bluuebunny/crossref_metadata_2025_split huggingface dataset:
Von Willebrand Disease: A Rare Cause of Puberty Menorrhagia
Authors: Ahuja Reena , Kriplani Alka , Choudhary V.P. , Takkar D. 
Published: February 2008

EDITORIAL COMMENT: In the editor's experience pubertal menorrhagia is an uncommon condition, probably because general practitioners see most of these young women and deal with the problem without the need for specialist referral. Most cases can be managed by reassurance after confirming that the full blood examination is normal (no anaemia, thrombocytopenia or evidence of leukaemia) and that there are no symptoms of pelvic pain, vaginal discharge or pruritus. Most of these girls present with their mothers and vaginal examination has never been necessary in the editor's experience and is likely to require anaesthesia if it is. Reassurance and explanation concerning pubertal anovulatory menstruation is usually all that is required, although iron tables should be prescribed. Occasionally if the problem persists or anaemia is present, hormone therapy is indicated (low dose combined contraceptive pill or a progestogen for the last 12 days of the cycle). This article makes the useful point that when pubescent menorrhagia is severe, a coagulation screen is indicated as well as full blood examination. Also important is that hormone therapy can control menorrhagia associated with Von Willebrand disease. The editor recalls a patient many years ago who presented to the Mercy Maternity Hospital with pubertal menorrhagia in whom idiopathic thrombocytopenia was diagnosed; she had a haemoglobin value of 4 g/dL and after resuscitation was treated by splenectomy.The discussion in this paper indicates that the articles concerning pubescent menorrhagia in journals are likely to be reporting the rare cases where bleeding is severe. We have previously reported from the same New Delhi institution a case of pubertal menorrhagia due to the Bernard Soulier syndrome (hereditary disorder with decreased platelet adhesiveness, thrombocytopenia and prolonged bleeding time) also successfully treated with oral contraceptive tabletsA.A. Sharma JB, Buckshee K, Sharma S. Puberty menorrhagia due to Bernard Soulier syndrome and its successful treatment by ‘Ovral’ Hormonal Tablets. Aust NZ J Obstet Gynaecol 1991; 31: 369–370.Summary: A 13‐year‐old girl with a family history of epistaxis presented with pubertal menorrhagia necessitating multiple blood transfusions. Her coagulation profile confirmed the diagnosis of Von Willebrand disease. The menorrhagia was controlled by cyclical use of oestrogen progestogen combination drugs. The important clinical implication of this case is that the patient with adolescent menorrhagia may have an underlying coagulation disorder, which can successfully be managed by hormones.
Tuberculous Uteroenteroeutaneous Fistula ‐ a Rare Post‐Caesarean Complication
Authors: Malhotra Diljot , Vasishta Kala , Srinivasan Radhika , Singh Gurpreet 
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication to remind readers that tuberculosis still does occur in the female genital tract ‐ indeed it is still very common in the Indian subcontinent, especially in women with infertility. When the editor was a registrar in the 1950s, in Australia, it was routine practice to culture premenstrual curettings or menstrual fluid for the tubercle bacillus in all women investigated for infertility as well as sending tissue for histological examination. Approximately 1–2 % were positive, especially in immigrants, in those days mainly from Europe and the United Kingdom. There were 5 such cases diagnosed in 1965 at the Royal Women's Hospital, MelbourneA. Note that in the authors' nation the figure was 13% in a report published in 1979. The practice of endometrial culture for tubercle bacilli ceased in the 1970s since positive findings became exceedingly uncommon. In the 1960s, when we did our fellowship courses in Scotland, routine chest X‐ray of the postgraduate students invariably detected a number of cases of active tuberculosis in each group, mostly in students from the Indian subcontinent. Antenatal chest X‐ray was performed routinely until the late 1960s ‐ it is the only routine antenatal test which comes to mind that has been discontinued ‐ will it become necessary for it to be reintroduced? The HIV epidemic has ushered in a new wave of tuberculosis which is another reason why this case was accepted for publication. finally, although the editor has seen tuberculosis present unexpectedlyB, he has not encountered a case of active tuberculosis of the genital tract presenting during pregnancy or the puerperium!A. Medical and Clinical Report of The Royal Women's Hospital, Melbourne 1965.B. See Mackay EV et al. Illustrated Textbook of Gynaecology, W B Saunders, 1992, p 336, figure 22.9 ‐a case of bilateral tuboovarian abscesses due to tuberculosis in a 44‐year‐old immigrant from Scotland with infertility, who had hysterectomy and bilateral salpingo‐oophorectomy performed for chronic pelvic pain.Summary: A case of uteroenteroeutaneous fistula which developed after lower segment Caesarean section is described. A total abdominal hysterectomy with removal of a tuboovarian mass with excision of the fistulous tract and repair of a small gut fistula were performed. The tuberculous aetiology of this fistula was established after surgery by a positive endometrial culture of acid fast bacilli and the demonstration of epithelioid granulomas in the surgical specimen. Antituberculosis therapy was started and the postoperative recovery was uneventful. The description of the nature of the fistula, its rarity and its presence in a woman with unimpaired fertility are discussed.
Cervico‐isthmic Pregnancy with Placenta Percreta Ending in a Livebirth
Authors: J. Souter Dereck , B. Roberts Alistair , Stables Simon 
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication not because of a morbid interest in placenta percreta, irrespective of whether the fetus is above the placenta or below it, as it usually is in cases of cervical pregnancy, but because this rare condition provides the most serious obstetric complication of all requiring massive resuscitation and expert surgery. We have commented before that when Caesarean section is performed in these cases it is wise to have a competent gynaecological oncologist scrubbed‐up assisting as he will rightly become the senior surgeon if the operation proves difficult. In the Editor's experience, it is probably wise to electively open the bladder to facilitate removal of the friable lower uterine segment and cervix in these women. As shown by this case, bilateral internal iliac ligation does not guarantee haemostasis ‐ blood coagulation failure often occurs during surgery in the more difficult cases and should be anticipated.Previous Editorial Comments on placenta praevia accreta/cervical pregnancy are:

Woolcott RJ, Nicholl M, Gibson JS. A Case of Placenta Percreta Presenting in the First Trimester of Pregnancy. Aust NZ J Obstet Gynaecol 1987; 27:258.
Altintas A, Ozgunen FT, Doran S, Doran F. Placenta Percreta Invading the Urinary Bladder. Aust NZJ Obstet Gynaecol 1991; 31:371.
Sanders RR. Placenta Praevia Percreta Invading the Urinary Bladder. Aust NZ J Obstet Gynaecol 1992; 32:375.

Author's response to editorial comment:We did have a gynaecological oncologist (Mr John Wittaker) assisting who performed the internal iliac artery ligation as well as 2 consultant anaesthetists (Drs E Hughes and G Crooks). The blood loss was phenomenal; we measured 14 litres of blood loss and estimated there was another 3 on the table and floor. We had planned for a significant degree of blood loss but the actual amount caught all of the team by surprise.We attempted to aspirate the vault haematoma as there were recurrent febrile episodes which did not respond rapidly to antibiotics in the postoperative period. We presumed the 2 × 2 cm collection was either a separate haematoma or inflammatory mass.
Thyrotoxicosis in Pregnancy Presenting as Pancytopenia
Authors: Ladwig P. , Coles R. , Fischer E. , Spurrett B. 
Published: February 2008

EDITORIAL COMMENT: In spite of its rarity we accepted this case report for presentation to remind readers of the dire complications that can occur in a woman with thyrotoxicosis that has escaped recognition. It is a reminder that thyroid function should be tested in patients who present with severe medical emergencies of uncertain aetiology.Summary: Delay in diagnosis of thyroid disease can result in morbidity and mortality. Thyroid disorders are not uncommon in the reproductive age group and therefore in pregnancy; recognition of both the common and the more unusual manifestations will optimize outcome.
Mild Cervical Atypia: A Management Dilemma
Authors: Lim Fang‐Kan , Razvi Khalil , Ling Yee‐Kiang , Chong Angela , Tham Kok‐Fun , Arulkumaran S. 
Published: February 2008

EDITORIAL COMMENT: This paper examines those patients with atypia on cervical cytology and their management. The findings reported in this study from Singapore are similar to those in Victoria (Victoria Cervical Cytology Registry, Statistical Report 1994). Of the 117 patients with atypia on cytology, 25% had a histologically proven C1N lesion. In Victoria 949 cases of atypia/HPV were found on cytology in 1994, with 28% having a colposcopy/histology finding of CIN. In Singapore 18% were found to have high‐grade lesions, compared to 13% in Victoria. The policy in Australia when atypica/HPV is reported on cervical cytology is to repeat the smear in 6 months and to refer for colposcopy only if the abnormality persists. This paper argues against such an approach. Our readers should appraise the arguments put forward by the authors.Summary: This study examined 117 patients with mild cervical atypia or atypical squamous cells of uncertain significance; it was found that 25% had histologically proven CIN lesions by colposcopically‐directed punch biopsy or cone biopsy, 18% were found to have at least CIN 2 lesions and there was 1 case of invasive cancer. These data strongly support the recommendation of early colposcopic referral in patients with mild cervical atypia.
A Randomized Trial of 2 Regimens for the Administration of Vaginal Prostaglandins (gemeprost) for the Induction of Midtrimester Abortion
Authors: Armatage R.J. , Luckas M.J.M. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because second trimester abortion is a sad necessity. The mean gestation in the series was 16 weeks and figure 4 shows the distribution of maturity at abortion. It seems proper to analyze the induction‐abortion interval, side‐effects and amount of gemeprost required and their cost. However it seems to the editorial committee that these studies should focus more on the need for surgical evacuation, immediate and late, and the presence of complications such as haemorrhage. It would be even better if follow‐up data of outcome in future pregnancies could be provided. It may not be statistically significant but it seems preferable to be in a group in which 64% require surgical evacuation than in one in which 78% require surgical evacuation. We require more data from a bigger series.Summary: The most frequently used method for second trimester termination of pregnancy is administration of gemeprost (16, 16‐dimethyl‐trans A‐prostaglandin E. methyl ester) as a vaginal pessary. This provides a safe and effective method for achieving abortion. The current prescribing advice is to insert the pessaries into the posterior vaginal fornix every 3 hours. This study compares this to a 6‐hourly regimen. The median abortion interval in the 6‐hour group was shorter than the 3‐hour group (15 versus 16 hours respectively) but the cumulative abortion rates were similar (98% in the 3‐hour group and 91.8% in the 6‐hour group). The 6‐hour group required a significantly lower total dose of gemeprost to induce abortion. There was no difference in the rates of side‐effects in the 2 groups but those receiving pessaries every 6 hours required less analgesia. This study finds no advantage in giving gemeprost every 3 hours.
Monoamniotic Twin Pregnancy and Cord Entanglement: A Clinical Dilemma
Authors: Ritossa Martin , O'Loughlin John 
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication because it makes the point that even accurate antenatal ultrasonographic diagnosis of monochorionic twin pregnancy with cord entanglement still leave dilemmas of management concerning testing for fetal welfare and decisions regarding timing and method of delivery. It may be of anecdotal interest to readers, as it is to the editor, that the 2 most complicated examples of cord entanglement in such pregnancies known to him both resulted in 2 living infants born vaginally. Figure 1 shows braided umbilical cords of the pregnancy published by Golan A, Amit A, Baram A, David MP. Aust NZ J Obstet Gynaecol 1982; 22:165–167. Figure 2, courtesy of Dr Michael Somerville, shows the placenta and knotted cords from a patient delivered at 39 weeks' gestation at the Mercy Hospital for Women, Melbourne, in 1994. In this pregnancy ultrasonography at 19 weeks and 32 weeks' gestation failed to detect either the monochorionic nature of the pregnancy or the knotted cords. Both of these cords were individually knotted and then entangled with additional pseudoknots, fibrotic segments at the points of crossing and with adhesions between the coils. It is extraordinary that both of these rare specimens shows what appears to our consultant pathologist to be chorioangiomas of the placenta that were not mentioned in the pathology reports of either specimen. At the Mercy Maternity Hospital, Melbourne, in the 16 years 1979–1994 there were 82,530 deliveries, 1,138 twin pregnancies and 4 cases of monoamniotic pregnancies with cord entanglement ± knotting, none of which were diagnosed antenatally. The first in 1981 resulted in delivery at 37 weeks of malformed infants, 1 stillborn, 1 neonatal death; the second in 1992 resulted in 2 intrauterine fetal deaths at 27 weeks with true knots in each cord; in the third, Caesarean section was performed at 30 weeks because of premature rupture of the membranes and both infants survived although the cords were knotted together; the fourth case is that shown in figure 2. This case reported by Drs Ritossa and O'Loughlin really is unusual and their discussion of the literature is comprehensive.Summary: Monoamniotic twin pregnancies are rare, but are associated with a high risk of perinatal death. The major complications are due to cord entanglement and twin twin transfusion. We were recently faced with the clinical problem of a monoamniotic twin pregnancy complicated by cord entanglement. Fortunately the outcome was favourable with the survival of both twins after delivery by elective Caesarean section at 32 weeks' gestation. Our case as well as some of the controversies in the management of this unpredictable condition are presented. Most authors seem to prefer abdominal delivery upon reaching fetal lung maturity in the case of known monoamniotic twins although this management is not validated by the available studies. Hospital admission for fetal monitoring upon discovery of a cord entanglement at a viable gestation is also advocated.
Fibronectin as a Predictor of Preeclampsia: A Pilot Study
Authors: Jones I. , Cowley D. , Andersen M. , Vacca A. , Voroteliak V. 
Published: February 2008

SummaryThe measurement of serum fibronectin levels in women carrying a singleton pregnancy at between 25–30 weeks' gestation has allowed the separation of those women who will remain normotensive from those who develop preeclampsia in this pilot study. The fibronectin assays were performed using nephelometry. It is recognized that some severe cases of preeclampsia will have already declared themselves clinically by 28 weeks' gestation, but if a screening test is to be limited by cost to a single test event, then this pilot study suggests the 28‐week gestation time to be the most suitable. Further studies are being undertaken to test this hypothesis and to adequately assess the test's reliability, predictability and its cost‐effectiveness.
Serum Ferritin Levels in Normal and HIV‐1 Infected Pregnant Women
Authors: Phuapradit Winit , Taeepanichskul Surasak , Jetsawangsri Thavat , Chaturachinda Kamheang , Khupulsup Kalayanee , Kunakorn Mungkol 
Published: February 2008

SummaryBetween May, 1994 and May, 1995 serum ferritin concentrations were measured in 74 pregnant women who were HIV‐1 positive (17 with CD4 cell counts below 200 cells/uL) and in 148 HIV‐1 negative pregnant controls in first trimester of gestation to determine if a high level of serum ferritin is present in pregnant women with HIV‐1 infection. Comparisons were made between groups stratified by CD4 cell counts. Pregnant women with HIV‐1 infection had 92% higher mean serum ferritin levels (112.8 versus 58.8 ug/L, p<0.005) compared to controls, whereas the mean maternal age, parity, gestational age, haemoglobin levels and body mass index at entry into the study did not differ significantly between the control and HIV‐1 infection groups. The serum ferritin levels inversely correlated with the percentage of CD4 lymphocytes, CD4 cell counts and the CD4/CD8 ratio. This study suggests that serum ferritin levels can also be used as an immunological marker in HIV‐1 infected pregnant women.
Operative Laparoscopic Management of Adnexal Cysts: Initial Experience at the Royal Women's Hospital 1991–1994
Authors: Parker Jim , Bethune Michael , Lau Phillips , Permezel Michael , Tan Jeffrey , Byrne Donald 
Published: February 2008

SummaryThe introduction of operative laparoscopic surgery for benign adnexal cysts had led to shorter postoperative hospitalization (mean stay of 2.0 days) in association with a low rate of major complications (1.6%). A planned laparoscopic approach was successful in 95.2% (179/188) of patients. The majority of women were premenopausal (93.6%) and the most common procedure performed was an ovarian cystectomy (73.5% of cysts). Three ovarian cysts that were thought to be benign by preoperative and intraoperative assessment were subsequently found to be ovarian tumours of low malignant potential after histological examination. Operative laparoscopy has become the preferred mode of treatment for benign adnexal cysts at the Royal Women's Hospital. It confers a wide range of benefits to patients, reduces health‐care costs and appears to be a safe and effective treatment modality.
Unexpected Ovarian Malignancy Diagnosed After Laparoscopie Surgery
Authors: Yuen Pong Mo , Leung Tse Ngong 
Published: February 2008

SummaryThe main concerns for laparoscopic management of ovarian masses are unexpected malignancy and the spillage of the cyst content. Careful preoperative evaluation is important in proper patient selection. We report a case of unexpected ovarian malignancy managed by operative laparoscopy in a 29‐year‐old woman. The role of ultrasonographic and laparoscopic assessment and their limitations are discussed. The potential role of intraoperative laparoscopic ultrasonographic assessment of the ovarian masses is proposed.
Underutilization of Laparoscopic Oophorectomy
Authors: Wood Carl , Maher Peter , O'Callaghan David , Hailey David , Downing Bruce 
Published: February 2008

The objective of this study was to compare the use and effectiveness of laparoscopic and laparotomy oophorectomy in 3 hospitals in Melbourne. A retrospective analysis was made of medical records of 140 patients having laparoscopic or laparotomy oophorectomy in the Mercy Hospital for Women (41), Monash Medical Centre (37), and Cliveden Hill Private Hospital (62).Both public hospitals used the laparoscopic procedure, 12% and 22% respectively, less often than the private hospital, 94%. The average number of hospital days for procedures completed by laparoscopy was 1.3 and for laparotomy 6.9. Fourteen percent of laparoscopic procedures were converted to laparotomy. Adjusting for this the average hospital stay was 1.6 days for procedures started laparoscopically.Assuming 1,000 oophorectomies are performed each year in Australia of which 80% could be performed laparoscopically, there may be cost savings to health care providers of over $1.5 million. Laparoscopic oophorectomy is a safe, effective and cost‐efficient method of removing the ovary and gynaecologists should be encouraged to learn and perform this procedure.
Cardiopulmonary Arrest in Pregnancy: Successful Resuscitation of Mother and Infant Following Immediate Caesarean Section in Labour Ward
Authors: Parker Jim , Balis Nicholas , Chester Stephen , Adey Douglas 
Published: February 2008

EDITORIAL COMMENT: This case will interest readers because it shows a frightening complication of epidural analgesia in association with hypotensive therapy. This technically was a case of postmortem Caesarean section and indicates that a favourable outcome for mother and baby is possible if intervention is prompt. Follow‐up of the infant is indicated in such cases because the literature indicates that the prognosis of surviving babies born under these circumstances is unfavourable.Summary: Our patient experienced cardiopulmonary arrest secondary to profound hypotension and was unable to be resuscitated with external cardiac massage and assisted ventilation. This case demonstrates the need for continued vigilance by medical and nursing staff when epidural anaesthesia is being established. Resuscitation equipment should be available in the labour ward as cardiopulmonary resuscitation and immediate Caesarean section can be life‐saving in the event of a cardiopulmonary arrest.
Mendelson Syndrome in the Labour Ward
Authors: Boyle R.K. 
Published: February 2008

EDITORIAL COMMENT: We accepted this case report for publication to remind readers that the Mendelson gastric aspiration syndrome, although uncommon (almost rare), is a formidable complication that can occur in labour. Because the condition is a significant cause of maternal death and severe morbidity in labour, it is accepted practice that once active labour has commenced no solid food should be given. This is not a simple answer to the problem since progress in labour is very often unpredictable. Furthermore, acid regurgitation or vomiting can occur in a woman who has not taken oral fluids or puree‐type foods in labour. The Editorial Committee reviewed midwifery practice in 2 delivery suites in a Melbourne teaching hospital and learned that approximately 10% of women in labour eat solid foods. Many of these women vomit when labour becomes established. If labour persists for longer than 12 hours, intravenous fluids and calories should be administered. A regimen to combat high acidity of the stomach contents should also be considered. Nonetheless the potential risk remains. Readers will profit from the advice discussed in this paper.Summary: A case history is reported to caution against the recommendation that a nonparticulate diet be permitted in labour unless participants are not candidates for regional analgesia. A woman was admitted to Intensive Care with Mendelson syndrome. She had been given a meal in early labour, delivered vaginally with epidural analgesia then aspirated stomach contents. Oral intake during labour may continue to be a risk factor for pulmonary aspiration.