bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Diagnosis of Marginal Placental Abruption in Placenta Praevia Using Transvaginal Sonography
Authors: Haines Christopher J. , Stock Anthony 
Published: February 2008

EDITORIAL COMMENT The timing of delivery inpatients with recurrent antepartum haemorrhage before practical fetal maturity (37 weeks' gestation) has always required clinical judgement and still does, unless the patient is in labour, or haemorrhage is so severe that conservative management is clearly contraindicated ‐ or the fetus dead, or doomed by irremediable malformations. At earlier gestations maternal and fetal welfare must be assessed (full blood examination and coagulation screen for the mother, and cardiotocography ± biochemical testing of fetoplacental function for the fetus). Estimation of fetal pulmonary maturity may be assessed and maturity enhanced by betamethasone therapy if appropriate. These comments apply not only to patients shown by ultrasonography to have placenta praevia, but also to those where there is evidence of retroplacental bleeding and hence placental separation. This report presents the possible value of transvaginal sonography in patients with recurrent antepartum haemorrhage.The mother was delivered at 35 weeks' gestation and the baby was growth retarded (the Victorian tenth percentile for birth‐weight at 35 weeks is 1,760 g), although this was apparently not recognized before delivery. The timing of delivery was apparently not based upon cardiotocographic or biochemical evidence of fetal compromise. We consider that recurrent antepartum haemorrhage indicates Caesarean delivery, irrespective of the site of the placenta, because of the risk of placental separation in labour. However, the timing of delivery in such patients remains a topic for clinical argument in obstetric practice.
Perinatal Mortality in a Tertiary Obstetric Institution
Authors: Fliegner John R. H. 
Published: February 2008

EDITORIAL COMMENT: Readers may wish to ponder on the remarkably good results achieved in the Royal Women's Hospital Birth Centre where according to an enquiry made by the Editor electronic fetal heart rate monitoring is not performed. This casts some doubt on the Author's opinion that the low intrapartum mortality rate reported in this series from the Royal Women's Hospital is due to fetal heart rate monitoring in labour!Reply from Author: The 2 groups i.e. the Women's Hospital Birth Centre and the Public Hospital patients are in no way comparable. Patients attending the Royal Women's Hospital Family Birth Centre are a highly selected low risk group. Women with any significant risk factors are excluded e.g. hypertension, antepartum haemorrhage, prolonged pregnancy, low oestriol excretion, abnormal antenatal CTG, decreased fetal movements, meconium‐stained liquor, Syntocinon infusion, slow progress in labour and abnormality on auscultation of the fetal heart in labour.Despite these rigid criteria, there are still a number of asphyxiated babies born in the centre and there have even recently been 2 perinatal deaths. Perhaps this low rate of neonatal asphyxia would have been even lower with intrapartum CTG monitoring in these very low risk women.Summary: At the Royal Women's Hospital, Melbourne in the 3 years 1987–1989 analysis of the records of 13,347 public patients revealed an overall perinatal wastage of 20.8 per 1,000 births. This seemingly high figure resulted from the fact that 45% of losses occurred in nonbooked and emergency admissions. Many patients were referred with major complications of pregnancy, especially gross prematurity, lethal congenital malformations and intrauterine deaths. During the 3‐year period 74% of perinatal losses occurred before 33 weeks' gestation and only 10% were after 37 weeks. By comparison at a Victorian State level, 47% of perinatal deaths occurred before 33 weeks and more than 35% after 37 weeks' gestation. The major causes of perinatal wastage in both groups were similar. At the Royal Women's Hospital in the 3‐year period lethal congenital abnormalities accounted for 19.1% of fetal wastage, premature labour, premature rupture of the membranes and cervical incompetence 16.2%, multiple pregnancy 14.7%, antepartum haemorrhage 14.0% and hypertensive disorders 9.7%. During the 3‐year period 7.7% of hospital stillbirths were intrapartum compared to 27% for the State of Victoria.The stillbirth rate in Victoria has declined over the past decade, but to a lesser extent than the neonatal death rate. Over the 3‐year period 1987–1989 the ratio of stillbirths to neonatal deaths was 3 to 2, and in 1989 there were nearly twice as many stillbirths as neonatal deaths (424 versus 240). Furthermore, 55% of stillborn infants in Victoria had birth‐weights of more than 1,500 g compared to the Royal Women's Hospital figure of 36%. It is clear that future improvement in perinatal mortality rate must be aimed at the prevention of stillbirths in mature pregnancies.
Excessive Birth Weight and Maternal Glucose Tolerance A 19‐year Review
Authors: Shelley‐Jones David C. , Beischer Norman A. , Sheedy Mary T. , Walstab Janet E. 
Published: February 2008

Summary: The incidence of birth‐weight of 4,540 g (10 lb) or more rose from 0.87% in the years 1971 to 1977 to 1.16% in the 12 years from 1978 to 1989 with a concomitant increase in hyperglycaemia in our antenatal population. The relationship between excessive birth‐weight and maternal glucose tolerance was investigated in the light of these observations.The results from glucose tolerance tests performed routinely during the pregnancies of 510 women who delivered infants with a birth‐weight of 4,540 g or more were compared with those from a control series of 5,003 women with consecutively tested pregnancies. Glucose tolerance in subsequent pregnancies was also compared with the control series, and in 1991 the study group women were investigated for emergence of permanent diabetes mellitus.Excessive birth‐weight was associated with maternal hyperglycaemia (p < 0.05) but not with gestational diabetes; 79% of infants with birth‐weight ≥ 4,540 g were born to mothers who were not hyperglycaemic. There was no increase in glucose intolerance in subsequent pregnancies in the study group and only 2 of 49 women with follow‐up testing had diabetes mellitus.Birth‐weight ≥ 4,540 g occurred in 1.1% of the total population and 1.1% of women with gestational diabetes, and was related to maternal hyperglycaemia in about 1 in 5 cases. The increased incidence of excessive birth‐weight infants was not related to the increased incidence of gestational diabetes in our pregnant population. Birth‐weight ≥ 4,540 g had a poor association with later development of diabetes.
Danazol in the Treatment of Menorrhagia: The Effect of a 1 Month Induction Dose (200 mg) and 2 Month's Maintenance Therapy (200 mg, 100 mg, 50 mg or placebo)
Authors: Need Jillian A. , Forbes Kevin L. , Milazzo Louise , McKenzie Elaine 
Published: February 2008

Summary: This paper highlights the difficulties of recruiting subjects to objective menstrual blood loss (MBL) studies. Such difficulties may explain the relative paucity of such studies in the literature. Eleven women with objectively assessed evidence of menorrhagia were treated for 1 month with an induction dose of 200 mg of danazol (Danocrine). Subsequently the women were randomly assigned to receive 50,100 or 200 mg of danazol or placebo for 2 months of maintenance dosing. Follow‐up with objective assessment of MBL was continued for 3 months after cessation of maintenance dosing.Danazol 200 mg as an induction dose significantly reduced MBL. The maintenance dose of 200 mg during the following 2 months produced a further decrease in MBL and in some cases amenorrhoea. The lower maintenance dosages of 50 mg and 100 mg were associated with a variable response.The study was unable to determine whether any beneficial effect of the maintenance dosages of danazol could be maintained following cessation of therapy since the study numbers had become too small. It appears, however, that there is unlikely to be any persisting benefit once therapy has ceased.
Stress Management and Infertility
Authors: Shepherd Judy 
Published: February 2008

Summary: The author through personal experience has gained knowledge in the area of infertility and stress management. Her professional background supports the experiences, emotions and management techniques encountered with sound theoretical knowledge.This article deals with some of the procedures confronting a couple who experience infertility problems. It aims to explain and qualify common emotional responses experienced by couples and offers stress management strategies to improve their coping ability.
Placenta Praevia Percreta Invading the Urinary Bladder
Authors: Sanders R. R. 
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication for readers to contrast the pros and cons of conservative management of placenta praevia percreta when hysterectomy appears a formidable undertaking and haemorrhage from a partially separated placenta does not render immediate hysterectomy a necessity. The author was very careful to avoid disturbance of the placenta at Caesarean section. The author's letter to the editor quoted experience of a fatal case of placenta praevia percreta and the editor unfortunately can say the same. The deaths from placenta praevia percreta as stated in most triennial reports of Maternal Deaths in Australia usually occur because of failure to achieve lasting haemostasis at the time of Caesarean section followed by further surgery when the patient has lost a large quantity of blood (1985–1987 report; p24). The finesse used in this successfully treated patient is only feasible when haemorrhage has not occurred. We have previously commented that when performing hysterectomy for placenta praevia percreta it is probably wise to perform classical Caesarean section, close the uterus with the placenta undisturbed, and proceed to hysterectomy, perhaps with elective incision of the bladder wall if there is no plane between it and the lower uterine segment (see Editorial Comment. Aust NZ J Obstet Gynaecol 1991; 31: 71; see also Obstetrics and the Newborn, Beischer NA, Mackay EV, WB Saunders, Second Edition 1986; pi04 for photographs of a patient with a placenta praevia percreta treated as described above). Whenever the eventual hysterectomy is performed the main prerequisite, apart from a skilled anaesthetist and appropriate resuscitation facilities, is a surgeon familiar with radical pelvic surgery; this usually means a gynaecological oncologist.Summary: A case of placenta praevia percreta involving the urinary bladder is presented. A classical Caesarean section was performed at 35 weeks' gestation but the placenta was left in situ and an elective hysterectomy was successfully performed 2 weeks postpartum.
Postmenopausal Endometrioma and Hormonal Replacement Therapy
Authors: Goh J. T. W. , Hall B. A. 
Published: February 2008

EDITORIAL COMMENT: We accepted this case as its message will interest readers. Rarely the postmenopausal woman who is not taking hormone replacement therapy will present with obstruction of bowel or ureter due to chronic inflammation caused by inactive endometriosis (A, B).

Macafee CHG, Greer HLH. Intestinal endometriosis: a report of 29 cases and a survey of the literature. J Obstet Gynaecol Br Commonw 1960; 67: 539–555.
Lam AM, French M, Charnock FM. Bilateral ureteric obstruction due to recurrent endometriosis associated with Hormone Replacement Therapy. Aust NZ J Obstet Gynaecol 1992; 32: 83–84.

Summary: This case of postmenopausal endometrioma following hormonal replacement therapy (HRT) demonstrates the often forgotten possibility of reactivation of endometriosis with HRT. The diagnosis of endometriosis should be considered in a postmenopausal woman who presents with pelvic pain and mass whilst on HRT.
Breech Presentation in South Australia, 1987–1989
Authors: Jonas Oswald , Roder David 
Published: February 2008

Summary: This study compares the maternal, obstetrical, labour and pregnancy outcome characteristics of 2,412 breech‐presenting births with 17,946 vertex‐presenting births. Mothers of babies presenting as breeches were significantly more likely to have had a previous miscarriage, an obstetric complication, a threatened miscarriage or threatened labour during the current pregnancy, or Caesarean section than mothers of babies with vertex presentation. The babies presenting as breeches had significantly more neonatal morbidity and perinatal mortality. They showed higher rates of suspected intrauterine growth retardation, prematurity, low birth‐weight, low Apgar scores and congenital anomalies. The overall perinatal mortality for breech presentations was almost 9 times higher than for vertex presentations. Unconditional multiple logistic regression analysis showed that, even after adjusting for low birth‐weight and the presence of congenital anomalies, breech presentation still showed a statistically significant association with perinatal death.The study alludes to the possibility that breech presentation, in a significant number of cases, may not be coincidental but a marker for some preconceptional or prenatal disturbance.The study also shows am excess of breech presentations in females which is unexplained and may point to a genetic or hormonal susceptibility of the fetus.
Induction of Labour in Pregnancy Complicated by Cardiac Disease
Authors: Sau A. K. , Vasishta K. , Dhar K. K. , Khunnu B. 
Published: February 2008

EDITORIAL COMMENT": We accepted this paper for publication so readers could review their thoughts on induction of labour in women with cardiac disease; a series of 450 women with organic heart disease during pregnancy was required to provide the 21 cases presented. A woman with cardiac disease can rapidly go into heart failure after delivery and, since a physician is never present fin the editor's experience) the obstetrician must know what to do in this circumstance. Prophylaxis is preferable. Therefore all except Grade I cases (murmur without symptoms) merit delivery in the sitting position with the legs held horizontally by 2 assistants; oxygen and morphine should be available and aminophylline 250–500 mg by slow intravenous injection is one regimen used to anticipate and prevent the onset of failure with delivery of the placenta. These women withstand blood loss poorly and, in our view, intravenous oxytocin 5–10 units is recommended after completion of the second stage. If cardiac failure occurs the woman should be sat upright, given oxygen, morphine 15 mg preferably intravenously, and digitalized(1 mg in divided doses. I. V. over 24 hours). Intravenous frusemide (40–80 mg) is a rapidly‐acting diuretic that is also recommended and was given as a routine to all women in the present study, the drug being administered at the time of induction and at the onset of the second stage of labour.Summary: Twenty one pregnant patients with cardiac disease had induction of labour for various obstetric reasons with a modified oxytocin infusion method. All of them went into labour and delivered within 20 hours. Twenty patients delivered vaginally. Three neonates had birth asphyxia (Apgar score < 7) and 1 of them died on the 4th day from prematurity. No adverse effect of oxytocin infusion on maternal cardiac status was observed and all of the women went home in good condition. Induction of labour with a modified oxytocin infusion is a safe and effective alternative for selected gravidas with cardiac disease where elective delivery is warranted.
ECG Waveform Analysis in Intrapartum Fetal Monitoring
Authors: Loh F. H. , Arulkumaran S. 
Published: February 2008

Summary: Intrapartum cardiotocography (CTG) has a high false positive rate and, in the absence of facilities for fetal scalp blood sampling, is associated with increased operative deliveries for ‘fetal distress.It is presently possible to obtain a representative fetal ECG signal using the fetal scalp electrode. There is renewed interest in fetal ECG waveform analysis in the hope that it will improve the specificity of detecting intrapartum fetal hypoxia when there is an abnormal fetal heart rate pattern. Two portions of the fetal ECG are potentially useful: the ST waveform (T/QRS ratio) and the PR interval correlated with the RR interval.Animal experiments suggest that changes in the ST waveform, increase in the T wave amplitude in particular, reflect myocardial anaerobic metabolism. Clinical studies have shown poor correlation between the T wave changes and fetal heart rate changes. There is also concern that the sensitivity of the ST waveform changes for fetal acidaemia may be poor.More information is required before its use is incorporated into routine clinical practice.
Pregnancy Complicated by the Antiphospholipid Syndrome
Authors: Munday David N. , Jones Warren R. 
Published: February 2008

Summary: A patient with previously undiagnosed antiphospholipid syndrome (APS) developed atypical severe preeclampsia at 31 weeks' gestation. Other complications of pregnancy included intrauterine growth retardation, thrombocytopenia and fetal distress necessitating urgent delivery of a live infant. There was a prior history of unexplained jugular venous thrombosis. Prophylaxis against thrombosis was commenced immediately postoperatively and no postpartum complications occurred.Recent evidence supports the use of antepartum prophylaxis with low dose heparin in patients with APS. The role of low dose aspirin, either alone or in combination with heparin, is yet to be determined. Human immunoglobulin may be useful in selected cases. Early diagnosis is a key factor in their management.
Fetal Blood Sampling and Its Complications Related to the Indications for Fetal Blood Sampling
Authors: Anandakumar C. , Annapoorna V. , Chee Wong Yee , Chia Dawn , Bongso Ariff , Ratnam S. S. 
Published: February 2008

Summary: A prospective study on fetal blood sampling (FBS) was conducted in the Fetomaternal Medicine Division of the Department of Obstetrics and Gynaecology at the National University Hospital, Singapore. FBS was performed on 159 occasions in 156 women between January, 1988 and December, 1991. The aim of this study was to identify the factors that were associated with an adverse outcome following the procedure.Twenty four abnormal pregnancies were terminated; of the remaining 132 desired pregnancies the overall pregnancy loss was 44 (33.3%), which included those within 2 weeks and those after 2 weeks of the procedure and neonatal deaths. Fetal loss occurring within 2 weeks of the procedure is considered a procedure‐related loss which occurred in 19 (14.3%) of the 132 pregnancies. When the fetal loss occurred within 2 weeks of the procedure 89% had a major abnormality on ultrasonographic scanning.The conclusion from our study is that the risks of FBS were increased in abnormal pregnancies, most likely due to the underlying pathology.
Posthysterectomy Rectal and Vaginal Prolapse, a Commonly Overlooked Problem
Authors: Barham Kevin , Collopy Brian T. 
Published: February 2008

Summary: The existence of combined rectal and vaginal prolapse is more common than the literature would suggest. This paper outlines a further development in the operative management which has been applied to 24 patients with this problem. All had had a hysterectomy and most had had in addition one or more vaginal repairs. The common mode of presentation was one of pelvic pain (19 patients), sometimes severe, crippling and intractable and some form of protrusion (14 patients), difficult or unsatisfied defaecation and rectal incontinence (9 patients). The vaginal prolapse which always involved the vault and usually involved the lower vagina was usually found to be incomplete and the rectal prolapse complete (but occult).The operative procedure essentially consists of a Wells type rectopexy which has a new modification in which the sling is extended to anchor the vaginal vault after correction of the enterocele by the abdominal approach. A vaginal repair is subsequently performed at the same operation where anterior or posterior vaginal prolapse persists. Important points in the procedure are the avoidance of sepsis (the vaginal vault is not opened during the procedure) and protection of the ureters by careful assessment of the lateral margins of the vaginal vault which is illuminated by transvaginal vault endoscopy. At this early stage operative morbidity has been minimal, relief of the pelvic symptoms has been most encouraging, but the length of follow‐up is short (range 6–30 months, average 15.6) and long‐term evaluation will be necessary as with all surgery for prolapse.
Amniotic Fluid Insulin Values in Women with Gestational Diabetes as a Predictor of Emerging Diabetes Mellitus
Authors: Weerasiri T. , Riley S. F. , Sheedy M. T. , Walstab J. E. , Wein P. 
Published: February 2008

Summary: Amniotic fluid insulin levels were estimated in 30 women with insulin‐dependent diabetes, 216 with gestational diabetes and 27 with normal glucose tolerance. Results were correlated with birth‐weight, incidences of fetal macrosomia and neonatal hypoglycaemia, and the risk of the mothers with gestational diabetes developing diabetes mellitus on follow‐up.The women with prepregnaney diabetes had significantly higher amniotic fluid insulin values and showed a significant correlation between raised liquor insulin values (>97th percentile) and hypoglycaemia in the infant (p = 0.039).In the gestational diabetic pregnancies there were highly significant associations between elevated liquor insulin values and macrosomia (p <0.0045) and birth‐weight (p <0.00004), and a weak correlation with neonatal blood glucose levels (p = 0.042).Women with gestational diabetes who later developed permanent diabetes mellitus had higher mean amniotic fluid insulin levels than those whose glucose tolerance remained normal on follow‐up (p ≤0.0072) and more of them had a level greater than the 97th percentile than those whose glucose tolerance remained normal (odds ratio 6.48, 95% confidence interval 1.51–27.8, p = 0.0094). However a high amniotic fluid insulin level was of less clinical value for detection of women destined to develop diabetes (7 of 25, 28%) than was the need for insulin therapy during pregnancy (18 of 39, 46%).
Female Sterilization By the Vaginal Route: A Positive Reassessment and Comparison of 4 Tubal Occlusion Methods
Authors: Hartfield V. Jonathan 
Published: February 2008

Summary: Over the last 15 years female sterilization by the vaginal route has been abandoned in favour of the abdominal approach via a laparoscope or a suprapubic incision. This was justified when the vaginal route was used for a fimbriectomy or a Pomeroy type of sterilization. The use of tubal occlusion methods designed for the laparoscope has simplified the technique of vaginal sterilization and lowered the morbidity.Four hundred and ninety consecutive cases over an 18‐year period are reviewed. Four hundred and eighty five were completed vaginally. The methods used were Pomeroy with catgut, Falope ring, Hulka and Filshie clips. The Filshie clip was the most satisfactory. Vaginal sterilization is suitable for day care. The readmission rate was 1%. There was no case of pelvic infection in 177 clip cases but 5 in 173 where the Pomeroy technique was used. The pregnancy rate was highest with the Hulka clip. The overall rate was 1%. With clip methods strong analgesics were only required in 6% postoperatively and only 14% took any analgesic after returning home; consequently return to normal activities was rapid. The patient's weight was not related to operative difficulty when clips were used so the vaginal route may prove to be the method of choice in the obese. Filshie clip sterilization via the posterior fornix of the vagina could be the most cost‐effective method of sterilization available at present. The vaginal route needs reappraisal using contemporary methods of tubal occlusion.