bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nonlaser Videolaparoscopic Surgery for Ectopic Gestation*
Authors: Verco Christopher J. 
Published: February 2008

EDITORIAL COMMENT: : Laparoscopic surgery for ectopic pregnancy has the important advantages of shorter stay in hospital and easier convalescence for the patient. The spate of articles on the subject also suggests that the treated tube is more likely to remain functional with high subsequent rates of intrauterine pregnancy; this could be due to the method of treatment or/and the fact that the technique is suitable only for early cases and ones where there are no extensive pelvic adhesions. Also the need for follow‐up serial beta HCG assay is important since residual trophoblast can result in tubal rupture. A recent case of near maternal death reported in conversation to the editor provokes us to warn readers that the patient with collapse from intraperitoneal haemorrhage due to a ruptured ectopic pregnancy requires resuscitation and laparotomy not laparoscopy. The new technology is impressive but follow‐up is also more sophisticated. Should all patients, after conservative surgery for ectopic pregnancy, undergo tubal patency investigation before embarking on further pregnancy?Summary: : The potential of nonlaser videolaparoscopic surgery for ectopic gestation in a metropolitan public hospital was assessed by the review of the last 16 consecutive women presenting to the author with either a ruptured or an unruptured ectopic pregnancy. Ten of the 16 were treated by the videolaparoscopic techniques of either salpingotomy or aquaexpression, removal of the ectopic pregnancy and pelvic lavage; there were no intra or postoperative complications. HCG levels were monitored to extinction in all but one woman who had a coexistent intrauterine pregnancy. Three of the 10 women have subsequently had intrauterine conceptions and none have had further ectopic gestations. Those women unsuitable for videolaparoscopic therapy had substantial haemorrhage (4), an ovarian ectopic pregnancy (1) and extensive adhesions precluding laparoscopy (1). The techniques of nonlaser videolaparoscopic treatment for tubal ectopic gestation are simple and appropriate in a majority of women presenting with this condition.
Bradyarrhythmias and Laparoscopy: A Prospective Study of Heart Rate Changes with Laparoscopy
Authors: Myles Paul S. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication to remind readers that routine procedures performed by the laparoscopist often cause problems for the patient and her anaesthetist. The paper reminds us of the necessary team work between nursing staff, anaesthetist and surgeon which is equally important for other gynaecological operations and for obstetric anaesthesia. Brief operations are often performed for conditions of major significance to the patient; they can be dangerous and should not be referred to as ‘minor’.Summary: : Cardiac arrhythmias are a common complication of laparoscopy. Brady‐arrhythmias (including asystole) may be life‐threatening. The recent introduction of new shorter‐acting muscle relaxants (atracurium and vecuronium), with their lack of vagolytic activity, may exacerbate this situation. At the Royal Women's Hospital there have been several episodes of severe bradyarrhythmias and/or asystole associated with these relaxants. This study evaluated heart rate changes in 49 women during laparoscopy: 47% of patients had arrhythmias, 30% of these being bradyarrhythmias. Nearly all the episodes occurred during carbon dioxide insufflation or with traction on pelvic structures. The life‐threatening nature of this phenomenon should be understood by all anaesthetists and gynaecologists engaged in laparoscopic procedures.
Ponderal Index: A Better Definition of the ‘At Risk’ Group With Intrauterine Growth Problems than Birth‐weight for Gestational Age in Term Infants
Authors: Fay Roger A. , Dey Philip L. , Saadie Christopher M.J. , Buhl Janice A. , Gebski Val J. 
Published: February 2008

EDITORIAL COMMENT: This study provides persuasive evidence that estimation of ponderal index provides a worthwhile parameter for assessment of fetal condition in newborn infants. We agree with the authors' conclusions that ponderal index warrants documentation as well as fetal growth retardation using the accepted definition of equal to or less than the tenth percentile for birth‐weight for infants of similar gestational age born in the community concerned. The disadvantage of ponderal index is that it is less useful for the obstetrician making management decisions, since it cannot he calculated before delivery, when clinical and ultrasonographic estimations of fetal growth retardation are available. Ponderal index certainly should be calculated for paediatric follow‐up studies of high risk infants. Hopefully we will be offered further studies on ponderal index versus fetal growth retardation, symmetrical and asymmetrical, as a parameter for assessment of the condition of the newborn infant and the risk of subsequent physical and neurological impairment.Summary: A study was undertaken at Nepean Hospital, Penrith to compare the outcome of pregnancies with growth retarded infants; 2,508 consecutive births were analyzed between August 1, 1989 and April 30, 1990. A comparison of outcome was made between infants whose birth‐weight for gestational age was below the tenth percentile and infants who had a low ponderal index from 37 weeks' gestation. The Caesarean section delivery and fetal distress rates were significantly higher for infants with a low ponderal index than for infants with a low birth‐weight. Ponderal index appears to be a better measure of infants with intrauterine growth problems than birth‐weight percentiles.
Can Ultrasonography Reliably Predict the Occurrence of Multiple Pregnancies in Gonadotropin Ovulation Induction?
Authors: Yu Su Ling , Pepperell R. J. , Evans J. H. 
Published: February 2008

EDITORIAL COMMENT: This paper illustrates the limitations of ultrasonography and estimation of urinary excretion of oestrogen in prediction of multiple pregnancy when ovulation is induced by gonadotropin therapy. However, the reviewer of this paper wishes to point out to readers that the authors presumably still use these techniques and do not wish to imply that they are useless. During the time of this study of 380 cycles, there were 28 cycles abandoned (table 1) presumably in order to avoid the risk of multiple pregnancy but the details are not provided. It is noteworthy that figure 2 in this paper shows that multiple pregnancy resulted in 6 of the 10 conceptual cycles in which total urinary oestrogen excretion was 200 ug/24 hours or above; had these 10 cycles been abandoned the 1 quadruplet and 3 of the 6 triplet pregnancies would have been avoided.Summary: retrospective study of 78 patients with 106 stimulated conception cycles after successful gonadotrophin ovulation induction was made to analyze the relationship between the sizes and numbers of ovarian follicles seen on ultrasound and the eventual number of conceptions that resulted in each cycle.Fifteen cycles (14.2%) resulted in spontaneous abortions. There were 58 singleton pregnancies (54.8%), 26 sets of twins (24.5%), 6 sets of triplets (5.6%) and 1 set of quadruplets (0.9%).In 86 cycles with the last scans performed shortly before the ovulating dose of HCG, 3 or more mature follicles were found in 50 (58%). These cycles resulted in 31 (62%) singletons, 16 (32%) twin pregnancies and 3 (6%) triplet pregnancies. Pregnancies resulted even when there were no ‘mature’ follicles seen on scan. No statistical correlation was found between plurality of pregnancy and size or number of follicles, or oestradiol excretion on the day the ovulating dose of HCG was given, although high‐order multiple pregnancies were more likely if the oestrogen excretion was more than 200 ug/24 hours (p = 0.001). The dosage of HCG correlated inversely with the occurrence of multiple pregnancies (p = 0.02).In conclusion, neither oestrogens nor ultrasonography could accurately predict multiple conceptions in gonadotrophin stimulated cycles.
Laparoscopy in the Management of Women with Chronic Pelvic Pain
Authors: Al‐Suleiman Suleiman A. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it analyses the fallibility of bimanual pelvic examinations in assessment of pelvic pathology, in comparison with laparoscopy, in a large series of women with chronic pelvic pain. Although 85% of patients had ultrasonography, the value of this investigation was not presented. We were surprised to read that only 9 of the 246 women had laparoscopic evidence of endometriosis. Although all patients had preoperative bacteriological study, the authors do not discuss the findings, nor indicate if chlamydial infection was sought for by culture or immunofluorescence testing. It would seem wise to perform bacteriological cultures (including testing for Chlamydia trachomatosis)from the pelvic peritoneum and any identified focus of infection in all women with chronic pelvic pain who have laparoscopy performed.Summary: review of 232 women who had diagnostic laparoscopy for chronic pelvic pain was undertaken. Diagnostic error in the preoperative pelvic examination in the series varied from 21% to 61%; of 135 patients who had normal pelvic examination findings preoperatively, 82 (61%) were found to have pelvic pathology on diagnostic laparoscopy, whereas 21 of 97 women (21.6%) who had abnormal pelvic examination, had normal findings on laparoscopy. The overall incidence of pelvic pathology in the series was found to be 69%. Our results suggest that there is poor correlation between findings of pelvic examination and the existence of pelvic disease. Laparoscopy has a definite place in the evaluation of patients with chronic pelvic pain and certainly justifies its increasing use in their management.
Complications and Bilaterality of Mature Ovarian Teratomas (Clinicopathological Evaluation of 286 Cases)
Authors: Ayhan Ali , Aksu Tarik , Develioglu Osman , Tuncer Z. Selcuk , Ayhan Ayse 
Published: February 2008

EDITORIAL COMMENT: This large series of cystic teratomas of the ovary, treated in one institution, should provide reliable figures for bilaterality of the tumour (13.7%; 31 of 226), and the incidence of complications. However, the most interesting information provided is that histological examination of both ovaries in 182 of 242 women with a unilateral ovarian mass led to identification of a teratoma in the ‘normal ovary’ in only 2 cases (1.1%). This finding would seem to support the authors'conclusion that bisection of the opposite ovary to exclude a tumour is not indicated, since it could decrease the fertility of the patient. Most textbooks recommend that after treatment of a cystic teratoma (usually by conservative cystectomy in the premenopausal patient) the opposite ovary should be sectioned, although in the editor's experience this is seldom performed‐correctly so, according to the findings in this paper.Summary: Bilaterality, complications and associated pathology were reevaluated in 286 cases of mature teratoma of the ovary, treated in the last 25 years. Torsion was the most frequent complication, occurring in 22 (7.7%) patients. Rupture, infection and secondary malignant change were uncommon complications, occurring in 11 (3.8%), 7 (2.4%) and 1 (0.3%) patients, respectively. Both ovaries were evaluated histologically in 226 patients, 31 (13.7%) of whom were shown to have bilateral tumours, including 2 patients with tumour in the normally appearing ovary, contralateral to the gross tumour.
Continuing Medical Education in Obstetrics and Gynaecology: The Challenge of the Nineties*
Authors: Hewson A. D. 
Published: February 2008

Summary: The Obligatory Continuing Medical Education (CME) programme of the Royal Australian College of Obstetricians and Gynaecologists (RACOG) which is linked to time‐limited certification has now been in operation for over a decade. Its somewhat unique features have attracted widespread interest both nationally and internationally and may be seen as part of an international movement towards obligatory CME in Western Medicine. However, the programme should also be seen as just a part of the educational responses necessary as the medical profession moves into the 1990s, particularly for those of us in the discipline of Obstetrics and Gynaecology.This paper reviews the increasing pressures from within the profession and from the community towards the obligatory CME concepts pioneered by the RACOG, but suggests that the challenges that have been faced in this area in the past although significant, are much less than those which will be faced in the 1990's, as the discipline addresses the challenges of educating obstetricians in the third phase of Continuing Medical Education ‐ education in managing the environment in which our discipline is practised.
Amniocentesis in the Management of Preterm Premature Rupture of the Membranes
Authors: Dudley Jan , Malcolm Girvan , Ellwood David 
Published: February 2008

EDITORIAL COMMENT: The clinical value of amniocentesis in the management of patients with premature rupture of the membranes is not established although this investigation is widely practised in the United States of America for this indication. This paper presents important information regarding the usefulness and limitations of amniocentesis, especially concerning the diagnosis and treatment of intrauterine infection. We support the authors' conclusion that a randomized controlled trial of amniocentesis is needed to assess its possible contribution to the management of patients with premature rupture of the membranes.Summary: A retrospective analysis has been performed of perinatal outcome in 81 pregnancies in which preterm premature rupture of membranes (PPROM) was managed using amniocentesis to diagnose intrauterine infection and lung maturity. Ten patients (13%) had a positive Gram stain on microscopy whilst 29 (37%) had a positive culture. Forty‐one patients (58%) had a mature lecithin:sphingomyelin ratio. There was evidence of sepsis in 13 neonates (16%), with a further 16 (20%) being colonized. Both Gram stain and amniotic fluid culture were relatively poor predictors of neonatal sepsis. For Gram stain the sensitivity was low at only 15%. Although the sensitivity for culture was higher (69%), the specificity (71%) was too low to be clinically useful. It is recommended that a randomized controlled trial of amniocentesis in PPROM is needed to define the role of this diagnostic test.
When Predictions Don't Predict
Authors: Speirs Andrew L. , Asch Ricardo H. , Siiber Sherman J. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper to remind readers that the rules of clinical common sense as well as the results of statistical calculations are needed to judge published results of clinical trials. Statistical rules for design of a trial should be followed, and advice of a statistician sought before rather than after a study begins. It seems self‐evident that if the raw data does not show a clinically meaningful difference in the results obtained, that statistical gymnastics cannot save the day; for example if a series of patients with prolonged pregnancy is large enough, then a difference in the perinatal mortality rate of0.2% between conservative treatment and induction of labour will be statistically highly significant, yet the difference may be too small to convince clinicians that one regimen is superior to the other.Summary: One of the most widespread abuses of statistical methods involves the misinterpretation of statistical significance after the application of multiple comparisons. This paper highlights the problem by demonstrating ‘significance’ when clearly none exists.
Total Perineal Reconstruction After Major Obstetrical Injuries with Extensive Tissue Loss: A Report of 2 Cases
Authors: Lee S. H. , Cheah D. S. H. , Poopalarachagan S. , Sivanesaratnam V. 
Published: February 2008

EDITORIAL COMMENT: This paper was accepted for publication to remind readers that trauma to the genital tract at forceps delivery can result in infection and gangrene, with awesome tissue loss following debridement. Except for abortional Clostridial infection and one case of uterine gangrene with wound dehiscence after Caesarean section, the Editor has seen no such cases in 34 years practice in our discipline. Nor has he encountered a case of ‘symbiotic gangrene of a gynaecological abdominal wound requiring debridement’, although there are many reports of such cases. The details of the corrective surgery used in these 2 patients will particularly interest those surgeons trained to tackle cases of rectovaginal fistula.Summary: Major perineal injuries following obstetrical complications represent difficult problems of reconstruction. We describe 2 such patients with perineal injuries simulating infantile cloacas. Surgical repair using an abdominoperineal pullthrough procedure in 1 patient, and a Bricker loop type of repair in another resulted in successful restoration of function in both. The operative details and basis for the reconstruction are described.
Racial Variation in Serum Uric Acid Concentration in Pregnancy: a Comparison between European, New Zealand Maori and Polynesian Women
Authors: Barry Christopher L. , Royle Gordon A. , Lake Yvonne 
Published: February 2008

EDITORIAL COMMENT: This paper confirms the findings of the study reported by Carter and Child (Aust NZ J Obstet Gynaecol 1989; 29: 213–214) that serum uric acid values increase during pregnancy. It provides extra data that the serum uric acid values are higher in New Zealand Maori and Pacific Islanders than in New Zealand European women. The authors did not tackle RA Fay's hypothesis (Aust NZ J Obstet Gynaecol 1990; 30:141–142) that the rise in serum uric acid in patients with preeclampsia is secondary to placental damage rather than alteration in renal function. None of the patients in this New Zealand study had hypertension or renal disease. The next step is to tell us when women with chronic renal disease, with or without superadded preeclampsia, and who have uric acid values well above the 0.45 mmol/l upper limit of normal, require delivery when tests of fetal well‐being (cardiotocography, blood flow studies) remain within normal limits. When do sustained high uric acid values signal that irreversible renal failure is imminent?Summary A prospective study was undertaken to measure serum uric acid levels in normal pregnant women of different races, to ascertain if there was any significant interracial variation. A total of 48 women were studied of which 13 were European, 11 New Zealand Maori, 22 Pacific Islanders and 2 Indian. In the second trimester, European, Maori and Cook Island women had similar uric acid levels and other Polynesian groups showed significantly higher levels. In the third trimester, both Maori and Cook Island women showed a marked rise so that their levels came to equal those of other Polynesian groups, all 3 having significantly higher levels than European women. The importance of these observations relates to the use of uric acid levels in the management of patients with gestational proteinuric hypertension. It is possible that in these cases unusually high results may alarm the clinician into hasty intervention.
Endocervical Chlamydia Trachomatis Infection in Pregnancy: Direct Test and Clinico‐Sociodemographic Survey of Pregnant Patients at the Port Moresby General Hospital Antenatal Clinic to Determine Prevalence and Risk Markers
Authors: Klufio Cecil A. , Amoa Apeawusu B. , Delamare Olivier , Kariwiga Grace 
Published: February 2008

EDITORIAL COMMENT: Chlamydia trachomatis causes symptomatic and asymptomatic infections which in pregnant women have been linked to chorioamnionitis, premature rupture of the membranes and premature labour (A). Chlamydial infection is easily treated (by erythromycin) but recognition requires screening. This study has shown that this means screening the entire population, since clinical methods are unable to identify a high risk group. Screening for C. trachomatis is reported to be cost‐effective when the prevalence of the infection exceeds 6% (B), as it did in the present study, and in studies reported in this journal from Saudi Arabia (1987; 27:126 ‐ antenatal incidence 12.6%) and Fiji (1987; 27: 213 ‐ antenatal incidence 38–50%). The standard antenatal investigations recommended in Australia do not include testing for C trachomatis. Readers are referred to the recently available compendium produced by the Royal Australian College of Obstetricians and Gynaecologists which includes a section on routine screening in pregnancy and lists those investigations generally accepted as necessary and also those frequently done in certain groups of patients.A. The Chlamydia Challenge. Am J Obstet Gynecol 1991; 164: 6: 2: 1776–1796.B. Nettleman MD, Bell TA. Cost‐effectiveness of prenatal testing for Chlamydial trachomatis. Am J Obstet Gynecol 1991; 164: 5: 1: 1289–1294.Summary The prevalence of endocervical C. trachomatis infection in 181 consecutive antenatal clinic patients at the first attendance and who had not received antibiotic therapy in the previous 4 weeks, was 17.7%. The direct fluorescent antibody test was used for diagnosis. There was no significant clinical or sociodemographic factor which distinguished patients who tested positive from those who tested negative.
Temperature Drop in Normal Term Newborn Infants Born at the University Hospital, Kuala Lumpur
Authors: Raman S. , Shahla A. 
Published: February 2008

EDITORIAL COMMENT: This paper was accepted for publication to remind readers that newborn infants, especially if premature, should promptly be dried, wrapped and placed in a cot. It is recommended that at about 1 hour of age, if the temperature is normal (≥ 36.5 oC per axilla, 36.8oC per rectum) and stable, the baby is undressed for measurement, estimation of birth‐weight and the routine examination. Our paediatrician reviewer commented that many obstetricians may have forgotten the importance of prevention of cooling of the newborn infant, the care of whom is usually left to members of the nursing staff. We all agree that bonding between mother and baby is important but should not delay the baby being dried and covered promptly after birth.Summary: A prospective study of temperature drop in 141 normal term newborn infants delivered vaginally at the labour ward, University Hospital, Kuala Lumpur were studied. The effect of various manoeuvres on the temperature drop were also studied. They were randomized into 3 study groups, 63 cases where the babies were wiped with dry cloth alone, 37 cases where the babies were put into a plastic bag immediately after birth and lastly 41 cases where the babies were wiped with dry cloth and then inserted into a plastic bag. There was significant temperature drop in all the 3 groups maximum in the first 15 minutes and the fall continued for 1 hour after delivery (p< 0.001). This shows that in an airconditioned labour ward in a tropical country the temperature fall in newborn infants can be significant. This study also showed that plastic is a poor insulator against significant temperature drop.