bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chlamydia Trachomatis Infections in Female Tertiary Students
Authors: Dhupelia Dilip K. H. , King Linda G. 
Published: February 2008

EDITORIAL COMMENT": We accepted this paper for publication since it reports the highest prevalence of chlamydial infection we have heard of in an Australian population. These findings are alarming and need to be confirmed by others before it will be agreed that a screening test for Chlamydia trachomatis should be performed at the time of routine pelvic examination in sexually active women, whether symptomatic or not. These findings are in contrast to the 1% prevalence reported in asymptomatic antenatal patients. We need further studies of the prevalence of this infection in both high risk groups (women attending for infertility treatment or termination of pregnancy) and in women having routine pelvic examination for the Papanicolaou smear test. Let us hope HIV infection will never sweep through our population like this. Regardless of moral considerations a life‐long unshared partnership looks a better proposition than ever before.Summary: Chlamydial infection of the endocervix was identified in 19.8% of 258 University students undergoing pelvic examination in a Student Services Health Clinic. The majority of consultations were for routine Papanicolaou smear. Chlamydial infection was present in 50% (12 of 24) of the women who had clinical evidence of mucopurulent cervicitis.
Submucous Fibroids: Clinical Profile and Hysteroscopic Management
Authors: Itzkowic David 
Published: February 2008

EDITORIAL COMMENTS: This paper was accepted for publication because it reports a further use of the hysteroscope other than endometrial ablation. Some of the cases clearly involved more than pedunculated polyps lying free in the uterine cavity; the technique included removal of intramural fibromyomas. It is too soon to judge the impact this new technology will have on avoidance of hysterectomy in women with menorrhagia and/or pain. The hysteroscopist reviewer made the comment that, in his view, laparoscopy should be performed by a second operator when intramural fibromyomas are resected during hysteroscopy, to avoid perforation of the uterus and thermal damage to pelvic structures. The laparoscopist at these procedures sometimes sees the uterine wall become inverted as the subjacent fibromyoma is resected, a fact that should be drawn to the attention of the hysteroscopist! The author's response to this editorial comment is the paragraph of the discussion section of this paper printed in italics.Summary: Fifty submucous fibroids were removed by hysteroscopic resection from 37 patients with abnormal uterine bleeding. Thirty‐seven fibroids were completely resected and 13 incompletely resected. Nine patients also had rollerball endometrial ablations. The average follow‐up period was 14 months (4 to 51 months) in 33 patients available for follow‐up. All of these patients had cure of their symptoms, 3 after repeat operations. The 1 immediate complication was a postoperative infection. A normal uterine cavity was found in 13 of 14 patients examined by office hysteroscopy at follow‐up.
The Efficacy of the Pipelle Endometrial Biopsy in Detecting Endometrial Carcinoma
Authors: Ferry J. , Farnsworth A. , Webster M. , Wren B. 
Published: February 2008

Summary: The purpose of this study was to determine the efficacy rate of the Pipelle endometrial biopsy sampler (Pipelle de Cornier) (1) in detecting endometrial carcinoma, and to analyze the tumour variables that may influence the success rate.Thirty seven women with known endometrial carcinoma were tested preoperatively; there were 25 correct diagnoses (67%), the remaining 12 cases (33%) failed to demonstrate the correct diagnosis: 4 showed ‘atypical epithelium’, 2 showed ‘atypical hyperplasia’, 3 showed ‘nonspecific epithelium’ and the remaining 3 showed ‘necrotic hyalinized material.All cases were analyzed with respect to several tumour parameters, including the degree of differentiation, tumour volume, depth of invasion, and the extent to which the tumour filled the endometrial cavity. Poor results were obtained in well differentiated, low volume, and minimally invasive tumours, i.e. most early tumours, precluding its use as a screening tool.A positive biopsy can save patients the time, cost, and inconvenience of a dilatation and curettage. However, in the light of these findings, a nonspecific finding should be interpreted with caution.
Caesarean Section Anaesthesia and the Apgar Score
Authors: Boyle R. 
Published: February 2008

EDITORIAL COMMENT": We accepted this paper for publication because it carefully challenges a commonly expressed clinical opinion regarding the optimal anaesthesia for delivery at Caesarean section of the low birth‐weight infant. Our anaesthetist reviewer commented that the indication for Caesarean section was not considered and emphasized that Apgar scores have a poor correlation with fetal well‐being and should not therefore be considered as incontrovertible evidence for or consequence of poor operating conditions or birth trauma. A number of facts relating to general anaesthesic agents and their effects on the neonate are mentioned in the discussion. However, the extremely important concept of aortocaval compression and its effect on maternal cardiac output, peripheral resistance and the placental circulation was not.Summary: Retrospective comparison of epidural and general anaesthesia by a multivariate analysis of 1 and 5 minute Agar scores did not show that general anaesthesia improves operating conditions for Caesarean section or reduces fetal trauma for preterm and term infants.
Laparoscopic Removal of Dermoid Cysts Using Endopouch
Authors: Yuen P. M. , Rogers M. S. 
Published: February 2008

EDITORIAL COMMENTS: We accepted this paper for publication since like other articles in this issue, it describes another laparoscopic technique available to the gynaecologist. However, reviewers of this paper wish to remind readers that cystic teratomas are often too large for this retrieval bag technique (> 7cm) and more importantly that the standard operation for cystic teratomas in premenopausal women is ovarian cystectomy with preservation of the ovary and ovarian function. In our experience enucleation of a cystic teratoma with conservation of the ovary is always possible unless the tumour has undergone torsion and is necrotic. Moreover, enucleation of an ovarian cyst can be performed by laparoscopic technique (A).A. Wood C, Maher P, Hill D. Gynaecological endoscopy. RACOG continuing education Resource Unit 100, 1993.Summary: Laparoscopic oophorectomy was successfully performed in 6 patients with ovarian dermoid cysts. The use of Endopouch eliminates the risk of spillage and the need to extend the wound. The duration of operation ranged from 60 to 90 minutes and all patients were discharged within 48 hours with minimal pain and no complications.
Laparoscopic Modified Radical Hysterectomy and Lymphadenectomy Simulating Open Operation for Stage 1A2 Cervical Carcinoma
Authors: Jobling T. , Wood C. 
Published: February 2008

EDITORIAL COMMENT": This paper gives a fine technical description of a modified radical procedure performed laparoscopically for a very early carcinoma of the cervix. The initial results of the operation in terms of blood loss and time in hospital are impressive. The paper does not however attempt to answer what we think are the most important issues raised by the advent of laparoscopic surgery. Unfortunately the comparison of open and laparoscopic surgery for gynaecological cancer cannot be measured in terms of immediate postoperative morbidity or mortality. The efficacy of this treatment can only be ascertained in following up these patients over several years and determining overall survival and tumour recurrence patterns. That being the case it is difficult to see how informed consent can be obtained from patients undertaking laparoscopic procedures for gynaecological cancer. We are not able to tell these patients that overall cure rates are as good as with conventional therapy and the potential for litigation looms high should this turn out not to be the case.One would expect the results of treatment for the patient presented in this paper to be excellent, as many would consider that a simple hysterectomy would have been adequate therapy. While these patients with very early lesions may be suitable candidates to refine the technique needed for this radical surgery once again the problem of informed consent is a concern. This is such a problem that the Gynecologic Oncology Group in the United States of America is holding a workshop to consider the ethical issues raised by laparoscopic surgery for gynaecological cancer. We believe that there is a place for radical laparoscopic surgery but are equally certain that its place has not yet been defined.Summary: A 31 year old patient with Stage 1A2 cervical carcinoma underwent a laparoscopically modified radical hysterectomy and pelvic lymphadenectomy simulating the open operation. The operative technique is described. The operative time was 7 hours and 40 minutes. The patient was discharged on the third post‐operative day. The procedure warrants further evaluation.
Pregnancy Complicated by Maternal Phenylketonuria
Authors: Peat Brian 
Published: February 2008

Summary: Pregnant women who have elevated levels of serum phenylalanine are more likely to have a spontaneous abortion or to give birth to an infant with congenital cardiac anomalies, symmetrical growth retardation, microcephaly and mental retardation than pregnant women with normal levels of this amino acid (1).Nine pregnancies in 7 women were managed in conjunction with the staff of the Children's Hospital, Sydney. In 6 patients, satisfactory serum levels of phenylalanine were attained and 6 offspring are all normal at follow‐up, ranging from 15 years to 1 year. The 2 children of the poorly controlled mother were of low birth‐weight and both had microcephaly at birth. The poor control of serum phenylalanine was due to poor compliance with the strict dietary regimen.It is concluded that dietary control of serum phenylalanine levels below 600 umol/1 in pregnant women with PKU is possible and desirable and may improve perinatal and long‐term outcome.This requires close co‐operation between paediatrician, dietician, obstetrician and patient. Further data are required to confirm these findings in larger numbers and to provide long‐term neurological follow‐up.
Septic Pelvic Thrombophlebitis: An Unusual Treatable Postpartum Complication
Authors: Keogh John , MacDonald Dermot , Kelehan Peter 
Published: February 2008

Summary: Septic pelvic thrombophlebitis is an uncommon but serious postpartum complication occurring in about 1 in 2,000 pregnancies, characterized by pain, antibiotic resistant fever and tachycardia. In about 50% of cases a pelvic mass is present which is usually right‐sided (especially when the ovarian vein is involved). It is estimated to cause 18 maternal deaths per million pregnancies in the United States.Use of contrast enhanced CT scanning and a trial of heparin therapy increases the diagnostic certainty.It is particularly important because surgical management which may otherwise be suggested because of a spiking fever and a mass seems to be associated with a poorer prognosis than does conservative management.
Sexuality and Pregnancy An Interview Study
Authors: Barclay Lesley M. , McDonald Peter , O'Loughlin John A. 
Published: February 2008

Summary: This paper reports the interview research which formed the basis for a large, recently completed study of sexuality and pregnancy by questionnaire. Semistructured interviews were conducted with 25 couples who presented at a large hospital antenatal clinic in the first trimester. Of these couples, 15 participated in second trimester interviews and 12 couples were interviewed between 38 and 40 weeks' gestation.The results showed a substantial decline in sexual interest amongst women that was not matched by their male partners but was reflected in a marked reduction in frequency of intercourse. The range of sexual activities also diminished during pregnancy. The majority (19 or 76%) regularly practised oral sex and 3 men (12%) regularly practised anal intercourse. A key observation is that 7 males (28%) did not always achieve orgasm during sexual intercourse per se.
Antepartum Screening and Non‐selective Intrapartum Chemoprophylaxis for Group B Streptococcus
Authors: Jeffery Heather E. , Mcintosh E. D. G. 
Published: February 2008

Summary: The efficacy of antibiotic chemoprophylaxis in labour for all maternal carriers of Group B streptococcus with respect to the neonatal mortality and morbidity was analyzed. The intervention consisted of a policy of maternal screening for Group B streptococcus at 28 weeks' gestation by a low vaginal swab, cultured on to nonselective media. If positive, all carriers were treated with intrapartum ampicillin regardless of other obstetric risk factors. The main outcome measures were studied prospectively for 16 months before and for 32 months after instituting the intervention. These included the incidence of early‐onset Group B streptococcal infection as defined by either a blood culture or a symptomatic neonate with a positive urinary streptococcal antigen test, the mortality and the morbidity.Intrapartum ampicillin significantly reduced the incidence of early‐onset Group B streptococcal disease, from 2.0 to 0.37 per 1,000 livebirths for neonates with a positive blood culture (p < 0.03), and from 4.9 to 1.5 per 1,000 livebirths for symptomatic infants with a positive urinary antigen test (p < 0.004) and the attributable morbidity, namely, neonates who were: admitted to a level 2 or 3 unit (p < 0.004); treated with antibiotics (p < 0.004); preterm (p < 0.04); ventilated (p < 0.01). Seventy five per cent of the maternal population was overall actually screened and the carriage rate was 12%. No serious adverse reactions to ampicillin were observed.Significant reduction in early‐onset neonatal Group B streptococcal disease has occurred concurrent with antepartum screening and nonselective intrapartum chemoprophylaxis.
Relationship of Fetal Macrosomia to a 75g Glucose Challenge Test in Nondiabetic Pregnant Women
Authors: Khan Khalid S. , Syed Amber H. , Hashmi Firasat A. , Rizvi Javaid H. 
Published: February 2008

Summary: We determined in nondiabetic women, the relationship of plasma glucose values obtained 2 hours after a 75 g oral glucose challenge test (GCT) at 16–20 weeks' gestation, with the incidence of macrosomia in term deliveries (37–41 weeks' gestation). From 1988–1990, in a systematic screening programme data collected prospectively from 1,331 women were analysed retrospectively. Women with gestational diabetes or impaired glucose tolerance (n = 53) were excluded. The rest (n = 1,278) had no evidence of glucose intolerance including 1,215 women with normal plasma glucose by GCT (< 7.8 mmol/L 2 hours after 75 g oral glucose load) and 63 women with abnormal GCT but no abnormal value at a glucose tolerance test. The GCT values were divided into 5 groups: Group A (< 4.5 mmol/L), B (4.5‐5.5 mmol/L), C (5.6‐6.6 mmol/L), D (6.7‐7.7 mmol/L) and E (> 7.8 mmol/L). The variables studied were age, parity, gestational age at delivery and incidence of macrosomia.Using <4 kg birth‐weight as the definition of macrosomia, the incidence increased from 1.2% to 9.5% with increasing plasma glucose values in the GCT from Group A (< 4.5 mmol/L) to E(> 7.8 mmol/L). Similar trends of increasing incidences from 7.2% to 15.8% and 2.9% to 9.5% were noted when 90th and 95th birth‐weight percentiles, respectively were used as definitions of macrosomia. The test of linear trend in this association was significant (p < 0.01). These results were not influenced by parity or gestational age at delivery.These data provide new information to help explain the biology of macrosomia and also highlight the need for stricter criteria for diagnosis and treatment of glucose intolerance.
Laparovaginal Hysterectomy
Authors: Wood Carl , Maher Peter , Hill David , Lolatgis Nick 
Published: February 2008

Summary: The technique and complications of 141 patients having laparovaginal hysterectomy in private practice are reported.Abdominal hysterectomy was avoided in the 110 patients having preliminary laparoscopic surgery for pelvic disease, ovarian removal, or a uterus larger than 12cm. Postoperative morbidity included pulmonary embolus (3), vesicovaginal fistula (2) and pelvic haematoma (4). The frequency of complications was less than that reported after abdominal or vaginal hysterectomy.The surgical technique changed during the series; the operative care of the bladder and ureter requires particular attention. A larger number of patients in a variety of centres require study before the laparoscopic procedure can be determined to be as safe as abdominal or vaginal hysterectomy. The laparoscopic procedure has the potential to replace the majority of abdominal hysterectomies.
The Global View of Reproductive Health
Authors: Fathalla Mahmoud F. 
Published: February 2008

Summary: Reproductive health is a condition in which the reproductive process is accomplished in a state of complete physical, mental and social well‐being and is not merely the absence of disease or disorders of the reproductive process. The Daily Reproductive Health News in our global village does not paint a bright picture.The past few decades have witnessed a revolution in reproductive behaviour, with a major expansion in contraceptive use in developing countries. Between 1960‐65 and 1985‐90, the number of contraceptive users in all developing countries has increased from an estimate of 31 million to 381 million. The major expansion in contraceptive use in developing countries has consequences for the quality of life, for the present and for the future, for the society at large and for the individuals and their families.Major challenges, however, still lie ahead. There is a major unmet need for family planning. The rhetoric about population and family planning is not matched by allocation of resources.
Colour Doppler Imaging of the Uteroplacental Circulation in the Mid‐Trimester: Features of the Uterine Artery Flow‐Velocity Waveform that Predict Abnormal Pregnancy Outcome
Authors: Fay Roger A. , Ellwood David A. , Bruce Suzanne , Turner Anne 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it presents data on the use of colour Doppler imaging in a screening test in healthy nulliparas to assess whether abnormal pregnancy outcome can be identified. Unexpectedly there were 4 perinatal deaths in this series and table 4 indicates that in the only case in which the perinatal death was potentially avoidable the 24‐week uterine Doppler studies were normal. There is mounting evidence that Doppler imaging of uteroplacental circulation is useful in the management of identified high‐risk pregnancies but the value of the method as a screening test remains unproven. If larger studies confirm the reliability of this investigation to detect patients who are destined to develop preeclampsia then a possible application of this is identification of women who warrant prophylactic aspirin therapy since recent results show that aspirin therapy is not indicated routinely in nulliparasSummary: The accuracy of raised Resistance Index (RI) and early diastolic notching (EDN) of mid‐trimester uterine artery flow velocity waveforms in predicting abnormal pregnancy outcome was assessed in a prospective longitudinal study using colour Doppler imaging at 14, 18, and 24 weeks. In 106 healthy nulliparas with a singleton pregnancy studied; 70 had a normal pregnancy outcome, 34 had an abnormal pregnancy outcome, and 2 were lost to follow‐up. EDN was more sensitive than raised RI at predicting subsequent abnormal pregnancy outcome but raised RI was more specific at 14 and 18 weeks. Sensitivities were highest for the pregnancies with the more severely abnormal outcomes. Uterine artery Doppler studies in the mid‐trimester can predict abnormal pregnancy outcome. The presence of an early diastolic notch is an important feature when defining an abnormal or high resisitance uteroplacental circulation.
Determinants of Maternal Mortality in Eclampsia in India
Authors: Arora Raksha , Ganguli R. P. , Swain S. , Oumachigui A. , Rajaram P. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication to remind readers of the savage toll on maternal life that can be claimed by eclampsia when there is inadequate antenatal care in the detection and management of cases of preeclampsia. In the 22 years from 1971–1993 there were 108,476 deliveries and 60 cases of eclampsia at the Mercy Hospital for Women, an incidence of 0.06% or 1 in 1,808 deliveries and the maternal mortality rate was 5% (3 of 60). In this large series from India of 271 cases, the maternal mortality rate was 7.8% and the incidence of eclampsia was 1 in 115 deliveries (0.87%). The authors refer to other series of eclampsia in India where the incidences of eclampsia were as high as 4.6% of all deliveries. These high incidences of eclampsia are largely explained by referral of complicated cases to major centres and expectedly the series reported here contains a very high proportion of cases of antepartum eclampsia. Where antenatal care facilities are better most cases of eclampsia occur intrapartum and the distribution of the 60 cases at the Mercy Hospital for Women was 19 (32%) antepartum, 14 (23%) intrapartum and 27 (45%) postpartum whereas in the series from India the distribution was 128 (47%) antepartum, 85 (31%) intrapartum and 58 (22%) postpartum. The causes of death in these cases of eclampsia were similar to those which occur in developed countries. The take‐away message for readers is that we must continue our antenatal vigilance to detect the signs of preclampsia and manage these patients appropriately.Summary: Two hundred and seventy‐one pregnant mothers with eclamptic seizures admitted in a tertiary level teaching institution in South India over a period of 9 years from 1984 to 1992 were critically analysed with a particular reference to maternal mortality. The incidence of eclampsia was 0.87% of the total hospital deliveries (1 in 115 deliveries) and was increasing in consecutive years. Seventy per cent of the patients were primagravidas and more than 95% of them had not received antenatal care and were alarmingly unaware of any kind of examination during pregnancy. Eclampsia accounted for 20.9% of all maternal deaths during the same period and the case mortality rate was 7.8%. There is an urgent need to impart special training in antenatal care to non‐obstetrician doctors as well as paramedical staff working in the community and to provide health education to the community to reduce mortality from eclampsia.