bluuebunny/crossref_metadata_2025_split huggingface dataset:
Umbilical Cord Haematoma: A Serious Pregnancy Complication
Authors: Gregora Michael G. , Lai Jerome 
Published: February 2008

EDITORIAL COMMENT: We accepted this report for publication because it informs readers that umbilical cord haematoma is yet another cause of acute fetal hypoxia which may present as diminished fetal movements where cardiotocography can indicate the need for prompt delivery and save a life. We hope that further follow‐up of the infant in Case 1 will not reveal evidence of cerebral palsy. Diminished fetal movements is the indication for about 15% of antepartum cardiotocographs; evidence of critical fetal reserve as in Case I was found in 1% of such cases (24 of 2,601)A. The 2 cases reported here are very uncommon. There was no case of cord haematoma causing cardiotocographic evidence of fetal hypoxia in the large series referred to above. A. Chew FTK; Beischer NA. Antepartum cardiotocographic surveillance of patients with diminished fetal movements. Aust NZ J Obstet Gynaecol 1992; 32: 107‐113.Summary: The 2 cases presented show the potential morbidity and mortality which may be associated with umbilical cord haematoma. That timely diagnoses and delivery can save such an affected fetus is seen in Case 1. If fetal movements are absent, both a nonstress cardiotocograph and ultrasound scan may lead to the correct management.
Using Glucose Tolerance Test Results to Predict Insulin Requirement in Women with Gestational Diabetes
Authors: Tan Y.Y. , Liauw P.C.Y. , Yeo G.S.H. 
Published: February 2008

EDITORIAL COMMENT: This paper shows that the blood glucose values recorded in the glucose tolerance test which resulted in the diagnosis of gestational diabetes do not reliably predict which women will require insulin when dietary measures fail. It is not surprising that, in this study, the 2‐hour glucose value correlated best with the need for insulin therapy since gestational diabetes was diagnosed solely on the basis of a high 2‐hour glucose value (≥ 7.8 mmol/L). The data from the 596 women with gestational diabetes shown in the tables and figures should especially interest readers who manage women with gestational diabetes. In many centres women with gestational diabetes are managed without admission to hospital. Attendance at a day centre after initial diagnosis is helpful to arrange instruction from a diabetes educator and dietitian, including instruction regarding home monitoring of blood glucose levels in those where this seems necessary. In the clinics which the editorial subcommittee attend, insulin is commenced in women with gestational diabetes when the 2‐hour postprandial plasma glucose level exceeds 6.5 mmol/L on 2 or more occasions, in spite of dietary measures. In this clinic women with gestational diabetes seldom require hospitalization for stabilization of blood glucose levels. Figures 1–3 clearly show that although insulin therapy is more likely to be indicated when fasting, 1‐hour or 2‐hour plasma values are high, there are many women with high values at these points on the glucose tolerance test resulting in diagnosis of gestational diabetes, who did not require insulin. Patient compliance with dietary advice is the one explanation of this finding which the clinician is most likely to be able to influence.Summary: This study was done to test the clinical impression that the result of the oral glucose tolerance test could be used to predict which patients with gestational diabetes did not need insulin therapy. If this was true, a full blood sugar profile assessment could be avoided in many of these women. The second analysis was to test the clinical impression that the fasting glucose level was the best predictor of insulin requirement in women with gestational diabetes. The results of the study showed that none of the 3 readings of the oral glucose tolerance test could be used to predict reliably which patients did not need insulin therapy. Hence, blood sugar profile assessment of all patients with gestational diabetes is still necessary. The receiver‐operator characteristic curves also showed that the 2‐hour postload glucose level during the 75 g load glucose tolerance test was a better predictor of insulin requirement than the fasting glucose level.
Quality of Life Assessment in Gynaecological Cancer Patients
Authors: Carter Jonathan , Saltzman Andrew , Chen Dwight , Carney Pamela , Johnson Peter , Hartenbach Ellen , Fowler Jeffrey , Carson Linda , Twiggs Leo 
Published: February 2008

EDITORIAL COMMENT: Quality of life assessment is becoming more and more important in gynaecological oncology. At present, quality of life issues are not commonly considered when treatment is assessed. With new treatments costing more and more it is likely that quality of life assessment will be required in the future for all trials, and for the justification of various ongoing treatments in cancer patients Although the numbers in this paper are small and provide only limited information in the way of results, it is a step in the right direction and will serve to inform, remind or encourage readers to consider adopting or developing similar assessment tools relevant to Australia.Summary: The feasibility of quality of life (QOL) assessment in a heterogeneous group of gynaecological cancer patients undergoing chemotherapy was determined.All new patients being prescribed cytotoxic chemotherapy were asked to complete a modified QOL assessment tool. The elected assessment tool is the Functional Assessment Cancer Therapy‐General (FACT‐G) tool, comprising 33 questions under 5 broad categories: physical well‐being, social well‐being, relationship with doctor, emotional well‐being and functional well‐being. Raw scores were calculated and then transformed to a 0–100 scale.Twenty eight patients received a total of 75 treatment cycles of chemotherapy. Four patients were not offered the assessment due to language difficulties. All patients offered the test satisfactorily completed the test to allow statistical analysis. The average number of chemotherapy courses received was 2.5 (range: 1–6). Of a total possible 2,475 study items (33 items × 75 cycles), 240 items were not answered (10%). Of these 240 unanswered items, 2 items (#14 and #15) comprised 38%. The mean transformed score for physical well‐being was 32 (SE 2.5), for social well‐being the mean transformed score was 50 (SE 1.7), relationship with doctor 86 (SE 2.4), emotional well‐being 41 (SE 2) and functional well‐being was 54 (SE 2.6). The assessment of QOL indices in gynaecological cancer patients undergoing chemotherapy is feasible. Further research needs to determine the optimal QOL tool for this patient population.
Early Uterine Prolapse Following Colponeedle Suspension
Authors: Neuman Menachem , Lavie Ofer , Gdansky Efraim , Diamant Yoram Z. , Beller Uriel 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because of the warning it carries about the risk of prolapse occurring following vaginal surgery. Those gynaecologists who were in practice in the 1960s will remember that posterior colporrhaphy then had a bad reputation because of dyspareunia or apareunia following Manchester repair. The lesson should have been that posterior repair needs to be done with caution without excessive excision of vaginal epithelium or approximation of vaginal supports too high in the vagina rather than that posterior repair should be omitted from the Manchester operation. Nonetheless, for a time, posterior repair was often not performed in women with classical vaginal prolapse with the result that following anterior colporrhaphy with or without vaginal hysterectomy the woman re‐presented, often within a short time of surgery, with massive vaginal eversion. It seems to us that this case carries the same message, namely that provision of support for the anterior vaginal wall alone potentiates any tendency to prolapse of the posterior vaginal wall (enterocele or rectocele).Summary: The association of retropubic colposuspension for the treatment of urinary stress incontinence with genital prolapse has been reported previously. Described here is a case of an 83‐year‐old patient who had a colponeedle suspension and was readmitted because of genital prolapse 3 weeks after surgery. This case emphasizes the need for proper evaluation of the whole pelvic floor prior to any surgical treatment for urinary incontinence, and addition of appropriate surgical measures aimed to avoid later genital prolapse, if necessary.
Transient Blindness Associated with Hypertensive Disorders in Pregnancy
Authors: To W. W. K. , Lau W.N.T. 
Published: February 2008

EDITORIAL COMMENT": Readers will enjoy this paper, especially those who have had to care for a woman who suddenly became blind during pregnancy. The authors quote a wide range of reported incidences yet who could forget such a case or fail to code the history appropriately? The Editor can remember seeing only 3 such women in 38 years of obstetric practice. The first in 1963, at the Royal Women's Hospital, Melbourne, was in a woman already in hospital with severe preeclampsia. Ophtha‐Imological assessment showed only bilateral retinal pallor. Her vision returned within days of delivery after receiving magnesium sulphate, paraldehyde and sodium phenobarbitone prior to induction of labour and delivery. The second unforgettable case, at the Mercy Hospital for Women in 1975, was of a 20‐year‐old nullipara who presented to an ophthalmologist because of sudden blindness. This doctor fortunately measured her blood pressure (220/160), examined her urine (solid'on boiling i.e. proteinuria 24 g/L) and then diagnosed that she was about 16 weeks' pregnant. Examination of the fundi showed retinal haemorrhages and exudates. A misdiagnosis of hydatidiform mole with fetus was made, since this was the only condition that we believed could explain this presentation at 16–17 weeks' gestation. Hysterotomy was performed of a normal fetus and placenta after the severe preeclampsia was controlled with magnesium sulphate and heavy sedation. The vision improved after delivery and became normal over the course of the next 2 months. This woman subsequently was shown to have chronic renal disease and in her next pregnancy had a surviving infant, birth‐weight 1,745 g, delivered at 34 weeks'gestation because the cardiotocograph showed loss of beat to beat variation and late decelerations. The third case was seen in 1990 in Munster, West Germany, where the Editor was guest lecturer. This woman was at term but did not have the signs of severe preeclampsia. Her vision returned to normal within 24 hours after treatment with magnesium sulphate, sedation and delivery.In both cases reported by the authors the patients had severe preeclampsia and in Case 2 the coagulation failure and abnormal hepatic function were indicative of the HELLP syndrome. The moral of this story and of these important cases is that sudden onset of blindness during pregnancy is usually a complication of preeclampsia, and requires control of the disease and delivery of the patient. This complication may be more likely when severe preeclampsia is treated conservatively i.e. without heavy sedation and prompt delivery. There have been 115,396 deliveries at the Mercy‐Hospital for Women from February. 1971 to April, 1995 and although the incidence of preeclampsia is 8.1% in this institution, we have seen only I case of blindness, transient or otherwise, associated with hypertensive disorders of pregnancy, in addition to the case summarized above.
The Significance of Mild Squamous Atypia on Cytology
Authors: Dew J. E. , Athanasatos P. , Hacker N. F. 
Published: February 2008

Summary: Between January, 1991 and February, 1993 inclusive, 396 Papanicolaou smears were reported to show Mild Squamous Atypia with or without Human Papilloma Virus (MSA ± HPV). All women with MSA ± HPV smears were routinely recalled for colposcopy. To determine the significance of MSA ± HPV on routine smear screening, the records of all patients were reviewed.Three hundred and thirty‐seven women (85.1%) attended the colposcopy clinic and are the subjects analyzed for this report. The remaining 59 (14.9%) failed to attend. Intraepithelial neoplasia was found in 61 patients (18.1%), of whom 27 (8.0%) had a high grade lesion (CIN 2 or 3 or GIN 2). No patient had invasive cancer of the cervix. Only 1 of the 45 pregnant women had a significant lesion.It is concluded that all asymptomatic women with MSA ± HPV on cervical smear may be managed in accordance with the current NH and MRC recommendations (1) and have a repeat smear in 6 months and colposcopy if the abnormality persists at 12 months.
Booking Ultrasound Examinations Performed by Obstetric Senior House Officers ‐ Time to Reevaluate?
Authors: Bahmaie Arash , Edmonds D. Keith 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication to warn obstetrics hospital administrators that although it is commendable to train house officers to perform ultrasonography, these medical practitioners should not perform the duties of a trained ultrasonographer for the reasons presented. This series considered only the errors in assessment of gestational age. There is considerable literature to indicate that with the detailed 18–20 week scan the need for an expert is far greater.Summary: We evaluated the proficiency of obstetrics senior house officers, not formally trained in ultrasonography, in assessing fetal viability, the number of fetuses and gestational age. Of 366 women who had an ultrasound examination at the first antenatal visit, 7 (2.1%) had nonviable pregnancies and 7 pairs of twins were correctly identified. Of these women, 329 had a detailed anomaly scan at 18–20 weeks. No anomalies were detected at either scan. Of the booking scans performed by the senior house officers, 89.4% correctly assessed the gestational age of the pregnancy when compared to the anomaly scan (±1 week). One in 10 of the scans performed by the senior house officers was inaccurate. This is important particularly when being used for risk assessment in serum screening for Down syndrome. At present the early ultrasound scan should be performed by more formally trained personnel.
Induction of Labour for Trial of Vaginal Birth After Caesarean Section in a Remote District Hospital
Authors: Kumar Sailesh , Maouris Panos 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper because it expresses an obstetric philosophy evolved in the circumstance of obstetrics practice in a hospital 1,800 km from a State capital city with patients whose homes may be hundreds of km from the ‘local’ hospital. In this setting induction of labour is more than a social convenience. This paper explores the hypothesis that it is reasonable to practise this finesse even when the woman has had a Caesarean section and wishes to achieve a vaginal delivery. This series is, as the authors indicate, very small ‐ absence of perinatal mortality or uterine rupture in 33 cases of trial of vaginal delivery after Caesarean section, with induction of labour in 26 of them, does not prove that the procedure is safe even if the obstetrician has the experience necessary to perform Caesarean hysterectomy should uterine rupture occur. Targett (A) reviewed a series of 1,577 patients having trial of vaginal delivery after Caesarean section and reported an incidence of uterine rupture of 0.8%. He concluded that to ensure the greatest chance of vaginal delivery with optimum safety, the onset of labour should be spontaneous. It is against this background that the excellent results in this small special series from Port Hedland should be viewed. Our statistician commented that with 33 cases and given a 0.8% chance of scar rupture, the study would have a 77% probability of finding no cases of uterine rupture just by chance. However, it does say with 80% certainty that the rupture rate is not more than 5%! The takeaway message from this report seems to be that induction of labour was favoured, not to increase the success rate of vaginal delivery after Caesarean section, but to satisfy the problems of planning the time of delivery within hours in women who had a previous Caesarean section and were living remote from a hospital with staff not routinely available to monitor labour and deal with any complications.Summary: In a retrospective review of 79 women with 1 or more previous Caesarean section, 33 (41.8%) women agreed to a trial of vaginal birth. Twenty nine women had labour induced and 26 (89.7%) of them had a successful vaginal delivery.Four women laboured spontaneously and 1 of them needed an emergency Caesarean section for failure to progress. The overall vaginal delivery rate for women selected to undergo a trial of vaginal birth after Caesarean was 87.9%. The overall emergency Caesarean section rate was 4 of 33 (12.1%). During the study period the Caesarean section rate for the hospital fell from 32.2% to 11%. This study suggests that induction of labour in women with a previous Caesarean section is very successful in achieving vaginal delivery and has a role to play in remote and rural hospitals.
Is ‘Herbal Health Tonic'Safe in Pregnancy; Fetal Alcohol Syndrome Revisited
Authors: Pradeepkumar V.K. , Tan K.W. , Ivy NG 
Published: February 2008

EDITORIAL COMMENT: We accepted this case report for publication because of the warning it carries that herbal health tonics may have an alcohol content ranging from 14 to 40% and could cause the fetal alcohol syndrome even when the mother ‘denies exposure to alcohol or any other drugs’. These tonics wherever they are sold, should be labelled appropriately to indicate the alcohol content and warning of fetal hazard if consumed during pregnancy. Both Asian and non‐Asian members of our population should be informed of the possible dangers of herbal health tonics.Summary: So called ‘Herbal Health Tonics' are freely available in the market. This has been promoted by the manufacturers for the following symptoms: poor appetite, gastroenteric weakness, poor blood circulation, chills, fatigue, weak constitution and weakness after disease.We report a case of suspected fetal alcohol syndrome (FAS). A baby boy of 3,7(X) g born to a 29‐year‐old Chinese mother at 41 weeks' gestation was found to have features consistent with FAS. On follow up at 3 years of age. both motor and mental milestones as well as speech and language were delayed suggesting the possibility of FAS. There was a history of maternal ingestion of ‘Herbal Health Tonic’ (which contained 14% alcohol) daily for the first 2 months of the antenatal period. She denied exposure to alcohol or any other drugs.The authors would like to highlight the risk of such ‘Herbal Health Tonics' in pregnancy and their probable deleterious effects on the growing fetus. We feel that it is extremely important to look into the traditional practices among pregnant women in Singapore and in other parts of the world where there are similar practices. otherwise more cases like these could occur in future.
Placenta Praevia Accreta with Delayed Hysterectomy
Authors: Matthews N.M. , McCowan L.M.E. , Patten P. 
Published: February 2008

EDITORIAL COMMENT: Placenta praevia accreta has an awesome fascination because of the horrendous haemorrhage that can occur; hence its contribution to maternal mortality is out of proportion to its incidence (A). This paper describes what can happen when the placenta is not disturbed at Caesarean section in such a case. We were interested that the authors did not consider the use of methotrexate which has been advocated in this testing circumstance and may be successful (B) or unsuccessful (C). The authors and their patient weathered the storm: readers can decide what they would have done. As stated previously, the editor would have called for the help of the most skilled gynaecological oncologist available before commencement of the hysterectomy (D). The antenatal findings in this woman are unusual, with features suggesting cervical pregnancy. The pathological diagnosis of placenta accreta 55 days postpartum may be more difficult to establish.Authors'response to above comment:In this case the surgery was performed by 2 senior gynaecologists one of whom was a gynaecological oncologist.Summary: A case of placenta praevia accreta is described. Delivery was achieved by Caesarean section and the placenta was left in place because of the risk of haemorrhage. Successful internal iliac artery embolization was performed 9 days postpartum to control uterine bleeding. Hysterectomy was performed at 55 days postpartum because of bleeding and sepsis.
The Use of Large Loop Excision of the Transformation Zone (LLETZ) in an Outpatient Setting
Authors: Powell Beverley 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it presents a detailed analysis of the results from one centre of treatment of women with cervical intraepithelial neoplasia by large loop excision of the transformation zone. Importantly it provides a very careful review of the reported literature on the subject: the conclusions warrant special scrutiny.Summary: An audit of the results of 129 patients treated in the first 12 months of operation of an outpatient large loop excision of the transformation zone (LLETZ) clinic was performed. It confirmed the efficacy of the procedure in treatment of cervical intraepithelial neoplasia (CIN) with a cure rate of 93.8%. Major deficiencies identified were the lack of compliance with recommended follow‐up, a major discrepancy between predicted diagnosis on colposcopically directed punch biopsy and LLETZ specimen histology, and a large proportion of LLETZ specimens which had negative histology and may be regarded as overtreatment. Suggested strategies to address these include observation of low‐grade lesions and treatment with LLETZ at the first clinic appointment.