bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Association of Maternal and Socioeconomic Characteristics in Metropolitan Adelaide with Medical, Obstetric and Labour Complications and Pregnancy Outcomes
Authors: Jonas Oswald , Roder David , Chan Annabelle 
Published: February 2008

EDITORIAL COMMENT:The use of residential area as a marker of socioeconomic status in Australia has been taken up by social scientists and public health researchers. There is inevitably some misclassification which is more likely for couples with young children. Another comment provided by our reviewer is that validation studies have shown that there is marked underreporting of antenatal complications in private patients. This is obviously true since the clinic patient has her complete antenatal record available for coding and classification, whereas the private patient's history includes only what the doctor remembers when he completes the record; how many readers ensure that all abnormalities recorded on their private patient's antenatal card are transferred to the hospital history after delivery? Another consideration is that disorders detected only by screening (gestational diabetes) will only be found if the test is performed and the result recorded in the patient's history. Differences between public and private hospitals or between public and private patients may therefore account for or contribute to some of the outcome differences in tables 1 and 2.SummaryMultiple regression analysis was used to measure associations of maternal age, race, gravidity, marital status and socioeconomic status with medical problems and pregnancy outcomes. The study population comprised all singleton births to residents of metropolitan Adelaide (in South Australia) during 1988 that were included in the State's perinatal statistics collection. The results indicate that in metropolitan Adelaide, low socioeconomic status is related to a higher risk profile of mothers and babies. It also highlights that there is a strong association of divorce and separation with medical problems and an adverse pregnancy outcome. Poorer outcomes are also seen in never married women, teenage women, older women, non‐Caucasian women and primigravid women. These poorer outcomes in older women and primigravidas include higher risks of low birth‐weight and prematurity of their babies. The study also demonstrates that groups that are less likely to have choice of obstetric care, eg. teenage women, non‐Caucasian women, and women of low socioeconomic status, have a lower odds of obstetric intervention as characterized by nonspontaneous labour and elective Caesarean section.
Born Before Arrival ‐ Uncovering the Hazards
Authors: King P. A. , Duthie S. J. , To W. K. , Ma H. K. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it examines the socioeconomic problems of mothers who deliver before arrival in hospital. The findings are important and though they may apply to communities other than Hong Kong, they are unlikely to apply to women who are admitted to metropolitan hospitals in Australia. There is remarkably little literature on birth before arrival in hospital (BBA) when one considers how many mothers‐to‐be, and their husbands, show much anxiety about the possibility of delivery before reaching hospital (A). There are different definitions used for birth before arrival that are relevant to an understanding of this paper. Weir's paper from Melbourne considered only booked patients, and the incidence of BBA's in his study was only 0.14% (1 in 695 confinements) ‐ these labours were usually precipitate (71%) and 51% occurred in the woman's first or second pregnancy; 65% were avoidable had the woman attempted to reach the hospital at the onset of labour (A). In this series from Hong Kong there were 78 (40%) unbooked patients and the main causes of the BBA's were ‘social deprivation and young maternal age’, although table 2 shows that fast labour accounted for 78 cases. The situation remains quite different in Australia: during the triennium 1987–1989 there were 15,216 women who delivered at the Mercy Hospital for Women, Melbourne, including 36 BBA's of booked patients (0.2%); none resulted in perinatal deaths although 23 of the 36 mothers had first or second degree lacerations of the perineum. During these 3 years there was only 1 nonbooked patient admitted after delivery, who had delivered anywhere else but in another hospital. The Discussion in this paper will interest readers, as the authors explain how the superior health‐care facilities available in Hong Kong should be directed to cater for those women destined to deliver their babies in an inappropriate setting.Summary In a retrospective case controlled study the demographic background and outcome of 193 mothers whose babies were born before arrival at hospital was compared to that of a control group who delivered within the maternity units of 2 teaching hospitals in Hong Kong. Mothers who delivered before arrival at hospital were significantly more likely to be single, to have received no antenatal care, to have an unplanned pregnancy, low family income and to come from a socially disadvantaged group such as Vietnamese refugees and illegal immigrants from China. Lacerations to the genital tract, postnatal anaemia and blood transfusions were more common in the study group. Results of cervical cytology and rubella status were available in significantly fewer of these mothers. They were more likely to be ambivalent about contraception and less likely to attend the postnatal clinic. The perinatal mortality and morbidity was significantly increased.
Prelabour Rupture of the Membranes at Term and Unfavourable Cervix; a Randomized Placebo‐controlled Trial on Early Intervention with Intravaginal Prostaglandin E2 Gel
Authors: Chung Tony , Rogers Michael S. , Gordon Helen , Chang Allan 
Published: February 2008

Summary Fifty nine women with prelabour rupture of membranes, unfavourable cervix and no evidence of infection or fetal distress were randomized formally to receive prostaglandin E2 (3mg) gel or sterile K‐Y Jelly intravaginally.Conservative expectant management was followed for the next 24 hours. The subsequent management of the labour followed departmental protocol. The women who received prostaglandin went into labour sooner and were delivered earlier but the duration of labour was not significantly different. There were no significant differences in other clinical outcomes. There was 1 case of uterine rupture in the prostaglandin group. We conclude that early intervention with prostaglandin E2 gel intravaginally confers no advantage compared with conservative management except for earlier confinement in this group of patients.
Autologous Blood Donation for Elective Gynaecological Surgery
Authors: Phuapradit Winit , Souppataratan Suratsawadee , Chaturachinda Kamheang , Chiewsilp Pimol 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because Australian women also are concerned about the possibility of a blood transfusion resulting in them developing the acquired immune deficiency syndrome. The ease and success of this programme of autologous blood donation should encourage us to emulate our colleagues in Thailand and develop increasing use of this method in Australia. In this series 20% of patients (438 of2,160) scheduled for elective gynaecological surgery enrolled in the programme and 10% of these 438 received an autologous blood transfusion. The authors did not tell us the proportion of autologous to homologous blood transfusions in their institution. In the United States of America the target is for autologous transfusion to be 5–10% of all blood transfusions. Dr Gordon White, Director of Red Cross Blood Bank, informed the editor that in the State of Victoria less than 2% of all blood donations are for the purpose of autologous transfusion. However, there is increasing interest in the method and the rate of autologous blood donation has increased 40–60% in each of the last 2 years.Summary The utilization and effectiveness of a hospital autologous blood donation programme for elective gynaecological surgery at Ramathibodi Hospital during April 1,1988 ‐ March 31,1991 were analyzed. A total of 438 patients or 98% of eligible patients were enrolled into the programme. Each patient gave 1 unit of blood within 14 days of undergoing gynaecological surgery. The untoward effects observed in the programme were higher than those found in the regular donors. However, these were very mild. Nearly 90% of the participants used no homologous blood during their hospitalization, 8% used only their autologous blood, while 2% used additional homologous transfusion. The released autologous components were subsequently administered to other recipients. The patients' acceptance was excellent. Autologous blood donation is a safe, inexpensive and feasible procedure for transfusion treatment in elective gynaecological surgery especially in developing countries.
A Study of Women Who Appear to Default from Management of an Abnormal Pap Smear
Authors: MD Heather Mitchell , Hoy Julie , BSc Meredith Temple‐Smith , Quinn Michael 
Published: February 2008

EDITORIAL COMMENT: Most readers of the journal will have patients who have had minor abnormalities in a Pap smear and who have passed the statutory time for repetition of cervical cytology. Is the expense of a central register of abnormal pap smears worthwhile? ‐ do the reminder letters to practitioners result in diagnosis of significant pathology when the defaulters are rounded up? (i.e. what proportion have CIN III or worse). This paper caused the reviewer to ponder that it may be better to spend our dwindling resources on encouraging never‐smeared women over the age of 30 to attend for cytology, especially those over 50 years of age ‐ should general practitioners seek to enrol these women from their practices rather than be worried about defaulters who have had a previous smear indicative of dysplasia? How many general hospitals have a policy of performing cervical cytology on all adult female patients in their medical and surgical wards? ‐ surely it would be a simple administrative matter to do this as the women were admitted to hospital. Our reviewer also made the comment, suggested by the authors in their penultimate sentence, that patients referred to a dysplasia clinic should be returned to their general practitioner for continued follow‐up after initial assessment and treatment.Summary A study of nonattendance at a Dysplasia Clinic found that 20% of women who had an appointment in 1988 failed to attend the clinic during the next 18 months. Most of the nonattendance was among women who had previously been assessed at the Dysplasia Clinic. Only 6% of the nonattending women had cytological/histological evidence of CIN which remained untreated. If all women who did not default from attendance at the Dysplasia Clinic were correctly managed, then 1% of all women who have appointments made for the Dysplasia Clinic were potentially receiving inadequate management for lesions considered to have a precancerous potential. A questionnaire to the women who failed to attend these appointments identified pregnancy and seeking management elsewhere as the most commonly stated reasons for the nonattendance.
Management of the Psychosocial Aspects of Infertility1
Authors: R. Daniels Ken 
Published: February 2008

Summary There is a growing recognition of the place and importance of psychosocial factors in the infertility field. Counsellors, social workers, psychologists and others who work with the psychosocial dimensions are of relatively recent origin and as a consequence it is not uncommon for there to be confusion, sometimes conflict and often uncertainty between them and the more established health professionals. Knowledge, understanding and appreciation of the contributions of the staff involved is essential if the referral process is to be beneficial for the patients and less frustrating for the staff.Against this backdrop, the paper will seek to clarify some of the factors associated with recognizing and responding to the psychosocial aspects of infertility, highlight some points concerning teamwork between doctors and workers in the psychosocial field, and finally present a list of indicators which might be used as a guide in determining when to make a referral for psychosocial assistance.
Antepartum Cardiotocographic Surveillance of Patients with Diminished Fetal Movements
Authors: Chew Franklin T. K. , Beischer Norman A. 
Published: February 2008

Summary: Over a 9‐year period, 2,601 women had antenatal cardiotocography (CTG) performed after reporting diminished fetal movements. This series represented 5.6% of the total hospital population and 16.1% of those having antenatal CTG performed.The perinatal mortality rate (0.8%) and major fetal malformation rate (2.2%) were lower than in the hospital population (1.1% and 4.5% respectively).The incidence of abnormal CTG tracings was lower in the 1,390 women with diminished movements alone (6.4%) compared with the 1,211 who had additional antenatal complications (10.2%, p<0.001).Likewise the incidences of critical fetal reserve CTG and perinatal mortality were significantly lower in the group without additional complications (0.3% and 0.5%) compared with those with additional complications (1.7% and 1.2% respectively).The 24 patients with critical fetal reserve CTG were promptly delivered (19 by Caesarean section) with favourable results in 19, cerebral palsy in 1, and 4 perinatal deaths ‐ 2 of these deaths resulted from intrauterine hypoxia (table 3, Cases 12 and 15).There were 17 perinatal deaths in cases where the CTG was satisfactory (13) or showed reduced reserve (4); 9 of these were unavoidable as a result of major malformations or other lethal conditions. The other 8 deaths resulted from hypoxia, including 4 in pregnancies at or beyond 37 weeks' gestation (table 3, Cases 6–9), illustrating that delivery is warranted in women with diminished fetal movements when conditions are favourable even when the CTG is satisfactory.Cardiotocography is useful in the management of patients with diminished fetal movements.
Telephone Fetal Heart Rate Monitoring in South Australia
Authors: Green Roslyn C. , MacLennan Alastair H. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication to remind readers again (A) that fetal cardiotocographs can be transmitted, over the telephone for interpretation by an expert. As the authors say this paper is not intended to argue the merits of cardiotocography or its indications. However we wish to comment on the authors' statement that gestational diabetes and hypertension are questionable indications for cardiotocography. These 2 conditions are classically associated with intrauterine death and in the case of gestational diabetes there may be no clinical warning such as the presence of fetal growth retardation, deaths in this condition being precisely similar to those that occur in women with insulin‐dependant prepregnancy diabetes mellitus (B). These are the very conditions in which cardiotocography may show the features of impending fetal death and hence indicate immediate delivery.A. Moore KH, Sill R. Domiciliary fetal monitoring in a district maternity unit. Aust NZ J Obstet Gynaecol 1990; 30: 36–40.B. White BM, Beischer NA. Perinatal mortality in the infants of diabetic women. Aust NZ J Obstet Gynaecol 1990; 30: 323–326.Summary: A pilot trial was conducted to assess the technical feasibility of long range fetal heart monitoring by telephone in an Australian setting. The indications for such monitoring and patient ability and attitude towards self‐monitoring was also assessed. One hundred and fifty seven tracings were received from 57 women using a simple doppler device to transmit fetal heart sounds to the central hospital fetal monitor. Thirty three of the patients were in country hospitals and 24 were at home. Gestation ranged from 26 to 42 weeks' gestation. Eighty six percent of the country hospital tracings and 94% of the home tracings were easily interpretable. The large majority of tracings were normal and appeared to encourage conservative management by the attendants. Two tracings were abnormal and these influenced early delivery in both cases. Nearly all women using the monitor at home found the procedure easy and reassuring. Tracings from country hospitals were initiated usually after an acute antenatal complication, whereas the indications for home‐monitoring were prompted by longer‐term, medium‐risk factors. Home‐monitoring may reduce the inconvenience and expense of inpatient or outpatient care and country hospitals without electronic fetal monitors may benefit from such a service. The selection of patients who might benefit from such technology remains controversial and warrants a prospective randomized controlled trial.
Organization and Early Results of a Shared Antenatal Care Programme
Authors: Ratten G. J. , McDonald L. 
Published: February 2008

EDITORIAL COMMENT: For the purposes of comparison of perinatal mortality rates with other papers discussing shared care/birth centre care, it should be noted that 2 of the 5 perinatal deaths in the 780 women who completed shared care (tables 4 and 5), and 2 of the deaths in the 185 women who were removed from the shared care programme (tables 6 and 7) were associated with birth‐weight less than 500 g, the criterion for inclusion of perinatal deaths for statistical purposes in the State of Victoria. With these cases excluded the perinatal mortality rate for the entire series of 962 women was 7.2 per 1,000 births; the rate was 3.9 per 1,000 in the 778 women who remained in the shared care programme, and 20.6 per 1,000 births in the 184 women who were removed from the programme.Summary: The organization and function of a public hospital based shared antenatal care programme is described. The programme has proved to be popular with pregnant women and local practitioners and currently 24% of public antenatal patients attending the hospital are cared for in this way.The study presents the results of management of 1,000 consecutive low risk patients whose antenatal care was shared between hospital doctors at the Royal Women's Hospital, Melbourne and local practitioners. Two hundred and twenty patients did not complete the programme because of social factors, medical diseases or pregnancy complications. The 780 patients who did complete the programme had a lower Caesarean section rate than the overall hospital population (8.3% compared with 18.5%) and a lower perinatal mortality rate (6.4 compared with 20.5 per 1,000 births).It is essential that patients are carefully assessed at their hospital booking visit before embarking on such a programme. Equally, careful assessment by local practitioners is important as abnormalities such as essential hypertension may be overlooked at the initial hospital assessment or may arise between the hospital visits.
Gestational Diabetes in Twin Pregnancy: Prevalence and Long‐term Implications*
Authors: Wein Peter , Warwick Michael M. , Beischer Norman A. 
Published: February 2008

Summary: During the period 1971–1991 at the Mercy Hospital for Women, gestational diabetes (GDM) was diagnosed in 3,447 of 61,914 tested singleton pregnancies (5.6%) and 59 of 798 tested twin pregnancies (7.4%, p = 0.025). A difference was apparent in the period 1971–1980, when the prevalences of GDM in singleton and twin pregnancies were 3.0% and 5.6% respectively (p = 0.012), but not in the period 1981–1991 when the corresponding prevalences were 7.4% and 8.4% (p = 0.36). Of the 59 patients in whom a diagnosis of GDM in a twin pregnancy was made, 27 attended the follow‐up programme. These patients were matched to a control group of 27 patients who had GDM in a singleton pregnancy with similar characteristics for known risk factors for the development of permanent diabetes mellitus. On WHO criteria diabetes mellitus occurred in 5 (18.5%) of the subjects and 2 (7.4%) of the controls (p = 0.21).The difference in prevalence of GDM in twin and singleton pregnancies is less now that the overall prevalence of the disease has more than doubled (1971–1980 versus 1981–1991). Although the increased rate of permanent diabetes mellitus after twin pregnancy is not statistically significant, it would seem wise to make a special effort to enrol these women in the follow‐up programme.
Placenta Praevia: Does Uterine Activity Cause Bleeding?
Authors: Magann Everett F. , Johnson Constance A. , Gookin Kathy S. , Roberts William E. , Martin Rick W. , Morrison John C. 
Published: February 2008

EDITORIAL COMMENT": We accepted this paper for publication since it attempts to evaluate whether uterine contractions or ‘taking‐up’ of the lower uterine segment initiate placental separation and haemorrhage in women with central placenta praevia. Obstetric practice in the USA is often different from that in Australia; certainly it is not our custom to manage women at home when central placenta praevia complicated by haemorrhage has occurred after the second trimester! The use of tocolysis for preterm labour in women with placenta praevia with or without haemorrhage is another regimen employed in this series that will interest readers.Summary: Twenty‐two women >24 weeks' gestation with a central placenta praevia were monitored to determine if an increase in uterine activity precedes bleeding in patients with central praevias. Monitoring of all subjects began at 26.3 ±4.4 weeks and continued until 37 weeks (or delivery if preterm).All subjects had at least one haemorrhage, 7 women had 2, and 4 subjects had 3 episodes of bleeding. Only 3 patients delivered at term while the remainder (86%) delivered preterm. The gestational age at first episode of bleeding was 29.1 ±3.6 weeks and at delivery was 34.3 ±3.3 weeks. Nine women (41%) had an increase in uterine activity above baseline the day of or the day preceding the first haemorrhage. The increase in uterine activity was not statistically significant when compared to the 6 days prior to bleeding when all 22 patients were considered.
Pregnancy Hazards Associated with Low Maternal Body Mass Indices
Authors: Cattanach S. , Morrison J. , Andersen M. J. , Williams G. M. , Sheahan T. 
Published: February 2008

EDITORIAL COMMENT": There are few obstetric hospitals that have computerized their clinical data such that maternal weight and obstetric results can be compared. The Mater Mothers' Hospital in Brisbane is one such institution. This paper seems to establish that the lower socioeconomic, light‐weight woman is at greater risk of producing a lightweight or very light‐weight infant and also is at increased risk of delivering a premature infant using the old definition of less than 2,500 g. Light‐weight mothers also had an increased incidence of pregnancy anaemia, infants with low Apgar score and an increased perinatal mortality rate. Interestingly in some populations the light‐weight woman is also at increased risk of gestational diabetes (El‐Shafei AMet al. Incidence and Severity of Gestational Diabetes in Bahrain and Australia. Aust NZ J Obstet Gynaecol 1989; 29:204–208). We agree with the authors that more data is required about low maternal weight, and low weight gain in pregnancy, and the associated obstetric results.Summary: Analysis of the obstetric records of 41,955 public patients with singleton pregnancies at the Mater Misericordiae Mothers' Hospital, South Brisbane, showed a significant association (increased odds ratio) between Low Maximum Pregnancy Maternal Body Mass Index (Quetelets Index 20–24.6 and maternal anaemia, the use of intravenous tocolysis, low birth‐weight (< 1,500 g and < 2,500 g), low Apgar score (< 7 at 5 minutes) and perinatal mortality.Parturients with a Very Low Body Mass Index (Quetelets Index < 20) had even greater odds ratios in respect of the above obstetric hazards.Both the Low and Very Low Body Mass Index cohorts had significantly reduced risks of having hypertension (both essential and preeclamptic) or having their labours induced or augmented.The results are presented as odds ratios with confidence limits after controlling for the potentially confounding covariables of maternal age, parity, smoking habits and gestational age.