bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors for Wound Infection Following Caesarean Section
Authors: Beattie P. G. , Rings T. R. , Hunter M. F. , Lake Y. 
Published: February 2008

EDITORIAL COMMENT: This paper has a special message for readers concerned about post‐Caesarean section wound infections, because of the careful documentation after the patients were discharged from hospital. We all have cared for women who telephone to tell us about a discharge from the Caesarean wound after they have returned home. We advise these women to return for examination if febrile, or if the wound is painful, or if there is a purulent discharge from it. Usually the problem is managed by the woman dressing the area of discharge without any but this verbal consultation. At the postnatal visit the wound is healed but the scar may signal the area of the problem. How important are minor wound infections as defined in this study? The patient and the surgeon would of course prefer to avoid these complications, but it is the major wound infections, with or without disruption, that really matter, and which hopefully have a reduced incidence when intraoperative antibiotic administration is practised. In addition to complete documentation we also require grading of wound infections in terms of risk to life and time spent in hospital. Response to editorial comment from authors: Although the majority of wound infections diagnosed after discharge from hospital were not ‘major’, with only 2 patients requiring readmission, there was significant morbidity amongst this group and considerable cost to the health services. General practitioners saw and treated 12 of the 30 (40%), and there was also an increase in the workload for the Home Care Midwifery service with 49% of all visits to Caesarean section women being to the 30% that were infected (figure 1). Thus, these nonmajor wound infections would appear to be important for both the woman with her delay in returning to normal activities, and for our already overstretched Home Care Midwives, with an increase in demand for their services.Summary: A prospective study was performed between April 1,1991 and April 30,1992 to determine factors involved in the development of post‐Caesarean section wound infection. During this period there were 4,857 deliveries, 428 by Caesarean section (8.8%). Complete data were available on 328 (76.6%) patients. Wound infection occurred in 25.3% of women and was confirmed by positive bacteriology in 77.1%; 36% of wound infections were diagnosed following the patients' discharge from hospital. A negative correlation was found between maternal age and development of wound infection up to age 40 (p = 0.03). Maternal weight was a highly significant indicator of subsequent wound infection development (p = 0.0001), the relationship between increasing maternal weight and infection appearing linear. Antibiotic prophylaxis was found to be the most significant protective factor (p = 0.0007) in the reduction of postoperative wound infection. This relationship was independent of maternal weight.
Sexual Function After Pelvic Surgery in Women
Authors: Poad D. , Arnold E. P. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication since it will remind readers to discuss the possibility of postoperative sexual dysfunction. It should go without saying that sexual function before surgery should also be discussed, particularly since it may determine the type of surgery selected for genital prolapse with or without associated urinary incontinence. Our reviewer stressed the point that in spite of the oft‐quoted opinion of Francis and Jeffcoate (reference 4 in this paper), posterior colporrhaphy will not cause dyspareunia if excessive narrowing of the vagina is avoided. Narrowing in the mid‐vagina is caused either by excessive excision of vaginal epithelium or by excessive approximation of paravaginal connective tissue. Moreover failure to perform posterior colporrhaphy after anterior colporrhaphy, with or without vaginal hysterectomy, can accentuate weakness of the vaginal vault and posterior vaginal wall and result in rapid development of an enterocele or even eversion of the vagina. A final comment is that it should be routine to review women 6 months or so following pelvic floor surgery to review the anatomical and physiological results. The 4–6 week postoperative visit is too soon since many have not recommenced coitus at this time. Furthermore, problems with discharge or postcoital bleeding from vault granulomas are best excluded some time after resumption of coital activity.Summary: To assess the prevalence of sexual dysfunction after pelvic floor surgery for nonmalignant conditions, a retrospective survey was performed. Replies from a postal survey were received from 66 of the 200 women canvassed. Dyspareunia developed in 10 patients who had never had it before the operation, however of those who had it preoperatively the pain stopped completely in 12 of 23. Reduced libido was noted in 16 of 54 (29%), reduced lubrication in 21 (38%), and reduced genital sensation in 10 (18%). Lack of information about the potential effects of surgery on sexual function was identified as a major deficit and of considerable concern to 35 of the 66 women. Sexual function after surgery should be evaluated more intensively, and the subject discussed openly before any contemplated operation.
Early Discharge Following Major Gynaecological Surgery
Authors: Ng Peng Hoong , Hogston Patrick 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication to remind readers that early discharge from hospital is possible following conventional gynaecological surgery as well as after that done by laparoscopy or associated with laparoscopy. This method of management has long been practised in the United States and recent American literature has even reported that vaginal hysterectomy can be done as an outpatient procedure! The editor's understanding of this paper is that the 40 patients described were not consecutive ones enrolled for the early discharge programme since those who remained more than 3 days were excluded from the study, which therefore does not provide information regarding what proportion of patients undergoing these procedures are suitable cases for early discharge. Nonetheless the paper reminds us that the early discharge option should be explored, not only for cost containment in hospitals, but also because many patients would prefer to convalesce at home. These days visiting hours are seldom rigorously enforced in hospitals and the editor's observation is that many patients after confinement and after gynaecological surgery must look forward to getting home in order to have a rest! Patients often have so many visitors that they are utterly drained coping with them socially when they are in the early stages of their convalescence.Summary: This prospective study was to assess the safety and acceptability to patients of early discharge after major gynaecological surgery. Selective patients who fulfilled certain criteria were offered early discharge after their operations. Forty patients were discharged within 72 hours. Fourteen of them had undergone abdominal hysterectomy, 5 with a mid‐line incision; 13 had vaginal hysterectomy; 9 laparoscopy and laparotomy for ectopic pregnancy; 3 laparotomy for ovarian surgery and 1 a Manchester repair. The patients were discharged home on average 2.4 days after their operations. All were satisfied with their pain relief at home. There were 4 post discharge complications. Two had superficial drip‐site phlebitis, 1 a possible urinary tract infection and 1 a wound abscess. There was only 1 readmission 2 weeks post discharge for constipation. Thirty‐one out of 40 (77.5%) of the patients had expressed that the home environment was more conducive to speedy recovery and 92.5% of the patients would choose early discharge again if given the option.
Ureaplasma Urealyticum Chorioamnionitis
Authors: Maher Christopher F. , Haran Mano V. , Farrell David J. , Cave Donald G. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication to remind readers that Ureaplasma urealyticum, which is a common vaginal commensal, can be associated with and apparently the cause of chorioamnionitis, premature labour, premature rupture of the membranes and intrauterine infection. As the authors note, antepartum cultures for Ureaplasma urealyticum are not useful in predicting pregnancy outcome (14). What then is the takeaway message from these cases? It seems to the editorial subcommittee that, since prematurity and premature rupture of the membranes tend to reoccur, that when the conditions have been associated with chorioamnionitis and culture of U. urealyticum, there is a case for prophylactic, long‐term treatment with an appropriate antibiotic in any future pregnancy. This is more strongly recommended if there is a past history of perinatal mortality associated with chorioamnionitis.The authors of this paper consider (communication to the editor in response to this editorial comment) that further research is required to establish risk factors for the development of Ureaplasma urealyticum chorioamnionitis, although they believe that previous uterine or cervical surgery may be a risk factor. Further trials of antibiotic therapy in women with a past history of premature labour and premature rupture of the membranes associated with or with Ureaplasma infection are required. Since about 40% of all perinatal deaths occur in the 1% of women who deliver between 20–28 weeks' gestation (A), it also seems necessary to reevaluate if women without a past history of the above obstetric complications should receive treatment when antepartum cultures for Ureaplasma urealyticum are positive.In summary, there is not much good news about prevention of the 2 main perinatal killers, prematurity and premature rupture of the membranes, but we should pursue all leads such as chorioamnionitis with Ureaplasma urealyticum or other bacteria (group B beta haemolytic streptococci) as its provocant.Summary: Controversy reigns over the role of Ureaplasma urealyticum in determining pregnancy outcome. U. urealyticum infection of the chorioamnion is strongly associated with chorioamnionitis (1–3), premature birth (2–4), and perinatal morbidity (4–6). We present 4 cases of U urealyticum chorioamnionitis and associated morbidity and mortality.
OCCASIONAL REVIEW: Twin‐Twin Transfusion Syndrome: Intraamniotic Pressure Measurement in the Assessment of Volume Reduction at Serial Amniocenteses
Authors: Meagher Simon , Tippett Christine , Renou Peter , Baker Lesleigh , Susil Beatrice 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because we consider it contains important information on management of patients with acute polyhydramnios. However the editorial committee considers that there is still doubt regarding how commonly fetofetal transfusion is the aetiological mechanism of the acute polyhydramnios syndrome seen in uniovular twins. We have reviewed the clinical data of the 13 cases reported by Steinberg and colleagues(A) with a particular emphasis on the haemoglobin discrepancies between the twins and whether or not the polyhydramnios was associated with the recipient twin. The findings were that there were only 4 cases where there were haemoglobin measurements performed on both twins; in only 2 of the 4 was the difference more than 4 g/dL and in both cases the smaller twin had a higher haemoglobin value. In 1 of the cases the haemoglobin values of the twins were 5.5 and 9.8 g/dL respectively and the smaller twin had the higher haemoglobin value; there was polyhydramnios in both sacs. In the other case where there was a haemoglobin discrepancy of more than 4 g/dL the smaller twin had the higher haemoglobin (20.7 g/dL) and the larger twin had a haemoglobin value of 16.6 g/dL and only this larger twin had a polyhydramniotic sac. It seems to us that the mechanism of acute polyhydramnios may not be the same in all cases and it is not proven that fetofetal haemorrhage is a convincing explanation for all cases. One of the problems in elucidating the problem is that these patients are often incompletely documented because of stillbirth or uncertainty as to whether the small or large twin occupied the polyhydramniotic sac. Summary: Two cases of severe twin‐twin transfusion syndrome are described. In both, serial amniocenteses were followed by resolution of the disordered inter‐twin haemodynamics with 4 intact term survivors. In all reports to date of aggressive reduction with or without successful outcome, volume reduction has been dictated by subjective or semiquantitative ultrasonic estimates of liquor volume. With the use of intraamniotic pressure estimation we describe a more rational basis for the removal of these large volumes of amniotic fluid.
Singleton and Twin Confinements Associated with Infertility Treatments
Authors: Kurinczuk Jennifer J. , Pemberton Richard J. , Binns Sarah C. , Parsons Deborah E. , Stanley Fiona J. 
Published: February 2008

EDITORIAL COMMENT: This paper provides important data concerning the contribution of the different infertility treatments (clomiphene plus gonadotropin versus GIFT plus IVF) to the community incidence of twin pregnancy. It seems to us that sampling only 0.6% of singleton pregnancies and 50% of twin pregnancies (table 3) may have underestimated the contribution to singleton pregnancy of both CC/GT and GIFT/IVF. Ideally, what we require is documentation on all the perinatal data forms of whether the index pregnancy resulted from treatment with CC/GT or GIFT/IVF ‐the multiple pregnancies rates (twin and higher order multiples) associated with these different treatment regimens could then be evaluated for the total population. This would give a new dimension to informed decision by the doctor and the infertile couple in selection of the method of treatment of infertility in those women who have patent tubes and are thus suitable candidates for either regimen. Knowledge of the twin and higher order multiple pregnancy rate, not to mention the rate of singleton pregnancy, associated with these 2 different regimens would also indicate if present drug regimens require further refinement to be competitive with GIFT and IVF, if. in terms of the community incidence of twin delivery but exclusive of other cost considerations. Summary: A cross‐sectional sample of 150 singleton and 159 twin confinements delivered in Western Australia in 1991 were randomly sampled in 1993; 63% of the women responded to a postal questionnaire. Thirteen percent of respondents with singletons and 26% of those with twins reported having problems conceiving at some stage in their life. Six percent of those who had singleton confinements and 22% of those women who had twin confinements sought fertility advice prior to the conception of the index pregnancy. One percent (95%CI 0.03%, 5.5%) of women with singletons received infertility treatment compared with 17% (95%CI 10.4%, 26.3%) of those with twins. Overall 82.7% (95%CI 75.2%, 90.1%) of twin confinements followed spontaneous conception, 11.2% (95%CI 5.7%, 19.2%) followed ovarian stimulation treatment alone and 6.1% (95%CI 2.3%, 12.9%) followed IVF or GIFT procedures. The probability of a spontaneous twin confinement was 1 in 95. It was concluded that nearly twice as many twin pregnancies were associated with ovarian stimulation treatment given alone than with IVF and GIFT combined. The routinely collected data about assisted twin conceptions provide an incomplete picture with regard to the role of different infertility treatment modalities.
The Effect of Vigorous Exercise During Pregnancy on Birth‐Weight
Authors: Bell Robin J. , Palma Sonia M. , Lumley Judith M. 
Published: February 2008

EDITORIAL COMMENT: When this paper was reviewed the question was raised that the period of gestation is an obvious factor which can determine birth‐weight and the authors were asked how this may have affected their results The authors response was as follows:The mean gestation at delivery in the 2 groups was not different statistically ‐ controls n = 41, mean = 39.96 weeks, standard deviation = 1.37 weeks; exercisers n = 58, mean = 39.48 weeks, standard deviation = 1.94 weeks. We were interested in the finding in our study that preterm delivery occurred in 4 of 58 exercisers and only 1 of 41 controls. However, the number of preterm deliveries in this study is small (a total of 5) and as the calculation of sample size was based on a shift in mean birth‐weight, this is the outcome which should be emphasized.Clearly, gestation is a very important determinant of birth‐weight. However, in terms of trying to determine whether exercisers deliver earlier, it would not help to put gestation in our analysis of variance and covariance. Gestational age would need to be the dependent variable for such an exercise and, for meaningful results, would require a larger study. Summary: The aim of this study was to assess the effect on birth‐weight of continuing a programme of vigorous exercise into late pregnancy. ‘Potential exercisers’ were women who had been doing vigorous exercise prior to pregnancy and intended to continue exercising during pregnancy. Controls were healthy pregnant women who did not do regular vigorous exercise. Both groups kept 2, 7‐day food ± exercise diaries at 25 and 35 weeks. The primary outcome variable was birth‐weight. Women who continued doing at least 30 minutes of vigorous exercise at least 3 times weekly at 25 weeks and either maintained this minimum level or had delivered by 35 weeks were classified as ‘exercisers’. Women doing more than 4 sessions of vigorous exercise weekly at 25 weeks had babies whose mean birth‐weight was 315 g lower than the mean birth‐weight of babies born to controls.
Evaluation of a Rapid Enzyme Immunoassay for Detection of Genital Colonization of Group B Streptococci in Pregnant Women: Own Experience and Review
Authors: Hordnes Knut , Eide Martha , Ulstein Magnar , Digranes Asbjorn , Haneberg Bjorn 
Published: February 2008

EDITORIAL COMMENT: As regular readers of the Journal will know we have published a number of papers recently on the subject of screening for group B beta‐haemolytic streptococcal (GBS) colonization of the vagina in pregnancy. This is the first paper we have published on the important problem of identification in labour of women who are GBS‐carriers so that appropriate antibiotic therapy can be given to them and their infants after delivery. It shows that the current technology is inadequate to quickly and reliably identify GBS‐carrier women.Summary: We have compared an enzyme immunoassay (ICON Strep B, Hybritech) with cultures for emonstration of genital carriage of group B streptococci (GBS) in pregnant women, and studied the relationship between vaginal and rectal carriage of this organism. Pertinent literature has also been reviewed. Two hundred pregnant women at gestational week 17 were included. Swabs from the uterine cervix were tested for GBS by ICON Strep B immunoassay and ordinary cultures on blood agar. Additional swabs from the rectum were tested by cultures. The percentage of women with GBS in cervical secretions was 13.5o7o (27/200) by cultures and 4% (8/200) by the ICON Strep B immunoassay. The overall sensitivity of the immunoassay was 7.4%, and the specificity 96.5%. In conclusion, the sensitivity of rapid enzyme immunoassays is too low for accurate screening of GBS in the genital tract of pregnant women.
Follow‐up of Patients with Gynaecological Cancer
Authors: Kerr‐Wilson R. H. J. , McCrum A. 
Published: February 2008

EDITORIAL COMMENT: In the editor's private practice the follow‐up of survivors of treatment of invasive cancer is favoured by both practitioner and patient ‐ we have become friends and are dependent upon each other ‐ our annual meeting allows mutual documentation of survival and morbidity as each assesses the effects of the ageing process on the other. The brief annual meeting is surely cost‐effective in terms of mutual morale ‐ and occasionally an unsuspected local recurrence or metastasis is detected and managed effectively after referral and discussion of treatment strategies with the appropriate oncologist. Nonetheless the questions asked by the authors after their analysis of our colleagues' regimens of follow‐up require answers, although the woman's wishes for continued surveillance should be heeded.Additional Comment by our Oncologist Reviewer: The follow‐up of the cancer patient is an essential part of the management of cancer and should follow a strict protocol. The objectives of follow‐up are:1. Assessment and documentation of the results of therapy with regard to cure, time to relapse and survival time.2. Early detection of recurrence and institution of further therapy when appropriate. On‐going surveillance wilt vary according to disease site, prognostic factors and family history of cancer. Routine investigation should include vaginal cytology, chest X‐ray, renal ultrasound, CT scans, mammography and tumour markers such as CA 125.3. Quality of life assessment with regard to the early and late sequelae of cancer therapy and the appropriate therapy for these side‐effects i e. lymphoedema, psychosexual problems, bladder or bowel problems.The value of a comprehensive follow‐up protocol is seen in many cancer clinical trials. The overall improvement in survival of patients entered into trials relates in part to early detection of recurrence and institution of salvage therapy.
Acute Hypoglycaemic Coma ‐ A Rare, Potentially Lethal Form of Early Onset Sheehan Syndrome
Authors: Zuker Naftaly , Bissessor Melanie , Korber Manfred , Conrads Martin , Margolis Jack , Massel Peter , FRCP Mohamed A. K. Omar MD 
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication because it mil inform readers that the rare patient with postpartum collapse, which is likely to be due to postpartum haemorrhage, may develop Sheehan syndrome and develop hypoglycaemic coma within a short time of delivery. (See also Editorial Comment Sheehan syndrome: An analysis of possible aetiologicalfactors. Aust NZ J Obstet Gynaecol 1994; 34:534–536).Summary: This case emphasizes the importance of intensive obstetric management that is required when confronted with prolonged postpartum haemorrhage. Anticipation of the possibility of acute hypoglycaemic coma as an initial manifestation of Sheehan syndrome and prompt recognition may prevent disastrous consequences, including maternal death.