bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abnormal Uterine Bleeding and Cancer of the Genital Tract
Authors: Alien D. G. , Coney J. F. , Marsden D. E. 
Published: February 2008

EDITORIAL COMMENT: This paper makes the point that dilatation and curettage need not be routinely performed in women under the age of 40 years with menor‐rhagia to exclude carcinoma of the endometrium. This point is worth making since many such operations are done for this indication. However, dilatation and curettage may be indicated in women under the age of 40 when excessive menstrual bleeding is causing anaemia, is associated with pain, or palpable gynaecological pathology. Presumably there were a number of patients in this study with menor‐rhagia, aged less than 40 years, in whom atypical hyperplasia of the endometrium was diagnosed as a result of dilatation and curettage and/or hysterectomy. The patients with menorrhagia included 195 with endometrial hyperplasia and 86 with endometrial polyps — one would imagine that a number of these women, even some under the age of 40, had their proper further management determined by knowledge of their endometrial histology!Summary: All patients in Tasmania admitted to hospital for investigation of abnormal uterine bleeding in 1987 and 1988 were studied. A total of 4,318 patients were investigated. Four of 539 (0.7%) patients with intermenstrual or postcoital bleeding and 31 of 538 (5.8%) patients with postmenopausal bleeding were found to have endometrial cancer. Of the 3,241 patients investigated for ‘heavy’ periods (menorrhagia) there was no case of endometrial cancer. The detection rate of endometrial cancer on dilatation and curettage before the menopause is extremely low. Patients presenting with menorrhagia should not be treated surgically in the first instance unless an obvious organic cause is present.
Caudal Analgesia by the Obstetrician
Authors: Dennerstein Graeme 
Published: February 2008

EDITORIAL COMMENT: Not many obstetricians in Australia perform ‘their own’ caudal blocks in patients requiring forceps delivery or manual removal of the placenta. This paper indicates that the practice is safe when training is appropriate and expertise is maintained by regular use of the technique.Summary: The results of 670 consecutive caudal blocks performed by the author for operative obstetrics over 20 years is reported. There was no morbidity attributable to the technique. Satisfactory analgesia was not achieved in 83 patients and obesity was not a major cause of failure. The causes of these failures are discussed. It is recommended that caudal analgesia continues to be used for operative vaginal obstetrics.
A Case of Multiple (5) Ectopic Pregnancies, Ultimately Resulting in a Twin Pregnancy After in Vitro Fertilization and Embryo Transfer
Authors: Kovacs Gabor T. , Shekleton Paul , Hurley Victor , Leoni Maria 
Published: February 2008

Summary: The history of a woman with anovulation, tubal disease and 5 ectopic pregnancies is presented. She finally succeeded in having a family by conceiving twins in her eighth attempt at in vitro fertilization.‘Tis a lesson you should heed’: Try, try, try again. If at first, you don't succeed, Try, try, try again.Try and Try Again William Edward Hickson (1803–1870)
Differentiation of Monochorionic and Dichorionic Twin Placentas by Antenatal Ultrasonic Evaluation
Authors: Cheung A. , Wan M. , Collins R.J. 
Published: February 2008

EDITORIAL COMMENT: Any lead that promises improved results in twin pregnancy warrants scrutiny since the condition accounts for more than 10% of perinatal deaths (78 of 677 in Victoria in 1987). Twins are monozygotic or identical in about 1 in 4 cases in Caucasian populations and about 1 in 2 in Asian populations (15 of the 31 consecutive cases in this series from Hong Kong). Differences in incidences of spontaneous twin pregnancies in different populations is accounted for by differences in rates of dizygotic twinning, monozygonic twinning apparently having a similar incidence (about 1 in 300 pregnancies) in all populations. This study shows that ultrasound is reasonably accurate at identification of dichorionic from monochorionic twins (70% of monozygotic twins) by assessment of the thickness of the septum between the 2 gestational sacs. The higher perinatal mortality rate in monozygotic compared to dizygotic twins is mainly due to complications that occur exclusively in the monochorionic variety (twin to twin transfusion and its various complications, acute polyhydramnios) but there is also an increased incidence of fetal growth retardation (about 25 %). This paper discusses the advantages of knowing if twins are monochorionic from the point of view of antenatal management. In the editor's opinion the principles of management of all twin pregnancies are: I) The patient should be encouraged to have extra rest at home, whether she believes it to be necessary or not, from 20 weeks' gestation until delivery. 2) Extra surveillance (more frequent testing) for anaemia and preeclampsia. 3) Ultrasonographic assessment of fetal growth every 3–4 weeks from 20 weeks. 4) Weekly cardiotocography from 30 weeks' gestation, especially if the twins are thought to be monochorionic, or if polyhydramnios is present, in order to detect severe fetal compromise (twin to twin transfusion, fetal growth retardation of 1 or both fetuses). Recognition of the rare monoamniotic twin pregnancy alters management only at delivery, the time at which the astute clinician makes the diagnosis by noting that there is only one amniotic sac, since the 25% incidence of cord entanglement or knotting indicates immediate delivery of the second twin if this condition is diagnosed antenatally by ultrasound, elective Caesarean section at 37 weeks' gestation has many advocates.ABSTRACT The prenatal identification of various types of placentation is important for the antenatal management of twin pregnancies. Such classification can be achieved with the use of ultrasound examination. In 32 cases of twin pregnancy the intervening septum was classified as either a thick (dichorionic) or thin (monochorionic) type. Macroscopic and microscopic examination of the placenta after delivery confirmed the ultrasound diagnosis in 24 of the 30 cases, an accuracy of 80%.
Intrauterine Surgery Using Electrocautery
Authors: Hill David J. , Maher Peter 
Published: February 2008

EDITORIAL COMMENT: This is a preliminary report. The authors informed the editor that they have treated 40 patients with this method. We will await the results of follow‐up and details of case selection. Endometrial ablation has been reported recently from several centres but authors have stressed that the procedure was not an alternative to hysterectomy except when the patient refused hysterectomy or was too ill for general anaesthesia (e.g. menorrhagia associated with coagulopathy due to neoplasia)—caution has been expressed because of the possibility that subsequent development of endometrial carcinoma may present late if cervical stenosis prevents tell‐tale vaginal bleeding; there is also the possibility of infection, or haematometra if endometrial ablation is incomplete. Many women would prefer to avoid hysterectomy when indicated by benign disease, but the operation has a relatively low mortality and morbidity, and endometrial ablation must be shown to do better. Is the retained cervix of coital value?—this has not, in the editor's opinion, been properly evaluated in follow‐up of premenopausal women having hysterectomy without oophorectomy. The answer to this question is relevant when counselling the patient about conservative methods of treatment aimed at avoiding hysterectomy.ABSTRACT A procedure is described which may considerably reduce the number of hysterectomies performed for abnormal uterine bleeding due to benign conditions.
Vaginal Cones for the Treatment of Genuine Stress Incontinence
Authors: Wilson P Don , Borland Margaret 
Published: February 2008

EDITORIAL COMMENT: This paper provides further evidence of the value of pelvic floor exercises as a viable alternative to surgery in the treatment of genuine stress incontinence. Many women will not have the motivation to continue with pelvic floor exercising over a prolonged period of time but the fact that over 40% are significantly improved up to 2 years later makes this a worthwhile treatment modality. Surgery for stress incontinence will never be 100% effective or without complications, so it is important that women with stress incontinence be given the option of conservative treatment in the first instance. Vaginal cones are one method of strengthening the pelvic floor and have a timesaving advantage for the busy General Practitioner or Gynaecologist.ABSTRACT The value of vaginal cones for genuine stress incontinence was assessed in 34 women with this condition. Subjective and objective assessments were made before and after 6 weeks of treatment using urinary diaries, perineometry, ‘home’ pad test and cone weights with and without voluntary pelvic floor contraction. There was a subjective improvement in 23 of the 34 women (68%) after 6 weeks of cone use with 16 (47%) deciding that no additional treatment other than cone therapy was required at this time. Statistical analyses showed that there were significant improvements in the objective indices. There were no side‐effects observed with cone use. When followed up 12–24 (mean 15.8) months from the start of the study, 14 women (41%) were still improved with either cone or pelvic floor exercises. Vaginal cones would seem to be a simple and practical means of improving both pelvic floor strength and genuine stress incontinence.
Repeat Sterilization Reversal
Authors: Wood Carl 
Published: February 2008

Summary: : Thirteen women had repeat sterilization reversal using microsurgery either because of failed IVF or personal preference for microsurgery. Six pregnancies occurred in 5 women resulting in 5 livebirths and 1 miscarriage. Pregnancy occurred in all 3 patients having isthmic anastomosis in the second sterilization reversal.Preliminary hysteroscopic tubal cannulation would have excluded operation on 2 patients who had tubal blockage extending several centimetres proximal to the site of the first anastomosis.
Borderline Epithelial Ovarian Tumours
Authors: Ayhan Ali , Akarin Rahime , Develioglu Osman , Yarali Hakan , Kücükali Türkan , Bilgin Filiz 
Published: February 2008

EDITORIAL COMMENT: : We accepted this series of cases of ovarian tumours of borderline malignancy because the series is quite large and will interest readers. Stage 3 borderline ovarian lesions should be dealt with by the type of radical surgery reserved for frankly invasive ovarian cancer. The place of chemotherapy where the metastatic disease is histologically borderline in nature is still unclear although many would advocate its use. However when there is no evidence of spread beyond the ovary and the histology confirmed by an expert places the tumour in the borderline malignancy group, then no further therapy is indicated, even when the ovarian tumour is large. Alkylating agents used for chemotherapy have approximately a 10% long‐term incidence of leukaemia and subsequent risk of death. There seems to be little point in having a classification of borderline malignancy if the patient is to be subjected to radical treatment in any case, even though the authors make the exception of the premenopausal patient who may wish to conceive. Proper staging at operation is important but it is also essential that the pathologist is an expert. In the Editors' experience there is usually only one or two such senior pathologists in any major city and usually pathologists are wise enough to make sure their local expert reviews the sections of all such cases. In this series a large proportion of the patients received radical surgery and chemotherapy as for ovarian carcinoma; although the results were exemplary, especially if one excludes the patient with the Stage 3 lesion, we consider that the treatment of Stage la ovarian borderline tumours does not require the use of adjuvant chemotherapy.Summary: : Twenty‐four patients with borderline epithelial ovarian tumours treated in the Department of Obstetrics and Gynaecology of Hacettepe University during the last 12 years were evaluated with regard to histopathology, therapeutic modalities employed and outcome. No mortality was encountered among the 23 patients with Stage 1 disease, regardless of the surgical mode of treatment or adjuvant therapy.The related literature was reviewed briefly to help enlighten the controversial issue of borderline ovarian tumours.
Determinants of Maternal Mortality in the Developing World
Authors: Stokoe Usha 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it considers the contribution of socioeconomic and cultural factors to maternal mortality in developing countries. These issues are relevant to much of the world's population and so should interest readers. There is also a useful bibliography of papers for those who wish to explore the subject further. It is of interest to reflect that the original prime aims of antenatal care (prevention of anaemia and preeclampsia), that still need to be introduced in some developing countries, are now pursued with less vigour than in the past in so‐called developed countries. there were 83,402 confinements and 7 maternal deaths in hospital, and 14 other pregnancy‐related deaths within I year of delivery. In the Tibur Anbessa (Black Lion) Teaching Hospital in Addis A baba, during the 6 years 1980–1985, there were 22,404 livebirths and 216 maternal deaths in hospital‐. These maternal mortality rates differ by a factor of 120 (0.08 per 1,000 versus 9.6 per 1,000). A recent ‘Newsletter of Worldwide Activity in Maternal Health’ slates that ‘mothers are not dropped from heaven, they are born as undervalued, neglected girls and grow as exploited, uneducated children’ ‐ this publication lists in its ‘fact File’ that ‘In Africa, 1 in every 25 girls reaching menarche will die as a result of pregnancy or childbirth’ and that ‘In South Asia, women face a lifetime risk of maternal mortality of 1 in 38’.Although teaching hospital statistics do not present the national maternal mortality rates, they are useful for purposes of comparison, being readily available, and the contrast is stark: At the Mercy Maternity Hospital, Melbourne, during the 18 years 1971–1988.
HELLP Syndrome: an Often Unrecognized Complication of Preeclampsia
Authors: Lim B.H. , Barry C.L. , Brown G.H. 
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication to remind readers that the HELLP Syndrome does exist and can be present in patients who do not exhibit hypertension or marked generalized oedema; it tends to occur when preeclampsia is treated conservatively. When diagnosed, prompt delivery is indicated, after commencement of the preferred drug regimen for treatment of severe preeclampsia, but Caesarean section is not necessarily the preferred route of delivery, as illustrated by the following case, courtesy of Dr Ian Maclsaac, seen 2 days after the editor read this paper.A 29‐year‐old primigravida presented with severe pain and tenderness under the right costal margin, at 35.5 weeks' gestation, after a normal antenatal course; she had proteinuria (urine 1/10 solid on boiling), BP120/70, platelet count 44× 109/I and elevated serum enzymes levels (aspartate aminotransferase 364 (0–31 μ/l), alanine aminotransferase 513 (0–31 μ/l); there was no haemolysis and the coagulation profile was otherwise normal. Two days later labour was induced by amniotomy and oxytocin infusion because the epigastric pain, thrombocytopenia, proteinuria and abnormal liver function tests had persisted; 8 hours after induction a 2,860 g infant was born normally in good condition. Two days later the platelet count had fallen to 19×109/l, and microscopic haematuria was present; the patient was given a 6‐unit platelet transfusion; 2 days later the platelet count was 122× 109/l and there were no further problems with mother or baby.Readers may debate whether this is a genuine case of HELLP syndrome without evidence of intravascular haemolysis or abnormal coagulation profile apart from thrombocytopenia. However, this case does undoubtedly endorse the author's message that patients with preeclampsia treated conservatively, and all those with epigastric pain associated with proteinuria, should have coagulation profile, full blood examination and tests of liver function performed, in addition to renal function tests and assessment of fetal well‐being by cardiotocography.Summary: We describe a case of preeclampsia with the HELLP (Haemolysis, Elevated Liver enzymes, Low Platelets) syndrome and highlight the delayed diagnosis due to its nonspecific presentation. This syndrome is associated with significant maternal and perinatal mortality and morbidity and we discuss the importance of early recognition of the condition, aggressive management and a multidisciplinary approach.
A Comparative Study of X‐Ray Pelvimetry and CT Pelvimetry
Authors: Raman S. , Samuel D. , Suresh K. 
Published: February 2008

EDITORIAL COMMENT: This paper compares conventional X‐ray pelvimetry with CT pelvimetry and the authors conclude that the latter is preferable due to the lower radiation dose, patient comfort and shorter time of examination; surprisingly they commented that the 2 procedures had no significant difference in cost.Ultrasonography has virtually replaced radiography in obstetric practice The exception is X‐ray pelvimetry which is still performed in many centres in the management of breech delivery at term, and in patients in whom a trial of vaginal delivery is planned after previous Caesarean section although the latter indication is not accepted in many centres (e.g. Dublin). In our mixed Australian community, moderate to severe pelvic contraction, even predominantly of the pelvic outlet (and hence especially relevant to breech delivery) is a reasonably common finding.Not all radiologists will agree with the conclusions in this paper. Our reviewers pointed out that the actual radiation doses were not measured but were quoted from references, those for conventional pelvimetry being 1962 and 1963 references. It should be noted that with modern X‐ray technique the radiation dose has been considerably reduced and ‘the radiation dose from CT pelvimetry including the 2 scout films and one axial slice using a reduced MAS is comparable to conventional pelvimetry including 2 films, the erect lateral film and the tube shift film for the transverse diameters but excluding the outlet view!’Our reviewers believe that both methods of pelvimetry are comparable and require meticulous technique; they agreed that there was no significant interobserver variability reporting the pelvimetries in this study. The take away message seems to be that there is still a place for pelvimetry in obstetric practice and CT pelvimetry is likely to become more popular. We agree with the practice of postpartum pelvimetry to avoid fetal irradiation and provide information for management of subsequent pregnancies in nulliparas who were delivered by Caesarean section or difficult forceps delivery.Summary: In this study 24 patients who had conventional erect lateral X‐ray pelvimetry had a CT pelvimetry done after delivery to complete the pelvimetry views. The erect lateral pelvimetry was read independently by a Consultant Radiologist, Consultant Obstetrician and a Medical Officer training in Obstetrics and Gynaecology. Using CT pelvimetry as the ‘gold standard’ (as the error of measurement was known with the machine used) the 3 readings were compared. There was no statistical difference in the values suggesting that X‐ray pelvimetry is comparable to CT pelvimetry. However CT pelvimetry is preferred, if available, because of the lower dose of radiation involved, more comfort for the patient and shorter time in performing the procedure. Measurements done are easily read directly from the CT console.
Pelvimetry — a Squatter's View
Authors: Gudgeon C. W. , Jarrett J. 
Published: February 2008

EDITORIAL COMMENT: These days there is much talk at antenatal classes and in delivery rooms of the options available to women regarding the position at delivery. Many who give advice antenatally lack delivery room experience, and many who give delivery room advice do not receive the blame for delivery difficulties. Comfort of the patient during the process of birth is important. It is also important for the accoucheur to perform his/her task in a satisfactory manner avoiding unnecessary perineal damage (episiotomy or extension thereof) or fetal hypoxia or injury due to difficulty with delivery of the shoulders.We agree with our radiologist reviewer that the bituberous diameter is difficult to measure with accuracy, and that the available AP of the outlet is a more important measurement to predict the outcome of labour. The Editor may be a square but he has not yet delivered a woman while she was in a squatting position ‐ he has often been! This paper provides some evidence that the squatting position does not improve the dimensions of the pelvic outlet during delivery.Summary: Patients were X‐rayed in supine and squatting positions in order to measure any increase in pelvic outlet diameters. An increase of less than 2% was found. Previous estimates of 20–30% increases in pelvic outlet area were not duplicated.
The Development of Infertility Treatment in Australia1
Authors: Cox Lloyd W. 
Published: February 2008

Summary: The development of fertility clinics in Australia began in Sydney at the Women's Hospital, Crown Street, in 1938 with Alan Grant. Clinics in other cities followed: Melbourne (1940), Adelaide (1946), Brisbane (1948), Perth (1949) and Hobart (1967).At first, the work was confined to clinical investigation and tubal surgery. In the early 1960's the university departments of Obstetrics and Gynaecology appointed scientists and developed endocrinology enabling investigation of anovulation and leading to ovarian stimulation with gonadotrophin and clomiphene. Male infertility had been investigated, but although there was occasional use of fresh semen donations, it was not until 1972 that sperm banks were set up, the first being in Adelaide.In 1979 the first IVF baby was born in Melbourne, and clinics in other cities had success over the next 3 years. Microsurgery had by then been introduced for tubal reconstruction.The high standing of Australian clinics has been due to the pioneers who were careful investigators, considerate doctors, and enthusiastic teachers; and later, to the close cooperation between clinicians and scientists and the sharing of new advances both informally and at scientific meetings.