bluuebunny/crossref_metadata_2025_split huggingface dataset:
Choroid Plexus Cysts in Christchurch
Authors: Duff G.B. , Anderson N.G. , Evans L.J. 
Published: February 2008

EDITORIAL COMMENT: The issue of ultrasound markers of aneuploidy is extremely complex. Surprisingly, the most promising marker would appear to be nuchal oedema between 10 and 14 weeks. Many soft signs of aneuploidy have been suggested which might be detected at a mid‐trimester ultrasound examination. These include nuchal oedema, choroid plexus cysts, pyelectasis (mild renal pelvic dilatation), echogenic bowel, relative shortening of long bones and reduced ear length (brachycephalus is less likely). There is probably a slightly higher risk of trisomy for each of these markers, but the incidence is low unless more than one marker is seen or unless it is seen in association with a fetal anomaly. The authors of this paper have suggested that the decision in relation to amniocentesis for choroid plexus cysts should be made by the obstetrician in consultation with the patient and knowledge of local data. If this is the policy, increasing numbers of couples will be faced with the information that their fetus is ‘abnormal’ on ultrasound which is followed by the predictable extreme anxiety. Another approach is that choroid plexus cysts warrant a very careful fetal ultrasound examination by a practitioner using high resolution equipment who is expert at detecting fetal anomalies, particularly congenital heart anomalies. If no other marker or anomaly is found, most would consider choroid plexus cysts to be normal variants. To offer amniocentesis for all these markers potentially opens a mine‐field resulting in increasing numbers of procedures and many couples undertaking a pregnancy in which their thoughts are inappropriately focused on an ‘abnormality’.Lachlan de Crespigny, Melbourne.Summary: Amongst 173 fetuses diagnosed in the second trimester as having one or more choroid plexus cysts, there was only 1 (0.58%) with a probable chromosomal anomaly. If a choroid plexus cyst was the only abnormality seen at ultrasound examination prior to 20 weeks' gestation, then there were no fetuses with either trisomy 18 or trisomy 21. If there was another abnormality seen as well as the choroid plexus cyst, then the risk of aneuploidy was 1 of 3. The association between choroid plexus cysts and aneuploidy in a community‐wide study in Christchurch was significantly less than that reported in 5 recently published papers.When choroid plexus cysts are diagnosed women should be referred for high resolution ultrasound examination to look for other signs of aneuploidy. The presence of an additional abnormality, seen on ultrasound examination, is a strong indication for amniocentesis. If choroid plexus cysts are isolated we do not believe amniocentesis should be offered routinely but the management of the choroid plexus cysts by the obstetrician should be based on consultation with the patient and the knowledge of the local prevalence of the association between sonographically isolated choroid plexus cysts and aneuploidy.
Vaginal Agenesis and the Embryology of Vaginal Epithelium
Authors: Fliegner John R.H. 
Published: February 2008

EDITORIAL COMMENT: We have accepted this paper for publication because we hope that readers will enjoy the discussion about the embryology of the vagina. Although the hymen has stratified squamous epithelium on both superior and inferior surfaces there are reported cases (A) of a transverse vaginal septum above the level of the hymen where the superior surface was covered by columnar epithelium and the inferior surface by squamous epithelium (figure A, 1 and 2). One interpretation of this finding is that the columnar epithelium was derived from Mullerian duct tissue and thus, that the squamous epithelium of the vagina arises by replacing Mullerian duct tissue. There is controversy regarding whether this second epithelium arises from endoderm of the urogenital sinus, mesoderm of the Wolffian ducts or ectoderm of the cloacal membrane (B). Recently a case of double uterus with 1 side having a blind vagina was seen in the University Department at the Mercy Hospital for Women. With this article in mind biopsies were taken from the vaginal walls in the side that had the haematocolpos. The biopsies showed columnar epithelium similar to endocervical epithelium. The editorial committee referred this article for opinion from anatomists and embryologists at the University of Melbourne, Department of Anatomy and Cell Biology and their comments are included as an addendum to this paper. Some of the arguments presented are not easy to follow and the editor considers that a convincing case is yet to be made to reverse the traditional teaching on the embryology of the vagina.

Stewart AD. Cryptomenorrhoea due to a transverse vaginal septum. Aust N Z J Obstet Gynaecol 1968; 8: 45–48.
Deppisch LM. Transverse vaginal septum. Histologic and embryologic considerations. Obstet Gynecol 1972; 193–198.

Summary: A review has been made of 29 cases of vaginal agenesis treated by the Sheares technique of vaginoplasty at the Royal Women's Hospital, Melbourne since 1976. Spontaneous epithelialization of the neovagina is rapid providing the newly created space is kept patent by regular dilatation. The process is usually complete by the 10th to 12th postoperative week. A review of the embryology of vaginal epithelium suggests that it is entirely of urogenital sinus origin. In cases of vaginal reconstruction where no grafting technique is employed it seems likely that epithelial rests are responsible for the rapid epithelialization that occurs.
A Case of Attempted IVF Surrogacy in Victoria: Breaking the Law or Breaking the Deadlock?
Authors: Leeton J. , Dawson K. 
Published: February 2008

Summary: A 37‐year‐old Melbourne woman underwent an emergency hysterectomy for severe postpartum haemorrhage after a twin delivery in 1990 where the pregnancy resulted from a GIFT (gamete intra‐Fallopian transfer) procedure. Two additional embryos had been produced and stored frozen at the time of conception. She and her husband subsequently wished to receive their embryos for implantation into a surrogate to allow them to achieve their own genetic offspring.The 1984 Infertility (Medical Procedures) Act allowed them to either donate their embryos to another infertile couple or have them discarded. Neither of these options was acceptable to this couple. IVF (in vitro fertilization) surrogacy was their only chance of obtaining their genetic offspring, but this procedure was and is currently illegal. An IVF surrogacy procedure was carried out in 1993 but the surrogate failed to conceive.
Value of Cardiotoeography in Women with Antepartum Haemorrhage ‐ Is It Too Late for Caesarean Section When the Cardiotocograph Shows Ominous Features?
Authors: Manolitsas Thomas , Wein Peter , Beischer Norman A. , Sheedy Mary T. , Ratten Valerie J. 
Published: February 2008

Summary: Caesarean section is thought to be indicated by an ominous antepartum cardiotocograph (CTG). However, the fear remains that infants delivered for this indication in the presence of antepartum haemorrhage, especially when premature, are destined to have severe hypoxic neurological damage. We therefore reviewed our experience of cardiotoeography in women with antepartum haemorrhage (APH) from 1989 to 1992. There were 472 women with APH who had a CTG performed. Of them, 68 had abruptio placentae and 317 had an APH of undetermined cause. For the group with abruptio placentae, the perinatal mortality rate (PMR) was 230.7 per 1,000 when the CTG was abnormal, but only 18.2 per 1,000 if the CTG was normal (odds ratio 16.2, 95% confidence interval [CI] 1.53–171.9, p = 0.02). For APH of undetermined cause, the corresponding rates were 90.9 per 1,000 and 9.8 per 1,000 (odds ratio 10.1, 95% CI 0.96–105.8, p = 0.13). There were no perinatal losses in women with APH due to placenta praevia (87 cases).There were 6 cases of critical fetal reserve identified on a CTG in women with abruptio or APH of undetermined cause. All were delivered by Caesarean section, with 4 surviving infants, 3 with normal neurological outcome and 1 lost to follow‐up. There were 3 cases of APH resulting in an infant with cerebral palsy, all of whom had had a normal antepartum CTG. Our data suggest that cardiotoeography allows pregnancy to be safely prolonged in pregnancies complicated by abruptio placentae or APH of undetermined cause, and that Caesarean section is an appropriate form of delivery when the CTG becomes abnormal in these cases.
Laparoscopic Evaluation of Apparently Normal Infertile Women
Authors: El‐Yahia Abdulrahman W. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it confirms an important message concerning infertile couples namely that about 50% have significant pelvic pathology found at laparoscopy even when the usual initial investigations, including hysterosalpingography, are normal. The pathology found is significant not because it is anatomically gross but because this group of women with treatment have about 4 times the pregnancy rate within 12–18 months than the untreated ‘normal group’ (42% versus 12%). The authors stress that the ‘normal group’ require more sophisticated investigations which will reveal a possible cause of the infertility in about 50%. This message was reported in this journal by Leeton and Talbot (A) many years ago, their conclusion being that laparoscopy was indicated early in the investigation of the infertile couple. Nonetheless simple investigations have an excellent success rate in the ‘treatment’ of infertility and one can bring on the big guns of the modern technology (superovulation ± IVF and GIFT) too soon. It is often assumed in infertility management that a successful pregnancy is a triumph for whatever was the current therapeutic regimen, yet women who conceive with treatment often subsequently conceive readily without treatment. In the infertility clinic at the Royal Women's Hospital, Melbourne in the 1960's there were bigger harvests of pregnancies in women referred with infertility at the stage of initial referral (before any treatment) and after treatment with placebo tablets, than with ovulation induction or drug treatment of endometriosis (B). The editorial committee agree with the basic investigational survey of the infertile couple shown in table 1 of this paper, although many would recommend laparoscopy after 6 rather than 12months ‘trying’ when the listed tests are normal.

Leeton J, Talbot JMc. A Comparative Study of Laparoscopy with Hysterosalpingography in 100 Infertility Patients. Aust NZ J Obstet Gynaecol 1973; 13: 169–171.
J H Evans MD thesis, University of Melbourne, 1976.

Summary: Laparoscopy was used to evaluate 130 women whose basic infertility survey revealed no abnormalities. Overall 75 (57.7%) patients were found to have evidence of pelvic disease while the remainder were completely normal. Pelvic endometriosis was the most common pathology accounting for 27.7%, pelvic adhesions 20.8% and mild pelvic inflammatory disease 6.2%. Appropriate treatment of the pelvic conditions resulted in 31 (42.5%) pregnancies compared with 7 (12.3%) pregnancies in the no treatment group. The outcome of this study suggests that additional pregnancies do occur as a direct result of laparoscopic examination and subsequent therapy. We believe that laparoscopy should be performed on all women to search for a tubal or pelvic cause of infertility when all other examinations have been normal.
The Incidence of Histological Chorioamnionitis in IVF/GIFT Preterm Births
Authors: Williams Heather , Jeffery Heather 
Published: February 2008

EDITORIAL COMMENT: We have accepted this paper for publication to inform readers of the high prevalence of chorioamnionitis in both IVF and GIFT pregnancies, and in normal singleton pregnancies that deliver before 37 weeks' gestation. It could be advantageous to analyse the incidence of chorioamnionitis in IVF pregnancies and GIFT pregnancies separately since the women treated by GIFT have patent tubes and presumably a different past history in terms of chorioamnionitis. It is also important to know the incidence of chorioamnionitis in term singleton pregnancies and in IVF and GIFT term pregnancies before one can make deductions regarding chorioamnionitis being a cause of preterm birth. Readers are referred to the other paper in this issue of chorioamnionitis associated with Ureaplasma urealyticum. Authors' response to editorial comment: We believe that the data presented suggests that subclinical infection/inflammation although it does not explain the 4‐fold increase in preterm births in the IVF/GIFT population may contribute to between one quarter and one third of the preterm births in both the IVF/GIFT and the control groups of less than 35 weeks gestational age. We were unable to study the incidence of chorioamnionitis in IVF/GIFT pregnancies that were not delivered prematurely but consider that from the literature and Russell's paper (8) the incidence of chorioamnionitis in term infants is less than 10% and probably less than 5 %. Accordingly chorioamnionitis is likely to be an important cause of preterm birth.Summary: A retrospective case control study was designed to investigate the role of subclinical infection as a risk factor for the high rate of preterm deliveries in IVF/GIFT pregnancies. The cases and the controls were identified from the records of consecutive livebirths of <35 weeks' gestational age (GA), at King George V Hospital from 1987–1993. Fifty one singleton and 58 twin IVF/GIFT preterm births were matched for GA, year of birth, plurality, maternal age, parity, preclampsia and antepartum haemorrhage. As a marker of subclinical infection, the incidence of histological chorioamnionitis (HCA) in the 2 groups (as defined by the standardized, semiquantitative method of Benirschke) was compared. The matched variables did not differ significantly between the IVF/GIFT group and the control group. No significant difference in the incidence of HCA was detected between IVF/GIFT and control groups for singletons or twins. Overall 24% of IVF/GIFT and 30% of controls showed evidence of HCA, odds ratio (95% confidence intervals), 0.72 (0.40‐1.31). This study showed no evidence that the incidence of HCA, is significantly increased in IVF/GIFT preterm births compared with other matched, preterm births. Therefore, we conclude that subclinical infection/inflammation cannot explain the 4‐fold increase in preterm births in the IVF/GIFT population.
Comparison of Prostaglandin E2 Vaginal Tablet with Amniotomy and Intravenous Oxytocin for Induction of Labour
Authors: Lo L. , Ho M.W. , Leung P. 
Published: February 2008

Summary: Prostaglandins have been increasingly used in obstetrical practice for cervical ripening and induction of labour. We set out to investigate the effectiveness of prostaglandin E2 (PGE2) vaginal pessaries in inducing labour in the Chinese population in Hong Kong. In the period August, 1991 to August, 1992, we recruited 206 pregnant Chinese women who required induction of labour for various obstetrical indications into the trial. The study group had induction of labour by PGE2 vaginal pessaries and the control group underwent amniotomy plus oxytocin infusion. These patients were alternately assigned either method of induction. They were further divided into primiparous and multiparous (parity 1 and 2 only) groups.Only 101 primiparas and 99 multiparas were available in the final analysis of the trial. Various aspects of labour, delivery, maternal and fetal outcome were compared. For primiparas, the traditional combined induction was the preferred method. For multiparas, both induction methods were quite satisfactory and there was a trend toward lesser blood loss and pethidine requirement in the PGE2 users.
Intravaginal Misoprostol for Termination of Midtrimester Pregnancy
Authors: Lim J.M.H. , Soh E.B.S. , Raman S. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because readers will be interested to see this alternative method for termination of second‐trimester pregnancy to that reported in the preceding paper by Prasad and colleagues. We agree with the authors that trials comparing intravaginal misoprostol with other prostaglandins are required. Such a study of a prospective, randomized trial comparing the efficiency and safety of misoprostol with that of prostaglandin E* in 55 women between 12–22 weeks' gestation, has recently been reported (Jain JK, MishellDR. A comparison of intravaginal misoprostol with prostaglandin E2for termination of second‐trimester pregnancy. New Engl J Med 1994; 331:290–293). This study concluded that misoprostol was at least as effective as PGE2 and was less costly, easier to administer, and associated with fewer adverse effects. Summary: Misoprostol seems to be a drug with many potential uses apart from the treatment of gastric and duodenal ulcers. The oral tablet appears to be effective for termination of midtrimester pregnancy when administered intravaginally. Further research should be carried out to determine its full range of action in order that the drug can be utilized to its maximum potential.
Early Severe Haemorrhage Complicating GnRH Analogue Treatment of Submucous Uterine Fibroids
Authors: Gregora Michael , Forbes Kevin , Hill Brian 
Published: February 2008

EDITORIAL COMMENT; This case was accepted for publication because of the warning it carries of treatment of women with large submucous uterine fibroids by gonadotropin releasing hormone analogues. We draw readers' attention to the discussion of the cases reported by Friedman (1) where haemorrhage from submucous fibromyomas was apparently successfully managed by hysteroscopy, laparotomy and myomectomy. Mullerian mixed cell sarcomas can also present with a large polypoid mass protruding through the cervix; this condition should be considered when performing uterus‐preserving surgery in such women. Summary: We present 1 case of early severe uterine haemorrhage as a result of GnRH analogue therapy for a submucous fibromyoma resulting in hysterectomy, to alert others of this potentially serious complication.
The Biochemistry and Clinical Application of Urinary Oestriol Measurement During Late Pregnancy in the 1990's
Authors: Beischer Norman , Brown James , Wein Peter , Sheedy Mary , Stereff Marianne , Boras Mary 
Published: February 2008

Summary: Part 1. The present disillusionment with oestriol measurement as a test of fetoplacental function could be explained by the use of poor methodology and inappropriate normal ranges rather than that the test has lost its usefulness. We have updated the Lever method for measuring oestriol in urine, and examined the automatic TDX system supplied by Abbott Laboratories. The precision of the methods and consistency of results between methods have been determined and normal ranges have been established for both methods. The overall accuracy of collection of 24‐hour urine specimens in a routine laboratory setting has also been calculated. The normal ranges suggested as a guide for the TDX method by Abbott were based on those derived from the original method of Brown and were found to be too low and therefore unsuitable for clinical use. This study reports appropriate lower limits of normal for both the updated Lever and the TDX methods. Part 2. The results obtained using the updated Lever method since its introduction in 1991 have been compared with those obtained by the original Brown method during the years 1971‐1989. The new, user‐friendly Lever method of oestriol assay measurement used in 1991‐1993 gave results of equivalent clinical value to the Brown method used in 1971‐1989, although the perinatal mortality rates in the tested populations fell from 0.95% to 0.37%.During 1971‐1989, low oestriol excretion on 1 or more occasions was associated with a 5.6‐fold increase in the perinatal mortality rate (0.66% to 3.67%), whereas in 1991‐1993, the factor was 4.4 (0.27% to 1.2%). Fetal growth retardation was identified by low oestriol excretion equally by the 2 methods, 27.8% with the Brown method and 26.5% with the new Lever method (tables 1 and 2). In the 1991‐1993 study the perinatal mortality rate of infants with growth retardation was 1.0%, and was increased by a factor of 7 if oestriol excretion was low on 1 or more occasions (from 0.4% to 2.8%); 7 of the 10 deaths of growth‐retarded infants were associated with low oestriol excretion. In our view, measurement of oestriol excretion is a practical method for identification of high‐risk pregnancies that require further surveillance (cardiotocography, ultrasonography). The new Lever method is suitable for screening purposes. Although perinatal mortality rates have fallen sharply in the past 20 years, increased risks of fetal growth retardation and perinatal death are still identified by urinary oestriol measurement.
A Prospective Study of the Microbiological Environment of the Genitourinary Tract in Hong Kong Chinese Women During Pregnancy
Authors: Yim So‐Fan , Lyon Donald J. , Chung Tony K.H. , Haines Christopher J. 
Published: February 2008

EDITORIAL COMMENT: There seems no doubt that Chinese women have a low incidence of premature delivery (less than 37 weeks) although the 5% quoted in this paper is similar to the 5.9% for Victoria in 1992 (3,874 of 65,252 confinements). Drew and Chan have confirmed the lower incidence of prematurity in Chinese women living in Hong Kong and in Melbourne than in non‐Chinese women living in MelbourneA. The Chinese women in this study had a remarkably low incidence of group B streptococcal isolation (0.8%) and a very high rate of detection of Candida (30.2%). It is of interest that the authors did not treat women with tests positive for Candida. Sexual practices could understandably influence the vaginal microbiological environment. Recently we reported on the frequency of anal intercourse and other sex practices in pregnancy in a small series from South AustraliaB. Also recently the Editor was privileged to visit a number of maternity hospitals in the Jiansu province in China. When discussing premature rupture of the membranes and prematurity we were told, repeatedly (via our interpreter), that in China it was customary to abstain totally from intercourse during pregnancy even in the absence of complications such as bleeding, ruptured membranes or evidence of infection in one or other partner. Should we disbelieve what we are told when the information seems unexpected? We need more information regarding sexual activity (frequency and route) and associated complications such as premature rupture of the membranes and otherwise uncomplicated spontaneous premature labour, so that we can advise our patients appropriately. A. Drew JH, Chan DP. Incidence of prematurity and low birth‐weight in an immigrant Chinese population. Aust NZ J Obstet Gynaecol 1989; 29: 303‐305.B. Barclay LM, McDonald P, O'Loughlin JA. Sexuality and Pregnancy. An Interview Study. Aust NZ J Obstet Gynaecol 1994; 34: 1‐7.
Remarkable Lubricating Capabilities of Amniotic Surfactant
Authors: Hills Brian A. 
Published: February 2008

Summary: Surface‐active phospholipid (SAPL) extracted from amniotic fluid or elutriated from the chorioamnionic sacs of placentas recovered from normal full term deliveries has been shown to be a remarkable lubricant. Coefficients of kinetic and static friction were reduced to 0.009 by SAPL from amniotic fluid and 0.011 for a membrane extract, even under high load (3 kg/cm2), compared with 0.04 for the best nonbiological boundary lubricants. The antiwear properties were equally remarkable, giving a mean scar diameter under extreme pressure of only 0.76mm for amniotic SAPL and 1.00 mm for membrane extract compared with 0.85‐0.95 mm for aqueous lubricants commercially available.These results support the hypothesis that premature rupture (PROM) is less likely to occur if movement between the fetus and the amnion or between the decidual surface of the uterus and the chorion is well lubricated.