bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vasa Praevia: Another Cause for Concern in In Vitro Fertilization Pregnancies
Authors: Burton G. , Saunders D. M. 
Published: February 2008

Summary: A case is reported of the velamentous insertion of the umbilical cord into the membranes of the placenta, unsuspected until delivery, in an in vitro fertilization pregnancy. Abnormal placental development adds a new dimension of risk to these pregnancies.The Australian Register of in vitro fertilization (IVF) pregnancies has shown (1) an increase in perinatal mortality rates but there are many possible causes for such an increase. A recent report (2) has suggested a higher incidence of velamentous and marginal insertions of the umbilical cord in IVF pregnancies.We wish to report a case of marked velamentous insertion of the cord which was associated with an uncomplicated vaginal delivery, but highlights the possible increased risks of vasa praevia in IVF pregnancies.
Primary Postpartum Haemorrhage in Tasmania 1982–1986
Authors: Allen D. G. , Correy J. F. , Marsden D. E. 
Published: February 2008

EDITORIAL COMMENT: This paper provides valuable statistics regarding the most common life‐threatening complication that occurs in the delivery room. The overall incidence of primary postpartum haemorrhage (PPH) was 7.2%, and the rate was significantly higher after either instrumental delivery (13.7%) or Caesarean section (15.4%), than after normal vaginal delivery (3.9%). This paper does not discuss the influence of episiotomy or retained placenta, and the authors do not tell us the method of management of the third stage of labour which they favour. Blood transfusion statistics are not quoted but the high incidence of PPH associated with Caesarean section, antepartum haemorrhage and multiple pregnancy, suggest that it is prudent to cross‐match blood in patients with these complications.In one hospital series of 15,860 deliveries (1) the incidence of PPH was 3.7% (excluding Caesarean sections unless blood loss exceeded 600 ml after the operation), and 1 in 3 patients with this complication received a blood transfusion, and 1 in 200 required hysterectomy. In this series there were 2,305 Caesarean sections and in these patients the blood transfusion rate was 8.3%, and 1 in 100 required hysterectomy.Postpartum haemorrhage and Caesarean section share a special association because, if blood loss is measured accurately at operation, the mean volume (± SD) is 1,290 ± 240 ml for first Caesarean section and 1,012 ± 380 ml for repeat operations (2). The presence of an episiotomy or perineal tear is also important, in terms of average blood loss, in patients delivered vaginally; Paull and Ratten (3) reported that, in both nulliparas and multiparas, the amount of blood loss more than doubled in patients with a sutured tear or episiotomy in comparison with those with an intact perineum.Estimation of blood loss at delivery is difficult, especially at Caesarean section. Because of this it is wise to perform a haemoglobin estimation in the puerperium — the results are often a surprise! It is the editor's practice to advise all patients to continue iron tablets for 3 months after delivery to minimize the risk of postpartum anaemia.Summary: Primary postpartum haemorrhage remains a significant problem in modern obstetric practice. The incidence and factors associated with postpartum haemorrhage in Tasmania over a 5‐year period were studied. The mode of delivery, anaesthesia, birth‐weight, induction and augmentation of labour, multiple pregnancy, antepartum haemorrhage and hypertension were found to be important factors. The incidence of retained placenta was not considered in this study.
The Reliability of a Cytological Prediction of Cervical Adenocarcinoma In Situ
Authors: Laverty Colin R. , Farnsworth Annabelle , Thurloe Julia , Bowditch Ronald 
Published: February 2008

EDITORIAL COMMENT: The entity of cervical adenocarcinoma in situ will be new to many readers. This careful large study established that cytological prediction of adenocarcinoma in situ of the cervix is a very meaningful finding, with a false positive rate of only 2% i.e. 1 of 47 patients having adequate investigation; the other 46 patients having in situ (28) or invasive (18) carcinomas. The authors have justified their conclusion that a cytological report of adenocarcinoma in situ of the cervix merits further investigation by cone biopsy. The appropriate management of very early or minimal microinvasive adenocarcinoma discovered at conization performed following a cytological prediction of adenocarcinoma in situ remains controversial, until such time as long term follow‐up of a series of such patients is reported.Summary: A spectrum of changes precedes clinical invasive adenocarcinoma of the cervix. Cytological and histological criteria for the diagnosis of adenocarcinoma in situ (ACIS) are becoming more clearly defined. A 5‐year prospective study was undertaken to test the accuracy of a cytological prediction of ACIS.From a total of 290,000 cervical smears 54 predictions of ACIS were made: 33 (61%) alone and 21 (39%) with associated squamous carcinoma in situ (SCIS). The rate of reporting ACIS was compared to the rates for intraepithelial and invasive squamous lesions and for frank invasive adenocarcinoma. The findings suggest that ACIS is being underdiagnosed.Forty‐seven patients were adequately investigated; 46 had intraepithelial or invasive malignancy. There were 10 cases of ACIS, 10 ACIS with SCIS, 9 microinvasive adenocarcinoma, 5 invasive adenocarcinoma, 2 microinvasive adenosquamous carcinomas, 1 invasive adenosquamous carcinoma, 8 SCIS and 1 endometrial carcinoma. There was one true false positive report. Thus cervical glandular neoplasia was confirmed in 37 patients (79%), 13 of these having adenosquamous tumours.Because 98% of patients had in situ or invasive malignancy and because 36% of cases were invasive (though mostly microinvasive) prompt investigation, by cone biopsy, must follow a cytological report of ACIS.
Papillomavirus Infection of the Female Genital Tract Before and After Treatment: A Cytological, Colposcopic and Histological Study*
Authors: Merkur Harry , Baird Phillip J. 
Published: February 2008

EDITORIAL COMMENT: All practitioners and many members of the public are becoming increasingly concerned about papillomavirus infection of the genital tract, in men and women, because of its apparent escalating prevalence, and its relationship to the development of invasive cancer. It is difficult to suppress fear that the HIV‐1 virus that causes AIDS will ultimately spread through the community in a similar manner. The authors have studied 135 patients with an abnormal Papanicolaou smear and reported the colposcopic and histological findings after a follow‐up for 12 months. The takeaway message is that HPV infection persists in spite of treatment; at the initial investigation 114 of the 135 women had colposcopic evidence of HPV ± CIN and 99 showed histological evidence of these lesions (tables 4 and 5); at follow‐up colposcopy 108 women still had evidence of HPV ± CIN (table 6). The enormous difference in the proportion of patients with HPV7CIN rather than HPV alone in 1986 compared with the 2 previous years (table 8) indicates either a rapid change in the disease, or in its interpretation by colposcopists and pathologists. The absence of invasive cancer on follow‐up is not reassuring after only 12 months' surveillance. In the authors' series the most recent follow‐up experience is that colposcopy showed persistence of HPV infection in 87% of patients who originally presented because of an abnormal Papanicolaou smear (table 7).Summary: Papillomavirus infection (HPV) of the female genital tract is now recognized as a major risk factor for the development of neoplasia. With the combined investigative modalities of cytology, colposcopy and histopathology, it is clear that precancerous changes and HPV are closely associated. The differentiation of innocent HPV infection from progressive premalignant disease is not clear‐cut in all situations. Despite various treatment modalities, close follow‐up of these patients by cytology, colposcopy and histology reveals the presence of persistent genital tract infection by HPV.
Cervical Cancer in South Australia: Trends in Incidence, Mortality and Case Survival
Authors: Bonett Anton , Davy Margaret , Roder David 
Published: February 2008

Summary: Approximately 90% of cervical cancers are considered preventable through regular screening and the treatment of precursor lesions, but fewer than 20% of South Australian women were found to have been screened in 1984.Data from the State Cancer Registry have shown an increase in cervical cancer incidence of approximately 80% in women under 50 years of age in the 9‐year period to 1986, but a decrease of about 25% in older women. Mortality data have shown similar patterns by age, although the increase in younger women tended to extend to an older age.Case survival was unchanged between the diagnostic periods 1977–1981 and 1982–1987 and there was little change in the proportion of cases that were adeno‐carcinomas.
Screening for Gestational Diabetes in a Teaching Hospital in Saudi Arabia
Authors: Khwaja Suraiya S. , Al‐Suleiman Suleiman A. , Al‐Sibai M. Hisham 
Published: February 2008

EDITORIAL COMMENT: It is difficult to compare the incidence of gestational diabetes in different communities unless the same methods of testing are used, and the same criteria for gestational diabetes adopted. In this paper from Saudi Arabia the authors used the same methodology and definitions as did El‐Shafei and Colleagues in the preceding paper in this issue of the journal, comparing the incidence and severity of gestational diabetes in Bahrain and Melbourne. However, it should be noted that Khwaja and colleagues estimated glucose in venous plasma whereas the other study used capillary plasma which has a higher glucose value — this probably accounts for the relatively small number of milder cases of gestational diabetes in the Saudi series.Summary: This study was undertaken to determine the incidence and severity of gestational diabetes in our hospital population which is predominantly Arab; 455 consecutive patients were screened by a 3‐hour glucose tolerance test in the third trimester of pregnancy. The overall incidence of gestational diabetes was found to be 11% and the incidence increased with increasing maternal age, parity and weight. A high prevalence of more severe degrees of gestational diabetes was noted among the Arabs. Glucose intolerance was observed in 2 patients in the absence of any risk factor. The most common high risk factor in patients found to have gestational diabetes was maternal age of 30 years or more.
Elective Caesarean Hysterectomy. Indications and Outcome: A 17‐Year Experience of 140 Cases
Authors: Bukovsky Ian , Schneider David F. , Langer Rami , Arieli Shlomo , Caspi Eliahu 
Published: February 2008

EDITORIAL COMMENT: Elective Caesarean hysterectomy for sterilization alone or for sterilization when there is other gynaecological pathology present (fibromyomas, menorrhagia) is not widely practised in Australia in so far as this editor is aware. This is quite different from results of practice reported from the United States of America or, as this paper reports, in Israel. This paper reports remarkably good results that justify the authors' practice of performing more than 5 Caesarean hysterectomies electively for every 1 performed as an emergency procedure (140 versus 26). It is not always easy to decide when a Caesarean Hysterectomy is elective; if the patient has many children and especially if she has had several Caesarean sections, then ‘difficulty with haemostasis’ or ‘a defective lower segment scar’ can become an ‘indication’ for emergency Caesarean hysterectomy. In this series the total incidence of Caesarean hysterectomy was 1 in 396 confinements (166 in 65,723); the incidence was 1 in 470 for elective and I in 2,528 confinements for emergency Caesarean hysterectomy. For perspective and contrast, readers are referred to Emergency Hysterectomy in Obstetrics ‐ a Review of 117 Cases A l‐Sibai MH, Rahman J, Butalack F. Aust NZ J Obstet Gynaecol 1987; 27:180–184. Table 1 below shows the total experience of Caesarean hysterectomy at the Mercy Maternity Hospital, Melbourne, where religious considerations preclude the practice of sterilization procedures. It is seen that the operation was performed 1 in 1,098 confinements and that in 70% of cases (46 of 66) the patient had had a previous Caesarean section. This table shows little change in the indications for Caesarean hysterectomy in the 16 years reviewed, apart from the remarkable increase in the incidence of placenta praevia accreta, an increase that cannot adequately be explained by the increasing Caesarean section rate.Summary: In an earlier report of 86 elective Caesarean hysterectomies (1970–1979) we showed that the operation was associated with few complications but a high blood transfusion rate.In this paper we report an extended series comprised of 140 cases (1970–1986), and compare results of the 1970's series with that of the 1980's. The operative and postoperative complications were minimal during the entire period. The blood transfusion rate which was 64% in 86 cases of the 1970–1979 period decreased to 17% in 54 cases of the 1980–1986. Our results show that Caesarean hysterectomy is a safe procedure with some long‐term advantages; therefore this option should be discussed with women who ask for tubal sterilization at the time of Caesarean section.
Mid‐trimester Abortion by Extraamniotic Emcredil Versus Normal Saline
Authors: Zauva B.L. , Gupta I. , Dhall G.I. 
Published: February 2008

EDITORIAL COMMENT: Midtrimester abortion using hypertonic saline (20% sodium chloride) was used extensively in the I950's‐1960's and was abandoned because of maternal deaths associated with seizures, hypernatraemia and coagulation failure, presumably due to accidental intravenous injection of the solution (or its rapid absorption into the intravascular space) resulting in cerebral infarction or haemorrhage (1,2). Intraamniotic instillation of 20% NaCl or 50% glucose was advocated as late as 1966–1969 for induction of labour in cases of intrauterine death, missed abortion, or therapeutic abortion beyond 14 weeks' gestation (3,4). It should be emphasized that normal saline (0.9% sodium chloride) is a physiological, isotonic solution which should have no such ill‐effects. It is always difficult to judge 2 solutions such as described in this paper when the regimens are complicated by use of Syntocinon infusion, which was commenced in both study groups 2 hours after extraamniotic instillation of the 2 solutions whose abortificient actions were being compared. Nonetheless the authors achieved acceptable results with the normal saline‐Syntocinon regimen described here, which justify continued evaluation of the method in a larger series of patients. Second trimester abortion is unfortunately necessary in modern obstetrics and the great variation of published methods indicate that none is entirely satisfactory.Summary: Data is presented for 40 mid‐trimester abortions, induced by 0.1% Emcredil (Group 1 — 20 cases) and normal saline (Group 2 — 20 cases) by instillation in the extraamniotic space. It was observed that the 2 groups were comparable for age, parity and period of gestation. The mean induction‐abortion interval was 18 hours 9 minutes in Group 1 and 19 hours 19 minutes in Group 2. Abortion was complete in 45% and 65% in Group 1 and Group 2, respectively. With a cutoff time of 30 hours, there were 3 failures, 1 in Group 1 and 2 in Group 2. The induction‐abortion interval was significantly less in the more advanced pregnancies in the saline group. There was no complication in either of the 2 groups. It is hypothesized that normal saline also acts by damage of the decidual cells with liberation of pro‐staglandins locally. Also since normal saline is a cheap and easily available commodity with no contraindication for its use and no side‐effects, it seems to hold a lot of promise for induction of mid‐trimester abortion.
When Do Perinatal Deaths in Multiple Pregnancies Occur?
Authors: Fliegner John R. H. 
Published: February 2008

EDITORIAL COMMENT: Dr R T O'Shea recently reported in this journal that ‘if bed‐rest in hospital is to be implemented as a possible means of improving perinatal outcome in twin pregnancy it needs to be effected between 21 and 28 weeks' gestation’ (Twin Pregnancy: Prematurity and Perinatal Mortality. Aust NZ J Obstet Gynaecol 1986;26:165). Dr Fliegner now provides us with supporting data from Victoria. Our main editorial comment remains that ‘a practical compromise could be for patients with multiple pregnancy to be rested in hospital for 2–3 days every 2–4 weeks from 20 weeks' gestation until the dangers of prematurity are past’. The problem of fetal growth retardation is another matter. Use of ultrasonography to detect discordant fetal growth and cardiotocography to detect fetal hypoxia in the last 4–6 weeks of pregnancy are an alternative to routine induction of labour at 38 weeks' gestation. As far as the editor is aware there is no published report of a controlled trial of elective induction of labour in twin pregnancy, and whether or not am‐niotomy is as effective as in singleton pregnancies; the 15% incidence of breech presentation of the first twin is another problem!Summary: Perinatal mortality for multiple pregnancy remains at least 5 times the rate for singleton births. The major causes are neonatal deaths due to gross immaturity before 30 weeks' gestation, and stillbirths due to intrauterine growth retardation at all gestations, but especially after 32 weeks. Sixty four per cent of perinatal losses before 30 weeks' gestation occur before 26 weeks, highlighting the need to commence prophylactic measures earlier than usually recommended. The perinatal mortality in infants in multiple births weighing more than 2,500g is the same as that of singletons, but is 10 times this rate in multiple births weighing between 500g and 2,500g. Because the stillbirth rate in twins proceeding beyond 38 weeks' gestation is 3 times that of singleton births, elective termination of pregnancy is recommended if spontaneous labour has not occurred by this time.
The Influence of In‐Utero Transfer on Perinatal Mortality in a Tertiary Care Centre
Authors: Wittekind Carola A. , Arnold John D. , Leslie Garth I. 
Published: February 2008

EDITORIAL COMMENT: It is often questioned at State Stillbirth and Neonatal Death Committees if deaths with avoidable factors occurred in country, peripheral or tertiary centres, and whether or not the attending practitioner was a general practitioner, specialist in training, or consultant obstetrician. This paper analyses the proportion of perinatal deaths in a tertiary centre occurring in nonbooked patients — i.e. in utero transfers expectedly these patients had a high perinatal mortality rate (152 per 1,000 livebirths), and in this study accounted for 39% of all perinatal deaths. In this study the perinatal mortality for booked patients was 10.8 per 1,000 births which was less than the overall State result although the hospital population would presumably have included a relatively high proportion of high risk pregnancies. These results are excellent and important e.g. for comparison, at the Mercy Maternity Hospital, Melbourne for the triennium 1984–1986 the perinatal mortality in 15,150 booked patients was 13.3 per 1,000; there were 508 nonbooked patients (3.2%) and they provided 30.6% (90 of 294) of all perinatal deaths. Perinatal deaths may have avoidable factors due to problems in management performed in teaching hospitals and this can occur in booked or nonbooked patients. Therefore scrutiny of the causes of perinatal death is essential in both booked and nonbooked cases although the latter, largely because of prematurity, will be associated with very high mortality rates.Summary: From March 1, 1986 through February 28, 1989 inclusive there was a total of 8,319 births with a birth‐weight of 500 g or more at Royal North Shore Hospital (RNS). Three hundred and sixty one births (4.3%) resulted from in‐utero transfer of high risk pregnancies (IUT); the remainder were booked at RNS. There were 141 perinatal deaths of which 55 (39%) occurred in infants transferred in‐utero.
Place of Second‐look Laparotomy After 18 Courses of Chemotherapy in Epithelial Ovarian Cancer
Authors: Ngan Hextan Y.S. , VVong L.C. , Ma H.K. 
Published: February 2008

Summary: Thirty‐two patients with epithelial carcinoma of the ovary underwent a second‐look laparotomy after the completion of an average of 18 courses of adjuvant chemotherapy. Nine patients (28%) were found to have persistent disease. This low‐rate of positive second‐look laparotomy is probably because these patients received chemotherapy for 18 months and in those patients whose tumour did not respond to the medication, the disease would progress and the patient died without becoming a candidate for laparotomy.There was no stage 1c patient whose second‐look laparotomy was positive and the need for second‐look laparotomy is questionable in such patients. Stage 111/ IV patients and patients with recurrence had a significantly higher positive second‐look laparotomy rate than stage Ic/II patients, 44% and 7% respectively. In the present group of patients with positive tumour at second‐look laparotomy, 33% responded to further debulking operation and chemotherapy and remained disease free 15–33 months after completion of their second line chemotherapy treatment. For second‐look laparotomy to be of maximum benefit to the patient, we recommend that it be performed after 12 courses of chemotherapy.
Peritoneal Washing Cytology: A Retrospective Analysis of 175 Gynaecological Patients
Authors: Lowe Elana , McKenna H. 
Published: February 2008

Summary: Accurate staging is the basis for optimal therapy in the management of the gynaecological cancer patient and, in recent years, peritoneal washings are one of the techniques used to determine this, both at the initial and subsequent lapa‐rotomies.Two hundred and four peritoneal washes were obtained from 175 patients during a 5‐year period. Fifteen cases of histologically proven intraperitoneal tumour were confirmed in 11 cases by peritoneal cytology at initial operation, a sensitivity of 73%. At second‐look laparotomy, 3 of 9 histologically proven malignancies were confirmed by cytology, a sensitivity of 33%. One false positive diagnosis was made in the series.Prodecures to avoid both false‐positive and false‐negative diagnoses by the clinician and the laboratory are discussed, and a review of the literature is provided.
Outcome of Pregnancies Complicated by Epilepsy in Tasmania 1981–1988
Authors: Sonneveld S. W. , Correy J. F. 
Published: February 2008

EDITORIAL COMMENT: Epilepsy and asthma are the neglected major medical diseases of pregnancy challenging in importance (prevalence, maternal and perinatal mortality and morbidity) essential hypertension, chronic renal disease and diabetes. This issue contains 2 complementary papers on epilepsy and pregnancy: the large Tasmanian community series confirms the significant increase in fetal abnormalities and other pregnancy complications; the South Australian teaching hospital series confirms the association with fetal malformations and antenatal complications and also discusses the medical management of epilepsy in pregnancy and how the 2 conditions influence each other. Summary: Epilepsy in pregnancy is associated with an adverse pregnancy outcome. In 347 pregnancies in an 8‐year retrospective study of all private and public patients in Tasmania from 1981 to 1988, epilepsy was found to be associated with an increased risk of hypertension (21%), antepartum haemorrhage (4.9%), postpartum haemorrhage (11.2%), fetal abnormality (3.5%) and perinatal mortality (2.3%).