bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low Vertical Uterine Incision in Caesarean Section
Authors: George Lourdes St , Kuah K. B. 
Published: February 2008

EDITORIAL COMMENT: The classical operation is performed in 1–2% of Caesarean sections usually for transverse lie, failure of development of the lower segment (prematurity 5 breech presentation), dense adhesions, large veins over the lower segment (placenta praevia), constriction ring and invasive carcinoma of the cervix. The classical operation is likely to be performed more often than formerly because more very premature infants (26–32 weeks' gestation) are being delivered by Caesarean section — in these pregnancies the lower segment is often poorly formed, especially when there is the combination of fetal growth retardation, oligohydramnios and breech presentation. This paper has 2 important messages: firstly that in only 11 of 3,420 (0.3%) Caesarean sections was a vertical uterine incision necessary; secondly that in all II cases a low vertical uterine incision was possible. Personal preference determines practice in obstetrics. This paper suggests that we should resist the temptation to incise the upper uterine segment and, if a vertical incision is needed, the technique described in this paper warrants consideration. The type of anaesthesia is also important. The problem of a poorly formed lower segment can usually be anticipated — if halothane is employed to relax the uterus, a vertical uterine incision is less likely to be required. Since these operations are performed for fetal indications it is essential that delivery of the fetus is gentle with minimal risk of overmoulding which may result in intracranial haemorrhage.Summary: Eleven of the 3,420 Caesarean sections performed in Westmead Hospital, Sydney during a 6‐year period from 1979 to 1985 were by a low vertical uterine incision. All the others were the standard transverse lower segment operation except for 1 which was a postmortem classical Caesarean section. There are indications when the preferred lower segment Caesarean section with a transverse incision should be avoided in the interest of the mother and baby. A low vertical incision has more advantages and less dangers than a classical fundal incision. It is prudent to defer the decision regarding the type of incision until the uterus is inspected intraoperatively. If access to the lower uterine segment is limited by prematurity, an obstructing lesion, a transverse lie, or if the presenting part is high and difficulty in delivering the baby is anticipated, a low vertical incision should be considered.
No Episiotomy?!
Authors: Thompson Derrick J. 
Published: February 2008

EDITORIAL COMMENT: Episiotomy is an important and common operation. Some practitioners perform the procedure almost as a routine, others avoid it almost at any price and claim that the operation is seldom necessary. The advocates of episiotomy claim that its performance when the head k safe& accessible must, by hastening delivery, avoid hypoxia that can cause perinatal death or intellectual impairment. Other considerations are maternal discomfort (painful perineum, subsequent dyspareunia) and the possibility that overstretching of the perineum to avoid episiotomy may predispose to prolapse. This paper re‐examines the mechanism of delivery of the head and advocates maintenance of flexion to avoid a perineal tear — it concentrates on pressure on the occiput and anterior vagina thus directing pressure away from the perineum. The method warrants consideration.Summary: A method is presented which with careful manipulation of the vagina around the crowning head reduces the incidence of an episiotomy or a perineal tear. Using the method described, the overall result obtained was an intact perineum in 68% of vaginal deliveries (which included forceps deliveries). An episiotomy was performed in only 7% of deliveries — all associated with the use of forceps.
Immunogenetic Studies in Habitual Abortion
Authors: Cauchi M. N. , Koh S. H. , Tait B. , Mraz G. , Kloss M. , Pepperell R. J. 
Published: February 2008

EDITORIAL COMMENT: Readers must judge whether their patients with habitual abortion warrant referral for the type of investigation and immunotherapy reported here. These patients are often anxious to explore every avenue to achieve a successful pregnancy. Many techniques are available with convincing and prestigious advocates. The treatment of infertility at its best is one of the marvels of modern scientific medicine — but there is a warning, many (most!) papers on the treatment of infertility lack controls, which makes it difficult to judge reported results. These comments apply to in vitro fertilization and embryo transfer, artificial insemination, tuba1 surgery, cervical ligation, ovulation induction, and immunotherapy. It is commonplace for couples with blocked tubes, anovulation and/or poor seminal quality/quantity to conceive happily, unexpectedly and successfully without treatment!Summary: Recent evidence suggests that immunological factors could play a role in the aetiology of habitual abortion. In this study, 71 couples with habitual abortion (i.e. more than 3 successive abortions) were investigated. Sharing of HLA‐A, B, DR between partners was not found to be significantly increased. Anti‐HLA antibodies in women against their partners' lymphocytes were found in 18.3%. After immunization with 107‐108 lymphocytes obtained from husband or unrelated donor, there was a seroconversion rate cf 61% in those without antibodies initially. This was not dependent on the number of cells injected, source of cells, degree of sharing of HLA antigens or whether the couple were primary aborters (i.e. having had no advanced pregnancy), or secondary aborters. Seven pregnancies have resulted following the immunization procedure so far, 5 occurring in cross‐match positive patients and 2 in cross‐match negative. Growth retarded infants resulted from the pregnancy of 1 primary aborter and 2 secondary aborters.
The Outcome of Hyperemetic Pregnancies Complicated by Transient Hyperthyroidism
Authors: MRCOG T. T. Lao , MRCOG R. K. H. Chin , PhD A. M. Z. Chang 
Published: February 2008

Summary: Thirty‐nine patients presenting with hyperemesis gravidarum were studied and the subsequent course and outcome of pregnancy between patients with normal and abnormal thyroid funcion was compared. Seventeen patients (43.6%) developed transient hyperthyroidism, for which a short course of antithyroid treatment was required in 2 patients. There was no difference in the outcome of pregnancy between patients with normal and abnormal thyroid function.The results suggest that while antithyroid treatment is effective for symptomatic control, it is unnecessary in the majority of patients since the condition is self‐limiting, and the outcome of pregnancy not adversely affected by the transient hyperthyroidism in hyperemetic patients.
Routine Screening of Gynaecological and Obstetric Patients for Chlamydia Trachomatis
Authors: El‐Sheikh M. Magdy , Sengupta B. S. , Bakir T. M. F. , Hossain A. 
Published: February 2008

EDITORIAL COMMENT: There is much discussion regarding the selection of tests which should be performed on all antenatal patients. Many centres perform routine cervical cultures in late pregnancy to detect Group B beta‐haemolytic streptococci since approximately 1 in 2,000 babies acquire a clinical infection with this organism and the infection is fatal in approximately 50% of cases. However, the prevalence of chlamydia trachomatis reported in this study suggests that the detection of this organism is at least as important, in both obstetric and gynaecological patients. Now that a simple accurate method of enzyme immunoassay recognition of chlamydial infection is available, it is important that large populations of antenatal and gynaecological patients be studied to determine the prevalence and significance of the infection in any particular community. It is salutary to note that the data reported in this paper were gathered in a community where chastity is exemplary.Summary: Chlamydia trachomatis infection of the cervix uteri was diagnosed in 9% of 221 gynaecological and obstetric patients. Infection occurred more commonly among obstetric (12.6%) than gynaecological patients (5.5%). In obstetric patients chlamydial infection was commoner in those complaining of excessive vaginal discharge or spontaneous premature rupture of the membranes. Chlamydial infection in gynaecological patients occurred in those with previous pelvic infection, menstrual disorders or excessive vaginal discharge. No cases of chlamydial infection were detected among intrauterine device users. The enzyme immunoassay we used is an easy and relatively quick method of diagnosis for genital chlamydial infection.
Maternal Mortality in Bahrain with Special Reference to Sickle Cell Disease
Authors: Ei‐Shafei Affaf Mohammed , Sandhu Amarjit Kaur , Dhaliwal Jagajeevan Kaur 
Published: February 2008

EDITORIAL COMMENT: This paper reports an analysis of 37 maternal deaths in a predominantly Arab population. Bahrain has excellent obstetric hospitals but not all patients avail themselves of these facilities — a situation not unknown in so called developed countries! Sickle cell disease has a maternal mortality rate of about 2% in Bahrain and accounted for 12 of the 37 deaths; the information regarding these cases should interest readers who have little experience of this important disease. The authors set high standards for themselves in their assessment of whether the cases considered had avoidable factors that might have minimized the risk of death. The maternal mortality rate was 33.9 per 100,000 livebirths; this figure is about double that in Australia, although it should be noted that incidental deaths (e.g. accidents, suicides, murders, malignancies), which account for about 30% of maternal deaths in Australia, were not considered. The authors' task was not made easier by the fact that autopsies were not performed because of the prevailing religious beliefs.Summary: The maternal mortality in Bahrain during the 10‐year period, 1977 ‐ 1986, was 33.9 per 100,000 livebirths; the second 5‐year period showed a significant reduction (26.9) compared to the first 5‐year period (42.3). Haemorrhage, pulmonary embolism, hypertensive diseases of pregnancy and infection were the main causes of maternal mortality. Sickle cell disease was found to be an underlying cause in about one third of the maternal deaths. Avoidable factors were present in 38% of the cases, the majority being due to the failure of the patients to seek medical care or follow medical advice. Health education, premarital counselling and family planning were identified as significant factors in reducing the maternal mortality rate.
Intravenous Clonazepam in Eclampsia
Authors: Harding David L. , Leong Chee M. 
Published: February 2008

EDITORIAL COMMENT: This is an unusual case of eclampsia in that it persisted in spite of sedation with conventional drug therapy and because myoclonic jerks occurred when her blood pressure rose above 130/90. This case has been accepted for publication to draw readers' attention to the possible value of clonazepam in patients with eclampsia. In many centres, especially in the United States, magnesium sulphate given by the intravenous route, is the main drug used in the treatment of severe preeclampsia and eclampsia. There are recent reports that Dilantin (sodium phenytoin) is also a useful drug, but only when used in much higher doses than has been recommended in the past. It is difficult to assess the value of a single drug in a patient who requires multiple drug therapy but the authors make a case for consideration of clonazepam in a patient whose convulsions persist in spite of the usual therapy.Summary: A case of postpartum eclampsia is reported, controlled by intravenous clonazepam, a benzodiazepine anticonvulsant. Clonazepam was effective in controlling the myoclonic jerks, which were a feature in this patient, without producing excessive sedation. The literature reveals several reports on the use of clonazepam in severe preeclampsia, but its use in Australia has not been widely employed.
Pap Smear Results of Victorian Teenagers, 1980–1987
Authors: Mitchell Heather , Medley Gabriele 
Published: February 2008

EDITORIAL COMMENT: There are times when appraisal of the medical literature seems as difficult as that of articles in the lay press — whose story do you believe? This careful paper reporting a large series of patients is reassuring — there is no epidemic of human papillomavirus in Victorian teenagers since the prevalence in the last decade has remained at about 5%. For cervical intraepithelial neoplasia the figures are less reassuring but not alarming. Next we must ask our cytologists to provide similar comparative data for the other age groups in Victoria. Certainly this paper would indicate that the pessimism of the colposcopists due to investigation of patients referred to them is not the last word on human papillomavirus infection.Summary: Pap smears reported by the Victorian Cytology (Gynaecological) Service between 1980 and 1987 for teenagers show a profile of abnormality which is similar to that for women for all ages. More than 90% of the cytology reports have consistently been reported as normal or showing minor benign abnormalities only. No evidence of an increasing rate of infection with human papillomavirus is apparent, with the infection rate as determined cytologically being constant at around 4% to 5% during 1981 to 1987. Some increase in the proportion of women having associated changes of CIN is apparent. No case of invasive cancer in teenagers has yet been confirmed. These data suggest that the teenagers in Victoria who are having Pap smears reported by the Victorian Cytology (Gynaecological) Service are not a high risk group for cervical cancer during their teenage years, but may be a high risk group during later years.
Changing Patterns of Caesarean Section
Authors: FRCOG Javaid H. Rizvi , MRCOG Sipra R. Chaudri 
Published: February 2008

EDITORIAL COMMENT: This paper was accepted for publication because it presents data from one hospital in which, over a period of 10 years, the perinatal mortality rate fell by about 50% with only a modest increase in the Caesarean section rate from 8% to 9.9%. The authors outline the relative changes in elective and emergency Caesarean section in their hospital and examine the changing indications for Caesarean section. The variables discussed are important although the explanation for the change in practice remains elusive — for example it is difficult to understand how an increase in the primary Caesarean section rate (from 5.7% to 7.2%) was not followed by a commensurate increase in the incidence of repeat Caesarean section (from 2.3% to 2.7%).Summary: There has been a substantial rise in the rate of Caesarean section in the last 20 years. There are many reasons for this increase, but it has been argued that the fall in perinatal mortality justifies a higher Caesarean section rate.In this retrospective study 7,274 deliveries were reviewed and 650 Caesarean sections were analysed. There was only a marginal increase in the rate of Caesarean section (1.9%) during the 2 biennial periods studied (1974–1975 and 1984–1985), but overall perinatal mortality rate dropped by half during the second study period.This study confirms that in recent years the indications for Caesarean section have altered, but the marked rise in the Caesarean section rate cannot be explained purely on medical grounds and is certainly not solely responsible for the very significant drop in the perinatal mortality rate.
The Efficacy of Electrocoagulation Diathermy Performed Under Local Anaesthesia for the Eradication of Precancerous Lesions of the Cervix
Authors: Chanen William 
Published: February 2008

EDITORIAL COMMENT: Elsewhere in this issue Merkur and Baird report the persistence of HPV infection in the majority of patients who originally presented because of an abnormal Papanicolaou smear. It is not easy to compare this with Chanen's paper because the method of treatment was different, and not all patients in Merkur and Baird“s series received treatment. However Chanen's paper reports almost complete eradication of HPV infection as well as associated intraepithelial neoplasia — in his series 62 % of patients (124 of 200) had evidence of HP V infection with or without intraepithelial neoplasia. Is the reader to conclude that electrocoagulation diathermy of the cervix can cure HPV infection, with or without associated intraepithelial neoplasia, in 98% of patients? Chanen's series had cytological and colposcopic follow‐up so one cannot challenge his results — one can only wonder why different centres are reporting such different results in treating what surely must be the same disease. A recent editorial comment in another journal stated ‘There is no satisfactory treatment of papillomavirus infections of the genital tract: Laser, cryosurgery and cautery have each been used, but recurrence rates are high … Problems associated with treatment of sexually transmitted human papillomavirus infections of the female genital tract are the use of surgical methods for treating a medical disease… (Obstet Gynecol Sum 1988; 43:679). The ultimate treatment of human papillomavirus will be to allow it to take its natural course when the patient has no symptoms, and no macroscopic or colposcopic visible lesions, except in those found to have the virus types that are associated with progression to cancer; perhaps a vaccine will ultimately be prepared to protect patients from such infections. In the patient who already has infection with human papillomavirus, treatment should be directed at exclusion of associated intraepithelial neoplasia and the treatment of such lesions.Summary: This study demonstrates the feasibility of performing electrocoagulation diathermy with intracervical infiltration of local anaesthetic for precancerous lesions of the cervix. A technique suitable for office procedure without, need of any supplementary analgesia is described; 200 patients were treated in this fashion with results indicating the ability to obtain high primary cure rates with low morbidity similar to those previously obtained with general anaesthesia.
A Comparative Study of Proliferating (Borderline) and Invasive Epithelial Ovarian Tumours in Young Women
Authors: Carter Jonathan , Atkinson Kenneth , Coppleson Malcolm , Elliott Peter , Murray John , Solomon John , Dalrymple Christopher , Tattersall Martin , Duval Peter , Russell Peter , Bannatyne Patricia 
Published: February 2008

Summary: A series of 18 patients with proliferating or borderline ovarian tumours and 18 with invasive ovarian tumours is discussed. Proliferating tumours occurred at a younger mean age than invasive disease, and presented at an earlier stage, both contributing factors to their more favourable outlook. Histopathological assessment revealed that the majority of both proliferating and invasive tumours were of serous origin. Mucinous cell type occurred less often as did the endometrioid and clear cell types.The management of the proliferating tumours involved ‘radical’ surgical procedures in 11 of 18 (61.6%) patients. Only 7 patients (38.8%) had conservative surgical procedures performed. Six patients (33%) had adjuvant chemotherapy while 2(11%) also underwent abdominopelvic irradiation. All patients with invasive disease had radical surgery and adjuvant chemotherapy and 2 also received abdominopelvic irradiation.The fact that epithelial malignancies of the ovary do occur in younger women needs to be remembered by gynaecologists contemplating surgical procedures on younger patients with adnexal masses. Proliferating or borderline tumours tend to occur more frequently in the younger age groups, and contrary to the implication of their name, they are associated with significant morbidity and mortality.
Vulvar Dystrophies: An Evaluation
Authors: Ayhan Ali , Yuce Kunter , Urman Bulent , Ayhan Ayse , Gököz Aytac 
Published: February 2008

EDITORIAL COMMENT: This paper provides readers with a logical plan of treatment for patients presenting with pruritus, vulvitis or visible vulvar disease who are found on directed biopsy to have vulvar dystrophy (hyperplasia, lichen sclerosus or mixed dystrophy). Excellent results were obtained using topical corticosteroid therapy for patients with hyperplasia, and topical testosterone for those with lichen sclerosus. In presenting the results in this series of 86 patients the authors do not explain the criteria for directed vulvar biopsy in women presenting with pruritus or vulvitis. These excellent results suggest that vulvar biopsy should be performed not only in all patients with clinical suspicion of carcinoma, but also in all those who fail to respond to initial therapy. The results presented here seem almost too good to believe because in this reviewer's experience vulvar biopsies in many patients with intractable pruritus and vulvitis show coexistence of hyperplasia and lichen sclerosus — in this series only 7 of 86 patients had mixed dystrophy. Readers should note that medical treatment was not used in patients with atypia on biopsy — these patients require a surgical approach to their treatment.Summary: Of 86 patients diagnosed as having vulvar dystrophy in a 10‐year period 56 (65.1%) had hyperplastic dystrophy, 23 (26.7%) had lichen sclerosus and 7 (26.7%) had mixed vulvar dystrophy. The diagnoses were made by colposcopic or toluidine blue directed biopsies. Fluorinated corticosteroids were given to patients with hyperplastic dystrophy with a response rate of 90.1%. Patients with lichen sclerosus received topical testosterone propionate and the response rate was 87.7%. Topical fluorinated corticosteroids followed by testosterone propionate was given to patients with mixed dystrophy and 85.8% of the patients responded. Surgical therapy was reserved for patients with failed medical treatment.
Hysteroscopy: An Analysis of 523 Patients
Authors: Finikiotis George 
Published: February 2008

EDITORIAL COMMENT: There is always the problem of when to perform curet‐tage in the premenopausal patient with irregular or heavy bleeding, when the clinical findings and cervical smear are normal, and the risk of significant endometrial pathology is low. Curettage is not without risk, inconvenience or expense and may be followed by irregular bleeding or infection. On the other hand oncologists remind us that about 20% of cases of endometrial cancer occur in premenopausal patients whose abnormal bleeding therefore warrants endometrial sampling. This paper makes a strong case for the more widespread use of hysteroscopy which does not enjoy the popularity it deserves. It may be used without anaesthesia, perhaps removing the need for hospitalization, and it can, as shown in this paper, select the patient with endometrial pathology that requires sampling by curettage. Hysteroscopy also has the added advantage, when used at the time of curettage, of ensuring that a macroscopic lesion has not been missed, or in the case of endometrial polyps, removed incompletely (figure 1).Summary: An analysis is presented of the indications for, and findings on, hysteroscopy in 523 patients undergoing gynaecological investigation or treatment. Abnormal uterine bleeding or discharge was the indication for investigation in 202 patients. Based on hysteroscopic observation, dilatation and curettage (D & C) was adjudged unnecessary in 114 (56%) and a subsequent D & C on these patients revealed no histological abnormalities. In the remainder, more abnormalities were observed visually on hysteroscopy than were detected by D & C. The results suggest that D & C should be replaced by hysteroscopy and biopsy as a first‐line investigation of abnormal uterine bleeding or discharge.