bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of Ureaplasma urealytkum in Adverse Pregnancy Outcome
Authors: Knox Christine L. , Cave Donald G. , Farrell David J. , Eastment Henry T. , Timms Peter 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it gives important information about the frequency of colonization of the lower and upper genital tract of pregnant women with Ureaplasma urealyticum. Although the authors discuss adverse pregnancy outcome they did not mention perinatal mortality or morbidity due to infection with Ureaplasma urealyticum although they note that there were 4 of the 16 preterm deliveries where there was evidence of chorioamnionitis. We have previously published a paper from the Toowoomba Base Hospital group on Ureaplasma urealyticum chorioamnionitis associated with 2 perinatal deaths and 1 case of severe chorioamnionitis where the infant survived (A). We refer readers to the Editorial Comment that accompanied this paper.Summary: We investigated Ureaplasma urealyticum genital tract colonization rates in an Australian population to determine whether colonization was associated with adverse pregnancy outcome. Women attending an antenatal clinic were evaluated for lower genital tract colonization at their first antenatal visit (162 women) and at 28 weeks' gestation (120 women). Placentas from 92 women were cultured. U. urealyticum was the predominant isolate from the lower (57.4%) and upper (17.4%) genital tract in this population of pregnant women. U. urealyticum was a persistent colonizer during mid‐trimester of pregnancy (in 88% of women colonized) whereas M. hominis, G. vaginalis, and Group B streptococcus were present as transient flora of the lower genital tract. Lower genital tract colonization during pregnancy was not directly associated with adverse pregnancy outcome. However preterm delivery in afebrile, asymptomatic women, could possibly be associated with chorioamnionitis (4 of 16 preterm births). Screening of women with a history of preterm birth may prevent upper genital tract infections and preterm delivery.
Access to Assisted Human Reproduction Services by Minority Groups
Authors: Daniels K.R. , Burn I. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it addresses an important issue in contemporary society – namely the rights of access to modern assisted reproduction technology by women who are single, lesbian and/or postmenopausal.Summary: This paper looks at the claims of lesbian and single women to have access to Assisted Human Reproduction (AHR) in New Zealand, discusses legislation, rulings and regulations, as well as the opinions of people who have been involved in this issue. These include clinics and health professionals who provide these services, ethics committees and other bodies, and public opinion. Some implications for policy development are also discussed.
Rectal Bleeding: A Rare Complication of Abdominal Pregnancy
Authors: Saravanane C. , Smile S. Robinson , Chandra S. Sarath , Habeebullah S. 
Published: February 2008

EDITORIAL COMMENT: We accepted this case report for publication not only because of its rare anecdotal interest, which is considerable, but also since it will warn readers that rectal bleeding in pregnancy may result from an abdominal pregnancy. It is strange that the ultrasonograph seems not to have identified the calcification as a fetus although we are not told that the latter was macerated or misshapen. The editor has never seen or heard of an ectopic pregnancy causing rectal erosion and bleeding although he has reported a primary abdominal pregnancy in which the placenta was implanted on the peritoneum of the pouch of Douglas posteriorly (A); this woman presented at 23 weeks' gestation when retroplacental haemorrhage resulted in a haematoma that bulged into the vagina causing acute urinary retention. One wonders why the placenta did not erode the anterior rectal wall in this more advanced case of primary placental implantment in the pouch of Douglas.Summary: A rare case of abdominal pregnancy, causing massive rectal bleeding due to invasion of the rectal wall by the placenta, is reported.
Effects of Intrapartum Hydrotherapy on Labour Related Parameters
Authors: Aird Ian A. , Luckas Murray J.M. , Buckett William M. , Bousfield Peter 
Published: February 2008

EDITORIAL COMMENT": We accepted this paper for publication because there is a lot of anecdotal discussion about water birth in obstetric practice but very few studies where the labours have been scientifically appraised and an attempt made to compare them with another group of patients. This paper attempts to make such a comparison and provides information which should interest all obstetricians and midwives. It is difficult to imagine how there could ever be a controlled trial on the usefulness of waterbirth compared with other methods of delivery. As the authors point out, there are so many advocates for waterbirth in the United Kingdom that compilation of scientific information and its publication must be encouraged. This study is small and we would encourage those who practise waterbirths to at least present an audit of the complications both maternal and fetal that occur with this method of delivery.Summary: The use of birthing pools during labour is increasing in the United Kingdom. This is without good scientific evidence of their efficacy or safety. To further investigate the value and safety of intrapartum hydrotherapy, an historical cohort study was performed in a District General Hospital in Liverpool. The study group consisted of 100 women of low obstetric risk who used the birthing pool at some stage during their labours and the control group consisted of 100 women who were matched in terms of age, parity and obstetric history but laboured and delivered in air. The main outcome measures were operative delivery rates, duration of labour, analgesic requirements, perineal trauma and Apgar scores at 1 and 5 minutes. The results showed that nulliparas who used the birthing pool had significantly reduced operative delivery rates, a shorter second stage of labour, reduced analgesic requirements and a lower incidence of perineal trauma. In multiparas there were significant reductions in analgesic requirements.
Changes in Folate Supplementation, and in Serum and Red Cell Folate Levels in Antenatal Patients Over the Course of a Health Promotion Project for the Prevention of Neural Tube Defects
Authors: MBBS Carol Bowerl , BSc Simon Knowlesl , MSc Darryl Nicol 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it presents useful information concerning folate intake in a community and the impact a health promotion project can have in changing folate supplementation in women before 20 weeks gestation. This study did not attempt to evaluate whether or not the health promotion project increased prepregnancy supplementation of folate by dietary intake or specific prescription of folic acid. However, the takeaway message seems to be that even in the final phase of the study, 85% of the 72 women investigated were not taking folic acid supplements before pregnancy. This finding is in keeping with data reported from other centres. Because pregnancy is not planned in about 40% of instances (reference 11 of this paper), and since the neural tube closes by the end of the 6th week from the last menstrual period, it seems that the incontestable conclusion from the data presented and discussed in this paper, is that a policy of folate fortification of food as recommended by the National Health and Medical Research Council of Australia, should be implemented.Summary: We assessed the use of folic acid supplements and changes in serum and red cell folate levels in pregnancy over the course of a healui promotion project in Western Australia by 4 cross‐sectional studies of women attending a public antenatal outpatient clinic in 1992 (before the launch of the health promotion project), 1993, 1994, and 1995. A short questionnaire was completed and blood taken for estimation of serum and red cell folate. There was an increase in the proportion of women taking folic acid supplements in the first trimester (51.9% in the final phase) and before pregnancy (15% in the final phase of the study), and no change in the proportion taking other vitamin supplements. Serum and red cell folate levels increased significantly over the study period in both women taking and not taking folic acid supplements. The proportion of women who had seen the pamphlet used in die health promotion project rose to 35.4% in die third phase, and fell to 27.8% in the final phase. Coincident with the health promotion project, there was an increase in folate status in early pregnancy. However, most women were not taking folic acid supplements before they became pregnant and, hence, may not have had sufficient folate at the time of normal neural tube closure.
Antenatal True Umbilical Cord Knot Leading to Fetal Demise
Authors: Eizenberg David 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because cord problems should interest readers and it is generally accepted, as the author notes, that a true knot is seldom a cause of death before the onset of labour in contradistinction to entanglement of the cord around the baby's limbs and body. As far as the Editor is aware, diminished or absence of fetal movements has never been shown cardiotocographically to be caused by a true knot with successful delivery of the fetus although one can imagine that this could occur. It is interesting to speculate, as the author has done, concerning how a true knot tightens when the umbilical cord is of normal length. In Chew's (A) paper the cardiotocographic findings were analyzed in 2,601 women who reported diminished fetal movements and there was no example of a knotted cord in any of the 21 perinatal deaths or in any of the 24 infants who had loss of baseline variation and type 2 decelerations, which was regarded as evidence of critical fetal reserve. A Medline search identified a case where a sinusoidal fetal heart rate pattern and moderate fetal hypoxia was associated with a true knot of the cord (B). Another study of 12 pregnancies in which fetal distress and death resulted from umbilical cord abnormalities included 8 where the patients had a history of decreased fetal movements, and where nonstress cardiotocography was abnormal (C). These authors concluded that antepartum fetal deaths due to umbilical cord abnormalities are still difficult to prevent, as it is often impossible to detect distress in time for appropriate intervention. Prompt action to deliver the baby after an abnormal cardiotocograph appears to be a necessary step to prevent such deaths, yet even this failed in Case 2 reported in this paper. These 2 cases may inspire us to keep looking. One can imagine that the fetus may have been saved in Case 1 had the patient reported change in fetal movements earlier.

Chew FTK, Beischer NA. Antepartum cardiotocographic surveillance of patients with diminished fetal movements. Aust NZ J Obstet Gynaecol 1992; 32: 107–113.
Goldstein I, Timor‐Tritsch IE, Zaidise I, Divon M, Paloi E. Sinusoidal pattern together with signs of moderate fetal hypoxia associated with a true knot of cord. Eur J Obstet Gynecol reprod Biol 1981; 11: 221–225.
Ghosh A, Woo JS, MacHenry C, Wan CW, O'Hoy KM, Ma HK. Fetal loss from umbilical cord abnormalities: a difficult case for prevention. Eur J Obstet Gynecol Reprod Biol 1984; 18: 183–198.
Haemoperitoneum Due to Cornual Endometriosis During Pregnancy Resulting in Intrauterine Death
Authors: Leung Wing Cheong , Leung Tsin Wah , Lam Yung Hang 
Published: February 2008

EDITORIAL COMMENT: We accepted this case report for publication not only because of the rarity of an acute haemoperitoneum causing intrauterine fetal death in late pregnancy, but also because of the cause of the haemorrhage. There are cases where the cause of a haemoperitoneum is never found and indeed, when the editor was a resident medical officer at the Royal Women's Hospital, Melbourne, such a case resulted in a maternal death; this woman died during repeat laparotomy and possibly the source of the bleeding was a ruptured vein over the uterosacral ligament. One reviewer of this paper commented that the source of bleeding may have been an area of ectopic decidua formation rather than endometriosis. Ectopic decidua is frequently seen at Caesarean section involving the peritoneum of the uterus and broad ligaments. Occasionally it occurs outside the pelvis and when located in the renal pelvis can cause haematuria, sufficient in the case reported by Bettinger to result in nephrectomy to control the bleeding(A). Ectopic decidua is not biopsied at Caesarean section because of the risk of haemorrhage and is possibly best studied histologically in Caesarean hysterectomy specimens.(A) Bettinger HF. Ectopic decidua in the renal pelvis. J Path Bact 1949; 59: 686–687.
Strangulation of the Small Intestine: A Late Complication of Ventrosuspension
Authors: Portmann C. , Goh J. , Teh J. 
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication to remind readers that small bowel obstruction can be a late complication of Ventrosuspension, and that as stated in the discussion, gynaecological surgery is responsible for a large proportion of cases of bowel obstruction requiring surgery in females. This case reminded the editor of an elderly woman seen a few years ago with postmenopausal bleeding which persisted after curettage had revealed no abnormality and no curettings. At laparotomy for hysterectomy it was found that the woman had had a previous ventrofixation and her elevated enlarged uterus attached to the anterior abdominal wall contained a huge malignant polyp; the previous curettage had been performed in the elongated cervix and lower uterine segment. Ultrasonography would have recognized this endometrial mass. The reviewer of this paper noted that a plain supine and erect abdominal X‐ray should be performed when bowel obstruction is a possible diagnosis and may have assisted the management of this woman by showing distended bowel loops with fluid levels; it would seem that in this case the ultrasound findings of fluid filled loops of bowel did not warrant immediate surgery.Summary: A case of strangulation of the small intestine as a late complication of Ventrosuspension is presented and discussed.
Diagnosis and Treatment of Cervical Intraepithelial Neoplasia in a Single Visit
Authors: Das S.S. , Elias A.H. 
Published: February 2008

EDITORIAL COMMENT— ‐Peter T. Grant, FRCS (Ed), FRACOG, CGO Gynaecological Oncologist, Gynaecological Cancer Centre, Royal Hospital for Women, New South WalesSummaryWe evaluated the diagnostic and therapeutic efficacy of large loop excision of the transformation zone (LLETZ) performed in the first visit (see and treat policy) as compared to LLETZ treatment performed as an interval procedure. Data of 248 patients were analyzed of which 206 patients had LLETZ. Two thirds of the procedures were performed at the first visit. Of all the women who had the ‘see and treat policy’ 94.9% were diagnosed to have cervical intraepithelial neoplasia (CIN) on histology compared to 90.8% in the interval treatment group. A total of 3 (1.4%) patients were detected to have microinvasive carcinoma. There was no difference in the immediate postoperative complication rate, overtreatment rate and need of repeat treatment in both the groups. Single visit colposcopy and loop treatment is a safe and effective option for treatment of cervical epithelial abnormalities. The experience of the colposcopist is very important.
Maternal and Umbilical Cord Serum Zidovudine Levels in Human Immunodeficiency Virus Infection
Authors: Phuapradit Winit , Sirinavin Sayomporn , Taneepanichskul Surasak , Chaovavanich Achara , Wiratchai Amompun , Sunthornkachit Rujanee , Puchaiwatanon Orawan 
Published: February 2008

EDITORIAL COMMENT: Because of the low prevalence rate for HIV in Australian antenatal populations and lack of a national or state policy for offering routine HIV testing in pregnancy, we have relied on our colleagues from Thailand to provide readers with information concerning treatment of pregnant women known to be HIV positive. Readers are referred to the January 24, 1998 issue of the British Medical Journal which contains 7 papers concerning HIV infection in pregnancy and neonates. The editorial by Danielle Mercey ‘Antenatal HIV testing. Has been done badly in Britain and needs to improve’ (A) should interest readers since HIV testing has been sufficiently performed in the United Kingdom to provide the information that in 1996 only 15% of previously unrecognized HIV infections were diagnosed in pregnancy. The prevalence in tested women in London increased 6‐fold from 0.03% in 1988 to 0.191% in 1996; for the rest of the United Kingdom the comparable percentages in tested women were 0.005% and 0.016% (B). For comparison, as noted in this paper, the prevalence rate of HIV positive mothers in Thailand was 2% in 1993, or more than 10 times greater than in London in 1996 and 125 times greater than in the rest of the United Kingdom. Tourists with sex adventures in mind should be aware of these facts when planning their itinerary for overseas tours. Obstetricians in Australia should heed the statement that ‘The advantages of ascertaining a pregnant woman's HIV positive status before delivery are clear’: transmission to the baby can be roughly halved by avoiding breastfeeding and reduced by a further two‐thirds by the administration of zidovudine (A).(A) Mercey D. Antenatal HIV testing. BMJ 1998; 316: 241–242.(B) Nicoll A, McGarrigle C, Brady AR et al. Epidemiology and detection of HIV‐1 among pregnant women in the United Kingdom: results from national surveillance 1988–1996. BMJ 1988; 316: 253–258.Summary: The aim of this study was to determine the maternal and umbilical cord serum ZDV levels at delivery in HIV‐1 infected parturients treated with a short‐course ZDV regimens in late pregnancy and labour. Serum ZDV and its metabolite were measured by high‐performance liquid chromatography. Concentrations of ZDV and its metabolite in umbilical cord blood appeared similar to maternal concentrations. There was a significant positive correlation between serum ZDV and its metabolite in maternal and umbilical cord concentrations. At delivery, maintenance of optimal virustatic ZDV concentration with oral antenatal and oral intermittent intrapartum ZDV dosage regimen can be achieved in only 53% of cases. The regimens used in this study were useful but not as effective as the ACTG 076 regimen with an intravenous dose intrapartum plus the oral administration to the infants for 6 weeks.
Massive Mature Solid Teratoma of the Ovary with Gliomatosis Peritonei
Authors: Nanda Smiti , Kalra Bharti , Arora B. , Singh Subedar 
Published: February 2008

EDITORIAL COMMENT: : We accepted this and the following case report for publication because they illustrate problems that may be associated with spontaneous or surgical spillage of contents of a cystic teratoma into the peritoneal cavity. The oncologist who reviewed this manuscript suggested that the editorial subcommittee publishes a statement that women with a large abdominal mass are unlikely to have their management altered by CT scan or MRI investigations although ultrasonography has usually been arranged by the referring practitioner. These women require prompt laparotomy, although chest X‐ray should be performed preoperatively to exclude metastatic disease. Diagnostic paracentesis which is often performed in women with abdominal masses, as in this patient, is potentially harmful and unnecessary in a patient fit and willing for surgery. Although most gynaecologists attempt to remove a cystic ovarian carcinoma intact, the literature is inconclusive about the risk of recurrence of a Stage 1 ovarian carcinoma if spillage of cyst contents occurs during surgery (A, B). It was also noted by the oncologist reviewer that most large solid teratomas are malignant and that a tumour of this size should be extensively sampled by the pathologist before a diagnosis of benign teratoma is made. Clinically, a large ovarian tumour can seem solid when it is cystic, and may also be mistaken for ascites as apparently was so in the patient reported here.(A) Sainz de la Cuesta R, Goff BA, Fuller AF, Nikrui N, Eichhorn JH, Rice LW. Prognostic importance of intraoperative rupture of malignant ovarian epithelial neoplasms. Obstet Gynecol 1994; 84: 1–7.(B) Sevelda P, Dittrich C, Salzer H. Prognostic value of the rupture of the capsule in Stage 1 epithelial ovarian carcinoma. Gynecol Oncol 1989; 35: 321–322.Summary: Glial implants on peritoneum and omentum may occur with mature solid teratoma of the ovary (gliomatosis peritonei). The case of a 17‐year‐old girl is presented, who had a massive solid ovarian teratoma with glial implants on visceral peritoneum and omentum. The massive size of the tumour posed difficulty in diagnosis. CT demonstrated a large teratoma. At laparotomy, the seedlings were initially thought to be evidence of malignancy and hysterectomy was offered which was refused by the parents. Oophorectomy was performed and the benign nature of the tumour and implants was seen on histopathology. It is important to recognize the benign nature of glial seedlings in such cases to avoid unnecessary extensive surgery.
Primary Genital Non‐Hodgkin Lymphoma
Authors: Sungurtekin Ümit , Lacin Selman , Ayhan Semin 
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication because it is interesting for readers to know that the uterus and/or ovaries can be the site of primary non‐Hodgkin lymphoma or the site where involvement of the disease causes presentation. One reviewer commented on the fact that clinical evidence of operability may be more likely to be misleading in cases of lymphoma than carcinoma. Certainly this case report indicates that clinically there was no evidence of extension of the tumour to the pelvic wall, but the fact that subtotal hysterectomy was necessary seems to indicate otherwise. Some years ago a patient in her thirties was operated on by the editor together with oncologist Peter Grant because she was in renal failure with a pelvic mass due to a lymphoma. She previously had had a generalized abdominal tumour which responded to irradiation with her pelvis shielded which accounted for the residual disease in the pelvis. This patient had an enlarged uterus of limited mobility, but it was thought that a total hysterectomy could be performed. This was found not to be so and a subtotal hysterectomy was performed as in the patient described in this case report. This woman survived for 4 years with a ureteric splint and repeated courses of chemotherapy.Summary: Although genital lymphoma either being an initial manifestation of occult nodal disease or secondary involvement is not uncommon, extranodal lymphoma originating primarily from the genitalia is quite rare. Here, we report a new case of primary genital lymphoma involving the uterus and ovaries, but not the Fallopian tubes. We also wish to emphasize that misdiagnosis of genital lymphoma, either clinically or histologically can occur.