bluuebunny/crossref_metadata_2025_split huggingface dataset:
Caesarean Section: An Audit of Time‐Based Efficiency in Providing a Clinical Service
Authors: Clark F.L. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication to encourage all our readers who practise obstetrics to examine the situation which obtains in the hospitals where they practise obstetrics to see if emergency Caesarean sections are performed within a reasonable time of the decision to deliver abdominally being made. Lance Townsend's favourite dictum that ‘clinical scrutiny improves performance without the need for witch hunt’ is supported by the findings in this paper. It may be noted that in the author's hospital the theatre was incorporated within the labour ward which unfortunately is not the case in many institutions, even level 3 hospitals. It seems obvious that Caesarean section when ordered can be performed quicker when the patient does not need to be shifted very far especially to another floor where a journey in a lift and the availability of a theatre orderly is a requirement. Availability of anaesthetic equipment and staff in conventional operating theatres is often a factor since it is claimed that an effective service cannot additionally be provided within the labour ward environment. These considerations should be considered in all hospitals where obstetrics is practised. Having visited a number of obstetric units in Australia and abroad in small and large hospitals it is the observation of the Editor that ironically the smaller the hospital the more likely it is to be able to perform a Caesarean section within the labour ward or in an operating theatre close‐by.Summary: An audit of the time taken to deliver a baby by emergency Caesarean section was conducted at a District General Hospital in Norfolk, U.K. An assessment was made of reasons for delay in delivering a potentially compromised fetus, and a follow‐up audit showed an improvement in time‐based efficiency that was marginally significant. Median decision to deliver until delivery time in Audit 1 was 40 minutes and at follow‐up in Audit 2 was 31 minutes, p=0.068 (Wilcoxon Rank Sum Test). Discussion of these results by an interdepartmental obstetric, midwifery and anaesthetic meeting concluded that, (a) continuous audit of efficiency should be implemented and, (b) the major factor needed to effect efficient and safe delivery was clear, ‘level headed’, directive leadership by the senior medical staff on duty.
Sheehan Syndrome: An Analysis of Possible Aetiological Factors
Authors: Ammini A.C. , Mathur S.K. 
Published: February 2008

EDITORIAL COMMENT: This condition is rare but the message is clear. These cases require a high index of suspicion to allow diagnosis before the woman is in dire straits. In 1962 the editor visited Professor Sheehan in Liverpool to discuss follow‐up of women who had had haemorrhagic shock to seek cases of pituitary failure. Professor Sheehan said to write letters to all the women who had required intensive resuscitation, then discard the names of those who answered the letter, and start to search for the remainder! At that time women with undiagnosed pituitary necrosis descended the social scale and tended to lack the application to seek medical assistance. Fancy seeing 12 cases of Sheehan syndrome in 1 hospital within 2 years! The problem of diagnosis remains. In this series the mean time from delivery to diagnosis was 5 years. The Editorial Committee members are doubtful if the recommendation in the last sentence of the summary is realistic because there is no simple screening test available for diagnosis of pituitary necrosis at the postpartum visit. The editor arranged for histories of all women with panhypopituitarism seen in 3 major teaching hospitals in Melbourne to be reviewed. There were 43 cases and review of the histories showed that none were cases of postpartum pituitary necrosis although one endocrinologist stated that he had seen 1 case of Sheehan syndrome diagnosed in the past 10 years. Apparently gonadotropin and prolactin secretion are the first hormone deficiencies that show up and early testing should be directed towards patients with amenorrhoea and lactation failure.Summary: Clinical features and obstetric care factors of aetiological importance were analyzed in 12 cases of Sheehan syndrome seen during the years 1992–1993. Eight patients were from urban areas. Eight of them were multiparas. Half of the patients had had hospital deliveries. The average duration between the onset of symptoms and diagnosis was 5 years. Patients were misdiagnosed as having general debility, hypothyroidism or unexplained amenorrhoea. Amenorrhoea, lactation failure, loss of body hair and signs and symptoms suggestive of hypothyroidism were present in most cases. Sheehan syndrome could be diagnosed on clinical grounds in our patients. We recommend that all women with peripartum complications should be followed in a postpartum clinic for early evidence of hypopituitarism.
Prediction of Caesarean Section from Ultrasound and Clinical Assessment of Fetal Size
Authors: Stock Anthony , Ming Wong Wai , Rogers Michael , Chang Allan MZ 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because the authors have explored the possible value of ultrasound versus clinical assessment of fetal size to see whether they can predict the need for Caesarean section when the baby is large. In this study both the ultrasound and the clinical assessment were impressively accurate and fetal femur length was the most accurate of the ultrasound parameters in assessing fetal weight in predicting the need for Caesarean section. However, as the authors indicate, none of these methods of assessment of fetal size are recommended as an absolute indication for Caesarean section. Every obstetrician uses clinical assessment of the fetus when evaluating management of the patient but the need for clinical judgment remains.Summary: One hundred and five women with singleton pregnancies and cephalic presentation were assessed. Fundal height and a clinical estimate of fetal weight were recorded. The fetal biparietal diameter, abdominal circumference and femur length were measured with ultrasound. Ultrasound estimated fetal weight was calculated using 3 different formulas (Shepard, Campbell and CUHK). The liquor volume was assessed using the amniotic fluid index.Ultrasound was able to predict Caesarean section with more reliability than clinical assessment of fetal size or weight. The biparietal diameter, fundal height and amniotic fluid index were poor predictors of mode of delivery. The measurements which best predicted the mode of delivery were the fetal femur length and abdominal circumference. Femur length, but not abdominal circumference, was a statistically better predictor of Caesarean section than clinical estimation of fetal weight. There was no improvement in prediction using ultrasound estimated fetal weight.
A Perinatal Audit of Stillbirths in a Teaching Hospital in Hong Kong
Authors: Lau T. K. , Li C. Y. 
Published: February 2008

EDITORIAL COMMENT: We have accepted this paper for publication became of the excellence of the results obtained in Hong Kong. We have previously reported in this Journal the low incidence of prematurity in Hong Kong and other Asian countries and this may be an important reason why the results published here are superior to those reported from Victoria (A). In Victoria in 1991 the stillbirth rate using the 500 g birth‐weight criterion was 5.8 per 1,000 total births and in 1992 the figure was 4.9 per 1,000. In 1992 the perinatal mortality rate in Victoria was 7.8 per 1,000 births which was a remarkable improvement on 1991 when the figure was 9.2 per 1,000. Perinatal mortality rates in teaching hospitals in Australia are almost double those of the State as a whole. For instance in the triennium 1987–1989 the perinatal mortality rate at the Mercy Hospital for Women was 14.7 per 1,000 total births. This is explained by referral of high‐risk patients especially women in premature labour or with premature rupture of the membranes. Deliveries between 20 and 28 weeks' gestation accounted for 45% of the perinatal deaths in the Mercy Hospital for Women figures referred to above for the 1987–1989 triennium. These figures are given to emphasize the excellence of the perinatal results reported in this paper from a level 3 hospital with a very high proportion of nonbooked patients. The authors were asked to include a statement about the number of terminations done for malformations of babies weighing less than 500 g at birth since this could have a potent influence on the stillbirth rate. For comparison in 1991 in Victoria there were 375 stillbirths (5.8 per 1,000 births) but excluded from this total were 138 terminations of pregnancy after prenatal diagnosis of a malformation before 20 weeks' gestation.Summary: In a 5‐year period, the stillbirth rate in a teaching hospital in Hong Kong was 4.4 per 1,000 total births, which accounted for 61% of the perinatal deaths. The stillbirth rate was 5.8 times higher in twin pregnancies, and 17 times higher in triplet pregnancies. One quarter of the patients were nonbooked, and 14.5 % had no antenatal care. The stillbirth rates were 3.8 and 8.0 per 1,000 among the booked and nonbooked cases respectively. The major causes of stillbirths were congenital abnormalities, haemoglobin Bart disease, abruptio placentae and gestational diabetes. No specific cause could be found in 46% of cases. There were 31 intrapartum deaths, of which 5 were potentially salvageable.
Stage 1 Endometrial Cancer: Treatment Modalities and Factors Influencing Recurrence
Authors: Foote Andrew J. , Proietto Anthony 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because the results of treatment of a group of women with Stage I endometrial cancer may interest readers. Although the overall 5‐year survival rate in this series of 93% is good, the paper does not provide statistically significant information regarding which patients with Stage 1 endometrial cancer warrant irradiation of the vault or of the pelvis following operation. The paper confirms other reports stating that the poorly differentiated lesion or the one that invades the myometrium has a worse prognosis. The Australian collaborative trial on the treatment of women with endometrial cancer has been concluded and we look forward to reading whether this larger study can give a clear indication of whether patients with endometrial cancer are better treated with pelvic lymphadenectomy or postoperative irradiation and whether Provera is useful adjuvant therapy in those who are shown to have high‐risk Stage 1 disease (deep myometrium invasion and/or a poorly differentiated lesion).Summary: One hundred and nineteen patients treated for FIGO Stage 1 endometrial adenocarcinoma were reviewed retrospectively to determine if adjuvant radiotherapy reduced disease recurrence. The patients had all been treated in the Hunter Region of New South Wales over a 10‐year period from 1978 to 1988. Median follow up was 82 months with a range of 24 to 163 months. Treatment consisted of surgery alone (75.6%), surgery and brachytherapy (17.6%), surgery and megavoltage therapy (4.2%), and surgery with both brachytherapy and megavoltage therapy (2.5%). The overall recurrence rate was 10.1%. Recurrence at the vaginal vault alone occurred in 3.4%. The median time to recurrence was 25.0 months. A statistically significant correlation was found between overall recurrence risk and poorly differentiated lesions (p < 0.0001). Just failing to reach statistical significance were age over 70 years (p < 0.06) and patient weight less than 70 kg (p = 0.06). Depth of myometrial invasion (p = 0.17), use of adjuvant radiotherapy (p = 0.17) and uterine cavity size (p = 0.48) were not significantly correlated with risk of recurrence. The 5‐year survival rate was 93.8%.
Transcervical Resection of the Endometrium Using Intracervical Block Only A Review of 278 Procedures
Authors: Ferry James , Rankin Lloyd 
Published: February 2008

Summary: The objective of this study was to assess the efficacy and safety aspects of performing transcervical endometrial resection (T.C.R.E.) on a selected group of 278 patients with menstrual disorders under local analgesia (intracervical block) only. Patient acceptance of the procedure was high, with only 3 cases not completed due to insufficient analgesia (1.07%), although a further 9 (3.2%) were completed with the help of intravenous sedation. Patient satisfaction at 4 months was 90%. There were 4 perforations (1.4%), but no laparotomy was required. Five cases (1.7%) of haemorrhage required a Foley catheter, with 1 needing a transfusion. There was no case of clinically evident glycine overload. Twelve patients required an overnight stay.Patient acceptance of T.C.R.E. under local analgesia, and the incidence of major complications, compared favourably with other published series, including a series of 330 cases performed concurrently by the same operators under general anaesthesia.
Variation in Caesarean and Instrumental Delivery Rates in New Zealand Hospitals
Authors: Johnson Neil , Ansell David 
Published: February 2008

EDITORIAL COMMENT: There is much data in this paper which we believe should interest readers. The policies established at Middlemore Hospital that have undoubtedly led to the reduction in the Caesarean section rate merit special scrutiny. We agree with the authors that a national perinatal database should be established in New Zealand. This will no doubt require regional centres to maintain their own statistics as is done in the various States in Australia. Hopefully perinatal mortality statistics will use the World Health Organization definitions namely that birth‐weight of 500 g or if birth‐weight is not known, birth after at least 22 weeks' gestation, becomes the criterion for inclusion. Readers should realise that the legal requirements for registration of perinatal deaths vary in different countries and are unsuitable for presentation of statistics. In Australia the statistical definition of neonatal death uses the 500 g birth‐weight criterion as for stillbirth, and includes all deaths occurring within 28 days of birth. If deaths occurring only within 7 days of birth are included this should be stated even although deaths occurring in the first 7 days outnumber those occurring from 8–28 days by about 4:1 (e.g. Victoria, 1992; 151:40 in 65,815 total livebirths). Summary: A study of Caesarean section and instrumental delivery rates in the maternity hospitals in New Zealand delivering over 1,000 women per year was undertaken. The results at Middlemore Hospital were compared with those seen elsewhere. The Caesarean section rate at Middlemore Hospital in 1993 was significantly lower than the other large maternity hospitals in New Zealand. The Caesarean section rate at Middlemore from 1988 to 1993 has shown a significant downward trend which is different from the trends at other hospitals. The spontaneous vaginal delivery rates at Middlemore Hospital were higher than at other New Zealand hospitals between 1988 and 1993. We conclude that Middlemore Hospital has been successful in maintaining low interventional delivery rates by New Zealand and international standards ‐ the Caesarean section rate remains below 10% and the spontaneous vaginal delivery rate approaches 85%. This is likely to be a consequence of a number of factors operating together but there is evidence to suggest that the obstetric management policies at Middlemore do play a role in this.
A Hepatic Ectopic Pregnancy Treated with Direct Methotrexate Injection
Authors: Nichols C. , Koong D. , Faulkner K. , Thompson G. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication not only because of its rare anecdotal interest but also because it seems to us that if ever an ectopic pregnancy warrants management with direct injection of methotrexate it is when it is attached to areas such as described in this paper where horrendous haemorrhage or damage to the biliary tract could occur as mentioned in the cases reviewed from the literature.Summary: An ectopic pregnancy of the liver posterior to the porta hepatis and therefore in a surgically hazardous area was successfully treated with injection of methotrexate at laparotomy.
The Amniotic Fluid Embolism Syndrome: 10 Years' Experience at a Major Teaching Hospital
Authors: Burrows A. , Khoo S.K. 
Published: February 2008

EDITORIAL COMMENT: Study of causes of maternal deaths and hence prevention of maternal mortality and morbidity requires a high autopsy rate of mothers who die. This is especially true for deaths from amniotic fluid embolism as the clinical signs can be confused with those occurring with pulmonary thromboembolism, Mendelson acid‐aspiration syndrome and rupture of the uterus. In the present study the 2 deaths from amniotic fluid embolism gave a death rate oj'33 7 per 100,000 births whereas in Australia the death rate from amniotic fluid embolism in the 27 years 1964–1990 was 0.90 per 100,000 confinements (table 1A).It may be noted that in the last 18 reported years of statistics from Australia the overall rate of direct maternal deaths has fallen from 23.9 to 6J per 100,000 confinements whereas the comparable figures for amniotic fluid embolism were a fall from 1.43 to 0.63 per 100,000. It is of interest that in the 18 years 1973–1990, amniotic fluid infusion accounted for relatively more direct maternal deaths (10%; 27 of 277) than in the previous 9 years (6%; 31 of 518). In comparison with amniotic fluid embolism there has been a marked reduction in the numbers of maternal deaths and of the death rates from abortion + sepsis (101 to 9), obstructed labour (24 to 2), placenta praevia (21 to 6), abruptio placentae (24 to 9), pulmonary thromboembolism (110 to 43) and preeclampsia/eclampsia (73 to 41). The cause of amniotic fluid embolism remains an enigma even when only those cases with an autopsy‐proven diagnosis are considered. The careful analysis of clinical findings in this series of 9 cases, 7 based upon clinical diagnoses alone, do not support the widely held belief that precipitating factors for amniotic fluid embolism are overactivity of the uterus, multiparity and misuse of oxytocic drugs. It should be noted that in 7 of the 9 women in this study the symptoms and/or signs of amniotic fluid embolism first occurred during or subsequent to Caesarean section or hysterotomy.Summary: A review of the syndrome of amniotic fluid embolism (AFE) was carried out over a 10 year period, 1984–1993, at the Royal Women's Hospital, Brisbane. There were 9 patients with AFE, of whom 2 died – this gave an incidence of fatal AFE of 3.37 per 100,000 pregnancies at the hospital, in comparison with an incidence of 1.03 per 100,000 pregnancies over a 27‐year period in Australia. The study revealed no identifiable risk factors in the characteristics of the patient or her baby, labour and delivery. Three of the patients did not undergo labour and in 4 of the 6 who did, the duration was less than 12 hours. The AFE syndrome could present before, during or after delivery; the common features were shock and respiratory distress, with coagulopathy occurring in 5 patients. Current views of predisposing factors, pathogenesis, diagnosis and management are discussed.
Sexuality in Nigerian Pregnant Women: Perceptions and Practice
Authors: Adinma J. I. B. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it undoubtedly will interest readers and hopefully encourage a similar report on Australian women. We could do with more data on the subject. We can understand that sexual activity can be ‘painful’ or ‘gratifying’, that it ‘may help to keep the husband around’ but need enlightenment on how the activity is ‘functional’ (table 3 and text). Our interpretation of the data provided is that the term means ‘fulfilment of marital obligations’.Summary: The sexual behaviour and beliefs of 440 pregnant women from South‐eastern Nigeria were investigated. The mean frequency of sexual intercourse during pregnancy (1.5 times per week) was less than that before pregnancy (2.3 times per week). The husband was the main initiator of sexual activity (41.6%), while the wife only rarely did so (2.7%). 44.3% of the respondents believed that sexual intercourse during pregnancy widens the vagina and facilitates labour; 34.8% that it improves fetal well‐being; 30.2% that it caused abortion in early pregnancy while 21.1% had no knowledge of any repercussions of sexual intercourse in pregnancy.Coitus during pregnancy was always painful in 22.7% of the respondents; was always gratifying in 46.1%; was functional in 49.3% and helped to keep the husband around, also in 49.3% of the respondents.The majority of the respondents (83.4%) considered that coitus should not be stopped during pregnancy. Whereas 19.3% of the respondents believed that sexual frequency should be increased during pregnancy, 73.9% considered otherwise, and 63.6% actually felt it should be reduced.Findings from this study suggest a ‘mixed‐feeling’ effect with a tilt towards a positive attitude to sexuality in pregnancy. Restriction should not be imposed on sexual activity during a normal pregnancy to enhance marital harmony.
Blood Loss in Termination of Early Pregnancy with Mifepristone and Gemeprost
Authors: Prasad R. N. V. , Choolani M. , Ratnam S. S. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it provides further evidence that the combination of an antiprogestogen and prostaglandin provides a medical termination of pregnancy with the median blood loss being approximately 90 mL and the median number days of bleeding 4. The amount of bleeding is comparable to a heavy period of normal duration albeit there being the risk that bleeding can be excessive. The antiprogestogen mifepristone is not available in AustraliaSummary: The combination of an antiprogestogen with prostaglandin has been shown to be an effective alternative to surgical procedures for pregnancy termination in the first 49 days of amenorrhoea and has been available in France since late 1988. Mifepristone when used alone caused poor efficacy with unacceptable vaginal bleeding. The addition of a prostaglandin analogue (sulprostone, gemeprost) produced acceptable efficacy with less bleeding. The present study provides a quantitative assessment of blood loss in a sample of 20 women undergoing medical termination of early pregnancy (amenorrhoea ± 49 days). Vaginal bleeding occurred between days 3 and 15 of commencing therapy. The median number of days of bleeding was 4 with a median blood loss of 91.5 mL. The mean blood loss was 136.8 mL (± SD 159.2) but this did not adversely affect the hemoglobin level in the volunteers. Most patients describe the experience as that similar to a heavy period and viewed the procedure positively especially since they are spared the anaesthetic risks and hospitalization attendant with surgical abortion. Caution is still however advised as there may be the occasional subject with excessive haemorrhage (as in this study where one woman bled a total of 761.4 mL) and close supervision by a physician is essential.