bluuebunny/crossref_metadata_2025_split huggingface dataset:
Autoimmune Disease and Pregnancy
Authors: Jones Warren R 
Published: February 2008

Summary: Autoimmune diseases are relatively common in women, and tend to occur in the childbearing years. These disorders fall broadly into two groups:

Multisystem diseases such as systemic lupus erythematosus (SLE) and related connective tissue disorders (CTD). This group includes the ‘pre‐clinical’ anti‐phospholipid or lupus obstetric syndrome which may first manifest itself as a pregnancy disorder causing recurrent abortion, fetal death, fetal growth retardation and early onset severe pre‐eclampsia.
Tissue‐ or organ‐specific disorders such as autoimmune thrombocytopaenic purpura (ATP), autoimmune thyroid disease (Graves' disease, Hashimoto's autoimmune thyroiditis, and post‐postum thyroiditis), autoimmune haemolytic anaemia, and the very rare myasthenia gravis.

The study of autoimmune diseases against the background of pregnancy as an experimental system of nature has provided important insights into the nature of the disease processes and the relevance or otherwise of circulating autoantibodies to pathological effects. Thus, for example, if neonatal manifestations of adult disease are causally related to the transfer of autoantibodies across the placenta, they will disappear over a time course consistent with the catabolism of IgG, providing no permanent damage is produced. Conversely, if autoantibodies are demonstrable in the neonate, in the absence of clinical effects, they may only be an epiphenomenon of the maternal disease. In addition, on occasions, disease manifestations may be seen in the baby when the mother shows none. This may occur when the mother is in remission, but still has circulating antibodies, or when she has an occult form of the disease.It is important also for clinicians to be aware of the reciprocal clinical effects in the mother of the disease‐pregnancy relationship. In addition to their potential importance for the fetus and neonate, individual autoimmune diseases may dictate care and specific action in the management of pregnancies complicated by these disorders. Of a more general nature, however, are the possible effects of drug therapy where this is necessary during pregnancy complicated by autoimmune disease.
Successful Pregnancy in Patients with Diabetes Following Myocardial Infarction
Authors: Wilson J. Dennis , Moore Geoff , Chipps David 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication to remind readers that women in Australia with severe medical disease, which in the past would be considered grounds for sterilization or even termination of pregnancy (Case 2) now expect or hope to tackle pregnancy successfully. It will be a challenge for obstetricians to maintain the maternal mortality rate in Australia at 1 in 7,860 births with current expectations of low and high‐risk mothers (A). In Case 2 the mother died more than 6 weeks after delivery and so would not be classified as a maternal death. Such cases explain why Henry et al have discussed the value of the maternal mortality definition being changed to include all deaths of women dying within 1 year of confinement (B). This paper informs us that women with a past history of significant myocardial infarction can cope safely with pregnancy and the puerperium.

Report on Maternal Deaths in Australia, 1988–1990.
Henry OA, Sheedy MT, Beischer NA. When is a maternal death a maternal death? A review of maternal deaths at the Mercy Maternity Hospital, Melbourne, M J Aust 1989; 151:629–631. Also editorial comment, same issue, 615–616.

Summary: Two cases of successful pregnancy are described in insulin‐dependent diabetic patients following myocardial infarction. Both mothers survived the pregnancies but 1 died from presumed cardiovascular causes 3 months postpartum. The relevant current literature is reviewed.
External Cephalic Version at a Military Teaching Hospital: Predictors of Success
Authors: Calhoun Byron C. , Edgeworth Deborah , Brehm Walter 
Published: February 2008

Summary: The purpose of this prospective study was to analyze our experience with external cephalic version under tocolysis. This included an expected (1) high success rate of version, (2) infrequent occurrence of reversion, (3) reduction in the incidence of intrapartum breech presentation, avoiding the need for Caesarean delivery, and (4) predictors of success in our series. The study spanned the period from 1985 to 1993, enrolling 113 subjects who presented to our OB/GYN Department with any type of breech presentation at 37 weeks' gestation or greater and met the following criteria: (1) absence of labour or ruptured membranes, (2) singleton pregnancy, (3) absence of medical or obstetrical complications and amniotic fluid index of greater than 8 cm. After a reassuring fetal assessment, IV terbutaline was given prior to an attempt at version.The results revealed a 46% (53 or 113) version success rate with a 4% (2 of 53) reversion within a week after procedure. There was a 2% (2 of 113) complication rate, with 1 being a minor incident of fetal bradycardia that responded easily to intrauterine resuscitation. One major complication occurred with placental abruption during the attempt, which required immediate Caesarean delivery.Predictors of success in our series included: multiparity, fundal/posterior placenta, and fetal head and spine on the corresponding side of the maternal sagittal plane. External cephalic version in a controlled setting can be a safe procedure for residents in training that lowers Caesarean delivery rate for breech presentation.
Repair of the Perineal Defect After Radical Vulvar Surgery: Direct Closure Versus Skin Flaps Reconstruction
Authors: Landoni Fabio , Proserpio Maria , Maneo Andrea , Cormio Gennaro , Zanetta Gerardo , Milani Rodolfo 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication to remind readers that the trend towards more humanitarian surgical treatment of gynaecological (including breast) carcinoma also applies to cancer of the vulva. A recent editorial in this Journal summarized the modern, less radical, principles of excisional surgery for malignant lesions of the vulva. This paper describes improvements in functional results that can be achieved by skin flaps reconstruction versus the traditional method of direct closure of the wound when radical excisional surgery is required in women with carcinoma of the vulva.Summary: From 1987 to 1990, 72 consecutive patients with primary untreated vulvar cancer underwent radical vulvar surgery with skin flaps reconstruction of the perineal defect. Postoperative complications, anatomical and functional results of this group of patients were compared with those of an historical control group of 77 patients submitted, at the same institution, to radical vulvectomy without reconstructive procedure from 1982 through 1986. The time of operation was significantly longer (180 minutes ± 15 versus 120 minutes ± 20) (p = 0.05) for patients submitted to the reconstructive procedure, while there was no statistically significant difference in intraoperative blood loss and hospital stay between the 2 groups. In comparison with direct closure, reconstructive procedures resulted in a significant lower rate of wound dehiscences (26% versus 64%) (p = 0.0001), vaginal introitus stenosis (2 versus 8) (p = 0.0001), sexual dysfunction (10% versus 50%) (p = 0.0001) and misdirection of the urinary stream (1 versus 5) (p = 0.001). It was concluded that skin flaps reconstruction is simple, reduces postoperative morbidity, and provides better anatomical and functional results than direct closure of the perineal defect.
Misdiagnosis of an Interstitial Ectopic Pregnancy After Unilateral Salpingectomy
Authors: Yim So‐fan , Fung Hedy Y.M. , To Ka‐fai 
Published: February 2008

SummaryA 36‐year‐old primigravida presented to us with symptoms and signs of ectopic pregnancy repeatedly but was misdiagnosed to have an intrauterine pregnancy based on 1 early ultrasound examination showing an ‘intrauterine sac’. She suffered the morbidity due to ectopic pregnancy which included hysterectomy which may have been prevented had the correct diagnosis been made.
Vaginal Vault Cytology in the Routine Follow‐up of Patients Treated for Endometrial Carcinoma: Is It Useful?
Authors: Ng T.Y. , Ngan H.Y.S. , Cheng D.K.L. , Wong L.C. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because the series reported and the literature reviewed indicates that follow‐up for endometrial carcinoma is unlikely to detect a recurrence that can be successfully treated. Perhaps a sensible compromise would be to see the patient annually after the first year especially when the patient knows which symptoms should be reported promptly should they occur. Follow‐up is important for the purposes of documentation and also for maintenance of the patient's morale by knowing that her treating practitioner maintains an interest in her welfare. (See previous editorial comment Kerr‐Wilson RHJ, McCrumA. Follow‐up of patients with gynaecological cancer. AustNZJ Obstet Gynaecol 1995; 35: 298.) Owen and Duncan (A) reported similar findings in a follow‐up of 97 women after treatment for endometrial cancer. Recurrent disease was diagnosed in 17 women, 7 of whom were asymptomatic at the time of diagnosis; there was no difference in survival between women with asymptomatic and symptomatic recurrences.Summary: Routine follow‐up visits and vault cytology following treatment for endometrial carcinoma generates a considerable workload and takes up valuable resources. A review is needed to evaluate the usefulness of this practice. Eighty six patients treated and followed‐up from January, 1987 to July, 1994 were reviewed. The standard follow‐up protocol consisted of physical assessment and vault cytology every 1 to 2 months for the first 2 years, every 3 months for the third year and every 6 months thereafter for at least 5 years. Recurrences were defined as histologically proven disease after a 3‐month disease free interval. Fourteen patients (17%) developed recurrences. Two of the 14 patients (14%) had local recurrences in the pelvis. Only 3 of these recurrences were detected during routine follow‐up. Vault cytology was negative in all patients with recurrences even when the recurrence occurred locally in the pelvis. Traditional surveillance protocols were ineffective in the detection of recurrences. Vault cytology was particularly ineffective. It was calculated that 1 recurrence was detected for every 606 visits. In this age of budgetary constraints, alternative follow‐up protocols should be explored.
High‐Dose Medroxyprogesterone Acetate for the Treatment of Dysfunctional Uterine Bleeding in 24 Adolescents
Authors: Aksu M. Feridun , Madazli Riza , Budak Erdal , Cepni Ismail , Benian AH 
Published: February 2008

EDITORIAL COMMENT": This classic study presents a very large experience of successful treatment of adolescent women with severe dysfunctional uterine bleeding all of whom responded to high‐dose oral medroxyprogesterone acetate therapy. It is interesting to note that none of these patients had underlying haematological disorders such as idiopathic thrombocytopenic purpura or Von Willebrand disease. In the editor's experience at least 1 such case would be expected in a series of 24 patients with adolescent dysfunctional uterine bleeding requiring hospitalization because of anaemia. The authors have not told us the further management or results of follow‐up of these patients. The editorial subcommittee considers that patients with severe dysfunctional bleeding should, after control of the presenting episode of bleeding, be given a 3–6 month course of either a low‐dose oral contraceptive pill or progestogen therapy for the last 18 days of the menstrual cycle; follow‐up is then necessary to check that menstrual function was normal and that anaemia had not recurred. These patients also warrant oral iron therapy during this interval. It is noteworthy that none of these 24 patients had demonstrable endometrial pathology with abdominal ultrasonography and none of them required curettage.Authors'Response to Editorial Comment:Our study group was purposely selected as adolescents with severe dysfunctional uterine bleeding without an underlying haematological disorder. We agree that one would expect to see such a case in a series of 24 adolescents with dysfunctional uterine bleeding sufficient to warrant admission to hospital. Our follow‐up regimen was the same as mentioned in the Editorial Comment and none of the 24 patients returned with the same complaint.Summary: The objective of the study was to evaluate the effectiveness of high‐dose oral medroxyprogesterone acetate therapy in the management of excessive dysfunctional uterine bleeding in adolescents. The study group consisted of 24 adolescents who were hospitalized with the diagnosis of excessive uterine bleeding and anaemia. Oral medroxyprogesterone acetate tablets were administered at a total dose of 60–120 mg during the first day of admission and 20 mg per day for the following 10 days. The blood loss was reduced to acceptable levels in all patients, and actually stopped in 6 (25%) within the first 24 hours of the treatment; bleeding ceased in 29.2%, 20.8% and 25% on the second, third and fourth days respectively. Significant correlation was identified between the initial haemoglobin concentration and the time required for cessation of bleeding (r=0.5, p=0.001). Rapid saturation of the endometrium with progestogens seems to be an highly effective mode of treatment for excessive dysfunctional uterine bleeding in adolescents.
Women Who Spontaneously Quit Smoking in Early Pregnancy
Authors: Panjari M. , Bell R.J. , Astbury J. , Bishop S.M. , Dalais F. , Rice G.E. 
Published: February 2008

EDITORIAL COMMENT: The takeaway message from this sophisticated audit of smoking behaviour of pregncny Seems to be that during pregnancy. seems to be that spontaneous quitters who lapse back to the habit should be identifed, since they comprise about 35% of smokers who a n likely to quit after counselling during pregnancy. This paper gives important insight into the logistics of planning a policy of prevention of smoking during prenancy. We await, with interest, the authors' findings in their randomized controlled trial of a smoking cessation interventionSummary: Spontaneous quitters are prepregnancy smokers who quit by the time of their first antenatal visit. We recruited 192 self‐declared spontaneous quitters and 407 smokers at their first visit to the antenatal clinic at the Royal Women's Hospital during April, 1994‐May, 1995. Spontaneous quitters made up 23% of prepregnancy smokers. Information about self‐declared quitters and smokers was collected by self‐completed questionnaires. Urine samples collected at the first visit and in late pregnancy were assayed for cotinine to validate smoking status. A cut‐off urinary concentration of >653 nmol/L cotinine was used to determine active smoking. At the first visit, 20% of the self‐declared spontaneous quitters were smoking and by late pregnancy, regardless of their initial biochemically verified status, 27% were smoking. Spontaneous quitters were different from women who said they were still smoking at their first antenatal visit, in a range of demographic variables and measures of addictive behaviour.
Differences Among Obstetricians in Caesarean Section Rates
Authors: Menticoglou Savas M. 
Published: February 2008

EDITORIAL COMMENT: The editor was once engaged in what was said to be the longest ever running case of medical investigation in Australia against an obstetrician whose Caesarean section rate was claimed to be excessive. The leading expert witnesses on both sides of the case were required to table the Caesarean section rates in their private practices. Who will be surprised to learn that both, including the editor, reported a rate above 20%. We are all charitable to ourselves when relating the high‐risk nature of our private practices, with many women referred with previous Caesarean section or poor perinatal result. This paper is carefully restricted to low‐risk nulliparas. In Melbourne, for a time, it was practice to notify each consultant of his/her Caesarean section rate and each was provided with an anonymous list of his/her colleagues' rates. In the Mc Bride case referred to above, the Judge asked the expert witness ‐ ‘do not the doctors in your institution with notification of low Caesarean rates fear accusation of malpractice?’Summary: This retrospective study examined the Caesarean section rates of 15 obstetricians at 1 hospital delivering 5,559 nulliparas with a single cephalic baby of birth‐weight ≥ 2,500 g. There was a wide variation in obstetricians' Caesarean rates, whether considering all their deliveries (5.5% to 20.1%), deliveries of their own patients (8.9% to 28.2%), or deliveries of their colleagues' patients (4.5% to 17.9%). There was no relation between Caesarean rates and perinatal outcome. The different Caesarean section rates among the obstetricians could not be explained by institutional factors, physician convenience, patient differences, or self‐serving economic incentives.
Nonunion of Uterine Incision: A Rare Cause of Secondary Postpartum Haemorrhage: A Report of 2 Cases
Authors: Nanda Smiti , Singhal Savita , Sharma Damyanti , Sood Madhulika , Singhal S.K. 
Published: February 2008

EDITORIAL COMMENT: We accepted these case reports for publication because they carry a message for readers, namely that secondary postpartum haemorrhage associated with nonunion of a Caesarean section scar can require a difficult and dangerous (for the patient) hysterectomy. The editor recalls such a case seen more than 30 years ago at the Royal Women's Hospital, Melbourne where at laparotomy the uterus, especially around the classical Caesarean wound, appeared gangrenous although no organisms were cultured. The pathologist considered the hysterectomy specimen resembled a treated case of Clostridium welchii infection. In this case the tissues were necrotic and sutures cut through all pedicles so that, eventually, a clamp hysterectomy was performed, with the instruments being removed, uneventfully, the following day. This patient survived; the memory of her operation remains! One reviewer raised the question of whether or not in Case 1 the vaginal examination with palpation of the lower uterine segment incision could have disrupted it, unknowingly, while finding it to be deficient. It is well recognized that curettage for secondary postpartum liaemorrhage has the risk of perforation of the uterus and/or disruption of a Caesarean section scar.Summary: Secondary postpartum haemorrhage after Caesarean section due to nonunion of the uterine incision is an unusual complication. Two women who had had lower segment Caesarean section for placenta praevia presented after 2 and 3 weeks respectively with shock due to massive postpartum haemorrhage. The uterine scars had not healed in both of these women who were managed by emergency subtotal
Three Recurrent Ectopic Pregnancies Case Report and Review of the Literature
Authors: Mustafa Mohamed Siddoq , Adelusi Babatunde , Sporrong Bengt 
Published: February 2008

EDITORIAL COMMENT: We accepted this case report for publication not solely because of its unusual anecdotal interest, or for its glimpse into reproductive requirements and wishes of women in Saudi Arabia, but for its summary of the literature on repeat ectopic pregnancy which should interest readers. Although preservation of the Fallopian tube by laparascopic salpingostomy is becoming the established treatment of unruptured ectopic pregnancy, we are unaware of a prospective trial comparing subsequent fertility in women with salpingostomy versus partial salpingectomy for unruptured ectopic pregnancy when the opposite Fallopian tube appears normal. In the present case there is no evidence that the preserved tube was useful from the reproductive point of view, although it remained patent. One reviewer of this paper performed a medline search and found that ‘there are no prospective studies and only a few retrospective reports comparing fertility rates after salpingostomy and salpingectomy. Three major retrospective studies found no significant difference infertility or incidence of repeat ectopic pregnancy between the 2 procedures, but salpingostomy carries a 5–8% risk of persistent ectopic pregnancy, contributing to increased morbidity and cost. Fertility after ectopic pregnancy is affected much more by the status of the contralateral tube than by the procedure performed, with fertility rates exceeding 80% after salpingectomy when the opposite tube is normal’(A).A. Rulin MC. Is salpingostomy the surgical treatment of choice for unruptured tubal pregnancy? Obstet Gynecoi 1995; 86: 1010–1013.Summary: Further studies on the obstetric performance of women after recurrent ectopic pregnancies are needed to adequately counsel women who are still interested in future fertility, even after their third ectopic pregnancy.
A Systematic Review of Single‐Dose Intramuscular Methotrexate for the Treatment of Ectopic Pregnancy
Authors: Parker Jim , Bisks Andrew , Proietto Anthony M. 
Published: February 2008

EDITORIAL COMMENT: The authors state that their review of the literature of single‐dose intramuscular methotrexate for the treatment of ectopic pregnancy‐revealed cases where the woman represented with shock secondary to ruptured ectopic pregnancy, requiring emergency laparotomy, but no report of a maternal death. The Annual Report for the year 1996 of the Consultative Council on Obstetric and Paediatric Mortality and Morbidity of Victoria, Australia, released in April 1998, provided details of such a case: (page 74 of report) ‘A 38‐year‐old woman had an ectopic pregnancy diagnosed and was treated conservatively with methotrexate. She developed anaemia and a haemoperitoneum and laparotomy was performed. The woman then developed a massive pulmonary thromboembolism and died 1 day later despite embolectomy’.Summary: The use of single‐dose intramuscular methotrexate for the primary treatment of ectopic pregnancy is increasing in frequency in many countries. We performed a systematic review of all available studies and case reports of intramuscular methotrexate to examine the therapeutic efficacy, side‐effects and complication rates of this new treatment approach. The pooled data show a successful resolution rate of 71% (95% confidence interval 58% to 81%) after a single dose of intramuscular methotrexate and 84% (95% confidence interval 77% to 90%) after 1 or 2 doses. Side‐effects were experienced by 24% (95% confidence interval 9% to 47%) of patients and 10% (95% confidence interval 7% to 14%) had a ruptured ectopic pregnancy. The pooled data show that single‐dose intramuscular methotrexate is associated with a high failure rate. Follow‐up is prolonged and there is a significant incidence of minor side‐effects. Serious complications and side‐effects have occurred. The use of intramuscular methotrexate should be confined to clinical trials until more evidence is obtained to support its more widespread use.