bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevention of Preeclampsia with Heparin and Antiplatelet Drugs in Women with Renal Disease
Authors: North R.A. , Ferrier C. , Gamble G. , Fairley K.F. , Kincaid‐Smith P. 
Published: February 2008

Summary: In a retrospective cohort study of women with renal disease in pregnancy we investigated if:

low dose aspirin reduced die prevalence of preeclampsia and improved fetal outcome compared to no anticoagulant therapy.
heparin plus low dose aspirin and/or dipyridamole reduced die prevalence of preeclampsia and improved fetal outcome compared to i. no treatment ii. low dose aspirin alone.

Women with renal disease were allocated into 3 groups according to the treatment received during their pregnancies: I. no prophylactic heparin or antiplatelet drags, n=76 II. prophylactic low‐dose aspirin 75(50–150)mg, n=27 III. prophylactic subcutaneous heparin 10,000 (5000‐12,500) IU b.d. combined witii low‐dose aspirin 50 (50–150)mg and/or dipyridamole 400 (200–400)mg, n=44. Preeclampsia and fetal outcome was analysed according to treatment group.Preeclampsia was less common in the heparin group (2.3%) compared with 27.6% in the no treatment group [O.R. 0.06 (0.01‐0.30)] and 25.9% in the aspirin group [O.R. 0.07 (0.01‐0.38)].Women on aspirin, who developed preeclampsia, delivered later in pregnancy [35.4 (33–38.2) weeks] than preeclamptic women on no treatment [29 (22–38) weeks], p=0.04. There was a trend to reduced perinatal deatfis in the heparin + antiplatelet drug group, [2.3%; O.R., 0.17 (0.02‐1.4)] and in the aspirin group [0%, O.R., 0.13 (0.01–2.3)] compared with 11.7% perinatal deaths in the no treatment group.Heparin widi anti‐platelet drugs may prevent preeclampsia in high risk women witfi renal disease. Further investigation in a randomized trial is indicated.
Efficacy of Bupivacaine Delivered by Wound Catheter for Post‐Caesarean Section Analgesia
Authors: Mecklem David W. J. , Humphrey Michael D. , Hicks Ross W. 
Published: February 2008

Summary: A prospective, randomized, double‐blind trial was conducted to assess contribution to postoperative analgesia of intermittent instillation of 0.25% bupivacaine beneath the rectus sheath in 70 women delivered by lower uterine segment Caesarean section. The operations were performed via a Pfannenstiel incision under spinal anaesthesia. Background intravenous narcotic analgesia was provided with a patient controlled analgesia system (PCAS) using a standard morphine regimen.Overall (44 hr) mean morphine consumption was significantly greater in the placebo (saline) group compared to the treatment group (84.2 mg versus 63.3 mg. Two tailed t test p<0.001). The most significant intergroup differences in narcotic use were found in the first 4 hours and between 24 and 36 hours after commencing PCAS (Two tailed t test p=0.014 and 0.003 respectively).Subjective pain scores were assessed with a 10 cm visual analogue scale (VAS). The mean peak VAS score was greater in controls (5.37) than the treatment group (4.25) between 18 and 24 hours postoperatively (Mann‐Whitney U=424, p=0.027). There were no intergroup differences in pain scores for any other time period. The overall incidence of nausea was lower in the treatment group compared to the control group (Chi squared with Yates' correction p=0.046) and a lower degree of sedation was seen in those receiving bupivacaine between 4 and 8 hours after commencing PCAS (Mann‐Whitney U=427, p=0.028). No differences in other narcotic related side‐effects (vomiting and pruritus) were shown between groups.Regular instillation of 0.25% bupivacaine beneath the rectus sheath of women delivered by Caesarean section reduces their morphine requirements by 25% in the 44 hours after operation, with an associated reduction in both nausea and early sedation.
Treatment of Preterm Cervical Dilatation with Glyceryl Trinitrate, a Nitric Oxide Donor
Authors: Rowlands Shelley , Trudinger Brian , Visva‐Lingam Shan 
Published: February 2008

EDITORIAL COMMENT: This paper reports very impressive results of treatment of cervical dilatation with glyceryl trinitrate in what seems to be a very high‐risk group of 10 women. The details provided of Case 1, table 1, suggest that glyceryl trinitrate patch therapy may be considered as an alternative to cervical ligation, at least in selected patients where insertion of a cervical stitch has contraindications (haemorrhage, uterine contractions, possibility of infection). It is early days yet, but the editorial committee wish to endorse the authors' conclusion that ‘the data presented here supports the need to perform randomized placebo‐controlled trials so that the role of glyceryl trinitrate, if any, and safety of its use can be established’. Should such trails include prophylactic use of this regimen in women without cervical dilatation when there is a past history of recurrent mid‐trimester fetal loss from premature labour ± premature rupture of the membranes? These women are significant contributors to the 35–40% of all perinatal deaths that occur associated with delivery between 20 and 28 weeks' gestation.Summary: We report an observational study on the use of transdermal glyceryl trinitrate as a treatment to delay delivery of women presenting in pregnancy with dilatation of the cervix. Ten women found to have cervical dilatation more than 2 cm (range 2 to 8 cm) at gestations between 16 and 32 weeks were studied. These women were treated with 50 mg glyceryl trinitrate patches. The mean prolongation of gestation from the time of admission was 46.2 days (range 1 to 130 days). There was 1 stillbirth in a 22.6‐week fetus and 1 neonatal death secondary to prematurity. Vaginal delivery occurred in all but 3 cases. All babies were of size appropriate for gestational age at delivery. The only reported maternal side‐effect was headache. No adverse fetal effects were noted. We conclude that glyceryl trinitrate may provide an effective and safe method of tocolysis, well suited for long‐term use. The purpose of reporting this study is to highlight the mounting accumulation of data on glyceryl trinitrate and reinforce the need to evaluate its use in randomized controlled trials.
Eclampsia in Kuwait 1981–1993
Authors: Makhseed Ma'asoumah , Musin Vijaya Manav 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it provides interesting data concerning the incidence and clinical results obtained in 101 cases of eclampsia in 167,080 confinements in Kuwait. The vicissitudes of the Gulf war influenced the data gathering during this series but the results warrant comparison with those from an Australian teaching hospital shown in table A from 113,909 consecutive confinements. It should be noted that the overall similarity in results (apart from maternal mortality) is as remarkable as the dissimilarity in the methods used to treat women with preeclampsia and eclampsia in these 2 centres. The incidence of eclampsia was the same in Australia as Kuwait (5.6 versus 6 per 10,000 confinements). Nulliparas comprised 72% and 73% of the series respectively although it should be noted that in the Australian series nulliparas comprised 42% of the total obstetric population in comparison with 23% in Kuwait. The associations with multiple pregnancy (4.7% versus 5%) and diabetes (3.1% versus 2%) were similar as was the perinatal mortality rate (10.9% versus 9.3%), but not the maternal mortality rate (6.3% versus 1%) or the Caesarean section rate (25% versus 49%). We concur with most of the authors' conclusions but cannot agree that, in 1996, we can label eclampsia as a ‘preventable condition’.Summary: The aim of this study is to investigate the maternal and fetal outcome and the risk factors for developing eclampsia in Kuwait. The study includes all patients with eclampsia observed at the Maternity Hospital, Kuwait during the period from 1981 to 1993. It revealed that the risk factors predisposing to eclampsia were primiparity, a maternal age below 30 years, multiple pregnancy and the presence of preeclampsia. The pregnancy outcome in terms of the stillbirth rate, neonatal death rate and low birth‐weight babies was significantly higher in mothers with eclampsia than in noneclamptic mothers. The operative delivery and maternal mortality rates were also significantly higher in these patients.
Fearing the Worst ‐ Why Do Pregnant Women Feel ‘At Risk’?
Authors: Searle Judith 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it explores the association of antenatal patients' anxieties about their own welfare and that of their fetus in terms of the antenatal investigations that are performed during pregnancy. It is noteworthy that women who were told the results of their tests were 8 times more likely than those not told the results to perceive that antenatal screening tests were helpful which is a message that probably all readers can profit from. It is also important to learn that routine antenatal screening tests were regarded by the patients as being the most effective factor in reducing the level of fear and anxiety experienced throughout pregnancy. Those who are responsible for antenatal classes will be interested to read that only a very small percentage of women identified them as being effective in the reduction of anxiety. The editorial committee of the Journal will be pleased to receive a paper such as this exploring the value of antenatal classes as perceived by women and their partners. At present the information on this subject is mainly anecdotal.Summary: Whilst pregnancy and childbirth are generally regarded as a joyful and exciting time in a woman's life they are also filled with fear, uncertainty, a feeling of being ‘at risk’ and anxieties about what the pregnancy and future may hold. In a society where the perinatal and maternal mortality and morbidity rates are low, where do these fears and uncertainties arise from? Why do pregnant women fear the worst? What are the implications of this?A cross‐sectional and qualitative study of 376 postnatal women in a major public teaching hospital in Melbourne was undertaken in 1995 to explore women's beliefs and fears about pregnancy and birthing outcomes, through their perceptions and use of routine antenatal screening tests. Through women's perceptions about the value of, and expectations of, routine antenatal screening tests, and their fears during pregnancy, the author explores the ‘notion of risk’ as perceived by these women.
Perinatal Infection with listeria Monocytogenes
Authors: Craig Simon , Permezel Michael , Doyle Lex , Mildenhall Lindsay , Garland Suzanne 
Published: February 2008

Summary: Listeria monocytogenes has been increasingly recognized as a cause of intrauterine sepsis with associated perinatal wastage. The condition is mostly acquired through dietary intake and appropriate advice should be given to all pregnant women. The most common presentations in pregnancy include premature labour, an influenza‐like illness and reduced fetal movements.In this report, we present a series of 24 cases of perinatal listeria infection presenting to either our obstetric or neonatal units and confirmed by the microbiology department of the hospital. In particular, we wish to highlight 3 cases in which antenatal diagnosis and aggressive therapy was associated with a successful outcome. Amongst the remaining 21 cases in which an antenatal diagnosis was not made, there were 5 perinatal deaths and 1 mid‐trimester loss at 18 weeks.Clinicians must maintain a high index of suspicion for listeria, particularly in gravid patients who present with fever in the setting of a persistent ‘flu‐like’ illness and premature labour. Once suspected, appropriate specimens for listeria culture should include blood, cervical swabs and midstream urine. Empirical antibiotic therapy with amoxicillin should be instituted while waiting for culture results in patients with possible Listeria monocytogenes sepsis.
Antenatal Human Parvovirus B19 Infection and Nonimmune Hydrops Fetalis Presenting as Severe Preeclampsia
Authors: Choong Shawn , Meagher Simon 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication since the authors believe it is the first report of hydrops fetalis due to parvovirus infection apparently causing severe preeclampsia. This is similar to the ‘maternal preeclampsia syndrome’ classically described with fetal and placental hydrops due to maternal rhesus isoimmunization (A), and which also can occur with fetal and placental hydrops due to fetal alpha thalassaemia major. The authors indicate that treatment of fetal anaemia could possibly result in resolution of the signs of preeclampsia in such cases. Indeed the members of the editorial subcommittee have already heard, on the Australian academic grapevine, of surviving infants treated in utero for anaemia caused by parvovirus and erythroblastosis due to maternal rheus isoimmunization respectively, in 2 mothers with signs of severe preeclampsia.(A) Scott JS. Pregnancy toxaemia associated with Hydrops foetalis, Hydatidiform mole and Hydramnios. J Obstet Gynaecol Br Emp 1958; 65:689–701. William Blair‐Bell Memorial Lecture delivered at the Royal College of Obstetricians and Gynaecologists on May 30, 1958.
Complete Inversion of the Uterus During Caesarean Section: A Case Report
Authors: Kriplani Alka , Relan Supriya , Roy Kallol Kumar , Mittal Suneeta , Buckshee K. 
Published: February 2008

SummaryA case of complete inversion of the uterus through the uterine incision at the time of Caesarean section is presented. The possible aetiological factors were a short cord and fundal insertion of the placenta. Disappearance of the lower segment incision and the raw appearance of the endometrial surface of a completely inverted uterus posed a diagnostic dilemma. Prompt understanding and immediate repositioning by a simple technique prevented any further complications. This rare complication of Caesarean section and its easy principles of management are described for the benefit of an unwary obstetrician.
Is Laparoscopically‐assisted Vaginal Hysterectomy Associated with Low Operative Morbidity?
Authors: Yuen Pong Mo , Rogers Michael S. 
Published: February 2008

SummarySeventy‐one consecutive patients undergoing laparoscopically‐assisted vaginal hysterectomy were prospectively evaluated with particular emphasis on the operative morbidity. Bipolar desiccation was the mainstay for haemostasis. Fibroids accounted for two‐thirds of the uterine pathology and the average uterine weight was 238.0 g (SD 134.6). Mean operating time was 126.3 minutes (SD 36.9) and decreased with experience despite the progressive increase in uterine weight. The mean blood loss was 432 mL (SD 288) with a mean haemoglobin change of 2.3 g/dL (SD 1.5). Intraoperative complications occurred in 5 patients (7.0%), 2 with inferior epigastric artery injuries and 3 serosal bladder injuries. Postoperative complications occurred in 45 patients (63.4%). Febrile morbidity was the major complication and occurred some 50% of patients, 45% of whom had no underlying cause identified. Vault haematoma was the second most common complication and occurred in 31.0%. The mean hospital stay was 5.4 days (SD 2.7) and the readmission rate was 10%. Our results of laparoscopically‐assisted vaginal hysterectomy did not conform with the benefits of reduced blood loss, shorter hospital stay and reduced postoperative complications reported in the literature. The true complication rate of laparoscopically‐assisted vaginal hysterectomy should be carefully assessed before this can be considered as the approach of choice to hysterectomy.
Genital Prolapse: A Legacy of the West?
Authors: Brieger G.M. , Yip S.K. , Fung Y.M. , Chung T. 
Published: February 2008

SummaryA retrospective study was undertaken to determine if there has been a change in the incidence of genital prolapse and urinary stress incontinence in Chinese women in Hong Kong. The medical records of 2,312 consecutive patients admitted for major gynaecological surgery for benign conditions in 5 out of 7 major public teaching hospitals in Hong Kong for the calendar year of 1993 were reviewed by way of an audit of all gynaecological operations performed in these hospitals. A total of 578 cases (25%) were identified as having genital prolapse and or urinary problems.
Hysterectomy, Massive Transfusion and Packing to Control Haemorrhage from Pelvic Veins in the Course of Bilateral Oophorectomy
Authors: Edwards William R. 
Published: February 2008

SummaryThe patient required bilateral salpingooophorectomy for pain caused by the late effects of pelvic infection. Division of adhesions was followed by torrential bleeding from the gluteal tributaries of the right internal iliac vein aggravated by the partial retraction of those veins into the subgluteal region. Measures to control the bleeding and the late complications are described.
Massive Ovarian Oedema: A Nonneoplastic Adnexal Mass Mistaken for a Neoplasm
Authors: Turan Cem , Ugur Mustafa , Mungan Tamer , Taner Dilara , Aydogdu Tugrul , Cobanoglu Omer 
Published: February 2008

SummaryMassive ovarian oedema (MOO) is an unusual clinical entity occurring in teenage girls and young women, and is thought to result from periodic and intermittent torsion of the ovarian pedicle. It is usually mistaken for an ovarian neoplasm and treated by oophorectomy. A case that underwent more radical surgery than is necessary is presented.
Low Aboriginal Birth‐weight‐Prematurity or Intrauterine Growth Restriction?
Authors: Humphrey Michael D. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it explores the important question of whether low birth‐weight in infants of Aboriginal mothers is due to prematurity or fetal growth‐retardation. This paper reviews the previous literature, provides some interesting new information, and shows that a prospective study with verification of fetal maturity is required to resolve the problem. Readers will realize the difficulties that exist in compilation of prospective data with sufficient numbers of cases to answer this question.Summary: Two thousand, nine hundred and twenty‐eight consecutive singleton public births at Cairns Base Hospital were studied retrospectively. Contrary to popular clinical belief, there was no statistically significant difference in the birth‐weights, corrected for gestational age between Aboriginal babies and Caucasian babies. There was a highly significant excess of preterm Aboriginal births, when compared with Caucasian births. This study suggests that any attempt to reduce the high incidence of low birth‐weight births in Aboriginal people should be directed at reducing the incidence of preterm birth, rather than the supposed high incidence of intrauterine growth restriction.
Fetal Growth and Perinatal Outcome of Pregnancies Continuing After Threatened Abortion
Authors: Das A. G. , Gopalan S. , Dhahwal L. K. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it provides some useful information on the outcome of a small series of women with threatened abortion who were followed carefully with serial ultrasonographic estimations. Although the results were excellent in comparison with the control series it should be noted that patients were excluded if delivery occurred before 28 weeks' gestation. This is an important point because threatened miscarriage may result in an increased incidence of premature births between 20–28 weeks' gestation and an increased incidence of fetal malformations in those pregnancies that terminate before 28 weeks. Nonetheless it is important to be able to reassure women who have had a threat to abort that if the pregnancy continues past 28 weeks there is no increased incidence of either major fetal malformations or perinatal deaths. A higher incidence of placenta praevia in patients with threatened miscarriage could also be hidden in a series excluding all those patients delivered before 28 weeks if those with placenta praevia were to deliver before this time. Other studies have also shown that pregnancies complicated by threatened abortion which proceed beyond 28 weeks' gestation have no significant increase in the incidence of prematurity, fetal growth retardation or major fetal malformations.(A) Evans JH, Beischer NA. The prognosis of threatened abortion. Med J Aust 1970; 2: 165–168.Summary: The present study was conducted with the aim to find out the effect of threatened abortion in the current pregnancy on the subsequent perinatal outcome and follow the growth pattern of the fetuses of such complicated pregnancies. The study group consisted of 55 women with threatened abortion and 55 women with normal pregnancies formed the control group. Most of the patients presented at 6–12 weeks' gestation. The fetal growth was monitored by both clinical as well as ultrasound (USG) parameters. The mean growth rates were almost identical throughout gestation. The mean values of each parameter of the study group were found lying within 95% confidence limit values of their control group. The apparent increased incidence of low lying placenta in early pregnancy probably contributed to threatened abortion. There was no significant difference in preterm delivery, low birth‐weight and overall perinatal outcome.
Uterine Rupture During Labour in a Primigravida
Authors: Chin Michael M.S. , Harvey James A. , Duffy Brian L. 
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication because it will interest readers. Certainly the woman had a haemoperitoneum and signs indistinguishable from a case of rupture of the uterus although technically this is not a rupture because the tear did not extend through the uterine wall to the endometrial cavity. The editor saw a patient some 38 years ago who had a haemoperitoneum and who came to laparotomy on 2 occasions where it appeared that the bleeding had come from a tear in the peritoneum between the uterosacral ligaments. This patient died during her third laparotomy. There is also literature describing tears in the peritoneum over the uterosacral ligaments as a cause of chronic pelvic pain. The editorial committee find it feasible that a patient in labour can develop a tear in the peritoneum and superficial myometrium in her posterior uterine wall which if it involved vessels could cause a life‐threatening haemoperitoneum. Of course similar tears occur due to trauma such as a motor‐car accident when the woman is wearing a seat belt which can localize trauma to the uterus.Summary: Uterine rupture ie extremely rare in the absence of any of the commonly recognized risk factors. We describe here a case of incomplete uterine rupture in a woman in her first pregnancy who had no previous instrumentation to the genital tract. Her only significant history was that of 2 episodes of minor antepartum haemorrhage occurring prior to induction of labour with artificial rupture of membranes and intravenous oxytocin. The rupture was manifested by 450 mL blood in the peritoneal cavity when an emergency Caesarean section was performed for persistent fetal bradycardia.