bluuebunny/crossref_metadata_2025_split huggingface dataset:
Why We Choose Caesarean Section: A Prospective Study
Authors: Spurrett Brian , Cook Colleen‐M. 
Published: February 2008

Summary: We wished to inquire into the reasons why obstetricians choose Caesarean section as the preferred delivery mode and how they make that decision in individual settings. We therefore surveyed obstetricians to ascertain die obstetrical events at the time of the decision and the reasons for the decision. Two hospitals with the same consultant medical staff were chosen for the study, The Jamison Private Hospital and The Nepean Hospital. The study group was analyzed using hospital, classification, parity, whether the procedure was elective or in labour, the stage of labour at which the Caesarean section was performed, and the primary and secondary reasons for the decision.Six hundred and twenty‐four women were studied. When comparing the 2 institutions, there were 2 statistically significant findings. Firstly, the women at The Nepean Hospital were younger (27.9 ± 5.6) than at Jamison Private Hospital (30.5 ± 4.4; p<0.001). Secondly, in the numbers of women undergoing Caesarean section in the ‘failure to progress’ category, there was a higher incidence (p<0.001) at the private hospital. Apart from these differences, the 2 groups were remarkably similar.
Postpartum Microangiopathic Haemolysis Complicating Severe Preeclampsia
Authors: Sfameni S.F. , Ihle B. , Dobsoni P. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication to remind readers that microangiopathic haemolysis or the HELLP syndrome can present postpartum in women with preeclampsia especially if the condition has been treated conservatively which is usually done in an attempt to gain fetal maturity. It seems to the editorial staff that the take‐away message of this paper is that liver and renal function tests and coagulation studies are necessary in all patients with preeclampsia especially if delivery is to be deferred. Also when microangiopathic haemolysis occurs postpartum it is probably a manifestation of further deterioration of the severe preeclampsia and not due to haemolytic uraemic syndrome or thrombotic thrombocytopenia purpura. The differentiation of these disorders is detailed in the Discussion section of this paper.The Editor asked the authors to perform an audit of all cases of preeclampsia seen in their institution in a 12‐month interval to provide readers with insight concerning the frequency of severe preeclampsia with or without microangiopathic haemolysis. Authors'reply: A 12‐month audit of the cases of preeclampsia within our hospital for the year 1995 revealed 128 cases of mild preeclampsia and 130 of severe preeclampsia. In 1995 there were 5,119 deliveries including all booked and nonbooked patients. Of those with severe preeclampsia there were 8 cases of HELLP syndrome, of which 4 occurred postpartum and 3 are presented in this paper. Thrombocytopenia with a platelet count of less than 150,000/L was found in 26 patients. Clearly microangiopathic haemolysis is an uncommon occurrence particularly when it is seen for the first time postpartum.
Effect of Zidovudine Treatment in Late Pregnancy on HIV‐1 In Utero Transmission
Authors: MD Surasak Taneepanichskul , Sirinavin Sayomporn , Phuapradit Winit , Chaturachinda Kamhaeng 
Published: February 2008

EDITORIAL COMMENT: This paper was accepted for publication to update readers on the effectiveness of treatment with zidovudine to prevent vertical transmission (mother to child by any route before or after delivery) of HIV infection antenatally. In the ACTG 076 trial referred to in this paper the treatment regimen was antepartum zidovudine (ZDV) (100 mg orally 5 times a day) initiated between 14 and 34 weeks' gestation and continued throughout the remainder of pregnancy, followed by intrapartum intravenous ZDV (loading dose 2 mg/kg, starting in labour followed by continuous infusion 1 mg/kg/hour until delivery), followed by oral administration of ZDV (syrup 2 mg/kg every 6 hours for 6 weeks beginning 8 to 12 hours after birth) to the infant. HIV infection of the infant was defined by 1 positive viral culture obtained from peripheral blood specimens taken at birth, 12, 24 and 78 weeks postpartum. Preliminary results showed HIV infection (at least 1 positive culture) in 7.2% (13 of 180) in the treatment group and 21.7% (40 of 184) in the untreated control group. The present study suggests that a less complex ZDV regimen is effective against vertical transmission since no evidence of HIV infection was found in any of the 50 infants within 48 hours of birth. The authors properly comment that these infants require follow‐up to assess intrapartum and postpartum transmission of HIV, and long‐term side‐effects of the ZDV treatment.Summary: In Thailand, the prevalence of paediatric HIV‐1 infection has increased rapidly through vertical transmission. According to the ACTG 076 trial regimen, zidovudine treatment in HIV‐infected pregnancy can reduce vertical transmission. However, this treatment is complex and costly. It is not applicable for developing countries. We conducted a study to evaluate the effect of zidovudine treatment in late pregnancy on HIV‐1 in utero transmission. Fifty cases of asymptomatic HFV‐1 infected‐women were voluntarily enrolled to the study. Zidovudine 250 mg orally twice a day was given to these patients from gestational age 36 weeks until labour. The newborns were evaluated at birth by a neonatologist and peripheral blood was tested for HIV genome by PCR technique within 48 hours of birth. The study revealed that no HIV genome was detected from the peripheral blood of newborns. It is suggested that zidovudine treatment in late pregnancy could reduce HIV‐1 in utero transmission.
Transvaginal Sacrospinous Colpopexy ‐A New and Easier Way
Authors: Barker Glen K. , Viggers John C.L. , Mason T. , FRACS G.O. Smith. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it provides useful technical details of another method to place a suture in the sacrospinous ligament in the operation of transvaginal sacrospinous colpopexy. Our urogynaecologist reviewer stated that long‐term review of results is essential to judge any such new technique and that postoperative findings at 6 weeks give no indication even of short‐term outcome. Nonetheless we believe many readers will be interested in this paper.Summary: Sacrospinous colpopexy is an operation which is gaining wide acceptance for suspending the vaginal vault in a woman with prolapse who wishes to retain the ability to maintain coitus. However, wider use may be prevented by the technical difficulty of the procedure. This article is a review of 63 cases where the operation was performed using a new ‘ENDO STITCH’ method which offers advantages both in ease (because it avoids the necessity of direct visualization of the ligament), and possibly safety (because it avoids the need for retractors).
Blood Transfusion Requirements for Abdominal Hysterectomy: 3‐year Experience in a District Hospital (1993–1995)
Authors: Ng Stanley P.H. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because the blood transfusion rate is an important consideration when discussing methods of hysterectomy. The author also provides interesting data concerning the complications encountered in this series of 236 abdominal hysterectomies. Readers are encouraged to give due attention to the details shown in table 1 especially the rates of injury to organs and need for unplanned return to the operating theatre.Summary: Two hundred and thirty six women who underwent abdominal hysterectomy for benign disease at Fairfield District Hospital were studied retrospectively. Eleven patients received a total of 28 units of blood. The transfusion rate was 4.7%. The average number of units transfused per operation was 0.12. Each transfused patient received an average of 2.5 units with a range of 1 ‐4 units. Only 27% of cross‐matched blood was actually transfused. Patients with preoperative anaemia, prolonged operation time and a larger uterus were more likely to require blood transfusion. The group and screen procedure is an adequate preoperative blood order for patients having abdominal hysterectomy.
The Incidence of Respiratory Distress Syndrome Does Not Increase When Preterm Delivery Occurs Greater Than 7 Days After Steroid Administration*
Authors: McNamara Michael F. , Bottoms Sidney F. 
Published: February 2008

EDITORIAL COMMENT: This and the preceding article analyzing obstetric practice in Australia concerning steroid administration to prevent the respiratory distress syndrome are complementary. Readers should give both careful attention. There seems sufficient evidence available suggesting that a single steroid dose is adequate, and that a prospective randomized trial should be mounted to address the issue of repeat steroid administration, as recommended by both groups of authors, rather than to persist with the possibly/probably unnecessary usual regimen of repeat steroid administration. Such a trial has been proposed by the Australian Collaborative Trials group, the originators of the ACTOBAT and ACTOMgS04 studies. It should be noted that the respiratory distress syndrome (hyaline membrane disease) remains a major contributor to perinatal morbidity and mortality. The Editorial Board and reviewers of this paper do not recommend alteration to current regimens of steroid administration; all are agreed that a prospective randomized trial is required to decide if repeat steroid administration is indicated.Summary: We sought to determine if the risk of the respiratory distress syndrome (RDS) is increased when preterm delivery occurs greater than 7 days from the last steroid administration. At our hospital, steroids were repeated weekly only on inpatients. Linking pharmacy and delivery records, we analyzed the risk of RDS with preterm delivery by interval since last steroid administration. Discriminant function analysis revealed that adjusted for gestational age, there was a negative correlation between interval since last steroids administration and risk for RDS (p<0.05, n=254). Using analysis of variance to control more precisely for gestational age (28–32 weeks, n=19) we found no difference in the risk for RDS with longer intervals since the last steroid administration. We then used multiway contingency analysis to consider intervals as zero to 7 versus greater than 7 days and similar results were obtained. Our findings suggest that the process of pulmonary maturation induced by steroid administration is permanent rather than transient. Repetitive steroid administration does not appear to be beneficial. Only a large, prospective randomized trial could definitively address the issue of repeat steroid administration. However, on the basis of our findings and review of available literature, we believe there is insufficient data to recommend weekly repeat steroid administration to women at risk for preterm delivery.
Comparison of Perforation Between Single and Double‐gloving in Perineorrhaphy After Vaginal Delivery: A Randomized Controlled Trial
Authors: Kovavisarach Ekachai , Jaravechson Siriwat 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because all surgeons are concerned, or should be concerned, about the possibility of contracting hepatitis or the immunodeficiency virus due to contamination with the patient's blood when operating. It goes without saying that all surgeons should be immunized against hepatitis B. There have been a number of studies recommending double‐gloving either as a routine or in high‐risk patients. We believe the Royal Australian and New Zealand College of Surgeons video recommends double‐gloving as a routine! There have been comments that double‐gloving causes clumsiness which could indeed be counter‐productive in rendering glove perforation more likely. However the reviewer of this paper made the point that with his experience with the double‐gloving technique the initial impression of clumsiness soon resolves.Summary: A prospective randomized controlled trial of single and double‐gloving methods in perineorrhaphy after vaginal delivery was performed between August 1, and September 30, 1996 at Rajavithi Hospital to compare glove perforation between both methods. We examined 1,316 individual gloves in the double‐gloving method and 742 individual gloves in the single‐gloving method. These gloves were tested by immersing in water. The glove perforation rate was 5.2% (107 of 2,058). There was significant reduction in the glove perforation rate of double‐inner gloves (2.7%) compared with the single‐gloving group (6.7%).The perforation rate of the double outer‐gloves group was 5.9%. The perforation rate in the matched outer and inner perforation was found only in 0.3% (2 of 658). The double‐gloving method had a significant benefit in protection of the surgeon's hand from the exposure to blood compared with the single‐gloving method.
A 6‐year Review of the Outcome of Endometrial Ablation
Authors: Tsaltas Jim , Taylor Nancy , Healey Martin 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication since it informs readers that more than 3 in 4 women who have endometrial ablation, and who can be contacted and are willing to provide follow‐up information, are satisfied with the results. This is important information in the context of the recent spate of papers, in this and other journals, advancing the merits of laparoscopically‐assisted vaginal hysterectomy, usually performed for dysfunctional uterine bleeding, which is also the main indication for endometrial ablation. The 2 procedures are competitive, but endometrial ablation has many advantages if it can produce the results presented in this paper. The hysterectomy rate of17% is a minimum figure since many of the 36% of women sent the follow‐up questionnaire, and who did not respond, may have had hysterectomy performed elsewhere. Women who have abdominal pain, chronic or periodic, and amenorrhoea after endometrial ablation require special consideration. They probably warrant cervical dilatation and/or ultrasonography to exclude haematometra if the pain is persistent.Summary: In June, 1995 a postal questionnaire was distributed to all 232 women who had an endometrial ablation at Monash Medical Centre between July, 1989 and December, 1994. Data was analyzed from the 149 who responded. Length of follow‐up ranged from 6 months to 6 years 6 months. Of these 78% were satisfied with their ablation and 84% found their menses to be lighter or to have stopped. The repeat ablation rate was 13% and the hysterectomy rate was 17%.
Outcome of Hysterectomy for Pelvic Pain in Premenopausal Women
Authors: Tay Sun‐Kuie , Bromwich Nicki 
Published: February 2008

EDITORIAL COMMENT: This article once again emphasizes that hysterectomy can be successful in alleviating chronic pelvic pain even in those women in whom the operative pathology is not usually associated with pain. Hillis (A) showed that in a group of 308 women who had a hysterectomy for chronic pelvic pain and were followed up for at least 6 months, 74% experienced complete resolution of pelvic pain and a further 21% reported decreased pain. Hillis found that pain was more likely to resolve in women with identifiable pathology, private health insurance or fewer than 2 pregnancies. However even in women with no identifiable pelvic pathology, 62% had complete resolution of their pain postoperatively. This indicates that in the woman for whom all other therapy has failed, after appropriate counselling, hysterectomy may be a reasonable option for the treatment of chronic pelvic pain.(A) Hillis SD, Marchbanks PA, Peterson HB. The effectiveness of hysterectomy for chronic pelvic pain. Obstet Gynecol 1995; 86: 941–945.Summary: The outcome of abdominal hysterectomy for pelvic pain in premenopausal women was studied retrospectively in 228 women. In 17 women, pelvic pain was the sole indication while in the others, pelvic pain was one of the contributory indications for hysterectomy. The most common surgical histopathological diagnoses were uterine leiomyoma (73.9%), uterine adenomyosis (40.4%), benign ovarian cyst (19.3%) and endometriosis (7.9%); 118 (51.8%) patients had single pathology and 48.2% had multiple pathologies. The agreement between operative clinical diagnosis and histopathological diagnosis was 66.1% for leiomyoma, 57.1% for uterine adenomyosis and 30% for endometriosis. The incidence of early postoperative complication was 20.6%, mainly minor morbidities including urinary tract infection (3.9%), wound infection (3.1%) and unexplained fever (6.0%). These complications significantly prolonged the duration of hospital stay from an average of 7 days to 9–17 days. Of 98 patients with pain as the sole or the most predominant indication for hysterectomy, 72% responded to an outcome survey 12 or more months after hysterectomy. Of these, 62 (87%) were satisfied with the operation, 8 were unsure and 1 was dissatisfied; 68 (95.8%) patients reported relief of their symptoms. Relief of symptoms did not correlate with the patient's report of her satisfaction with hysterectomy. Pain in the abdominal wound a year or more after surgery was one of the commonest reasons cited for dissatisfaction with hysterectomy. We conclude that in well‐selected cases, hysterectomy is an appropriate and satisfactory treatment for premenopausal women with pelvic pain irrespective of clinical evidence of associated pathology. Effective measures to reduce postoperative complications and wound pain are needed to further improve the outcome of abdominal hysterectomy.
Clear‐Cell Carcinoma of the Ovary in a 19‐year‐old Woman
Authors: Parker Jim , Proietto Anthony M. , Lowe Glenn 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication as the youngest reported patient with clear‐cell carcinoma of the ovary and for the issues that arise in relation to the diagnosis and the sequelae of treatment. All cyst aspirate or tissue taken at any procedure must be submitted for cytological or histological examination and, as is evident in this case report, a specialist in gynaecological histopathology and cytology is essential for evaluation of the material. The dilemma of fertility preservation in such a young patient with Stage 1 disease has not been addressed by this paper and it is unclear whether the uterus and right ovary were removed. The classical teaching of complete pelvic clearance for disease greater than Stage la is now challenged on a number of issues. If the contralateral ovary and the uterus is retained will chemotherapy lead to infertility? If chemotherapy or surgical removal will result in infertility should the ovary be removed for cryostorage? The possibility of embryo donation or IVF with cryopreserved ovum would support the retention of the uterus in all nulliparous patients, as a major quality of life consideration. These become important issues for discussion and decision‐making by the patient and treating oncologist when dealing with potentially curable cancer in the young patient.Summary: The risk of inadvertently treating an ovarian malignancy is always present regardless of the patient's age, clinical history, ultrasound features, serum tumour markers, menopausal status and intraoperative findings. This risk can be minimized by paying particular attention to high‐risk characteristics in any of the above assessment criteria and by obtaining an intraoperative frozen section if there is any suspicion of malignancy. The same approach should be used whether the initial treatment is by laparotomy or laparoscopy. We present a case of clear‐cell carcinoma of the ovary in a 19‐year‐old woman where there was delay in diagnosis and treatment as a result of an incorrect initial histopathology assessment. This appears to be the youngest patient reported in the literature with a clear‐cell carcinoma of the ovary.
Polyglandular Autoimmune Syndrome Type 2 Presenting for the First Time During Pregnancy
Authors: Mathur G. , Fulcher G. , Pollock C. , Ferry J. 
Published: February 2008

EDITORIAL COMMENT: We asked the authors to explain what a Schilling test was and they provided the following explanation. The Schilling test is used to determine whether there is failure of vitamin B12 absorption due to a lack of gastric intrinsic factor. The patient is given radioactive labelled vitamin B12 orally and unlabelled vitamin B12 by intramuscular injection. The portion of administered radioactivity excreted in the urine over a 24‐hour period provides a measurement of B12 absorption. Patients with B12 deficiency secondary to pernicious anaemia will have low excretion of administered radioactivity. The test is then repeated adding intrinsic factor to the oral dose of labelled vitamin B12. In pernicious anaemia the absorption of the vitamin will now approach normal.Summary: We report a case of polyglandular autoimmune deficiency presenting during pregnancy which was associated with a favourable outcome for both mother and fetus (apart from fetal growth retardation) with appropriate replacement therapy and adequate steroid cover at the time of delivery.
Pseudocyesis and its Modern Perspective
Authors: Trivedi A. N. , Singh S. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because we have not reported previously on pseudocyesis, which is a rare condition, especially if ‘first trimester cases’ are excluded where there has been confusion with interpretation of intervals of amenorrhoea. These cases can occur at the climacteric when elevated levels of LH can give a false positive HCG test result with older methods of assay and add further to the temporary clinical confusion. The classical clinical picture, unlike the 3 cases reported in this paper, is said to be the nullipara approaching the time of the climacteric who is anxious to conceive. Queen Mary's case must be the most famous on record and also the best documented by means of the serial bulletins issued for her loyal subjects concerning the progress of her royal pregnancy (A). The editor can remember only 1 case of ‘late pregnancy’ pseudocyesis in 40 years of obstetric practice. This woman was finally convinced of her nonpregnant status by failure of a fetal skeleton to show on an abdominal X‐ray. This was many years ago. This test was claimed to be definitive. One wonders how these women coped thereafter. We agree with the authors that follow‐up, not necessarily by a psychiatrist, is important. In the editor's experience pseudocyesis of late pregnancy is less common than advanced true normal pregnancy in a nullipara aged more than 40 years, married for many years, who presents with abdominal pain and finds out to her delighted surprise that she is in labour at term and shortly thereafter produces a surviving normal infant. The reviewers of this paper did not agree with the suggestion that curettage would be an appropriate procedure to convince a woman with pseudocyesis that she was not pregnant. However, the authors, having read this editorial comment, stated that curettage is mentioned in the pseudocyesis literature (4).(A) Dewhurst J. Royal Confinements. Weidenfeld and Nicolson, London. 1980; 28–29.