bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in Ectopic Pregnancy in New Zealand
Authors: Macintosh Mary C. M. 
Published: February 2008

EDITORIAL COMMENT: In the Commonwealth of Australia the number of maternal deaths from ectopic pregnancy is substantial, and with reduction in other causes, ectopic pregnancy deaths now have a greater relative importance— 7 of 275 in 1964–1966, 3 of 237 in 1967–1969, 9 of 244 in 1970–1972, 5 of 137 in 1973–1975, 3 of 106 in 1976–1978 and 6 of 98 in 1979–1981. The majority of deaths occur because of failure to diagnose the condition. It is against this background that one must interpret the significance of a rise in the incidence of ectopic pregnancy, and wonder whether this is a consequence of an increased incidence of pelvic inflammatory disease.Summary: The rate of ectopic pregnancy in New Zealand from 1965 to 1983 was examined and shown to have increased 3‐fold from 4.3 per 103 total births in 1965 to 13.6 per 103 total births in 1983. Over this period the risk was greatest for the older conceiving woman, with a woman aged 35–44 years 2.2 times more likely to experience an ectopic pregnancy than a woman aged 15–24 years.
Twin Pregnancy: Prematurity and Perinatal Mortality
Authors: O'Shea Robert T. 
Published: February 2008

EDITORIAL COMMENT: Multiple pregnancy continues to account for approximately 10% of perinatal deaths (72 of 765 in Victoria, 1984); likewise debate continues as to whether or not bed rest in hospital minimizes the onset of premature labour and preeclampsia in these patients. Increased use of ultrasonography has minimized the incidence of unrecognised twins before the onset of labour, which previously occurred in approximately 20% of cases. It is therefore theoretically possible to conduct a controlled trial of rest in a consecutive series of patients with multiple pregnancy. This is not as easy as it sounds because many patients with multiple pregnancy have minimal discomfort and will not agree to rest in hospital before 28–30 weeks' gestation. Likewise, the onset of complications (hyperemesis, gross oedema, premature labour, premature rupture of the membranes, preeclampsia, polyhydramnios, antepartum haemorrhage) will often require admission to hospital irrespective of trial requirements.This paper presents one side of the rest in bed story. The author has shown that a considerable proportion of perinatal deaths in multiple pregnancy occur before the time at which it is customary to admit patients to hospital for rest. Since this paper did not analyse the details of all patients in the series, it did not consider the possible benefit of rest in patients whose babies survived. This paper emphasizes that for rest to be effective in twin pregnancy, it should be effected between 21 and 28 weeks' gestation. A practical compromise could be for patients with multiple pregnancy to be rested in hospital for 2–3 days every 2–4 weeks from 20 weeks' gestation until the dangers of prematurity are past.Summary: An 8‐year (1976–1984) retrospective analysis was undertaken of the management and outcome of 245 twin pregnancies delivered at Flinders Medical Centre, Adelaide. The incidence of twin delivery was 1 in 69 with a perinatal mortality of 85.7 per 1,000 total births. Amongst 42 perinatal deaths, 28 were associated with preterm labour at or before 28 weeks' gestation. If bed rest in hospital is to be implemented as a possible means of improving perinatal outcome in twin pregnancy it needs to be effected between 21 and 28 weeks' gestation; there is no rational theoretical basis for hospitalization beyond this time.
The Significance of Cardiotocographic Monitoring in Pregnancy Complicated by Intrauterine Growth Retardation and Prematurity
Authors: Sfameni S. F. , Cole M. , McBain J. , Heath P. 
Published: February 2008

EDITORIAL COMMENT: It is unlikely that a controlled study to establish the risk of intrauterine death when there is cardiotocographic evidence of critical fetal compromise will ever be conducted or published. These 4 cases are more than anecdotal since they occurred in 1 of 5 obstetric units within a major teaching hospital during a 6‐month interval (information provided by authors)— gestation ranged from 28–33 weeks’, birth‐weight from 425‐l,550g and in all cases fetal death occurred 2–24 hours after critical fetal reserve was identified by cardiotocography.Summary: Intrauterine growth retardation is a condition of chronic fetal compromise. The most accurate method of fetal assessment in this condition is by serial cardiotocography. In pregnancy associated with intrauterine growth retardation, abnormal cardiotocography with spontaneous decelerations may be an indicator of imminent fetal death in utero. Delivery should be effected immediately if the fetus is at a gestation where viability is probable.
Intrapartum Hysteroscopy
Authors: MD Boris Petrikovsky 
Published: February 2008

EDITORIAL COMMENT: This technique warrants consideration /evaluation especially in the patient having a trial of vaginal delivery after a previous Caesarean section (Case 2).Summary: A new method of visualization of fetus, uterus, placenta, umbilical cord and amniotic fluid is presented. A flexible endoscope was inserted into the uterine cavity after spontaneous or artificial rupture of the membranes via the vaginal route in 85 patients. Endoscopy could be beneficial for precise determination of the nature and type of umbilical cord and placental pathology, signs of fetal dysmaturity, the presence of meconium and evaluation of the integrity of a uterine scar. Intrapartum hysteroscopy could be especially helpful for patients with no prenatal care who appear in labour with incomplete histories. The method is proven to be safe for both the mother and the neonate.
Prospective Study of 3 Metabolic Regimens in Pregnant Diabetics
Authors: Farrag O. A. M. 
Published: February 2008

EDITORIAL COMMENT: Tight control of blood sugar values (below 5.6 μmol/l) has many advocates and has been associated with reduction in perinatal mortality rates in overt diabetics. This paper questions the value of very tight control — the answer provided warrants consideration and verification in larger studies, because the point is central to management of the pregnant diabetic. Other considerations are that too tight control risks the harmful effects of hypoglycaemia (on the fetus) which itself is reported to be equally as harmful (to the fetus) as hyperglycaemia (*1, *2). In support of this an increased incidence of fetal growth retardation in strictly controlled diabetics has been noted (*3). The recently published perinatal mortality results (4%) in diabetes must be considered to be satisfactory, although argument continues with regard to the necessary incidence of Caesarean section and the optimal maturity for delivery, Another important area for future study is the value of low fat, high unrefined carbohydrate diet to improve glucose tolerance in diabetics (*4, *5) a consideration that may profoundly influence long‐term maternal prognosis, especially in gestational diabetics where complications of the disease (small vessel changes) are absent or less overt.*1. Abell, DA, Beischer NA. The effects of hypoglycaemia and hyperglycaemia on pregnancy outcome. ANZ J Obstet Gynaecol 1976; 16: 75–81.*2. Drew JD, Abell DA, Beischer NA. Congenital Malformations, Abnormal Glucose Tolerance, and Estriol Excretion in Pregnancy. Obst Gynecol 1978; 51: 129–132.*3. Harley G, Belfast. Personal communication.*4. Brunzell JD, Lerner RL, Hazard WR, Porte D Jnr, Beirman EL. Improved glucose tolerance with high carbohydrate feeding in mild diabetes. N Engl J Med 1971; 284: 521–524.*5. Nolan CJ. Improved glucose tolerance in gestational diabetic women on a low fat high unrefined carbohydrate diet. ANZ J Obstet Gynaceol 1984; 24: 174–177.Summary: Three tight regimens to maintain blood sugar values of 5.6 SI (group A), 5.6–6.7 SI (group B), and 6.7–8.9 SI (group C), were studied in 60 pregnant diabetic patients. The perinatal salvage rate was 96.6%. Maternal hypoglycaemia occurred only in group A. The group C regimen produced more complications than occurred in the other 2 groups. Very tight control of blood sugar is not necessary for successful management of diabetes in pregnancy and blood sugar value between 5.6–6.7 SI offers the best outcome.
A Reappraisal of Urinary Oestriol Excretion as a Screening Test in Pregnancy6
Authors: Beischer Norman A. , Parkinson Patricia , Walstab Janet 
Published: February 2008

Summary: During the years 1971–1982 urinary oestriol excretion was tested in 38,536 patients (group 1). One or more low oestriol value was found in 11.0% of patients; in this group the stillbirth rate was 8 times higher, the neonatal death rate 4 times higher, and fetal growth retardation rate 4 times higher than in patients with normal oestriol values (all p < 0.001).During the years 1982–1984 a further 12,887 patients were tested (group 2) and 9.5% had one or more low oestriol value. The perinatal mortality rate in patients with normal oestriol excretion fell from 0.8% in group 1 to 0.5% in group 2 (p < 0.05), and in patients with low oestriol excretion from 4.7% in group 1 to 2.4% in group 2 (p < 0.01). However, patients in group 2 with low oestriol values still had significantly unfavourable results, compared to those with normal oestriol values — stillbirth rate 4 times higher, neonatal death rate 5 times higher, and fetal growth retardation rate 4 times higher (all p< 0.001).Although perinatal results have improved, fetal growth retardation and the risk of perinatal death are still identified by urinary oestriol assay.
Antepartum Cardiotocography — an Audit
Authors: Oats Jeremy N. , Chew Franklin T. K. , Ratten Valerie J. 
Published: February 2008

Summary: Between 1981 and 1986, 9,840 women were monitored by antepartum nonstressed cardiotocography (CTG). A satisfactory fetal reserve pattern was detected in 91%, a reduced reserve pattern in 8% and a critical reserve pattern in 1%. The incidences of fetal growth retardation, Apgar score < 6 at 1 minute, perinatal mortality and Caesarean section all increased significantly (p < 0.001) as the degree of cardiotocographic fetal reserve worsened. Intrauterine growth retardation and/or low urinary oestriol excretion was associated with a highly significantly increased incidence of abnormal CTG traces (14.2%, p < 0.001).A satisfactory fetal reserve pattern on cardiotocography was a reliable predictor of fetal well‐being, since after exclusion of lethal malformations, the perinatal mortality rate in those patients monitored within 7 days of delivery was 3/1,000.
Vaginal Delivery After 3 Previous Caesarean Sections
Authors: Lawson Gerald W. 
Published: February 2008

EDITORIAL COMMENT: When Caesarean section is performed for the standard indications and trial of scar considered in the next pregnancy, it will seldom be necessary to perform trial of scar after 3 Caesarean sections as reported here. However, this provocative case report, together with the review of similar examples in the literature, indicates that in the unusual patient who requests trial of scar after more than I Caesarean section, this obstetrical finesse is not reprehensible — provided that the labour is monitored with meticulous care, and, in our view, conducted without either induction of labour, oxytocin augmentation, epidural analgesia, or difficult forceps delivery. One reviewer of this paper still has the impression that trial of scar after multiple Caesarean section is inherently dangerous! This case also illustrates how important it is to try to avoid the first Caesarean section.Summary: A patient who had had 3 previous Caesarean sections was permitted a trial of scar in her subsequent confinement. Labour occurred spontaneously at 39 weeks, and was closely monitored. After an uneventful labour of 3 1/2 hours, a Wrigley forceps lift‐out was performed. There was no maternal or neonatal morbidity and the uterine scar was intact.
The Value of Clinical Symptoms in the Diagnosis of Urinary Incontinence in the Female
Authors: Korda Andrew , Krieger Mark , Hunter Peter , Parkin Gordon 
Published: February 2008

EDITORIAL COMMENT: Urodynamic investigation is being used increasingly in patients with urinary incontinence. Although many gynaecologists stress the importance of a careful history and examination as the basis for surgery, the recent literature would support the rule that no patient should have a second operation for stress incontinence without the benefit of preoperative urodynamic assessment.Summary: In a study of 566 patients with urinary incontinence the presenting symptom or combination of symptoms were shown to have limited diagnostic predictive value as measured by urodynamic diagnostic criteria.
Obstetric High Risk Screening and Prediction of Neonatal Morbidity
Authors: Webster M. A. , Linder‐Pelz S. , Martins J. , Greenwell J. 
Published: February 2008

EDITORIAL COMMENT: I commend the aim of the paper, that of assessing the ability of an obstetric risk score protocol to predict low risk pregnancies thus enabling patients to attend alternative birth centres. It is salutory to note that this retrospective study was not selective in predicting low neonatal morbidity for patients confined in birth centres.If a risk‐scoring protocol could be devised which would adequately predict low perinatal, intrapartum and neonatal risks, then births at alternative birth centres could be recommended on more scientific grounds than is possible at this time.Data predictive of the need for birth centre beds and of the need for support services for birth centres could be obtained. This might reduce the load on labour ward beds for level II and III patients and could assist the organization of obstetric services in the community.Summary: A retrospective study using an obstetric risk score protocol was applied to a stratified sequential sample of 843 singleton livebirths, occurring in the Royal Hospital for Women, Sydney, over a 12‐month period (March, 1985‐February, 1986). Data collection included 53 prenatal factors, 41 intrapartum factors and 37 neonatal factors. The study was comprised of 346 women admitted to the hospital birth centre and 497 women admitted to labour ward.In labour ward admitted women there was a significant association between high prenatal scores, high intrapartum scores and high neonatal morbidity scores. Women admitted to the birth centre were subjected to a screening procedure which resulted in low prenatal and relatively low intrapartum risk scores. However, neonatal morbidity scores were similar for both groups.The risk scoring protocol used in this study requires further revision to allow the adequate selection of low risk women delivering infants with a low risk of neonatal morbidity in a low risk obstetric setting.
Suppression of Puerperal Lactation Using Jasmine Flowers (Jasminum Sambac)
Authors: Shrivastav Pankaj , George Korula , Balasubramaniam N. , Jasper M. Padmini , Thomas Molly , Kanagasabhapathy A.S. 
Published: February 2008

EDITORIAL COMMENT: It is unlikely that the use of jasmine flowers for suppression of lactation will become the rage but we thought that readers would be interested in this safe and simple method. We respectfully disagree that it would be unethical to have included a placebo treated control group in the study (read on for reason). Twenty years ago (2), when the association between oestrogen therapy and venous thromboembolism was reported (1), our management of suppression of lactation changed abruptly from stilboestrol 5 mg tds for 5 days, to avoidance of breast stimulation, the use of a good supporting brassiere, and aspirin for pain if engorgement occurred — we were surprised to see how little difference there was and how few patients required analgesic drugs. Provoked by this paper, discussion with 12 charge sisters of postnatal wards disclosed that about 20% of patients who elect to suppress lactation are prescribed bromocriptine — in most cases prophylactically rather than as treatment of severe engorgement. This miniaudit revealed that the nursing staff were not in favour of bromocriptine therapy except when engorgement was severe, because of nausea and rebound lactation (often after the patient had gone home) — interestingly in one postnatal ward in Melbourne, the charge sister used cabbage leaves to treat engorged breasts and claimed that the method was successful! Routine therapy can become a crutch you can afford to throw away.Summary: The efficacy of jasmine flowers (Jasminum Sambac) applied to the breasts to suppress puerperal lactation was compared that of Bromocriptine. Effectiveness of both regimens was monitored by serum prolactin levels, clinical evaluation of the degree of breast engorgement and milk production and the analgesic intake. While both bromocriptine and jasmine flowers brought about a significant reduction in serum prolactin, the decrease was significantly greater with bromocriptine. However, clinical parameters such as breast engorgement, milk production and analgesic intake showed the 2 modes of therapy to be equally effective. The failure rates of the 2 regimens to suppress lactation were similar; however, rebound lactation occurred in a small proportion of women treated with bromocriptine. Jasmine flowers seem to be an effective and inexpensive method of suppressing puerperal lactation and can be used as an alternative in situations where cost and nonavailability restrict the use of bromocriptine.
A New Technique for Closure of the Uterus at Caesarean Section
Authors: Sivasuriya M. , Sriskanthan R. , Sriskandarajah M. N. 
Published: February 2008

EDITORIAL COMMENT: This paper was accepted for publication so that readers might pause and review their technique for closure of a Caesarean section incision. This paper favours a one layer closure in patients in whom sterilization is planned, presumably because the authors fear that the resultant scar would be more likely to rupture if a subsequent labour occurred. The time saved would not seem of great importance in most centres. Our editorial panel still favour the technique of closure of the incision in uterine muscle in 2 layers, with both lateral angles being secured before proceeding medially with the first continuous stitch. The use of a guide stitch in the centre of the lower edge of the uterine wound also facilitates closure (Ashton P, Beischer N, Cullen J, Rattan G. Return to Theatre — Experience at the Mercy Maternity Hospital, Melbourne 1971–1982. Aust NZJ Obstet Gynaecol 1985; 25: 159–169).Summary: A new method of closure of the uterus at Caesarean section is described. The technique which comprised suturing the uterine incision in a single layer was employed in 100 patients, in all of whom there was also a valid indication for sterilization. Apart from being simple, safe and effective the main advantage of the technique appeared to be saving operating time. A noteworthy feature was that the incidence of postoperative complications was no higher compared with the standard 3‐layer suture of the uterus.
Vaginal Delivery After Caesarean Section: Is It Safe in a Developing Country?
Authors: Muylder Xavier De 
Published: February 2008

EDITORIAL COMMENT: Evaluation of trial of vaginal delivery after previous Caesarean section (trial of scar) is at the cutting edge of modern obstetric practice and so we offer no apology for the number of papers we accept for publication on this subject. Trial of scar has been practised successfully, and reported consistently from centres in the United Kingdom and Eire for decades, but recent interest stems mainly from the United States of America where Caesarean section rates of 20–30%, and the realization that the leading indication for Caesarean was ‘Previous Caesarean’, has resulted in the abandonment of the philosophy of ‘Once a Caesarean always a Caesarean’, a dictum attributed to Dr E. Cragin, in 1916, at a time when the Caesarean section rate was only about 1% and most were by the classical technique! This paper reports impressive results from a centre where electronic fetal heart monitoring and X‐ray pelvimetry were not available. The elective Caesarean rate (28.2%) was low and 82% of those having a trial of labour delivered vaginally — the incidence of uterine rupture was 0.7% (2 of 288), but readers please note that in this series trial of scar was not performed if induction of labour was required, and there was no oxytocin augmentation in cases of dysfunctional labour — 59% of the 401 patients with a previous Caesarean were delivered vaginally. Readers may be interested to compare these results with those at the Mercy Maternity Hospital, 1971–1984 — of 3,524 patients with a previous Caesarean section 2,337 (66.3%) had an elective Caesarean and trial of vaginal delivery was attempted in 1,187 (33.7%). Vaginal delivery occurred in 895 patients i.e. in 75.4% of those having a trial of scar which was only 25.4% of the 3,524 patients with a previous Caesarean. Uterine rupture occurred in 10 of the 1,187 patients having a trial of scar; the price paid (by fetus, mother and obstetrician) for vaginal delivery after previous Caesarean section can be excessive.Summary: Many studies from developed countries have shown that a trial of vaginal delivery after a Caesarean section can be a safe alternative to repeated Caesarean section when certain criteria are fulfilled. However, few data are available from developing countries where, in most cases, there is no electronic fetal heart rate monitoring, no information about the prior section and no X‐ray pelvimetry. At Gweru Hospital, 401 patients with a scarred uterus have been managed according to a standard protocol and 288 were allowed to have a trial of scar. The results show that the trial was successful in 235 mothers (82%) and there were only 2 uterine ruptures (0.7%). Postpartum morbidity was higher after Caesarean section than after vaginal delivery.
Effect of Maternal Cardiac Disease on Perinatal Outcome
Authors: Jindal U.N. , Dhall G.I. , Vasishta K. , Dhall K. , Wahi P.L. 
Published: February 2008

EDITORIAL COMMENT: In Australia cardiac disease is a well recognized cause of maternal death, but the incidence is so low that it is seldom considered as a cause of perinatal mortality or morbidity. In the 7 triennia from 1964–1966 to 1981–1984 cardiac disease accounted for an increasing proportion of maternal deaths in Australia — 4.2% of 275, 4.2% of 237, 8.0% of 244, 8.6% of 137, 8.8% of 106, 7.0% of 98 and 10.6% of 94 respectively. The incidence of cardiac disease in pregnancy is much higher in developing countries and in those where rheumatic carditis is common (Ireland, Malaysia, India). At the Mercy Maternity Hospital, Melbourne, 1971–1983, there were 56,842 confinements and 209 patients (0.4%) had cardiac disease; the perinatal mortality (20 weeks and beyond) was 19.1 per 1,000. These figures are in sharp contrast to those quoted in this paper from the Postgraduate Institute in Chandigarh, India, where the incidence of cardiac disease was 1.4% (223 of 15,664) and the perinatal mortality rate (28 weeks and beyond) 67.2 per 1,000. The authors present convincing evidence that cardiac disease is associated with fetal growth retardation and prematurity.Summary: Perinatal outcome of 223 pregnancies complicated by maternal cardiac disease, over a 5‐year period has been studied. Mean birth‐weights of these babies were compared to the Institute's reference neonatal weight curves at different periods of gestation and found lower than the reference. The mean difference of 150 g was statistically significant. The incidence of prematurity, small for gestational age and perinatal mortality was analyzed according to the risk factors i.e. type, duration and severity of symptoms. The perinatal outcome was directly proportional to the severity of symptoms, irrespective of the type and duration of heart disease.