bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors associated with pregnancy or miscarriage after clomiphene therapy in WHO Group II anovulatory women: a study conducted at Fertility Plus, National Women's Hospital, Auckland
Authors: Milsom Stella R , Gibson Gillian , Buckingham Karen , Gunn Alistair J 
Published: October 2004

ABSTRACTObjectivesThe present study was designed to determine whether clinical and endocrine characteristics assessed on initial screening of normogonadotropic oligo/amenorrhoeic infertile patients could predict ovulation and then conception and successful live birth or miscarriage.Study designRetrospective cohort study.SettingOutpatient clinic.PopulationEighty‐two consecutive women receiving clomiphene citrate (CC) therapy from 1993 to 1998.ResultsA cumulative conception rate of 67% was reached after six or more CC‐induced cycles. Patients with failure of ovulation after a full course of CC had more severe oligomenorrhoea (p < 0.001) and greater BMI (p < 0.05) at initial screening. There was no relationship with levels of LH or androgens. In contrast, among women who ovulated in response to CC, conception was associated with less frequent periods, and higher basal levels of LH, free testosterone and androstenedione. Conceptions with subsequent miscarriage were associated with intermediate levels of LH and numbers of spontaneous periods between non‐conception and live births.ConclusionsThese observations are consistent with the hypothesis that failure of ovulation after CC is related to different factors (overweight and severe oligomenorrhoea) from those that predispose to non‐conception (low basal LH and androgen levels and mild oligomenorrhoea).
Trends in labour and birth interventions among low‐risk women in New South Wales
Authors: Roberts Christine L , Algert Charles S , Douglas Ian , Tracy Sally K , Peat Brian 
Published: October 2004

ABSTRACTObjectiveTo examine recent trends in obstetric intervention rates among women at low‐risk of poor pregnancy outcome.DesignCross‐sectional analytic study.Setting and PopulationA population of 336,189 women categorised as low‐risk of a poor pregnancy outcome who gave birth to a live singleton in NSW from 1 January 1990 to 31 December 1997.Main outcome measuresObstetric intervention rates including oxytocin induction and augmentation of labour, epidural analgesia, instrumental births, caesarean section and episiotomy.MethodsTrends over time were assessed by fitting trend‐lines to numbers of births or by trends in proportions. Unconditional logistic regression was used to assess the impact of epidural analgesia on instrumental birth over time.ResultsRates of operative births did not rise despite increases in maternal age and use of epidural analgesia. Instrumental births declined over time from 26% to 22% among primiparas and 5% to 4% among multiparas. There was also a shift to vacuum extraction rather than forceps. Although instrumental birth was strongly associated with epidural analgesia, the strength of the association declined over the study period, for primiparas from an adjusted odds ratio of 7.2 to 5.2 and for multiparas from 13.2 to 10.3.ConclusionsIncreased use of epidural analgesia for labour has been a feature of the management of birth at term during the 1990s. The decline in the strength of association between epidural analgesia and instrumental birth may reflect improved epidural techniques and management of epidural labour, and recognition of the adverse maternal outcomes associated with forceps and vacuum births.
Late antenatal carriage of group B Streptococcus by New Zealand women
Authors: Grimwood Keith , Stone Peter R , Gosling Isobelle A , Green Robyn , Darlow Brian A , Lennon Diana R , Martin Diana R 
Published: October 2004

ABSTRACTObjectivesTo determine in New Zealand women the prevalence of group B Streptococcus (GBS) carriage late in pregnancy and to identify GBS colonisation risk factors, antibiotic susceptibility and serotype distribution.DesignProspective, observational study.SettingCommunity and hospital antenatal clinics in Wellington and Auckland during 1998–1999.SampleConvenience sample of 240 women between 35–37 weeks gestation.MethodsSociodemographic data, obstetric details and anogenital swabs were collected from each subject. Swabs were inoculated into selective media. GBS isolates underwent serotyping and antibiotic susceptibility testing.ResultsTwo hundred and forty women (9% Maori, 11% Pacific) aged 15–41 years were recruited. Fifty‐two (22%; 95% CI 17, 27) were colonised by GBS. Carriage was independently associated with younger age (59%≤ 30 years; adjusted OR 3.25; 95% CI 1.53, 6.95) and least social deprivation (57% NZ Dep 96 score ≤ 3; adjusted OR 1.22; 95% CI 1.06, 1.39). All GBS isolates were penicillin‐susceptible, but resistance to clindamycin (15%) and erythromycin (7.5%) was detected and associated with serotype V strains. Predominant serotypes were: III (29%), Ia (21%), Ib (20%) and V (20%).ConclusionsApproximately 20% of New Zealand women carry GBS late in pregnancy, with young age a major risk factor. Increased risk in the socially advantaged, development of resistance to erythromycin and clindamycin, and emergence of new GBS serotypes are findings with important implications for prevention strategies requiring further confirmation.
Aboriginal teenage pregnancies compared with non‐Aboriginal in South Australia 1995–1999
Authors: Westenberg Leontine , van der Klis Karin AM , Chan Annabelle , Dekker Gustaaf , Keane Rosemary J 
Published: October 2004

ABSTRACTObjectiveTo compare pregnancy characteristics and outcomes between Aboriginal and non‐Aboriginal teenagers.Design, setting and populationA retrospective cohort study using the perinatal data collection for South Australian births in 1995–1999: 449 Aboriginal and 4625 non‐Aboriginal teenagers.MethodsComparison of socio‐demographic and clinical characteristics, using relative risks.Main outcome measuresRates of pregnancy, smoking during pregnancy, induction, delivery method, preterm and small‐for‐gestational‐age births and perinatal mortality.ResultsAboriginal teenagers have a pregnancy rate more than twice as high as non‐Aboriginal, but a smaller proportion of pregnancies are terminated. They have pregnancies earlier, are more likely to be single, to smoke during pregnancy, to have few antenatal visits, to give birth in a country hospital and to have infections and anaemia. They have lower induction and analgesia rates, but a higher caesarean section rate. Their babies are more likely to be small‐for‐gestational‐age and preterm, to have a congenital abnormality, to require special and intensive nursery care and stay longer in hospital. While their perinatal mortality rate has halved since a decade ago, their neonatal death rate is still twice that of non‐Aboriginal births.ConclusionsAboriginal teenagers need special attention. Support in particular is needed for Aboriginal health workers in preconceptional counselling and health promotion programs that build the capacity of the community, eg concerning proper nutrition during pregnancy, smoking cessation, breastfeeding, SIDS prevention, support for early and regular attendance for antenatal care in friendly and culturally appropriate environments. Outreach services and sexual health services for young Aboriginal people also need expansion.
A prospective study of the short‐term outcomes of hysterectomy with and without oophorectomy
Authors: Farquhar CM , Sadler L , Harvey S , McDougall J , Yazdi G , Meuli K 
Published: October 2004

ABSTRACTObjectiveTo determine the symptom profile and satisfaction rate for women undergoing hysterectomy with and without oophorectomy.Study designWomen under 46 years of age who underwent hysterectomy with (n = 266) and without oophorectomy (n = 57) were followed for six months.ResultsSatisfaction was high at six months. In‐hospital complication rates were 28% in Group 1 and 39% in Group 2 (p = 0.11). Pelvic pain was reported in more than half the women at six weeks. A reduction in constipation, diarrhoea, abdominal and pelvic pain, and depression was reported at six months. Quality of sexual function in women did not improve. New symptoms of pelvic pain or depression were present at six months in more than 16% to 37% of the women. Regrets about loss of fertility were increased at six months.ConclusionsAlthough levels of satisfaction with the procedure of hysterectomy were high, new symptoms and regrets about the loss of fertility were commonly reported.
The benefits and problems associated with minimal access surgery
Authors: Garry Ray 
Published: October 2004

ABSTRACTThe place of minimal access surgery (MAS) in current gynaecological practice remains controversial. As a consequence, MAS techniques have been subject to a significant amount of prospective, evidence‐based assessment. The ultimate results of these comparative trials will undoubtedly have a profound impact on the future direction of our speciality. It is timely, therefore, to review the currently available data.Evidence from 2195 patients in 23 randomised clinical trials of five different treatment modalities (ectopic, ovarian cysts, myomectomy, colposuspension and hysterectomy) clearly demonstrates that uncomplicated MAS procedures produce patient‐friendly benefits, at least in the short term. No matter what operation is performed, the laparoscopic approach is associated with less pain, shorter hospital stay and shorter recovery. These immediate patient‐orientated benefits are a generic consequence of replacing the manoeuvres of open surgery through laparotomy incisions with minimal access. These benefits must be offset against significant disadvantages.Minimal access surgery procedures always require the use of expensive, high technology equipment and usually take longer to perform. Such procedures may be more costly than current open procedures and costs will, in part, be dependent on the amount of disposable equipment employed.Patients undergoing MAS procedures may be at risk of new and/or increased risk of traditional complications. The longer‐term results of most MAS procedures have not yet been determined.These potential benefits and disadvantages of MAS require that each procedure is carefully and individually assessed. This paper seeks to review the current evidence.
A survey of entry techniques and complications of members of the Australian gynaecological endoscopy society (AGES)
Authors: Kaloo Philip , Cooper Michael , Molloy David 
Published: October 2004

ABSTRACTObjectiveTo identify various aspects of laparoscopic entry technique and visceral injury experienced by members of the Australian Gynaecological Endoscopy Society (AGES).DesignA retrospective mailed survey.SampleAll members of the Australian Gynaecological Endoscopy Society (AGES).Main outcome measuresNumbers of bowel and major retroperitoneal vascular injuries experienced, entry techniques utilised, alternative entry sites.ResultsOf the respondents, 73% use a Veress needle entry. In subjects with an increased risk of peri‐umbilical adhesions 83% of respondents use an alternate site of entry, 66% of which use Palmer's point. Sixtyfour per cent of respondents had experienced one or more bowel injuries, 21% had experienced major retroperitoneal vascular injury, 33% of respondents had no plan in place for the management of vascular injury and 51% of respondents would alter their clinical practice if accepted entry technique guidelines were available.ConclusionsThe majority of respondents use the Veress needle method of entry, have had at least one entry‐related bowel injury and use Palmer's point as an alternative entry site in high‐risk subjects. The majority of subjects would alter their clincal practice if accepted entry technique guidelines were available.
An Australasian survey of the management of hydrosalpinges in women due to undergo in vitro fertilisation
Authors: Johnson Neil P , Norris Julie 
Published: October 2004

ABSTRACTObjectiveTo ascertain current practice of surgical interventions for women with hydrosalpinges prior to in vitro fertilisation and to compare this with a subsequent systematic review of the literature.DesignSurvey.SettingSpecialists in Australasian IVF clinics.MethodsQuestionnaire sent to all specialists in Australasian IVF clinics via the clinical directors of these units.ResultsThere were 79 respondents from 33 fertility clinics. Although only 66% expressed a belief that there was convincing evidence of an improvement in pregnancy outcomes from surgical treatment for hydrosalpinges prior to in vitro fertilisation, 94% currently offer surgical treatment for hydrosalpinges prior to in vitro fertilisation, 32% always and 62% only in selected cases. Of the 74 respondents offering surgery, all but three expressed a preference for the laparoscopic approach. Of those offering surgery, 89% performed unilateral or bilateral salpingectomy depending whether unilateral or bilateral hydrosalpinges were present, 5% routine bilateral salpingectomy, 14% proximal tubal occlusion with clips, 24% salpingostomy, 7% ultrasound‐guided needle aspiration of hydrosalpinges at the time of egg collection.ConclusionsThe diverse practice among Australasian fertility specialists reflects the apparent conflict in the literature prior to this survey. A Cochrane Review has now demonstrated the efficacy of laparoscopic salpingectomy in improving the odds of live birth for women with hydrosalpinges due to undergo in vitro fertilisation. It will be interesting to review whether this leads to greater uniformity of practice in the coming years.
IVF and tubal pathology — not all bad news
Authors: Johnson Neil P , Sadler Lynn , Merrilees Margaret 
Published: October 2004

ABSTRACTObjectivesIn light of evidence that hydrosalpinges compromise the chance of success of in vitro fertilisation (IVF), the aim of this study was to analyse the results of IVF treatment at our clinic in relation to the cause for infertility and to make inferences concerning the impact of mild tubal disease on IVF outcome.DesignRetrospective observational study.SettingTertiary fertility clinic in New Zealand.PopulationNine hundred and six consecutive cycles among 639 couples receiving IVF treatment in the six‐year period 1995‐2000 inclusive.MethodsData extraction from the clinic database.ResultsThe clinical pregnancy rate of 17.5% per ovarian stimulation cycle and 23.9% per embryo transfer for the cycles of couples with tubal disease as the only cause for infertility was not significantly different from the clinical pregnancy rate of 15.4% per ovarian stimulation cycle and 24.1% per embryo transfer for all other couples undergoing IVF.In the cycles of women with tubal disease, the clinical pregnancy rate of 6.6% per ovarian stimulation cycle where other causes for infertility were also present, was significantly lower than the clinical pregnancy rate of 17.5% where tubal factor alone was present.In the cycles of couples with multiple causes for infertility, where the overall pregnancy rate was 10.9% per ovarian stimulation cycle, there was no significant difference in pregnancy rate between those whose multiple causes included tubal disease (6.6% per ovarian stimulation cycle) and those whose multiple causes did not include tubal disease (17.5% per ovarian stimulation cycle).ConclusionThe overall population of women with tubal disease as the sole cause for infertility (including women with hydrosalpinges and those with non‐hydrosalpinx tubal disease) does not have an overall reduced likelihood of success at IVF. This suggests that non‐hydrosalpinx tubal disease does not compromise the chance of success from IVF. Surgical treatment prior to IVF for the milder forms of tubal disease is not warranted.
Immediate and associated complications of hysterectomy for benign disease
Authors: Tamizian O , Gilby J , Symonds IM , Cust MP , Arulkumaran S 
Published: October 2004

ABSTRACTAbdominal and vaginal hysterectomy are common operations for benign gynaecological conditions. Though safe operations, they are not without complications. Good medical practice requires that patients be fully counselled regarding risks involved in undergoing medical interventions. This can only be done by regular review of local practice and comparison with national and international standards. We have reviewed 502 case notes of patients who have undergone a hysterectomy for benign conditions over an 18‐month period.
Complications of laparoscopic hysterectomy: the Monash experience
Authors: Tsaltas J , Lawrence A , Michael M , Pearce S 
Published: October 2004

ABSTRACTA retrospective review of medical records was performed to assess the incidence and type of significant complications encountered during laparoscopic hysterectomy. Two hundred and sixty‐five consecutive patients were reviewed between the years 1994 and August 2001. Two hundred and thirty‐two laparoscopic vaginal hysterectomies and 33 total laparoscopic hysterectomies were performed.The operations were performed at Monash Medical Centre, a Melbourne tertiary public hospital, and two Melbourne private hospitals, by three surgeons. Ten significant complications occurred. There were two cases of ureteric fistula, two bladder injuries, two bowel obstructions, two postoperative haematomas, one case of a bladder fistula and one superficial epigastric artery injury. In‐patient stay ranged from two to six days. Our complication and in‐patient stay rates are consistent with previously reported rates.
Early‐onset group B Streptococcus prevention protocols in New Zealand public hospitals
Authors: Gosling Isobelle A , Stone Peter R , Grimwood Keith 
Published: October 2004

ABSTRACTObjectiveDetermine group B streptococcus (GBS) prevention protocols.MethodsQuestionnaire survey of 19 hospitals accounting for 73% of New Zealand births.ResultsPrevention policies were reported by 16 (84%) hospitals (bacteriological‐screening n = 4, risk‐factor determination n = 8, both strategies n = 4). Only five out of 12 (42%) centres using risk‐assessment administered antibiotics for all high‐risk criteria. Inadequate specimen collection and culture methods meant no hospital maximised culture‐based strategies. Nevertheless, hospitals with prevention policies had lower early‐onset GBS disease rates (0.46 versus 1.44 per 1,000 births; OR 0.32; (95% CI 0.12, 0.98)).ConclusionsPrevention strategies can be further improved by hospitals fully implementing nationally agreed guidelines.
A survey of practice preferences and attitudes to the New Zealand Guidelines for the Management of Heavy Menstrual Bleeding
Authors: Park Serena , Farquhar CM 
Published: October 2004

ABSTRACTObjectiveTo survey the practice preferences and the attitudes of New Zealand gynaecologists, general practitioners and family planning doctors to Guidelines for the Management of Heavy Menstrual Bleeding.Study designA postal survey collected information on the following: demographics, practice preferences, knowledge of, usage of and attitudes toward the Guidelines for the Management of Heavy Menstrual Bleeding. The survey was sent to randomly selected practising general practitioners (n = 531), all specialist gynaecologists (n = 194) and all Family Planning Association doctors (n = 69) in New Zealand. Replies were received from 441 (56%).ResultsThe preferred first choice for the management of heavy menstrual bleeding by general practitioners and family planning doctors was nonsteroidal anti‐inflammatory medications (23%). Tranexamic acid was the preferred first choice medication for the management of heavy menstrual bleeding by specialists (57%), and preferred second choice (as well as levonorgestrel intrauterine system) by general practitioners and family planning doctors (34%). Barriers identified by general practitioners and family planning doctors to implementing the guideline included inability to access ultrasound scanning and specialist services, and a lack of subsidy for tranexamic acid and the levonorgestrel intrauterine system.ConclusionsThere has been a change in prescribing patterns since 1995 among specialist and general practitioners and family planning doctors in New Zealand in accordance with the Guidelines for the Management of Heavy Menstrual Bleeding. Further attention to reducing barriers should focus on increasing access to ultrasound scanning, specialist services and subsidising the levonorgestrel intrauterine system.
Clinical relevance of urokinase‐type plasminogen activator and its inhibitor type 1 (PAI‐1) in squamous cell carcinoma of the uterine cervix
Authors: Horn LC , Pippig S , Raptis G , Fischer U , Köhler U , Hentschel B , Martin R 
Published: October 2004

ABSTRACTObjectiveThe expression of uPA and PAI‐1 as parameters of tumour‐associated proteolysis has been implicated in the process of tumour cell invasion and the metastatic process. However, there is limited information on the impact of these parameters in cervical carcinoma.MethodsQuantitative levels for uPA (n = 114) and PAI‐1 (n = 103) were researched in operatively treated, surgically staged squamous cell cancer of the uterine cervix, using an ELISA‐technique. Results were assessed regarding their impact in predicting pelvic lymph nodes metastases, tumour recurrence rate and recurrence free survival (RFS) using uni‐ and multivariate analysis.ResultsMedian levels of both parameters were significantly higher in tumour tissue than in normal cervical tissue (p < 0.001). Detection of uPA gave no useful prognostic information. PAI‐1 concentration showed a positive correlation with advanced tumour stage (p = 0.008), but no significant correlation with nodal status (pN0: 2.6 vs. pN1: 4.0 ng/mg protein; p = 0.092). Using a cut‐off level of 2.4 ng/mg protein, patients with elevated PAI‐1 levels demonstrated reduced RFS (45.9 versus 52.9 months; p = 0.1). Multivariate analysis, including nodal status, tumour stage, lymphovascular space involvement and grading failed to demonstrate any prognostic impact of uPA and PAI‐1.ConclusionsThe results indicate, that PAI‐1 expression is of some prognostic impact in cervical cancer, indicating an association of elevated PAI levels with local tumour progression and reduced recurrence‐free survival.
The pre‐operative identification of low‐risk endometrial cancer: an audit of women treated in the South Island of New Zealand 1998–2000
Authors: Sykes P , Nam S , Wynne C , Anderson N , North J , Hunter L , Laney M , Fentiman G 
Published: October 2004

ABSTRACTObjectiveTo assess if determine whether pre‐operative investigations identify a group of patients with low‐risk endometrial cancer, that who do not require tertiary referral for surgical staging or pelvic radiotherapy.DesignRetrospective chart review.SettingSouth Island of New Zealand gynaecological oncology services.SampleOne hundred and forty consecutive patients with newly diagnosed endometrial cancer from 1988 to 2000.MethodsThe results of preoperative investigations were compared with the final pathology.Main outcome measuresCorrelation of preoperative investigations with low risk disease. For the purpose of the study, women with grade 1 or 2 endometrioid tumours confined to the uterine body and less than 50% myometrial invasion were considered to have low risk disease.ResultsIn total, 50 women had low risk disease. Only 53% of patients with grade 1 tumours on initial biopsy had‘Llow risk disease. Women who had a grade 1 tumour at biopsy and, an ultrasound report with an endometrial thickness of less than 20 mm, and no evidence of myometrial invasion, cervical involvement or adnexal metastasis had a 76% chance of having low risk disease.ConclusionWe were unable to accurately define the low risk group from pre‐operative assessment.