bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abdominoperineal Urethral Suspension: A Report of 20 Cases
Authors: Browne David S. , Frazer Malcolm I. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because we consider Zacharin's operation does not enjoy the popularity it deserves ‐ it is also ironical that this operation and the anatomy of the pubourethral ligament as described by Zacharin, and on which the technique is based, has been acknowledged in overseas journals (Obstet Gynecol Surv 1989; 44:833) but not our own. Zacharin uses abdominoperineal urethral suspension exclusively for patients with recurrent stress incontinence but he, unlike the authors of this paper, does not advocate its use as a primary procedure when there is uterovaginal prolapse. Most of the 335 patients Zacharin has operated on in the past 20 years for the relief of stress incontinence have had previous surgery, although there were a few without prolapse who had not (personal communication to the editor). Zacharin reported an 85% overall cure rate for his operation after long‐term follow‐up in a series of 194 women treated during the 15 years, 1965–1980 (Obstet Gynecol 1983; 62: 644–654). During the past 15 years Zacharin has been invited to perform his abdominoperineal urethral suspension procedure in university centres in the United States, Canada. Europe, the United Kingdom, Africa and Asia. The editorial board is unaware of any other Australian gynaecologist who is repeatedly asked to demonstrate a surgical procedure abroad ‐ it seems appropriate that the technique be reexamined by all gynaecologists who treat patients for stress incontinence when it recurs after primary surgery.Summary: Twenty patients adjudged to require surgical management of genuine stress incontinence underwent the abdomino‐perineal urethral suspension procedure between May, 1989 and February, 1990. Short‐term subjective follow‐up revealed a 94% cure and improved rate in 19 patients in whom the operation was completed. There was a striking absence of postoperative voiding morbidity. We believe this somewhat neglected procedure is worthy of further objective study and comparison with the more popular methods of surgical management of genuine stress incontinence.
Chorion Villus Sampling — Transcervical or Transabdominal
Authors: Finikiotis George , Gower Lisa 
Published: February 2008

EDITORIAL COMMENT: This study provides interesting information on the relative effectiveness of chorion villus sampling performed transcervically and transabdominally regarding obtaining a suitable specimen. The results seem to indicate that the abdominal route is preferred unless contraindicated, because of a lesser risk of infection. Although the series is not a controlled trial with alternate patients receiving transcervical or the transabdominal technique, the results seem clinically meaningful. It is important to note that the spontaneous abortion rate following chorion villus sampling by any route is less than the rate observed in normal obstetric practice when early ultrasound has not been used to exclude cases of unsuspected missed abortion. This explains the remarkably low incidence of miscarriage following chorion villus sampling. It will be interesting to see whether the low complication rate of chorion villus sampling will eventually result in the test being offered to all patients rather than those that are high risk — it should be remembered that the majority of recognizably malformed fetuses are born to patients without any risk factor. This is already the practice in some areas of the United States of America. The present state of the art is that when chorion villus sampling is indicated it is performed by the transcervical route at 8–12 weeks and by the transabdominal route at 10–12 weeks. However, the normal genetic counselling amniocentesis when liquor rather than chorion is sampled, is performed ideally at 16 weeks.Summary: Chorion villus sampling was performed transcervically on 84 patients and transabdominally on 126 patients. Two of 4 (5%) spontaneous abortions in the transcervical group were complicated by uterine infection. Five (4%) spontaneous, abortions in the transabdominal group were uncomplicated by infection. The results support the contention that the transabdominal method may be safer and that the procedure related fetal loss rate is similar to that following amniocentesis.
Chlainydia Trachomatis — Role in Tubal Infertility
Authors: Garland Suzanne M. , Lees Maxwell I. , Skurrie Ian J. 
Published: February 2008

Summary: The prevalence of humoural IgG and IgM antibodies to Chlamydia trachomatis was determined in 110 infertile women and compared to 87 healthy pregnant women without any known fertility problem. Overall antibodies to chlamydia were detected in 45% of infertile women. Antibodies were found in significantly more patients with tubal factor infertility (65%) than in women whose infertility was due to other causes (22%) (p< 0.005). These findings are consistent with the hypothesis that C. trachomatis is a major cause of tubal factor infertility.In addition the prevalence of antibody in patients with other sexually transmitted diseases (STD), pelvic inflammatory disease and confirmed chlamydia cases were evaluated. Within this miscellaneous high risk group of patients, chlamydial antibodies were detected commonly, ranging from 19–72%.
Birth‐weight of Newborns to Chinese Women Subsequent to a Previous Abortion
Authors: Tan Tah‐Chew , Chang Allan MZ , Rogers Michael S 
Published: February 2008

EDITORIAL COMMENT: It is left to the reader to tell us why birth‐weights of infants born to Chinese primiparas were significantly higher when there was a previous induced (73 g) or spontaneous abortion (110 g).Summary: The mean birth‐weight of firstborns of women was significantly higher when there was a previous abortion. The increase was 73.5 and 119.4 g in newborns of women with an induced and a spontaneous abortion respectively. This trend of significant increased birth‐weight among firstborns of women with either a previous induced or spontaneous abortion continued for male infants, in recent migrants, and in subjects aged 20–24 and 30–34 years. Stepwise logistic regression analyses showed that a history of an induced or a spontaneous abortion increased the birth‐weight of the firstborns, while short maternal stature and female newborn were associated with decreased birth‐weight. For low birth‐weight, a previous abortion was not selected into the regression models but short maternal stature and female newborns continue to contribute to low birth‐weight. Prematurity and mean gestation were found not to be associated with previous abortion using logistic regression analyses.
CO2 Laser Laparoscopic Salpingotomy for Treatment of Tubal Ectopic Pregnancies: Potential Limitations
Authors: O'Shea Robert T. , Thompson Graeme R. St J. 
Published: February 2008

EDITORIAL COMMENT: In appropriate selected cases (no shock, no active bleeding, no significant adhesions and no very high HCG levels) the treatment of choice of tubal ectopic pregnancy is by laparoscopic conservative surgery (salpingotomy). A laparoscopic approach compared to laparotomy, has proven economic advantages (shorter hospital stay and convalescence and earlier resumption of normal occupation) and suspected clinical advantages (less adhesion formation and better subsequent viable pregnancy rates) awaiting randomized prospective controlled studies for verification. Laparoscopic salpingectomy can also be performed with laser, as in this paper, or with cutting/coagulation diathermy (which is much, much cheaper) which yields comparative results. Salpingotomy can be performed laparoscopically with safety and could have been considered for one of the patients in this series who returned to theatre. The persistence of trophoblastic tissue requiring further treatment (usually methotrexate) occurs in about 10% of cases. Raphael Kuhn, MelbourneSummary: Linear salpingotomy was performed on 16 patients using the CO2 laser laparoscopically directed. Median operating time was 60 minutes (range 40–100) and all patients were discharged on the first postoperative day. There were 4 patients in whom persistence of trophoblast activity was detected, 2 of whom were treated surgically and 2 by oral methotrexate therapy.Conservative techniques for the treatment of ectopic pregnancy have proliferated since 1953 (1–4) being made possible because of the early presentation of patients and the more sensitive methods of intrauterine pregnancy detection. In the past decade laser technology has been added to the armamentarium of infertility surgeons and there have been 2 reports (5,6) of its successful use in cases of ectopic pregnancy. The present study aimed to examine the application of this technique in our patient population and to investigate any associated problems.
The Effect of Condom Use on Cervical Intraepithelial Neoplasia Grade I (CIN I)
Authors: Thomas Ifor , Wright Gordon , Ward Bruce 
Published: February 2008

EDITORIAL COMMENT: This study shows how necessary it is for any research finding relevant to patient care or clinical belief to be verified before enshrinement in the regimens of clinical practice — the more important the finding, the more necessary the verification. This paper will not be the last word on the effect of condom use on prevention of initiation or progression of cervical intraepithelial neoplasia, but it does make one wonder if the role of seminal fluid in the pathogenesis of carcinoma of the cervix should be reexamined — or is the die cast and the role of seminal fluid as carcinogenic factor complete once there is histological evidence of intraepithelial neoplasia Grade 1?Summary: A prospective, controlled study of condom use in patients with histologically‐proven CIN I was undertaken. Forty‐six patients were studied, 22 by random allocation and 24 by nonrandom allocation to either condom use or non‐condom use for 6 months. At the end of this time, patients were reassessed cytologically, colposcopically and histologically. There was no significant difference between the groups with respect to outcome. Six patients' lesions (13%) progressed in this period, 5 (11%) to CIN III. Condom usage is not an effective treatment for CIN I.
A Randomized Controlled Trial of Extra‐amniotic Ethinyloestradiol for Cervical Ripening in Multiparas
Authors: Peedicayil Abraham , Jasper Padmini , Balasubramaniam N , Jairaj Prabha 
Published: February 2008

EDITORIAL COMMENT: It is a pity that this study did not include a third group of patients with a Foley catheter alone passed into the extra‐amniotic space—since, as the authors note, it could be that a Foley catheter is as effective as ethinyloestradiol in ripening the cervix and shortening the induction‐delivery interval. Another comment made by the referee was that since both groups of patients had mean induction‐delivery intervals of less than 5 hours, the results of this study suggest that an unfavourable cervix is not an important prognostic entity for the ease of induction of labour in multiparas. It should be noted that all patients also had amniotomy and oxytocin infusions 12 hours after the extra‐amniotic introduction of the Foley catheter.AUTHORS' COMMENTS ON OUR COMMENT: Though the oestradiol and control groups had induction‐delivery intervals under 5 hours, both had shown improvement in cervical score before amniotomy. We cannot conclude from this study that an unfavourable cervix is not an important factor in multiparas. Studies with only amniotomy and oxytocin in multiparas revealed a Caesarean section rate of 7 to 8% (Aust NZ J Obstet Gynaecol 1985: 25: 190–193) and induction delivery intervals that often exceed 8 hours (Obstet Gynecol 1976, 48: 635–641; J Obstet Gynaecol India 1984; 34:972–979). Of course induction is much easier in multiparas than in primiparas but whether we can altogether do without ripening, we are uncertain. The Foley catheter is an effective cervical ripener (Br J Obstet Gynaecol 1980; 87: 281–286) and was probably responsible for the cervical change in the control group. Therefore it turned out that oestradiol did not have any extra advantage.ABSTRACT A double‐blind randomized controlled trial was carried out to determine if ethinyloestradiol applied extra‐amniotically would ripen the unfavourable cervix at term. Twenty five multiparas were given 150 mg ethinyloestradiol gel while 25 multiparas were given gel alone. There was no difference between the ethinyloestradiol and control groups in either mean change of Bishop score or the induction‐to‐delivery interval.
Single Intrauterine Fetal Death in a Suspected Monozygotic Twin Pregnancy
Authors: Cattanach Stephen A. , Wedel Maura , White Susan , Young Michela 
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication because the management of a patient with intrauterine death of one twin is an interesting problem and recent literature has, in our opinion, overemphasized the risk of intravascular coagulopathy in the surviving twin i.e. we consider these patients are managed too aggressively. The authors have reviewed the literature and the experience in their own institution and concluded that conservative management is indicated, especially in a preterm pregnancy. Although fear of litigation is a factor, the management of these patients is not clearcut. This is because the condition is uncommon and the complication may be unrecognized—e.g. in this series the time of fetal death was known in only 2 of 13 cases in which the dead fetus succumbed before the onset of labour (i.e. was macerated). With modern methods of diagnosis of twin pregnancy (ultrasonography) and fetal condition (cardiotocography), death of one t win is much more likely to be recognized and so provide the obstetrician with a management decision. Ultrasonography as reported by Cheung et al in this issue may indicate the presence of monochorionic twins and hence the greater risk of intravascular coagulopathy—however, since prematurity is the greatest hazard in the majority of cases, we would favour conservative management until 37 weeks' gestation, if fetal movements are normal and cardiotocography and ultrasonography reveal no abnormalities. We consider that intrauterine death of one twin does not constitute an indication for elective Caesarean section as the method of delivery in the absence of signs of fetal distress, unless there is ultrasonographic evidence that the twins are of the rare monoamniotic variety with the 25% risk of cord entanglement or knotting.ABSTRACT The antepartum death of a fetus in a twin pregnancy is associated with significant risk of mortality and morbidity in the surviving infant. A recent case of single intrauterine death in a suspected monozygotic twin pregnancy at a regional hospital prompted a study of similar cases in the hospital's recent experience and a review of the current literature. We report the successful conservative management of fetal death in a monozygotic twin pregnancy.
Major Gynaecological Surgery in Patients with Severe Coronary Artery Disease — the Combined Approach
Authors: Kantian P. , Sivanesaratnam V. , Jeyamalar R. , Delilkan A. , Ong Grade 
Published: February 2008

EDITORIAL COMMENT: It is generally concluded that despite advanced age, and associated medical problems, very elderly women can usually tolerate major gynaecological surgery, after careful preoperative medical evaluation and therapy. This paper considers the particular problem presented by severe coronary artery disease, and the necessary precautions during surgery are elaborated. The decision whether or not to operate in elderly patients will depend upon how pressing is the indication (it seemed imperative in the 2 cases presented here), and how willing is the patient (how distressing are her symptoms)!—in other words the same considerations as in younger women. It is remarkable how well elderly women tolerate major gynaecological surgery as long as extra care is taken to avoid complications (blood loss, tissue trauma, infection, tight sutures in vaginal epithelium). However, in the editor's experience, coronary artery disease is the most common absolute contraindication to major gynaecological surgery in middle‐aged and elderly patients.ABSTRACT The gynaecologist today is likely to encounter elderly patients with severe coronary heart disease requiring major gynaecological surgery. The successful outcome in 2 such patients with compromised coronary circulation and impaired left ventricular function emphasized the importance of combined care with the cardiologist and the anaesthetist. The insertion of a Swan‐Ganz catheter for close perioperative monitoring is vital. The intra‐and postoperative problems are discussed.
Possible Causes Linking Asphyxia, Thick Meconium and Respiratory Distress
Authors: Coughtrey H. , Jeffery H. E. , Henderson‐Smart D. J. , Storey B. , Poulos V. 
Published: February 2008

Summary: : The cause of fetal distress and neonatal respiratory distress (RD) in association with meconium‐stained liquor is not always clear. To clarify this, a prospective study was undertaken in a tertiary referral maternity hospital for 1 year. In all infants born after meconium‐stained liquor who developed RD, evidence was sought for 1) fetal distress (from the cardiotocograph (CTG), the cord blood pH, the Apgar score and the asphyxial complications in the neonate) 2) causes of fetal distress (including maternal risk factors, fetal infection and fetal malnutrition) 3) causes of respiratory distress (including meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn (PPHN) and infection).Of 4,026 livebirths, 717 (17.8%) had meconium‐stained liquor and 44 term and 5 preterm infants developed RD. In the 44 term infants, there was frequent evidence of fetal distress possibly caused by previously unrecognized factors such as fetal malnutrition with reduced neonatal skinfold thickness in 35% triceps and 41% subscapular measurements, and histological chorioamnionitis (CA) in 74%. The cause for respiratory distress was identified in only 48% of infants, and included clinical evidence of PPHN (41%), MAS (16%) and infection (2%). However in preterm infants, 80% had definite or suspected infection.The findings indicate that fetal distress is common in infants who develop respiratory distress after meconium‐stained liquor. A role for histological CA and reduced nutrition in the fetus, as factors contributing to the vulnerability of the term infant to intrapartum fetal distress, is suggested.
Occasional Review: Allergy to Coitus
Authors: Jones W. R. 
Published: February 2008

Summary: : Acute systemic hypersensitivity reactions to semen are rare but may be life‐threatening. Chronic or recurrent local reactions are more common and may be misdiagnosed as infective or nonspecific vaginitis. The antigen(s) involved in these reactions reside in a glycoprotein fraction of seminal plasma. Allergic vulvovaginitis may also occur in sensitized women when they are exposed to exogenous allergens such as drugs, food and infective agents during sexual activity.Skin testing and other relevant investigations are indicated when these disorders are suspected. Condom usage will prevent symptoms of coital allergy. Desensitization has had variable success in acute systemic hypersensitivity. Precoital antihistamines may modify local reactions.
Treatment of a Patient with Severe Menstrual Migraine Using the Depot LHRH Analogue Zoladex
Authors: Holdaway I. M. , Parr C. E. , France J. 
Published: February 2008

EDITORIAL COMMENT: : We accepted this case because of the unusual finesse of inducing reversible hypogonadism to decide if bilateral oophorectomy was indicated in a 38‐year‐old women with menstrual migraine. It seems strange that preoperative continuous oestrogen and/or progestogen regimens did not control her migraine which however did not return with oestrogen replacement therapy after bilateral oophorectomy and hysterectomy had been performed.Summary: : Migraine occurring at menstruation is frequently difficult to treat. A 38‐year‐old woman with exceptionally severe menstrual migraine was treated by temporary ovarian suppression using Zoladex, a long acting luteinizing hormone‐releasing hormone agonist. There was prompt relief of headache, and after several months of treatment the patient elected to undergo surgical oophorectomy with subsequent resolution of her migraine. A trial of reversible hypogonadism using an LHRH agonist may thus be helpful in predicting the result of surgical castration in this situation.
Transabdominal Chorion Villus Sampling: A Safe and Reliable Procedure
Authors: Robinson H. P. , de Crespigny Ch. , Ngu A. C. , Robertson A. , J. L. Hallida B Sc(Hon)  
Published: February 2008

Summary: A complete follow‐up of the first 578 patients undergoing transabdominal chorion villus sampling (TACVS) in our combined practices was undertaken to determine the pregnancy loss rate. Factors contributing to losses and the problems incurred in achieving a clinically relevant result were also examined.It was found that increasing experience led to fewer procedural difficulties but that there persisted a higher problem rate in those women with a retroverted uterus. In 98.1% of patients an adequate volume of tissue was obtained and in 95.5% a clinically relevant result was achieved. This second figure rose to 96.3% in the latter part of the study. There was a total fetal loss rate of 2%, with only 0.5% (3 patients) having a missed abortion within 4 weeks of the procedure.It is concluded that TACVS is a reliable procedure with a high level of safety.
The Second Stage of Labour: Durational Dilemmas
Authors: Dei‐ham Roger J. , Crowhurst John , Crowther Caroline 
Published: February 2008

EDITORIAL COMMENT: We commend this essay on the second stage of labour to all readers since it will encourage them to rethink their management of the patient who is in the second stage of labour, without evidence of fetal or maternal distress. The editorial committee firmly agrees with the authors'belief that midforceps delivery is a dangerous manoeuvre and should be performed only when indicated, rather than because the patient is deliverable or because the second stage has exceeded a statutory period of 1–2 hours. We were taught many years ago, when difficult manipulative deliveries were more often resorted to, and when the Caesarean section rate was less than half of the present rate land the perinatal mortality rate was more than double the present rate J that ‘distress plus dystocia is dangerous for the fetus’ and we consider that this adage remains true. The permissible duration of the second stage of labour, when the head is on view, and where delivery can be readily effected by episiotomy, with or without low forceps delivery, is another mailer. In this instance the obstetric philosophy of the accoucheur will determine whether to act or to wait.(A) Cacsaican section rate6.2%: perinatal mortality rale 3 5%, Medical and Clinical Report, Royal Women's Hospital. Melbourne, 1970.Summary: The optimal management of prolonged second stage of labour remains a confused area of thought and action. This confusion is particularly evident when epidural analgesia is also being used. A review of the literature indicates that prolonged duration of the second stage, i.e. from full dilation of the cervix until delivery, with or without epidural analgesia, has little adverse effect on perinatal outcome. More attention should be paid to the expulsive phase of the second stage and greater efforts made to reduce unnecessary interventions.