bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Multiple Induced Abortions on the Outcome of Subsequent Pregnancy
Authors: Lopes A. , King P. A. , Duthie S. J. , To W. K. , Ma H. K. 
Published: February 2008

Summary: The obstetric outcome of 285 women with a history of previous multiple induced abortions is compared to that of 285 age matched primigravidas. In the study group, 219 women had 2 previous induced abortions and 66 had 3 or more, the maximum number being 8. There was a higher incidence of unmarried women and smokers in this group but a lower incidence of uneducated women. There was no difference in the incidence of antenatal complications between the 2 groups. The mean gestation at delivery, duration of labour and mode of delivery were comparable. There was an increased incidence (p<0.01) of retained placenta in the subgroup of women with 3 or more previous induced abortions. There were no maternal or perinatal deaths. The mean birth‐weight was comparable and there were no infants weighing < 1,500 g in cither group.We conclude that multiple previous induced abortions appear to have minimal impact on the obstetric outcome of subsequent pregnancy in this population, and in the absence of other risk factors there is no need to alter standard obstetric management in this group of women.
Second Trimester Abortion by Extra‐Amniotic PGF2 alpha Infusion: Experience of 178 Cases
Authors: Peat B. 
Published: February 2008

EDITORIAL COMMENT: The need for second trimester termination of pregnancy is a reality in modern obstetric practice. However, in spite of the increasing advocacy of routine 17–18 week ultrasonography to identify major fetal malformations, and the increasing use of genetic counselling amniocentesis when indicated, the majority of second trimester terminations are performed for ‘psychosocial’ indications ‐ in 102 of 178 case in Peat's series and 87 of 101 cases in the preceding article by Bennett and colleagues. These 2 papers are complementary and both conclude, after reporting different methods, that surgical evacuation after cervical dilatation with a vaginally inserted prostaglandin pessary is a more satisfactory technique than that using extraamniotic infusion of prostaglandin F2 alpha. It is a well known and important fact that the operation of dilatation and piecemeal evacuation of the fetus and placenta is abhorrent to both the operator and all members of the nursing staff in attendance. The performance of the procedure under ultrasound control as described in the previous paper seems a major improvement in terms of avoiding damage to the uterus, and problems due to incomplete removal of the conceptus. Hopefully this is not the last word, and further refinement of technique will allow spontaneous expulsion in second trimester abortion ‐ the use of an orally administered antiprogesterone in addition to vaginal Cervagem pessaries (Rodger and Baird, 11), may, by shortening the induction‐abortion interval, result in a regimen more acceptable than surgical evacuation.Summary: here is a continuing need for second trimester induced abortions, most recently due to the increase in the use of antenatal diagnostic procedures, amniocentesis, high resolution ultrasound and cordocentesis. To evaluate the efficacy and safety of extraamniotic infusion of PGF2 alpha for this purpose a retrospective review of 178 procedures was undertaken. There were 4 failures of the technique and the major complication rate was 5.6%. This rate was independent of gestational age The mean induction to abortion interval was 29.6 (+/‐ 16.3) hours. The conclusion reached after comparison with other published data is that extraamniotic PGF2 alpha infusion is a slow and painful but safe and effective technique, but that at gestational ages less than 17 weeks, a comparative trial of Dilatation and Evacuation versus extraamniotic PGF2 alpha infusion would be justified.
Was That Hysterectomy Really Necessary? Audit of Operative Justification at the Aga Khan University Medical Centre, Karachi
Authors: Rizvi Javaid H. , Afzal Wasim , AH Amjad , Khan Khalid S. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because readers may wish to use it as a model for scrutiny of their own hospital statistics, especially in Australia where the hysterectomy rate is probably considerably higher than in Pakistan.Summary: Hysterectomy in Pakistan, like in other parts of the world is considered to be overused in a number of cases. As a part of a quality assurance process at the Aga Khan University Medical Centre, Karachi, 376 hysterectomies performed between January, 1987 and December, 1989 were retrospectively analysed and the results are presented. In 250 (66.5%) cases, where pathology was expected to be found, the hysterectomy was considered justified if the preoperative diagnosis was verified by the pathology report of if significant alternate pathology was present. In 126 (33.5%) cases, where no pathology was expected to be found ‘validation criteria’ were used to ascertain justification of the procedure. The results showed justification rates of 83% for recurrent uterine bleeding, 85% for adenomyosis, 90% for adnexal masses and endometrial carcinoma, 95% for fibroids, 97% for pelvic relaxation and 100% each for pregnancy catastrophe, endometriosis, chronic pelvic inflammatory disease and premalignant disease of uterus and cervix. In general 92.0% of all hysterectomies in this series were justified.
Pelvic Lymph Node Metastases in Early Invasive Carcinoma of the Cervix ‐ Histopathological ‘Risk’ Factors
Authors: Jayalakshmi P. , Sivanesarathnam V. 
Published: February 2008

EDITORIAL COMMENT: The findings in this series of patients with early invasive carcinoma of the cervix supports other reports regarding the importance of depth of invasion and vascular space permeation in terms of lymph node metastasis. This paper in contrast to the preceding series reported from India showed a lower rate of positive lymph nodes in patients with adenocarcinoma than in those with squamous cell lesions. In neither of these papers was follow‐up sufficient to allow comment regarding survival. It is generally considered that adenocarcinoma of the cervix is likely to be associated with poorer prognosis when endocervical extension of the tumour is extensive before symptoms result in presentation and diagnosis.Summary: Histopathological features in 89 cases of Stage IB and early 2A invasive carcinoma of the cervix who underwent Wertheim radical hysterectomy and pelvic lymphadenectomy were studied. Depth of tumour invasion and lymphatic/vascular space permeation by tumour cells were significantly associated with lymph node metastases. The other features such as tumour type, and stromal leucocytic reaction showed no significant relationship to the presence of lymph node metastases.
Incidence and Management of Obstructed Labour in Eastern Nigeria
Authors: Ozumba Benjamin C. , Uchegbu Herbert 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication to remind readers of the maternal and fetal hazards of obstructed labour in communities where obstetric hospitals still receive a high proportion of unbooked patients referred with intrapartum complications. The results reported for booked patients are also noteworthy; although the incidence of obstructed labour was only 1.7%, the 10,202 booked cases provided 19 cases ofCaesarean hysterectomy and 10 others where uterine rupture was treated by repair. The Caesarean section rate of all booked patients in this series is not provided but was presumably very low by western standards. The discussion provides a rare insight into the difficulties which occur in obstetric practice in other lands; even booked patients may refuse to go into hospital until it is too late to deliver them safely.The maternal mortality rate in this series for the entire hospital population was 11 per 1,000 births, somewhat less than the 12.2 per 1,000 reported from the Royal Women's Hospital, Melbourne for the years 1939–1947A ‐ at this time the perinatal mortality rate at the Royal Women's Hospital was 68.6 per 1,000 or approximately 50% higher than in this series reported for Nigeria. It is interesting to note that the Caesarean section rate at the Royal Women's Hospital during these years was 2%; it may be that conditions in the developing world are not all that different from the so called developed world of 40 years agoSummary: Over a five year period (1985–1989) 527 cases of obstructed labour were recorded while 11,299 deliveries were conducted giving an incidence of 4.7%.The majority of the patients (59%) were primigravidae. The incidence of obstructed labour was much higher for the unbooked patients (33 %) than for the booked patients (1.7%). Cephalopeivic disproportion was the greatest cause of obstructed labour (67%), while Caesarean section was the main method of delivery (85%).The leading complications of obstructed labour were puerperal sepsis (57%), post partum haemorrhage (15%), uterine rupture (14%), and genital tract laceration (14%). A maternal mortality rate of 32 per 1000 and a perinatal mortality rate of 294 per 1000 were recorded.Education of primary health providers and traditional birth attendants on the dangers of obstructed labour and the need for early referral is suggested to reduce the incidence of this condition. Governmental assistance is also required to improve existing health facilities so that antenatal and delivery services will be affordable to all pregnant women in the society.
Induction of Labour in Nulliparas with Poor Cervical Score: Oxytocin or Prostaglandin Vaginal Pessaries?
Authors: Kurup A. , Chua S. , Arulkumaran S. , Tham K. F. , Tay D. , Ratnam S. S. 
Published: February 2008

EDITORIAL COMMENT: This study is important and unusual, the latter because the control series of nulliparas with an unfavourable cervix having labour induced by amniotomy and oxytocin infusion were managed by the same authors and reported in this journal in 1985 (1). One could argue that the 2 groups should not be compared because the indicatons for induction of labour were different, and other clinical regimens had changed. Nonetheless this paper is important because it reaffirms that induction of labour, by amniotomy and oxytocin infusion, in nulliparas with an unfavourable cervix is likely to result in Caesarean section; in 43.5% in the previous study and 48.6% in the present subgroup. Patients may well elect to be managed by elective Caesarean section if counselled regarding the prospects of vaginal delivery with such a regimen when the cervical score is poor. The takeaway message is that prostaglandin vaginal pessaries (2 doses of 3 mg of PGE^, 4 hours apart) in such women reduces the Caesarean rate significantly, especially in those who come into established labour within 24 hours of insertion of the pessaries, or when the cervical score improved within 24 hours of their insertion.Summary: In a previous study nulliparas with poor cervical score (≤ 5 out of 10) had a 43.5% Caesarean section (CS) rate of which 55% were for failed induction when labour was induced by artificial rupture of membranes and oxytocin infusion. In this study induction of labour by 2 doses of 3 mg prostaglandin E2 (PGE2) vaginal pessaries, 4 hours apart, and if necessary by artificial rupture of membranes and oxytocin infusion 24 hours later, resulted in a CS rate of 23.7% of which 38.9% were for failed induction. The latter regimen resulted in a significantly lower CS rate compared with labour induced by oxytocin infusion and rupture of membranes without the use of prostaglandins (p < 0.001). In the prostaglandin group 53.3% were established in labour within 24 hours of inserting the pessary and in these patients the CS rate was 18.5%. In those who did not start labour and needed rupture of membranes and oxytocin infusion 24 hours after the first pessary, 34 (47.9%) had a good cervical score (≥ 6 out of 10) and 37 (52.1%) had a poor cervical score (≤ 5 out of 10) at the time of amniotomy. The CS rates in these groups were 8.8% and 48.6% respectively (p < 0.001). In nulliparas with poor cervical score induction is better performed with vaginal prostaglandin pessaries in order to reduce the high CS rate associated with artificial rupture of membranes and oxytocin infusion.
Completed Follow‐up of 1,000 Consecutive Transcervical Chorionic Villus Samplings Performed by a Single Operator
Authors: Wass Debbie M. , Brown Gillian A. , Warren Peter S. , Saville Toni A. 
Published: February 2008

Summary: Completed follow‐up data on 1,000 patients undergoing transcervical chorionic villus sampling (CVS) performed by a single operator at the Royal Hospital for Women is presented. Prior to the introduction of CVS, approximately 750 amniocenteses were performed annually in this unit. Over the past 5 years the total number of patients having CVS or amniocentesis has increased by Vi and almost Vi of procedures are now done by CVS.We have persisted with the transcervical route believing that once the learning curve is past, this route compares favourably with the transabdominal method in loss rate and perinatal outcome. We feel the transcervical approach is better tolerated by our patients and that less procedural difficulties are encountered. With increasing operator experience the total fetal loss rate to 20 weeks' gestation in our series declined to 2.1% and late complications were no more frequent than expected. In 98.4% of patients, sufficient villi were obtained for analysis. Culture failure was extremely uncommon, occurring only twice in our series. In 1.5% of patients, a follow‐up amniocentesis was required, which compares favourably with other published series.It appears that many units abandoned the transcervical route before loss rates were stabilized. In units where transcervical CVS is still performed the transabdominal route is also utilized. The reverse is not true. The authors feel that both procedures have a role in modern antenatal diagnosis.
Factors Associated with Failure to Receive Antenatal Care
Authors: Lumbiganon Pisake , Laopaiboon Malinee , Panamonta Manat , Pothinam Somporn 
Published: February 2008

EDITORIAL COMMENT: We seldom read why women in our community present late for antenatal care, fail to attend regularly or, heaven forbid, have no antenatal care at all. There are many countries where a large section of the population receives no antenatal care, even in nations where oil‐earned riches abound. It is an accepted fact that lack of antenatal care results in higher perinatal and maternal mortality nates. In Australia the causes of poor attendances are mainly socioeconomic (working mother, no baby minder, cost of fares), apart from general unreliability, and drug dependency with its associated problems. There is also the problem of communication with immigrant women who, in the editor's experience, are very cooperative and willing attenders when the aforementioned factors are not operative (some will attend only when accompanied by their husbands who speak better English, even when the hospital provides a good interpreter service). Nonattendance seems related more to poverty than ignorance ‐ this statement is an opinion and is not the result of the painstaking investigation that characterizes this paper from Thailand. The authors found that education of the husband is needed for his wife to receive the care she deserves; the details of maternal age and parity, and affluence of the family of these dwellers in 120 villages, in terms of antenatal attendance, should please readers with an interest in the problems faced by our colleagues in other lands. It also suggests that a careful audit of the causes of poor antenatal attendance and its sequelae should be undertaken in every community. The editor was surprised and dismayed to learn that at the Mercy Hospital for Women where he works such a study has not been conducted; provoked by this paper we will try to do better ‐ perhaps improvement of antenatal creche facilities may be the first priority required.Summary: A community‐based case‐control study was conducted to characterize pregnant women who did not receive antenatal care. 1,274 deliveries over a 1‐year period were documented by weekly visits to 120 study villages. Eighty five women (6.7%) received no antenatal care. By univariate analysis, factors found to be associated with failure to receive antenatal care included maternal age, paternal age, paternal education, home ownership, availability of toilet, annual income, housing condition, gravidity, parity, history of infant death and birth intervals. After logistic regression analysis, only paternal age, paternal education, parity and lack of toilet in the household were found to be associated with failure to receive antenatal care.
Ovarian Tumours in Pregnancy
Authors: El‐Yahia Abdul Rahman , Rahman Jessica , Rahman Mohammad Sayedur , Al‐Suleiman Suleiman A. 
Published: February 2008

EDITORIAL COMMENT: We agree with the authors of this paper that routine ultrasonography in the first trimester will diagnose many ovarian cysts that have been missed on clinical examination. However, we consider that the possibility of finding an unrecognized ovarian tumour is not an important item in the case for routine ultrasonography in pregnancy. Most cysts found incidentally are less than 5–10 cm in diameter, are asymptomatic, and can be treated conservatively; most are probably cysts of the corpus luteum. If the cyst is large, symptomatic or suspicious of malignancy (solid elements or complicated echos), then laparotomy is indicated as recommended by the authors. It should be noted that follicular and corpus luteum cysts, of which only 10 were included in this series, can occasionally reach large dimensions. In the rare patient who has rapid growth of an ovarian tumour during pregnancy, the histology is usually benign, mucinous cystadenoma. Figures 1A and B and the following mini‐case report are included in this comment to illustrate that even a huge cyst can be overlooked on clinical examination.Summary: Ovarian tumours associated with pregnancy were reviewed for the period 1982–1991. The overall incidence of this complication was 1:653 deliveries; 62.7% of the tumours were diagnosed in the first and second trimesters of pregnancy. The value of routine pelvic examination and ultrasonic scan as a diagnostic aid in early pregnancy is emphasized; 25.4% of patients presented as an acute emergency; 23.9% of the tumours were incidentally discovered at Caesarean section which underlines the importance of examining the ovaries at operation. Benign cystic teratomas were the most common ovarian tumours found, followed by serous cystadenomas. The incidence of malignant tumours was 4.5%. Whenever an ovarian tumour is found, the possibility of malignancy should always be borne in mind. Treatment of ovarian tumours in pregnancy should be tailored according to the age of the patient, parity, clinical presentation, gestational age and biology of the tumour.
Premenstrual Syndrome and Spironolactone
Authors: Burnet R. B. , Radden H. S. , Easterbrook E. G. , McKinnon R. A. 
Published: February 2008

Summary: A double blind placebo controlled randomized cross over study was conducted to assess the response to spironolactone by patients suffering from ‘Premenstrual Syndrome’. Somatic and neurophyschiatric symptoms were self‐assessed daily and a total score was calculated for each symptom for the 14 days prior to menstruation. No significant difference was noted for the symptoms assessed on or off spironolactone. The levels of oestradiol, progesterone and prolactin showed no changes from the first to the second half of the cycle.In those patients who did respond to spironolactone, a significant difference in androgen levels from the follicular to the luteal phase of the cycle prior to treatment was demonstrated. Significant differences in androgen levels from the follicular to the luteal phase of the menstrual cycle may therefore be an important determinant in predicting those patients with premenstrual syndrome likely to respond to spironolactone therapy.
Placenta Percreta Invading the Urinary Bladder
Authors: Altintas Aytekin , Özgünen Fatma Tuncay , Doran Saban , Doran Figen 
Published: February 2008

EDITORIAL COMMENT: Placenta praevia percreta is the most fearsome surgical complication of pregnancy. The incidence is steadily increasing as Caesarean section rates escalate, since in the majority of cases the patient has had a previous lower segment Caesarean section. This case report was accepted for publication to indicate to readers that elective cystostomy can facilitate hysterectomy in these cases. Successive triennial reports of maternal mortality in Australia have made the point that in cases of placenta praevia accreta the decision to perform hysterectomy should not be delayed. When the diagnosis is obvious after the abdomen has been opened the baby should be delivered by classical Caesarean section and, after rapid closure of the upper segment incision, hysterectomy should be commenced with the placenta undisturbed. It is best to begin the hysterectomy before attempted removal of the morbidly adherent placenta results in massive bleeding, which is often associated with disseminated intravascular coagulopathy. When adhesions to the bladder are dense it can be helpful, as the authors report in this case, to electively open the bladder to facilitate hysterectomy. In this case haematuria was an important warning that hysterectomy would be necessary and it was a brave decision to deliver this woman vaginally since the diagnosis of placenta percreta was as certain as it is ever likely to be before an attempt is made to deliver the placenta. Three of the 86 maternal deaths which occurred in Australia during the 1985–1987 triennium were due to haemorrhage from placenta praevia accreta.Summary: The case of a woman with a placenta percreta invading the urinary bladder treated by hysterectomy and partial bladder resection is presented. It is emphasized that if physicians in an emergency clinic are aware of this rare condition, preoperative diagnosis can be made and surgical intervention may be accomplished under ideal conditions.