PGE2 group and 93% of the oxytocin group were in established labour; 24% of the PGE2 treated group required subsequent augmentation with oxytocin. Spontaneous delivery occurred in 69% of PGE2 treated women and 62% of those treated with oxytocin (N.S.). Analgesic requirements were not statistically different between the groups. Fewer fetal heart rate abnormalities were recorded in the PGE, treated group (p<0.02). No serious and only minimal adverse events were recorded in either treatment group.
Maternal Weight Gain, Smoking and Other Factors in Pregnancy as Predictors of Infant Birth‐weight in Sydney Women
Authors: Ash S. , Fisher C.C. , Truswell A.S. , Allen J.R. , Irwig L. 
Published: February 2008

Summary: Two hundred and four (204) women attending a Sydney maternity hospital and their babies were followed throughout pregnancy in a study, which aimed: 1) to describe the distribution of maternal weight gain in present day Australian women and 2) to determine the effect of weight gain and other factors on birth‐weight.Maternal weights and skinfold thicknesses were measured serially to give an indication of weight gain. Mean weight gain from conception to term was 14.2kg and mean birth‐weight was 3,442g.Maternal predictors of birth‐weight such as maternal weight gain, parity, age, education, height, public or private booking status, smoking, prepregnancy weight, and sex of the infant and gestational age were explored using simple and multiple regression analysis. Weight gain was predictive of birth‐weight, each kg increase in total weight gain resulting in about a 30g increase in birthweight. Other strong predictors were gestational age, maternal smoking, sex of the infant and maternal parity. Maternal height was less strongly predictive and age and prepregnant weight were not predictive.Smoking mothers had infants who were 268g lighter than those of nonsmoking mothers. However, smokers were also younger, shorter, had less education and were more likely to book as public patients than nonsmokers. After adjusting for all other predictors, the birth‐weight of infants whose mothers smoked, was still 224g less than that for nonsmoking mothers.
Ureteric Obstruction by the Gravid Uterus
Authors: Carey Marcus P. , Ihle Benno U. , Woodward C. Susan , Desmedt Els 
Published: February 2008

EDITORIAL COMMENT: Use of modern ultrasonographic techniques during pregnancy have given us a new understanding of the frequency and degree of physiological dilatation of the ureters and renal pelves, which is mainly right‐sided, and is mainly due to compression by the gravid uterus (Woo, Wan, Ma (la)). The recently available technology of ultrasonographically controlled placement of nephrostomy tubes, and ureteric stents from above, has dramatically changed the investigation and treatment of ureteric obstruction in pregnancy. This may account for the remarkable change in the apparent prevalence of pathological ureteric obstruction at the Mercy Maternity Hospital as reported in this paper; however, the successful treatment of these patients indicates that such management is appropriate.For readers' perspective Table 1 was prepared from the 5 Clinical Reports of the Mercy Maternity Hospital, 1971–1986. Given the limitations of coding of minor procedures (removal of IUDs, treatment of vulvar warts, ovarian cysts found at Caesarean section), it can be seen that urological surgery, even cystoscopy, until recently, has seldom been performed in pregnancy in comparison with surgery for appendicitis or cholelithiasis.One may wonder what happened to patients with ureteric obstruction in previous years! In 3 of the 6 patients reported here the condition was unilateral, and the main problem was pain and infection (Cases 4 and 5), with the possibility of permanent renal impairment. The important take away message is that bilateral ureteric obstruction due to compression by the gravid uterus (Cases 1 to 3), especially in patients with multiple pregnancy and/or polyhydramnios, can result in acute renal failure requiring immediate delivery to resolve the problem — although we can see no reason why nephrostomy tubes should not be inserted in such patients (eg Case 2) to improve renal function and allow prolongation of pregnancy, when fetal viability due to immaturity is in doubt.Summary: This paper reports the only 6 cases of ureteric obstruction apparently caused by the gravid uterus diagnosed at the Mercy Maternity Hospital in the past 17 years, during which time there were 82,836 confinements. In 3 of the 6 cases there was clear radiographic evidence that the level of obstruction was at the pelvic brim. The rapid resolution of the ureteric obstruction shortly after delivery strongly suggested that the gravid uterus was the cause of the obstruction. Cases 1–3 were the only patients of 793 with polyhydramnios who developed bilateral ureteric obstruction and acute renal failure. In Cases 4 and 5 there was unilateral ureteric obstruction and pyelonephritis; in Case 4 a ureteric catheter was inserted from below, and in Case 5 a ureteric stent was inserted via a nephrostomy tube. In Case 6 a percutaneous nephrostomy tube was inserted.
The Effects of a Mother's Second Pregnancy on the Firstborn Child
Authors: Harris M.J. , John K. , Sharp R. 
Published: February 2008

EDITORIAL COMMENT: This paper was accepted for publication because it reminded us of how little data are available on such matters of importance. The only comparable obstetric topic that comes to mind is the long‐term effect, on both spouses and their children, of the presence of the male at his partner's confinement. The mother's second pregnancy can indeed profoundly and permanently affect the firstborn child, and in turn the ‘guilty’ parents, who, in retrospect, handled the problem inappropriately. Image the serene, secure 12‐month‐old first baby son, sent away from home and parents to be cared for (expertly) by a stranger during his mother's second confinement; episodes of spurious labour add to the duration of the parting and when the child is collected to return home 4 weeks later he accepts, more or less, the father who collects him, but is deeply saddened and no longer his extroverted happy self. One has only to look at the face of a happy child to appreciate the enormity of the change. They arrive home; the mother greets him with great love, immediately rejected in a storm of tears as his pain is revealed, this being a matter not quickly resolved — this is not an imagined tale but an anecdote from the home of a member of your editorial committee! Of course when the mother goes to hospital the first child should preferably remain in his/her own home, preferably with people he/she knows (father, grandparents) — to be separated from both parents and home when too young to understand the events of the hour is to be avoided at almost any cost. This advice should be given to all expectant mothers during their second pregnancy. Many patients state that their first child's behaviour changes during their second pregnancy are due to changes in their own behaviour to the child, due to fatigue and / or loss of patience. We need more data on this subject, especially since most of what we hear is bad news, unless the first child is no longer a baby and anticipates with pleasure the arrival of a playmate. It is difficult to explain to a baby how things may change but we should try. Most mothers give much attention to anticipation of the first child's needs after the second is born, when she returns home. This paper indicates that there is room for improvement in the antenatal management of this situation and, in the editor's opinion, the care of the firstborn during the mother's absence from home at the time of her confinement.Summary: Mothers in the last trimester of the second pregnancy admit to being less active, more tired and moody than previously. Many were more anxious than usual. Their first child frequently showed behavioural changes. Those surveyed were between 11/2 and 4 years of age and showed more clinging, sleep disturbance and misbehaviour with tantrums than expected. It is presumed that the mother's pregnancy induces anxiety in her child with consequent behavioural changes.
The IUCD‐assodated Incidence of Actinomyces israelii in the Female Genital Tract
Authors: Cleghorn A. G. , Wilkinson R. G. 
Published: February 2008

EDITORIAL COMMENT: The gynaecological literature has in recent years carried a number of reports of pelvic inflammatory disease due to Actinomyces israelii, some with pelvic abscesses where surprisingly the infection was unilateral. This careful, large study provides readers with the incidence of colonization and clinical infection with Actinomyces israelii in women wearing IUCD's. This paper does not comment upon how often IUCD's should be changed but the data support the view that 4 years is long enough for any type of device. Readers should remember that there are other more common causes of pelvic infection (Chlamydia trachomatis and Neisseria gonorrhoeae) that can be activated by insertion of an IUCD. Acute or chronic pelvic inflammatory disease, with resultant tubal damage and consequent infertility, can also result from organisms of the Mycoplasma group, or an enteric pathogen, either aerobic (especially Escherichia coli) or anaerobic, especially one of the Bacteroides group. Because these organisms all respond to a course of tetracycline and metronidazole, these drugs are often prescribed empirically when an IUCD is inserted, especially if the patient is known to be promiscuous. The association between IUCD's and pelvic inflammatory disease seems a very good reason to advocate another method of contraception, especially in nulliparas.Summary: Cervical swabs and in many cases also intrauterine contraceptive devices were examined from 973 women for the presence of Actinomyces israelii. It was detected in 11.6% of these women, the majority of whom were asymptomatic. The detection, however, of A. israelii in the female genital tract was associated with an almost 4‐fold increase in the incidence of pelvic inflammatory disease (PID), indicating that colonization may progress to an infection in a small number of women.The incidence of A. israelii in the female genital tract of IUCD wearers was more than doubled when the IUCD was worn for longer than 4 years. The type of IUCD worn did not appear to be an important risk factor.Immunofluorescent staining of cervical smears identified 64% of cases. Specific culturing for A. israelii or cytological screening of Papanicolaou smears in addition were required to increase the isolation rate to nearly 90%.
Changes in Smoking and Drinking During Pregnancy
Authors: Hilton Christine A. , Condon John T. 
Published: February 2008

EDITORIAL COMMENT: If maternal nicotine and alcohol usage really do cause more harm than the combination of diabetes, preeclampsia and all other conditions screened for routinely during pregnancy, then we must pay even more attention to these evils. To properly advise our patients we urgently require information regarding the degree of risk of mild to moderate indulgence, since about I in 3 women smoke and at least as many consume alcohol during pregnancy, often in the early weeks before the pregnancy has been suspected, and when the risk of teratogenesis would be expected to be greatest. Moreover, we must avoid needless panic of the patient who has now stopped drinking but had not done so in the few weeks before her symptoms of pregnancy began. Obviously prepregnancy counselling or general public education are necessary, but so too is data concerning the patient's chance of kicking the habit if this is her wish. This exploration of the problem in 40 patients indicates that it is easier to abstain from alcohol than nicotine, and some of the implications of this finding are discussed. A recent visit to the United States of America indicated that Australia certainly does not lead the world in legislative insistance that vendors of alcoholic beverages post warnings of the possibility of harmful effects on the fetus.Summary: Changes in alcohol and nicotine usage during pregnancy are reported from a sample of 40 pregnant women, 28 of whom smoked prior to pregnancy and 32 of whom drank alcohol. Although most women wanted to reduce or stop their intake during pregnancy, the drinkers were far more successful in their attempt than the smokers. Thus, 85% of drinkers achieved or bettered their target behaviour (in terms of consumption), while 53% of smokers ‘failed’ in their attempt. Women can identify reasons which influence their smoking and drinking behaviour during pregnancy and, in particular, the amount of emotional attachment to the unborn child appears to be important. However, endorsement of a particular reason docs not appear to relate in any simple way to actual consumption, and a major disparity between health beliefs and actual behaviour was apparent. Implications for primary prevention programmes and future research are discussed.
Transdermal Oestrogen for Postmenopausal Women: A Double Blind Crossover Comparative Study with Ethinyl Oestradiol
Authors: Pattison N. S. , Uptin T. , Knox B. , France J. 
Published: February 2008

EDITORIAL COMMENT: The importance of postmenopausal symptoms and whether or not they can be safely controlled is undeniable — the 3 main considerations are patient compliance, complications and cost. This paper shows that transdermal administration of oestradiol was a clear winner in comparison with oral ethinyl oestradiol, although the important entity of osteoporosis was not addressed in this study. The findings reported in this paper are of more than academic interest; the trial warrants verification with a larger number of patients, and other oral oestrogen preparations (oestriol, oestrone, oestradiol) should be compared with transdermal and subcutaneous oestradiol therapy. We will be pleased to publish the findings of such studies in this journal. The pattern of uterine bleeding with different treatment regimens warrants careful documentation, since the return of menstruation is often the reason patients give for discontinuation of hormone replacement therapy.Summary: A double blind crossover study of transdermal oestradiol (50ug/ day) and ethinyl oestradiol (20ug/day) was conducted with 25 postmenopausal women.Transdermal oestradiol increased circulating levels of oestradiol and oestrone. Both preparations favourably improved patients' symptoms and vaginal cytology, lowered gonadotrophin levels and urinary calcium loss and gave a satisfactory menstrual pattern,Transdermal oestradiol had no effect on measures of hepatic function whereas oral ethinyl oestradiol significantly altered levels of sex hormone binding globulin, plasma renin substrate and lipoproteins.Transdermal oestradiol has a comparable beneficial effect on postmenopausal symptoms to ethinyl oestradiol without the adverse effects on hepatic proteins.
The Effect of Patient Smoking Habit on the Outcome of IVF and GIFT Treatment
Authors: Harrison K. L. , Breen T. M. , Hennessey J. F. 
Published: February 2008

EDITORIAL COMMENT: This paper provides strong evidence that infertile women who are smokers achieve significantly fewer successful pregnancies with treatment. This is yet another reason to advise smokers to conquer the habit, although worry about reproductive failure (perhaps the most potent of all anxieties) may result in increased difficulty in giving up this variety of drug addiction ‐ unfortunately this is likely to particularly apply to heavy smokers.The morality/legality of withholding treatment from patients who request it, is questionable, even when they persist with habits that lessen their chances of success, yet insist that expensive modern technology (IVF‐ ET, GIFT) be made available to them. When patients pay for their treatment and are counselled regarding the chances of success or failure of the method, the problem is different, but remains. Some gynaecologists refuse to operate on patients for cure of stress incontinence of urine if they continue to smoke or remain grossly overweight. Some IVF units will not accept patients over 40 years of age or those whose command of English precludes ready understanding of complicated treatment regimens. How should we react when we see couples who request referral for treatment of infertility when we judge that a baby would be very unlucky to have such parents?We agree with the authors' conclusion that vigorous attempts to convince infertile couples to stop smoking should be made well before they embark upon an assisted reproduction programme. A more important conclusion, if larger studies confirm these findings, is that the general public should be informed about the harmful effects of smoking on the reproductive process. Another comment is that infertile couples, smokers or not, often need counselling, especially when repeated treatment has failed; a clergyman, who was researching an address he was giving on IVF ‐ ET, once told the editor that he considered that there was inadequate counselling of infertile couples to accept their infertility!
Postabortal Pelvic Sepsis in Association with Chlamydia Trachomatis
Authors: Wein Peter , Kloss Michael , Garland Suzanne M. 
Published: February 2008

EDITORIAL COMMENT: This paper reports that 5% of women having an elective termination of pregnancy, in Melbourne, in 1986, harboured Chlamydia trachomatis and that these women had triple the risk of postabortal sepsis. Expectedly the risk of postabortal sepsis when an IUD was inserted after termination was double in chlamydia positive women. Unless the problem of asymptomatic chlamydial infection is addressed in these women, many are likely to suffer impairment of fertility and/or the other miseries of chronic pelvic inflammatory disease. Although we accept the authors' statement that compliance for follow‐up is poor in such women, we are anxious to learn (and publish in this Journal) the state of tubal patency in such a group of patients. We also believe it is questionable practice to insert IUD's in nulliparas, especially after termination, unless there are unusual circumstances (repeated termination of unwanted pregnancies and refusal/inability to use other methods of contraception). The authors explain the need to use direct immunofluorescent staining for rapid diagnosis of chlamydial infection so that treatment with doxycycline can be commenced before termination is performed. Readers will have to scan the pages of Venereology to learn the more recent findings from the authors' clinic.Summary: Cervical swabs for Chlamydia trachomatis culture were taken from 527 women presenting for elective termination of pregnancy. Twenty‐six patients (4.9%) harboured C. trachomatis; 21 (81%) of these were less than 25‐years‐old and 21 (81%) were nulliparas. Postoperative pelvic sepsis developed in 11.5% of chlamydia‐positive women, in contrast to 3.6% of chlamydia‐negative women. Consequently it is suggested that all patients, especially those younger than 25 years, presenting for termination of pregnancy or in whom an intrauterine device is to be inserted should be screened and have treatment commenced for C. trachomatis prior to the operative procedure.