bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transabdominal Chorionic Villus Sampling
Authors: Umstad Mark P. , Robinson Hugh P. , de Crespigny Lachlan Ch , Ngu Andrew C. 
Published: February 2008

EDITORIAL COMMENT: Chorion villus sampling is likely to replace genetic amniocentes'is in many patients mainly because the procedure can be performed so much earlier in pregnancy (8–12 weeks rather than 16–17 weeks) when the safety of termination of pregnancy, should this be required, is greater. Most recent reports state that the risk of genetic amniocentesis is less than 1 %, but readers may find it difficult to believe that the loss rate following chorion villus sampling is as low as 2–3% when the spontaneous abortion rate is about treble this figure in patients with apparently normal pregnancies who book for confinement with their obstetrician at about the time that chorionic villus sampling is performed. The important point to note is that, many patients with apparently normal pregnancies clinically at 8–10 weeks have a missed abortion (blighted ovum) which would not be diagnosed unless ultrasonography and/or estimation of urinary or plasma oestrogen and pregnanediol were performed.Summary: The first 100 patients undergoing first trimester transabdominal chorionic villus sampling (placental biopsy) in our hospital are reviewed. At the time of follow up 24 patients had delivered, 68 pregnancies were at 24 weeks or more and progressing normally, 7 pregnancies were terminated and there was only 1 spontaneous miscarriage. The advantages of the transabdominal approach are discussed.
Blood Transfusion and Caesarean section
Authors: Maxwell Chris N. 
Published: February 2008

EDITORIAL COMMENT: The AIDS epidemic has resulted in a reexamination of the need for blood transfusion and many patients express the wish to avoid a blood transfusion if possible. It is reasonably easy to reduce the incidence of blood transfusion for postpartum anaemia in a patient who is not bleeding — our criterion is a haemoglobin value of less than 8 g/dl whereas previously it was a value of less than 10 g/dl. This paper presents useful information concerning the incidence of urgent blood transfusion at Caesarean section, and argues that preoperative cross‐matching of blood is necessary only in patients with placenta praevia, abruptio placentae and severe preeclampsia. It may interest readers to note the following incidence of blood transfusion associated with Caesarean section at the Mercy Maternity Hospital, Melbourne: 13.7% of 1,214 Caesareans (1971–1974), 10.8% of 1,513 (1975–1977), 8.2% of 1,906 (1978–1980), 8.3% of 2,305 (1981–1983) and5.7% of 2,530 (1984–1986). We should remember that acute blood loss at Caesarean section cannot always be anticipated. If the author's recommendation for blood group and antibody screening alone for most patients is to be taken, the anaesthetist must always have an intravenous line in place, volume expanding fluids available and be prepared to give uncross‐matched blood of appropriate group and Rh type if the need arises.Summary: A clinical audit of 1,000 consecutive Caesarean sections at the Royal Women's Hospital indicated that 9.4% of patients required blood transfusion. Urgent blood transfusion was required in 53% of the 33 patients requiring Caesarean section because of placenta praevia, 43% of the 23 with accidental haemorrhage, 11% of the 36 with severe preeclampsia, but in only 2.3% of the remaining 908 patients.Blood was cross‐matched preoperatively in 47.7% of patients and 90% of this blood was either not administered or given as a delayed nonurgent procedure. It is suggested that routine preoperative cross‐matching of blood could be replaced by a blood type and antibody screening procedure for Caesarean sections being performed for those indications associated with low risk of blood transfusion requirement.
Gestational Trophoblastic disease in New Zealand, 1980 — 1986
Authors: Duff G.B. 
Published: February 2008

EDITORIAL COMMENT: This community based study reports an incidence of hydatidiform mole ofl in 1,497pregnancies in New Zealand, including spontaneous abortions, terminations of pregnancy and ectopic pregnancies. In 21% of the 299 histologically confirmed cases, the diagnosis of hydatidiform mole was made only, when the specimen was examined by a pathologist, illustrating the importance of routine examination of curettings. Analysis of the symptoms and signs on presentation indicated that the ‘classical’ presentation of hydatidiform mole (uterus large for dates, severe hyperemesis ± preeclampsia) is the least common. The most common presenting symptom was bleeding, illustrating the importance of ultrasonography in all patients with a threatened abortion. In this series the incidence of malignant sequelae was 10.9%.Summary: During the period 1980 to 1986 inclusive 350 cases of gestational trophoblastic disease were recorded within New Zealand; of these cases nearly 70% were reported to a Register established to obtain epidemiological information. Clinical information obtained with the notifications revealed no difference in incidence of gestational trophoblastic disease among the 3 main ethnic groups which make up the New Zealand population; the uterine fundus was recorded as being large for dates in only 26%; the most common clinical presentation was as a threatened abortion; 7% of the cases were diagnosed at either routine ultrasound examination or at termination of pregnancy, there having been no suspicions prior to that procedure. A review of histological material obtained following notification suggested that the histological diagnosis of trophoblastic disease could not be substantiated in 14.7% of cases. During the period under review, therefore, there were 299 cases of trophoblastic disease (all but 2 of which were hydatidiform mole) and 447,667 pregnancies giving an incidence of 1 case of trophoblastic disease per 1,497 pregnancies.
Deep Venous Thrombosis in Pregnancy and the Puerperium
Authors: Paraskevaides E. C. 
Published: February 2008

EDITORIAL COMMENT: How have we done so well in preventing maternal deaths from pulmonary thromboembolism when most deaths from this cause are judged to be unavoidable? The number of maternal deaths from thromboembolism in Australia has fallen 90% in the 7 reported triennial 44 (1964–1966), 43 (1967–1969), 22 (1970–1972), 11 (1973–1975), 13 (1976–1978), 8 (1979–1981), 4(1982–1984).The remarkable reduction in the death rate has continued although the Caesarean section rate, an acknowledged contributing cause, has continued to increase. How important is the reduction in the number of grand multiparas?In high risk patients (previous deep vein thrombosis, previous pulmonary thromboembolism) prophylactic therapy (aspirin, anticoagulation with heparin or warfarin) is indicated during pregnancy and for about 6 weeks after delivery, but prophylactic anticoagulation therapy in all patients having Caesarean section, in the Editor's opinion, is definitely not indicated — when he was a Resident Medical Officer at the Royal Women's Hospital, Melbourne, in 1957, routine prophylactic anticoagulation therapy with heparin was used in gynaecology patients having radical hysterectomy and in patients having Caesarean section. These were the days when the death rate from thromboembolism was a great deal higher than now. This therapy was abandoned because of the complications of the use of heparin short‐term, namely, haemorrhage into wounds. We should remember lessons learned by past mistakes. This paper provides a good review of those aspects of patient care in modern obstetrics that probably account for the considerable reduction in what was for many years the leading cause of maternal death in Australia and the United Kingdom.
Serum CA‐125 Levels m Women with Endometriosis
Authors: Fraser Ian S. , McCarron Gay , Markham Robert 
Published: February 2008

Summary: Forty‐two women with laparoscopically‐confirmed pelvic endometriosis (assessed according to the American Fertility Society modified classification) had serum levels of the cell‐surface antigen CA‐125 measured before, during and after medical therapy with nafarelin acetate or danazol combined with follow‐up laparoscopic surgery or laparotomy. Serum levels before treatment (39.3 [SE 6.61 U/ml) were elevated above accepted normal levels in many subjects, and these were highly significantly suppressed during medical therapy with both nafarelin and danazol (13.1 [SE 1.5] U/ml at 5 months); t = 3.198; p = 0.002). Levels tended to rise following therapy but a clear correlation between a rise in serum CA‐125 and recurrence of disease was not demonstrated.In 3 individuals treated with nafarelin a dramatic rise in serum CA‐125 levels was seen after 2 weeks of therapy. This did not correlate with any exacerbation of symptoms or with any rise in serum oestradiol or with pretreatment AFS scoring.Serum CA‐125 levels provide a potential approach to the monitoring of treatment and recurrence in a substantial proportion of women with endometriosis. although preliminary evidence suggests that there will be individual exceptions to any broad correlations.
Pulmonary Thromboembolism Complicating Recurrent Placental Abruption at 29 Weeks' Gestation
Authors: von Dadelszen Peter , Peddie David J. 
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication mainly because the discussion presents a useful review of the use of heparin in patients with placental abruption. Readers may be interested to know that the editor does not possess the ‘degree of courage’ advocated by Scott (5) in using intrapartum heparin to prevent disseminated intravascular coagulation in patients with severe placental abruption. Although the use of heparin is frequently discussed in such patients, the editor has never seen it used in patients with abruption in his 32 years of obstetric experience. Moreover there was a time in the 1960's when heparinization was used, in selected patients, at the Royal Women's Hospital, Melbourne, to control severe preeclampsia and achieve prolongation of pregnancy Fairley KF, Adey FD, Ross IC, Kincaid‐Smith P. Heparin treatment in severe preeclampsia and glomerulonephritis in pregnancy. Perspect Nephrol Hypertens 1976; 5:103–112., 3 of the 10 patients who presented before 30 weeks, and were treated with heparin, had living babies, but 2 accidental haemorrhages, 1 mild and I severe, both resulting in intrauterine fetal death, occurred in this group of women. As far as the editor can ascertain the occurrence of placental abruption in these patients led to the abandonment of heparin therapy in patients with preeclampsia in this hospital. The use of heparin in patients with glomerulonephritis, with or without associated preeclampsia, is a different problem. In the present report the patient's postoperative heparinization was continued in spite of the development of an abdominal wall haematoma and the need for 14 units of blood. Pulmonary thromboembolism is a risk to life but heparinization also has its problems. We leave it to readers to judge if they would have sterilized the patient, ‘under heparin prophylaxis 6 weeks after completing warfarin therapy’.ABSTRACT A patient with major pulmonary thromboembolism associated with recurrent placental abruption is described. Delivery by Caesarean section was necessary, followed by full heparinization. The use of peripartum heparinization and Caesarean section is reviewed.
Evaluation of an Antenatal Education Programme: Characteristics of Attenders, Changes in Knowledge and Satisfaction of Participants
Authors: Redman Selina , Oak Stephanie , Booth Peggy , Jensen Jean , Saxton Anne 
Published: February 2008

EDITORIAL COMMENT: As the authors of this paper point out there have been only 5 published studies exploring the operation of antenatal education programmes in Australia and New Zealand ‐ yet most obstetricians support the concept of antenatal education and recommend it to patients, especially their private patients. This paper provides the sort of data we need and will interest readers ‐ reading it will hopefully encourage obstetricians to support further studies of the best ways to deliver antenatal education to our patients and their partners/family members.Summary: The evaluation of the efficiency and effectiveness of antenatal education programmes has been identified as a priority in improving maternity services in Australia. Two hundred and ninety four primiparas completed a brief questionnaire in the 3 days following delivery; 82% of the women surveyed attended antenatal education classes. Women were less likely to attend if they were single, younger than 26 years, had lower levels of education, received care during pregnancy from the antenatal clinic and did not have private health insurance. Attenders at antenatal education were also more likely to plan on breast feeding, to be nonsmokers and to know of a greater number of community organizations to help new mothers. However, logistic regression analyses indicated that, with the exception of number of community organizations known, these differences were attributable to demographic differences between attenders and nonattenders. One hundred and forty two women and their partners attending the major provider of antenatal education classes in Newcastle were surveyed prior to and following classes. Significant increases in knowledge were evident following the programme among both women and their partners. Satisfaction with the programme was high as indicated by a large proportion of respondents attending all 4 classes, most programme components being reported as useful or very useful and only a small proportion of respondents experiencing problems with the programme.
Maximum Effort in the Management of Ovarian Cancer, Including Pelvic and Para‐aortic Lymphadenectomy
Authors: Allen D. G. , Planner R. S. , Grant P. T. 
Published: February 2008

EDITORIAL COMMENT: There is no doubt that the competent gynaecological oncologist has marvellous skill at removing tumour in women with Stages 3 or 4 ovarian cancer ‐ in the very type of patient regarded as inoperable 10–30 years ago by general gynaecologists. Present‐day general surgeons presumably have the skill, but apparently not the will, to remove tumour in women with metastatic bowel cancer, for reasons not clear to the editor. Is it established fact that removing as much tumour as possible is a waste of time in women with extensive peritoneal metastases from bowel cancer; or does the general surgeon have a different therapeutic philosophy because a high proportion of his patients with bowel cancer have early stage disease, a state of affairs not enjoyed by those who operate on women with carcinoma of the ovary? Readers must be patient and await the publication of the 2 to 5‐year results of treatment of women with ovarian cancer managed by members of this oncology unit in Melbourne.Summary Patients treated for ovarian cancer at the Mercy Hospital for Women, Melbourne over a 51/2 year period were studied with an emphasis on the need for lymphadenectomy. There were 80 patients identified with ovarian cancer. Forty patients underwent pelvic and/or para‐aortic lymphadenectomy and 25 (62.5%) were found to have lymph node metastases, in 7 of the 40 women the lymphadenectomy resulting in upstaging of the disease. FIGO has adopted a surgicopathological approach to the staging of ovarian cancer and this requires lymphadenectomy to be performed. The importance of accurate staging in clinically early ovarian cancer and maximum surgical effort in advanced disease is discussed with particular regard to the place of lymphadenectomy.
The Demographic Characteristics of Early and Late Attenders for Antenatal Care
Authors: Essex Charles , Counsell Anthea M. , Geddis David C. 
Published: February 2008

EDITORIAL COMMENT: The findings in this study will probably not surprise readers but the authors have established clinical markers for first antenatal attendance after 13 weeks' gestation in New Zealand. Although the authors provide references (1–4) for an association between late initial antenatal attendance and unfavourable perinatal results we urge them to analyze data from their own population and tell us what correlations exist.Summary: In the Royal New Zealand Plunket Society's 1990‐91 Cohort study, 581 of 4,286 women questioned (13.7%) had not initiated antenatal care until after the first trimester. These late attenders were more likely to be non‐European or of high parity; 42.9% of Pacific Islander mothers and 28.9% of Maori mothers did not initiate antenatal care until after the first trimester. Late attenders were also more likely to be unmarried, of lower socioeconomic status, young or with lower educational attainment. The reason for delayed antenatal care needs to be investigated and mothers who are high parity and non‐European need to be particularly targeted to encourage them to attend for antenatal care early.
Outpatient Hysteroscopy: A Comparison of 2 Methods of Local Analgesia
Authors: Finikiotis G. , Tsocanos S. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication to inform readers who perform hysteroscopy that the procedure can be done under local analgesia with minimal patient discomfort. This is important now that we must increase the number of patients managed as day cases and because in many major institutions hysteroscopies are still done under general anaesthesia.Summary: A prospective, randomized study was undertaken to objectively compare pain tolerance of 2 methods of local analgesia for outpatient hysteroscopy. Patients in group 1 received a paracervical block using 20 ml of 1% lignocaine. Patients in group 2 received a uterosacral block using 2 ml of 2% lignocaine. There was no statistical difference between the 2 groups (p = <0.65) in efficacy of pain relief. The method used for patients in group 2 reduces time and costs for outpatient hysteroscopy.
Value of Early Glucose Tolerance Testing in Women Who had Gestational Diabetes in Their Previous Pregnancy
Authors: Dong Z. G. , Beischer N. A. , Wein P. , Sheedy M. T. 
Published: February 2008

Summary: The patterns of glucose tolerance, clinical characteristics, and follow‐up results of 1,027 pregnant women who had gestational diabetes diagnosed in their previous pregnancy, were analyzed. Glucose tolerance testing was performed before 24 weeks (mean 16.6 ±4.5 weeks) in 180 women (group 1); when the result was normal the test was repeated at 26–30 weeks' gestation. In this group the incidence of recurrent gestational diabetes was 49.4%, and early testing diagnosed 61.8% of cases. Group 2 consisted of 685 women in whom glucose tolerance was tested only at 26–30 weeks' gestation. In this group the incidence of recurrent gestational diabetes was 34.0%. Group 3 consisted of 162 women in whom glucose tolerance was not tested in the subsequent pregnancy. Perinatal mortality rates in Groups 1 to 3 were 2.2%, 0.6% and 3.1% respectively in the pregnancy subsequent to that in which gestational diabetes was first diagnosed.The risk of emerging diabetes mellitus on follow‐up was greater in women in whom gestational diabetes was diagnosed early than in those diagnosed at the usual time (33.3% versus 12.5%, p<0.05).Analysis of the 13 perinatal deaths in Groups 1–3 revealed 5 that were potentially avoidable; none of the 3 women with recurrent gestational diabetes in the early tested group who had perinatal deaths received insulin in their subsequent pregnancies. Although perinatal deaths are unavoidable in some high‐risk pregnancies associated with gestational diabetes, this study suggests that early diagnosis of gestational diabetes may allow further reduction of perinatal mortality. However, early diagnosis is wasted unless it results in early treatment, including insulin therapy when dietary measures fail to control hyperglycaemia.Women who have had gestational diabetes in a previous pregnancy warrant glucose tolerance testing early in a subsequent pregnancy, since those with recurrent disease, especially when the degree of intolerance is severe, have a high perinatal mortality rate, which may be improved by early management.
Nonobstetrie Lower Genital Tract Trauma
Authors: Sau Ashish K. , Dhar Kalyan K. , Dhall Gian I. 
Published: February 2008

EDITORIAL COMMENT": We accepted this paper for publication to remind readers of the different types of nonobstetric trauma to the lower genital tract. The mechanism of tearing in the upper vagina during coitus is debated; this report does not favour the theory that tearing in the unsupported upper vagina results from levator spasm rather than direct injury (A).A. Ahnaimugan S, Asuen MI. Coital laceration of the vagina. Aust NZ J Obstet Gynaecol 1980; 20: 180–181.Summary: In a 4‐year‐period there were 31 admissions to Nehru Hospital, because of nonobstetrie injuries of the female genital tract. This constituted 0.8% of all gynaecological admissions over this period. The injuries were caused by voluntary coitus, automobile accidents and various types of astride injuries. Seven of the 18 patients with noncoital injuries presented with vulval haematomas and all were managed by evacuation under general anaesthesia. Two of the 13 patients with coital injury were admitted with haemorrhagic shock and required initial resuscitation with blood transfusion. The vaginal vault, especially the right and posterior fornices were the frequent sites of coital injury for parous women; on the other hand lower vaginal and introital injuries were caused by first acts of coitus. Except for trivial superficial lacerations with minimal bleeding, primary definitive surgical repair other than vaginal packing was favoured for better healing and to reduce morbidity.
A Direct Comparison of the Measurement of a Random Plasma Glucose and a Post‐50 g Glucose Load Glucose, in the Detection of Gestational Diabetes
Authors: McElduff A. , Goldring J. , Gordon P. , Wyndham L. 
Published: February 2008

Summary: We have compared the use of a random plasma glucose measured within 2 hours of a meal and a plasma glucose measured 1 hour after a 50 g glucose load to detect pregnant patients likely to have an abnormal 100 g glucose tolerance test at 28 weeks' gestation.The 50 g glucose load detected 24 of 28 women with gestational diabetes whereas the random plasma glucose detected only 13 of these patients. The 50 g glucose load gave fewer false positives, that is, patients who had an abnormal screening test but went on to have a normal glucose tolerance test (8.8% versus 13.4%).These data support the use of the 50 g glucose load to screen pregnant women for gestational diabetes as recommended by Australian authorities (1).