bluuebunny/crossref_metadata_2025_split huggingface dataset:
Second Trimester Detection of Unilateral Hydrothorax: A Case Report of Successful Pregnancy Outcome with Passive Management
Authors: Weaver Edward , Costello Gerry , Innes Marty , Dye David , O'Brien Greg 
Published: February 2008

EDITORIAL COMMENT: This case illustrates the important option of conservative management of abnormalities detected using ultrasound antenatally. The number of investigative and therapeutic techniques available for use on the fetus antenatally is increasing rapidly. All of these techniques however carry some degree of risk to the fetus. In some instances such as amniocentesis this risk is well defined but in others less well so. After the initial enthusiasm for operative intervention antenatally for treatment of such conditions as hydrocephalus and hydronephrosis most experts now recognize such procedures have a very limited role to play in the antenatal period. The natural history of many ultrasound detected abnormalities is poorly characterized. It is increasingly evident as more publications appear in the literature that many conditions such as that illustrated in this report will disappear spontaneously without any intervention being necessary.There is still a place for masterly inactivity in obstetrics. With the sophistication of modern technology, observation of fetal condition can indeed be masterly, but the need for clinical judgement is probably greater now that spectacular beneficial intervention is technically possible in some conditions.Our librarian traced for us the likely origin of the aphorism that ‘in obstetric practice an error of omission is better than an error of commission’—‘In medicine the sin of commission is mortal, the sin of omission venial.“1. Bulletin of the New York Academy of Medicine, 1929: 5.
The Prediction of Intrauterine Growth Retardation in Remote Area Aboriginal Women Using Serial Fundal‐Symphysial Height Measurements
Authors: Norton R. 
Published: February 2008

Summary: A well recognised, simple and effective method of charting uterine growth by measuring the fundal‐symphysial height serially was used in 3 tribal Aboriginal communities in East Arnhemland.A total of 34 women were followed with serial measurements using a nomogram derived from Quaranta et al (1). There were 7 births with recorded birth‐weights of 2,500g or less (range 2,130g‐2,500g). Six of these had serial fundal height measurements consistently at or below the 10th percentile. These 6 babies were also found to be small for gestational age. There were 13 births with recorded birth‐weights between 2,500g‐3,000g. Four of these babies had serial fundal height measurements at or below the 10th percentile and 3 of the 4 were small for gestational age.It is suggested that fundal‐symphysial height measurements may be useful in the detection of intrauterine growth retardation, particularly in remote areas where there is a shortage of experienced medical personnel. It can be used by trained Health Workers and provides an objective record of antenatal progress.
Secondary Postpartum Haemorrhage
Authors: King P.A. , Duthie S.J. , Ven Dip , Dong Z.G. , Ma H.K. 
Published: February 2008

EDITORIAL COMMENT: This paper provides a useful review of the clinical features and management of secondary postpartum haemorrhage. Table 1A shows comparable statistics from an Australian hospital which the incidence was 2–3 times higher than the 0.5% reported by the authors from their hospital in Hong Kong. Since there are no predictive factors for secondary postpartum haemorrhage the important data concerns proper management. The high incidence of suction evacuation (87%) is noteworthy as was the authors' finding that the procedure stopped the bleeding in all 72 patients requiring this operation. The 1 case of uterine perforation serves as a reminder that the uterus may be soft and friable in these patients. Hysterectomy is seldom required in patients with secondary postpartum haemorrhage but when it is necessary, an experienced surgeon is required, since it is often difficult to secure haemostasis, and ligation of internal iliac arteries may be necessary. The 1 subtotal hysterectomy required in this series was performed before secondary postpartum haemorrhage occurred. The 3 other useful pieces of information provided in this Hong Kong series were that 24% of patients required blood transfusion, that bacteriology although useful on occasions was positive in only 12% of patients, and that histologically proven placental tissue was obtained at suction evacuation in 42% of patients — oedematous decidua is often macroscopically mistaken for placental tissue at the time of surgery in these patients.Summary: Eighty‐three cases of secondary postpartum haemorrhage managed in this teaching unit over a 3‐year period are described. Bleeding occurred most frequently between the 8th and 14th day of the puerperium; 73% of the patients had already been discharged from hospital and required readmission. Suction evacuation was performed in 72 patients and was successful in arresting haemorrhage whether retained placental tissue could be demonstrated on histology or not. There was histological confirmation of retained gestational products in only 30 (42%) of the patients treated surgically. No predictive factors for secondary postpartum haemorrhage could be identified in the obstetric profiles or antenatal course of most of these patients. Patients with retained gestational products could not be distinguished from those without on the basis of history or examination alone apart from 4 patients noted to have incomplete membranes at delivery.
Is Elective Cerclage Justified in the Management of Triplet and Quadruplet Pregnancy?
Authors: Goldman Gil A. , Dicker Dov , Peleg Dan , Goldman Jack A. 
Published: February 2008

Summary: The main complication in multiple gestation with more than two fetuses is prematurity, with its concomitant increase in perinatal mortality and morbidity. Clearcut indications as to management of these pregnancies are lacking, and the efficiency of elective cerclage is controversial.Twelve triplets and three quadruplets out of 27 multiple pregnancies were electively sutured and compared to 10 triplets and two quadruplets without this procedure. Otherwise, both groups were managed uniformly regarding bed‐rest, beta‐mimetic drugs and dexamethazone for the enhancement of fetal lung maturity.Mean duration of pregnancy in patients with cerclage was 35 weeks, significantly longer than those who did not undergo this procedure (30.7 weeks) (p<0.01).Furthermore, in the former group, the mean neonatal weight was significantly higher (p<0.01), mean Apgar scores were better, significantly lower rates of respiratory distress syndrome occurred (p<0.05), perinatal mortality rate was significantly reduced (p<0.01) and the mean hospitalization period was shorter (p< 0.025).It seems that elective cervical suture is a definite contribution to the successful management of multiple pregnancies with more than two fetuses.
The Inadequacies of Instruments Used for Cervical Screening
Authors: Spurred B. , Ayer B. , Pacey N.F. 
Published: February 2008

EDITORIAL COMMENT: This paper illustrates the need for improved instruments for performing cytological screening of the cervix, especially the endacervix. Comparison of techniques is not easy because of the problems of variation of findings due to observer interpretation and the problem of the order in which the smears are taken — for example was the spatula inferior to the cytobrush in this study because it was used second or because it provided a less satisfactory specimen? Another problem with comparisons of different techniques is that there is an interobserver variation (cytological interpretation) of more than 30 per cent in the severity of cervical intraepithelial neoplasia lesions. In this study one gynaecologist took all of the smears and one cytologist interpreted them all.Summary: Cervical cytology has a high false negative rate, especially for adeno‐carcinoma and its precursors. This study compares the traditional spatula with the cytobrush. Both the modified Ayre spatula and the cytobrush were found to be inadequate in a significant number of patients with known cytological atypia.It is concluded that inadequate sampling instruments make a contribution to false negative rates and that brush cytology is superior to rigid instrument cytology in routine cervical screening.
Vaginal Dystocia in a Patient with a Double Uterus and a Longitudinal Vaginal Septum
Authors: Carey Marcus P. , Steinberg Lionel H. 
Published: February 2008

EDITORIAL COMMENT: About 1 in every 500 women are born with a longitudinal vaginal septum. Presenting symptoms resulting in diagnosis of the malformation are usually dyspareunia or difficulty in insertion of a tampon. Septa may be thick and inelastic, or thin and readily displaced from the midline, such that the patient is unaware of the condition. Indeed the writer has the experience of diagnosis of such a septum at the time of Manchester repair in a postmenopausal multipara — the septum had been asymptomatic and unrecognized by herself or her obstetrician at her uneventful vaginal deliveries, and was displaced laterally such that the left sided uterus and vagina was unused — the diagnosis was made when the cervix was amputated! Management should be division and Hgation even if asymptomatic, because of the problems that can occur in labour. It is unnecessary to excise any of the flap since it takes up into the vagina with intercourse — even a large septum will disappear without a ridge remaining. The writer has 2 indelible memories of problems with such septa in labour. The first was being called, in 1961, to a case of delay in the second stage in a general practitioner unit in Coleraine, Northern Ireland. The mass projecting through the introitus was the longitudinal septum, seemingly transverse, pushed down by the head. Treatment was midforceps delivery of a healthy infant after pushing back the head so that the septum could be clamped, ligated and divided. The second, in 1965, was a 20‐year‐old primigravida with a known breech presentation (normal X‐ray pelvimetry), whose vaginal septum was not diagnosed until precipitate delivery occurred with the breech astride the septum which spontaneously avulsed from the posterior vaginal wall, after an episiotomy was made, and before the septum could be divided. The baby (birth‐weight 2,900 g) was alive and well. The vagina was packed after noting that the septum was a ‘huge necrotic fold the size of the placenta due to haematoma within it’, and the episiotomy was sutured. The septum was still noticeable anteriorly at the postnatal visit, but was no longer apparent I year later during the patient's second pregnancy.In the case reported here, once the septum was recognized at the lime of curettage, the patient should have been counselled appropriately and the septum divided.Summary: A case of a breech straddling a vaginal septum requiring urgent division is reported. This case demonstrates some of the obstetric complications asociated with congenital genital tract anomalies.
Uteroplacental Doppler Ultrasound in Routine Antenatal Care
Authors: Brown M.A. , North L. , Hargood J. 
Published: February 2008

Summary: Three hundred and five pregnant women referred consecutively from a single antenatal clinic for imaging ultrasound after 26 weeks' gestation had doppler velocimetry of umbilical artery, uterine artery and umbilical vein. Results of doppler studies were not available to clinicians until after delivery and clinical case records were examined postpartum for the development of pregnancy‐induced hypertension (PIH) or gestational diabetes mellitus (DM) and for fetal outcome.Accurate data were available for 272 women, of whom 167 had a normal pregnancy, 61 had or developed PIH and 44 had or developed DM. None of the various doppler velocimetry measurements differed significantly amongst these 3 groups at any gestational stage. Abnormal values for doppler systolic: diastolic (A/B) ratio were found in only 7% of umbilical artery measurements, 6% of uterine artery measurements and none of umbilical vein measurements. Specificity of abnormal results for PIH or DM was high (95–97%) but sensitivity low (16–17%) and positive and negative predictive values were generally low. Two perinatal deaths occurred and umbilical artery A/B ratio was abnormal in both cases. This study shows that there is a low yield of abnormal results for doppler velocimetry of umbilical artery, uterine artery or umbilical vein in routine antenatal screening.
Does Cord Drainage of Placental Blood Facilitate Delivery of the Placenta?
Authors: Thomas I. L. , Jeffers T. M. , Brazier J. M. , Burt C. L. , Barr K. E. 
Published: February 2008

EDITORIAL COMMENT: Most busy practitioners hold strong opinions, based on clinical experience they will say, of the preferred regimen for management of common clinical problems. This study shows that strongly held beliefs may be falacious. The authors have shown that drainage of placental blood from the cord does not affect the rates of retained placenta and postpartum haemorrhage. The editor has always taught that releasing the cord clamp and allowing drainage of placental blood minimizes fetomatemal haemorrhage and assists placental delivery ‐ he stands corrected. However, draining the cord does no harm, and the reviewer of this paper commented that at least it minimizes the mess if the cord breaks during delivery of the placenta by controlled cord traction!Our common clinical regimes should be scrutinized more often, especially when clinical results or community costs are involved. This study did not attempt to assess the value to the fetus of early versus late clamping of the cord. However, the volume of cord blood drained by release of the clamp (mean 54ml; range 0–185ml) suggests that the practice of early versus late clamping of the cord should be reevaluated to assess the volume of blood denied to the infant and the clinical implications of withholding this blood infusion.Summary: A series of 1,908 women delivering vaginally, and actively managed in stage 3 of labour, were randomly assigned to 2 groups to study if cord drainage of placental blood facilitated delivery of the placenta. Prophylactic oxytocics were given with the birth of the anterior shoulder. In both groups, early cord clamping was practised, timing being at the midwives' discretion. In the control group the cord remained clamped; in the drainage group the cord was undamped and the volume of placental blood measured. Controlled cord traction completed active management at evidence of separation/descent of the placenta.Rates for retained placenta, postpartum haemorrhage and transfusion were similar. It was concluded that when the third stage of labour is actively managed, placental drainage of cord blood confers no extra benefits.Pre‐ and post‐delivery Kleihauer tests were performed on blood from 20 women in each group. All tests were negative. Contrary to previous work, this does not suggest that cord drainage reduces the fetomatemal transfusion rate.The well known association of prolonged duration of stage 3 of labour and the risk of haemorrhage was strongly confirmed.
Macrosomic Babies
Authors: Cheung T. H. , Leung Ares , Chang Allan 
Published: February 2008

EDITORIAL COMMENT:
This paper presents the useful information that shoulder dystocia associated with macrosomia is more likely to result in neonatal morbidity when instrumental delivery is necessary than when delivery is spontaneous; whether or not this important conclusion applies equally to nulliparas and multiparas cannot be evaluated from the data presented here where only 17 of the 93 patients delivered vaginally required forceps delivery. In the editor's opinion mid‐forceps delivery is likely to be followed by shoulder dystocia when macrosomia is associated with occipitoposterior position in either nulliparas or multiparas. One reviewer of this paper was uneasy that in the presence of suspected macrosomia, Caesarean section rather than forceps delivery should be performed. If the head is arrested in the mid‐pelvis the risk of shoulder dystocia is considerable. Trial of forceps in theatre does not provide an easy solution because the greater problem may prove to be the shoulders when, in spite of some articles to the contrary, one is committed to vaginal delivery once the head is born. Another consideration is the type of analgesia used for such forceps deliveries ‐ in the editor's opinion mid‐forceps delivery merits general anaesthesia when there is the possibility of macrosomia, to provide ideal conditions for assessment and forceps rotation and delivery, and dealing with impacted shoulders if this complication occurs. A final comment is to remember the advice we received in training to ‘beware of mid‐forceps delivery in a multipara’ and this is especially true if she has previously required mid‐forceps delivery and/or has delivered an infant with birth‐weight above 4,000–4,500g. (see previous comments on Shoulder Dystocia Aust NZ J Obstet Gynaecol 1988; 28: 107 and 1989; 29: 129). Summary: A review on 3,241 delivery records was made to study the obstetrics and the neonatal outcomes of 129 macrosomic (>4,000g) babies. They were found to have a nearly 6‐fold increase in the neonatal morbidity rate compared with normosomic babies. The emergency Caesarean section rate for nulliparas and parous women with macrosomic babies was 41.3% and 8.4% respectively. Among macrosomic babies, shoulder dystocia was not associated with maternal stature, induction of labour, use of oxytocin or abnormal labour patterns, but was associated with instrumental delivery. Macrosomic babies with shoulder dystocia after instrumental delivery had a higher neonatal morbidity rate than those delivered spontaneously.
CO2 Laser Laparoscopic Salpingotomy for Treatment of Tubal Ectopic Pregnancies: Potential Limitations
Authors: O'Shea Robert T. , Thompson Graeme R. St J. 
Published: February 2008

EDITORIAL COMMENT: In appropriate selected cases (no shock, no active bleeding, no significant adhesions and no very high HCG levels) the treatment of choice of tubal ectopic pregnancy is by laparoscopic conservative surgery (salpingotomy). A laparoscopic approach compared to laparotomy, has proven economic advantages (shorter hospital stay and convalescence and earlier resumption of normal occupation) and suspected clinical advantages (less adhesion formation and better subsequent viable pregnancy rates) awaiting randomized prospective controlled studies for verification. Laparoscopic salpingectomy can also be performed with laser, as in this paper, or with cutting/coagulation diathermy (which is much, much cheaper) which yields comparative results. Salpingotomy can be performed laparoscopically with safety and could have been considered for one of the patients in this series who returned to theatre. The persistence of trophoblastic tissue requiring further treatment (usually methotrexate) occurs in about 10% of cases. Raphael Kuhn, MelbourneSummary: Linear salpingotomy was performed on 16 patients using the CO2 laser laparoscopically directed. Median operating time was 60 minutes (range 40–100) and all patients were discharged on the first postoperative day. There were 4 patients in whom persistence of trophoblast activity was detected, 2 of whom were treated surgically and 2 by oral methotrexate therapy.
Immunology of Anogenital Human Papillomavirus (HPV) Infection
Authors: Tindle Robert W. , Frazer Ian H. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it takes the human papillomavirus story further than the many other papers we have published on this increasingly common genital tract infection which has precancerous connotations. Many of the details may not excite the interest of general readers but the possibilities of vaccination against infection, nonsexual transmission and cocarcinogenesis are discussed. It seems to the editor that the main requirement is an accurate test to determine if women/men already harbour or have harboured the virus, because how else can we select candidates for vaccination when a vaccine becomes available ‐ unless one envisages a strategy of vaccinating the entire (? female) population, to preclude the need for selection of those already infected.Summary: A subgroup of human papillomaviruses (HPVs) is implicated in the aetiology of neoplastic change in anogenital epithelium. Although abundant circumstantial evidence exists for the involvement of the immune system in the control of HPV infection, restriction of infection to epithelium and the lack of a viral productive phase pose problems for immune response induction, and for immunological effector mechanisms. In this article we discuss how HPV antigens may be presented to the immune system on the surface of keratinocytes as well as, or in addition to, presentation by ‘classical’ antigen presenting cells, and outline putative roles for non‐specific and specific (B‐ and T‐ cell) effector functions. We discuss the prospects for a vaccine and the use of anti‐HPV antibodies in immunodiagnosis.
The Significance of Polyhydramnios Diagnosed During Labour or at Caesarean Section
Authors: Desmedt Els J. , Henry Olivia A. , Beischer Norman A. 
Published: February 2008

EDITORIAL COMMENT: This paper reports a simple clinical message that may not surprise readers, but should interest them — polyhydramnios diagnosed for the first time during labour or at delivery is not a benign finding.Summary: In the 38 cases of polyhydramnios reported here the diagnosis was made only at the time of artificial rupture of the membranes to induce or augment labour, or at Caesarean section. Usually this was a benign finding often associated with overweight in the mother (60%) or baby (39.4%). However there was an increased incidence of major congenital abnormality (13.1%) resulting in a high perinatal mortality rate (10.5%); the paediatrician should therefore be alerted prior to delivery of these patients.
Office Hysteroscopy and Curettage — A Safe Diagnostic Procedure
Authors: Itzkowic David J. , Laverty Colin R. 
Published: February 2008

Summary: In a series of 50 patients investigated by office hysteroscopy and curettage, satisfactory direct inspection of the cervical canal and uterine cavity was possible in all patients. In addition satisfactory endometrial specimens suitable for reliable histological evaluation were obtained in 98% of patients. No endometrium was obtained in 1 postmenopausal patient.Patients chosen for this form of investigation are those with an indication for diagnostic curettage who have no serious cardiovascular disease, are not bleeding or have light bleeding, and are willing to have an office procedure. Currently office curettage is done with a 5mm Karman catheter with an attached 10ml syringe for suction. Local analgesia is rarely used.
The Influence of Paternal Height and Weight on Birth‐weight
Authors: Morrison J. , Williams G. M. , Najman J. M. , Andersen M. J. 
Published: February 2008

Summary: : Analysis of 5,989 couples, for whom fathers' and mothers' heights and weights were recorded, showed that paternal height had a significant influence (p< 0.0007) on birth‐weight while paternal body mass index (Quetelets Index) had no significant effect (p>0.05).Depending upon mother's height, the average effect of father's height (ranging from 165 cm to 184 cm) on birth‐weight was up to 152 g, with a greater effect where the mother was taller (up to 235 g) and a lesser effect where the mother was shorter (confirming the effect of maternal constraint).The significance of these findings lies more with the need to consider this effect as an important variable in statistical analysis involving birth‐weight than in its immediate obstetrical implications.