bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interstitial Ectopic Pregnancy—Management with Laparoscopically‐guided Local Methotrexate Infiltration
Authors: Wilkinson Chris , Petrucco Oswald , Pachulicz Maureen , Furness Margaret 
Published: February 2008

EDITORIAL COMMENT: This issue of the journal contains 2 case reports of interstitial ectopic pregnancies, both treated by injection of methotrexate, by intramuscular injection in one case, and by laparoscopically‐guided injection into the ectopic pregnancy mass in the other. The methods were not equally successful. Parker and colleagues reviewed the published data and concluded that single‐dose intramuscular methotrexate for treatment of ectopic pregnancy is associated with a high failure rate, and serious complications have occurred (11). The authors of this report advocate the use of laparoscopically‐guided local methotrexate infiltration. The selection of which cases of ectopic pregnancy warrant this regimen is not yet established in the editor's opinion. Ironically one of the reviewers of this case report, selected because of his known experience with ultrasonographically‐guided direct local methotrexate injection into early tubal ectopic pregnancies, stated that, because of the risk of causing haemorrhage, that he had preferred methotrexate by intramuscular injection in 2 women with interstitial ectopic pregnancies, who then, at a later date, had excision of the ectopic pregnancies performed laparoscopically.Summary: This case describes the use of ultrasound to diagnose an interstitial ectopic pregnancy and the subsequent management and ultrasound follow‐up. Interstitial pregnancy is a rare but potentially life‐threatening complication of pregnancy. Management options depend upon the timing of diagnosis, and the desire for maintenance of fertility. Methotrexate injection, under ultrasonographic or laparoscopic guidance, seems to be the management of choice when the ectopic is diagnosed at an early stage.
Estimation of fetal weight by ultrasound prior to 33 weeks gestation
Authors: Hotcfain Anne , Bell Robin , Umstad Mark P , Robinson Hugh P , Doyle Lex W 
Published: February 2008

Summary: The aim of this study was to develop an accurate formula for the ultrasonic prediction of fetal weight for infants < 33 weeks gestational age and s 1500 g birth‐weight. The subjects comprised live births free of lethal malformations or chromosomal anomalies, < 33 weeks gestational age and with birthweights s 1500 g born in the Royal Women's Hospital between January 1990 and March 1996. All subjects had accurate gestational age confirmed by ultrasound prior to 20 weeks gestation and ultrasound measurements within 72 hours of birth of biparietal diameter (BPD), femur length (FL) and abdominal circumference (AC). A formula with the highest explained variance was computed by linear regression analysis using the three fetal variables in various combinations from 54 infants born between January 1990 and December 1993. The optimal formula was:Log10birthweight = 0.714627 + 0.077362.AC + 0.058758.BPD + 0.287037.FL ‐ 0.011274. AC. FLThe new formula was more accurate compared with existing formulae when tested in a separate cohort of 39 infants born between January 1994 and March 1996.
Pain relief following day case laparoscopic tubal ligation with intra‐peritoneal ropivacaine: a randomised double blind control study
Authors: Dreher JK , Nemeth D , Limb R 
Published: February 2008

Summary: The aim of this study was to examine the effectiveness of ropivacaine administered by a simple intraperitoneal technique in relieving pain following laparoscopic application of Filshie clips.Nineteen patients were randomised to receive either ropivacaine (200 mg) or normal saline through the umbilical port following clip application. Using a visual analogue scale women receiving ropivacaine had significantly lower pain scores 2 hours post operatively (0.97 vs 2.03 p < 0.05). The mean total postoperative fentanyl use was also significantly lower on the ropivacaine group (40 μg vs 104 μg p < 0.02).Only 10% (1/10) of the women in the ropivacaine group complained of nausea compared with 44o (4/9) in the control group. Furthermore, 80% (8/10) of women in the ropivacaine group were either very or totally satisfied with their pain relief. Only 56% (5/9) of the women in the control group were very or totally satisfied with their pain relief.Ropivacaine administered by a simple intraperitoneal technique following laparoscopic sterilisation significantly reduces postoperative pain and parenteral analgesic requirements. It would be reasonable to consider this method as standard practice following laparoscopic tubal ligation.
Management of essential thrombocythaemia during pregnancy
Authors: Cincotta Robert , Higgins John R. , Tippett Christine , Gallery Eileen , North Robyn , McMahon Lawrence P. , Brennecke Shaun P. 
Published: February 2008

SUMMARYEssential thrombocythaemia is a rare myeloproliferative disorder that often presents with haemorrhagic or thrombotic complications. It may be detected incidentally in an asymptomatic younger adult and there are only a few case reports of essential thrombocythaemia in pregnant women. The risks posed by essential thrombocythaemia during pregnancy and its optimal management are uncertain. To determine if there is increased incidence of obstetric complications seen in women who have essential thrombocythaemia, we collected a large case series from a number of tertiary obstetric units in Australia and New Zealand.There were 30 pregnancies in 12 women who had essential thrombocythaemia. There were 17 live births (57%). 7 stillbirths (23%), 5 miscarriages (17%) and 1 ectopic (3%). Five pregnancies were complicated by placental abruption. When the outcomes of those women who received treatment with aspirin or interferon were compared to those that did not receive any treatment, there was a trend towards a higher livebirth rate (79% v 38%, p = 0.06). Seven women were treated with aspirin and 5 had successful outcomes with no fetal complications. Four women were treated with α‐interferon which reduced their platelet counts and all had successful outcomes with no fetal complication. These findings suggest that there is a high incidence of miscarriage, stillbirth and abruption in women with essential thrombocythaemia. Their pregnancies should be carefully monitored. Treatment with low dose aspirin and/or the use of α‐interferon may be associated with an improved pregnancy outcome.
Single dose oral azithromycin versus seven day doxycycline in the treatment of non‐gonococcal mucopurulent endocervicitis
Authors: şendaǧ Fatih , Terek Coşan , Tuncay Güngör , özkinay Erdinç , Güven Melih 
Published: February 2008

SUMMARYThe aim of this study was to compare single dose oral azithromycin versus seven‐day doxycycline in the treatment of non‐gonococcal mucopurulent cervicitis (MPC). One hundred and thirty‐one women with non‐gonococcal MPC were enrolled in a prospective‐randomised study to compare the efficacy and safety of a single oral dose of 1 g azithromycin and a seven‐day course of 100 mg doxycycline twice daily Clinical examination and culture samples for Chlamydia trachomatis and other microorganisms were performed before and approximately 14 days after starting the treatment.Of the 131 women recruited (67 in the azithromycin group and 64 in the doxycycline group), Ureaplasma urealyticum was isolated from 21 (16%); Chlamydia trachomatis from 15 (11.5%); and Mycoplasma hominis from 3 (2.3%) of the patients at the initial examination. The eradication rate of baseline culture‐positive cases at the follow‐up visit in the azithromycin group was 71.4%, and 77.3% in the doxycycline group. There was no statistically significant difference in efficacy between the single dose azithromycin and seven‐day course of doxycycline in the treatment of culture‐positive cases. Azithromycin 1 g appears to be an effective and safe alternative to doxycycline for the treatment of non‐gonococcal MPC.
The relationship of physical trauma and surgical stress to menstrual dysfunction
Authors: To William W K. , Wong Margaret W N. 
Published: February 2008

SUMMARYTo evaluate the incidence and pattern of menstrual dysfunction in reproductive age group women suffering acute musculoskeletal trauma, 198 women between 15 and 50 years of age admitted consecutively into an acute orthopaedic unit were recruited over a 6‐month period. The patients were then followed up for 6 months with menstrual diaries to compare their menstrual pattern with their preadmission status. Excluding those with significant menstrual problems before admission, the menstrual pattern remained normal in 135 (68%) (EM), while 12 (6%) developed polymenorrhoea (PM), and 51 (25%) had oligomenorrhoea or amenorrhoea (OAM) within the 6‐month observation.The three groups did not differ in their mean age, body mass index, parity or age of menarche, but previous cycle lengths were shortest in the PM group (25.4 days, SD 7.64) (p<0.05) and history of amenorrhoea in the previous one year was most common in the OAM group (p<0.025). Univariate analysis showed the incidence of moderate to major trauma, operative treatment, longer operative time, general anaesthesia, blood transfusion and immobilisation were significantly higher in the PM and OAM groups compared to the unchanged group (p<0.05).A logistic regression model showed that general anaesthesia and longer surgical operations remained significantly related to the development of menstrual dysfunction. We conclude that the pattern of menstrual dysfunction after acute orthopaedic trauma appeared to be dictated by the woman's pre‐existing menstrual characteristics and the stress of surgical treatment.
Referral patterns for gynaecological radiotherapy in Victoria
Authors: Gard Gregory B. , Quinn Michael A. , Narayan Kailash , Bernshaw David M. , Planner Robert S. , Taylor Mandy 
Published: February 2008

SUMMARYA retrospective chart review was undertaken on all patients in Victoria who were referred for radiotherapy for a gynaecological cancer from February 1997 to January, 1998. Three hundred and ten patients were identified which represents less than one‐third of all gynaecological cancers diagnosed in Victoria each year. Ninety‐two of the 310 patients (30%) referred for radiotherapy were managed without the prior involvement of a certified gynaecological oncologist. The 310 patients included 95 patients with cervical cancer, 33 patients with ovarian cancer and 142 patients with endometrial cancer. The initial management strategies employed for patients with the major gynaecological cancers varied depending on the source of referral. This difference was most marked in endometrial cancer due mainly to differing indications for full surgical staging and subsequent referral for radiotherapy both between types of specialists and also between gynaecological oncology units.The development of evidence based guidelines in the major gynaecological cancers should lead to a more uniform approach to the care of women with gynaecological malignancies.
Validation of women's self‐reported smoking status in a Sydney colposcopy clinic
Authors: Donnelly Neil J. , Ward Jeanette E. , Dalrymple Chris 
Published: February 2008

SUMMARYThis study validated a self‐reported smoking prevalence questionnaire against urinary cotinine levels among women referred to a Sydney based public hospital colposcopy clinic over the period November 1997 to June 1998. Of 213 eligible women, 160 (75%) agreed to participate. Of these, 151 (94%) completed the smoking prevalence item and 130 (86%) also provided a urine specimen. 40% (95% CI: 33%‐49%) of respondents self‐reported as current smokers.Observed agreement between self‐reported and biochemically validated smoking status was 94% compared with 52% chance agreement (kappa = 0.87, p < 0.001). This high level of agreement was also robust to sensitivity analyses using a more conservative cutoff for the urinary cotinine levels. We conclude that self‐reported smoking status provides valid estimates of actual rates of smoking among women referred with abnormal cervical smears.
A RACOG sponsored pilot study of a quality assurance program regarding management of labour by provincial Fellows
Authors: Humphrey Michael D. , Maher Claire F. , Panjari Mary 
Published: February 2008

SUMMARYObjectiveTo develop an effective and practical self‐administered obstetric audit program for use by clinicians within their own practice.SettingThe private and public practices of specialists in provincial practice.SampleTwo periods of 3 months in each Fellow's practice, separated by a period of 3 months to allow for data review, resulting in the review of management of 6708 singleton births.MethodsAll provincial Fellows in active practice in Australia in early 1998 were invited to take part in a voluntary ‘quality cycle’ obstetric practice audit. The data from the first 3 month period was fed back to participating Fellows for review before a second 3‐month audit period was undertaken.ResultsOne hundred and twenty provincial Fellows were invited to take part; 62 registered for the study, 58 commenced the project, and 52 completed the entire cycle.60.1% of the 6708 women studied laboured spontaneously, 25.8% had labour induced, and 14.1% had elective Caesarean sections. 87.8% of the 5759 women who laboured gave birth vaginally. There was little change in the incidence of intervention in labour between the first and second study periods.ConclusionsIt is possible to design a worthwhile self‐administered clinical audit in obstetric practice with which specialists in full‐time practice can cope and which provides useful personalised feedback for the specialist.
Is the irritable bladder associated with anterior compartment relaxation? A critical look at the ‘integral theory of pelvic floor dysfunction’
Authors: Dietz HP , Clarke B 
Published: February 2008

Summary: The ‘integral theory of pelvic floor dysfunction’, first proposed by Petros and Ulmsten in 1990, claims that anterior vaginal wall relaxation is associated with symptoms of urgency, frequency, nocturia and urge incontinence. A retrospective study was designed to test this hypothesis. Imaging data and urodynamic reports from 272 women suffering from symptoms of lower urinary tract dysfunction were evaluated. Opening of the retrovesical angle, bladder neck descent, urethral rotation and descent of a cystocele during Valsalva were used to quantify anterior vaginal wall laxity.None of the tested parameters were associated with symptoms and signs of detrusor overactivity. On the contrary, patients with higher grades of urethral and bladder descent were less likely to suffer from nocturia and urge incontinence and were less likely to have sensory urgency and detrusor instability diagnosed on urodynamic testing. The findings of this study therefore do not support this hypothesis of the ‘integral theory’.
How long does it take to deliver a baby by emergency Caesarean section?
Authors: Spencer Michael K , MacLennan Alastair H 
Published: February 2008

SUMMARYThis audit documented the current range of decision‐to‐delivery reaction times for 464 emergency Caesarean sections performed in maternity hospitals with differing levels of facilities, and examined the reasons for any perceived delay.The median (with 10th‐90th percentile) times from when the decision was made to perform an emergency Caesarean section to the delivery of the child were: 69 (37–114), 54 (28–94) and 42 (17–86) minutes in Level 1, 2 and 3 maternity hospitals respectively when the indication for delivery was urgent. Less urgent emergency Caesarean sections took 70 (42–125), 66 (38–141) and 67 (35–164) minutes respectively. The main perceived reasons for delay in the delivery were staff unavailability in Level 1 hospitals, theatre access in Level 2 hospitals and anaesthetic complications in Level 3 hospitals. Therefore the decision‐to‐delivery reaction times in the majority of urgent emergency Caesarean sections are, in practice, much longer than the times commonly advocated and are influenced by the facilities and staff available.
Seroprevalence of varicella zoster virus, parvovirus B19 and Toxoplasma gondii in a Melbourne obstetric population: implications for management
Authors: Karunajeewa Harin , Siebert David , Hammond Rachel , Garland Suzanne , Kelly Heath 
Published: February 2008

SUMMARYAt an antenatal clinic at a Melbourne obstetric hospital, 308 women were questioned about a known past history of infection with varicella zoster virus (VZV), human parvovirus B19 and Toxoplasma gondii. Immunoglobulin G (IgG) concentrations were determined for the 3 infectious agents and a recalled history of infection was compared with the presence of specific antibody. Exactly 66% of women recalled being infected with chickenpox (VZV) and 94% showed serological evidence of past exposure. Although 64% of women had parvovirus specific IgG, only one gave a definite history of past parvovirus infection. None of the 23% of women with evidence of previous exposure to Toxoplasma gondii recalled a past infection. The proportion of antenatal women at risk in this study was used to estimate the potential burden of disease from congenital infections in Australia and to examine implications for management of pregnancies complicated by these 3 infections.
Prognostic value of baseline serum oestradiol in controlled ovarian hyperstimulation of women with unexplained infertility
Authors: Costello Michael F , Hughes Graeme J , Garrett Don K , Steigrad Stephen J , EkangaM Abie 
Published: February 2008

SUMMARYThis study aimed to evaluate the prognostic value of the baseline serum oestradiol E2 level on the cycle pregnancy rate (PR) in women with unexplained infertility (UI) undergoing controlled ovarian hyperstimulation (COH). This study is unique in that it evaluates the effect of cycle day 1 (rather than day 3) E2 levels on cycle PR in a COH setting (without IVF) in women with UI (rather than multiple causes of infertility).Structured as a retrospective cohort study, the setting was the Ovulation Induction Clinic at an academic tertiary care hospital. One hundred and forty‐five patients with UI underwent 374 cycles of COH with either human menopausal gonadotrophin (hMG) alone or hMG and clomiphene citrate.Outcome was measured as cycle pregnancy rate (PR) according to the cycle day 1 level of E2. Patients with an E2 level > 150 pmol/1 on cycle day 1 of COH achieved a significantly lower PR (4%) compared with those with E2 levels ≤ 150 pmol/1 (13%). Logistic regression analysis demonstrated that women with day 1 E2 levels below 150 pmol/1 were 3.2 times more likely to conceive than those with day 1E2 levels above 150 pmol/1. Also, the impact of day 1E2 levels on the chance of pregnancy was independent of day 1 serum FSH levels.Women with UI undergoing COH in our unit with an elevated baseline serum E2 > 150 pmol/1 have a significantly lower PR and should be counselled regarding the decreased likelihood of pregnancy.
Guideline use for gestational diabetes mellitus and current screening, diagnostic and management practices in Australian hospitals
Authors: Rumbold Alice R , Crowther Caroline A 
Published: February 2008

SUMMARYA postal questionnaire investigating screening, diagnosis and management practices for gestational diabetes mellitus (GDM) and guidelines use for GDM, was sent to 544 Australian hospitals providing maternity care. Of these, 360 (66%) responded. Guidelines for GDM were available in 127 (39%) hospitals. Screening for GDM was undertaken by 284 (87%) hospitals and of these, 151 (53%) screened all women and 63 (22%) selectively screened women. Half (143, 50%) of the hospitals surveyed screened women using a 50 g oral glucose challenge test (OGCT) and 70 hospitals (25%) used a 75 g OGCT.A 75 g oral glucose tolerance test was most commonly used to diagnose GDM (207; 81%) and 126 hospitals (60%) recommended a 2 hour blood glucose level of ≥ 8.0 mmol/1 as diagnostic for GDM. In the management of women with GDM, levels for optimal glycaemic control varied. Postpartum testing for diabetes mellitus was recommended by the majority of hospitals (202; 72%). This study has shown the majority of Australian hospitals providing maternity care screening for GDM, but there is little consensus in screening practices.
Obstetric and neonatal outcomes associated with maternal naltrexone exposure
Authors: Hulse GK , O'Neill G , Pereira C , Brewer C 
Published: February 2008

SUMMARYPoor maternal and neonatal outcomes are associated with the pregnant heroin user. These include increased antepartum haemorrhage, decreased neonatal birthweight and increased neonatal mortality. Medically supervised withdrawal from heroin during pregnancy has, however, been discouraged due to possible risk to the fetus and because of the high incidence of return to regular illicit heroin use by the mother. In recent years, however, a number of withdrawal procedures using anaesthesia, oral sedation, or intravenous sedation, precipitated by naloxone and/or naltrexone have been developed and carried out successfully on pregnant heroin users.We have now collated information on 18 cases (19 detoxifications) from three countries (Portugal, Australia and the United Kingdom). These case study data, although limited, indicate that detoxification of the pregnant heroin user is possible without significant risk to the neonate or mother, with many women not returning to dependent heroin use following detoxification. Naltrexone maintenance has also been used in the non‐pregnant heroin user to discourage illicit heroin use.Similarly to methadone, stabilisation on naltrexone may be associated with conception and pregnancy, i Over the past three years, 26 women have conceived j while on the Western Australia naltrexone pro‐ i gram. Due to the unknown teratogenic effects, most have ceased naltrexone intake at approximately seven or eight weeks gestation. In a number of ! instances, however, naltrexone maintenance has : been recommenced following return to a dependent pattern of heroin use. As a consequence, neonates have had different periods of naltrexone exposure. building from the initial seven or eight weeks.We now report on seven women who have delivered and three who are well into their third trimester. Neonatal and obstetric features were unremarkable with good Apgar scores, birthweight and head cir cumference observed. In the three cases still in third‐term gestation, normal fetal development has been observed at recent ultrasound examinations. These case data indicate that naltrexone maintr nance may have a role in the management of the pregnant heroin user.
Pregnancy after Fontan repair of complex congenital heart disease
Authors: Hoare Jane V , Radford Dorothy 
Published: February 2008

SUMMARYWe describe four successful pregnancies in three women who had previously had a Fontan repair for congenital heart disease. Each pregnancy resulted in a live birth and there was no maternal mortality. The infants were premature, being delivered at 26, 30 and 35 weeks, and weighing 1020, 1333 and 1930 g respectively. The fourth infant was born at 32 weeks and no birthweight is available.Maternal complications occurred and were those anticipated after a Fontan repair. Two mothers required treatment for supraventricular arrhythmias (atrial flutter and fibrillation). Ventricular failure was present in two mothers and required ongoing drug treatment. Raised systemic venous pressures caused peripheral oedema in two mothers and hepatomegaly and ascites in one mother. The physiology, potential complications, anaesthetic concerns and drug treatment in pregnancy after Fontan repair are discussed.