Showing papers in "Australian & New Zealand Journal of Obstetrics & Gynaecology in 1994"
TL;DR: No differences existed between women with PCO and normal ovaries with respect to uterine size, body mass index, luteinizing hormone levels, serum hormone binding globulin levels and fertility status, but hirsutism, elevated testosterone levels and irregular menstrual cycles were significantly more frequent amongst women withPCO.
Abstract: Polycystic ovaries (PCO) diagnosed by ultrasound have been commonly reported amongst healthy women. The study aimed to determine the prevalence of PCO in a population of women from the community, and to relate it to clinical and endocrinological data. Twelve hundred women chosen randomly from electoral rolls were invited to take part in the study. Two hundred and fifty five women (21%) who met eligibility criteria greed to participate and 183 women 916%) finally completed the study. Seventy two women did not attend. An ultrasound scan and blood tests were taken on day 5-9 of their menstrual cycles. Data about their menstrual periods and reproductive history was collected. The prevalence of PCO was 21% (39 of 183). No differences existed between women with PCO and normal ovaries with respect to uterine size, body mass index, luteinizing hormone levels, serum hormone binding globulin levels and fertility status. Hirsutism (Ferriman Gallwey score > 7), elevated testosterone levels and irregular menstrual cycles were significantly more frequent amongst women with PCO. Mean ovarian volume was larger in women with PCO irrespective of the use of hormonal contraception. Fifty nine per cent of women with PCO had irregular menstrual cycles or elevated Ferriman Gallwey scores or both. There was no detectable effect of PCO on parity or miscarriage although only 70% of women with PCO had evidence of an adequate ovulation compared to 95% of women with normal ovaries.
238 citations
TL;DR: Growth percentiles require periodic revision because of changes in the ethnic mix of a population and socioeconomic factors, and factors such as sex of the infant and ethnic origin of the mother should be considered.
Abstract: Growth percentiles require periodic revision because of changes in the ethnic mix of a population and socioeconomic factors. Anthropometric measurements were derived from singleton livebirths, without lethal malformations, from 22 completed weeks' gestation, at the Mercy Hospital for Women, Melbourne, from 1980 to 1989 (49,429 infants). Infants were included if reasonable assessment of gestation was available. Birth-weight percentiles were derived for the study group, male and female infants separately and for infants whose mothers were born in South-East Asia (Vietnam, Laos and Cambodia). Percentile charts for length, head circumference and ponderal index were also prepared. When compared with the intrauterine birth-weight growth curves reported by Kitchen et al (4) there was generally an elevation of all percentiles. Male infants were larger than female infants. Infants delivered by mothers born in South-East Asia were smaller than the study group as a whole, although the 10th percentiles for birth-weight were similar to the study group especially from 36-39 weeks' gestation. Periodic review of local standards is required to correctly categorize newborn infants' growth characteristics; factors such as sex of the infant and ethnic origin of the mother should be considered.
114 citations
TL;DR: Although uterine AVM is a rare cause of menorrhagia or postmenopausal bleeding, accurate diagnosis can allow appropriate treatment to be planned and avoid hysterectomy in women who wish to retain their reproductive capacity as mentioned in this paper.
Abstract: Summary: Uterine arteriovenous malformation (AVM) is a rare cause of massive uterine bleeding, with 70 cases reported in the English literature. Although uterine AVM is a rare cause of menorrhagia or postmenopausal bleeding, it is important to consider in the assessment of a patient with abnormal (especially heavy) uterine bleeding because accurate diagnosis can allow appropriate treatment to be planned and avoid hysterectomy in women who wish to retain their reproductive capacity. Until relatively recently this condition was difficult to diagnose and management almost always required hysterectomy. Special investigations (hysteroscopy, Doppler flow ultrasound and pelvic angiography) are important for diagnosis and assessment. Transcatheter embolization has replaced hysterectomy as the treatment of choice in women who wish to retain their fertility. Curettage may precipitate life-threatening haemorrhage and is therefore contraindicated when uterine AVM is suspected.
87 citations
TL;DR: The patient and the surgeon would of course prefer to avoid these complications, but it is the major wound infections, with or without disruption, that really matter, and which hopefully have a reduced incidence when intraoperative antibiotic administration is practised.
Abstract: A prospective study was performed between April 1, 1991 and April 30, 1992 to determine factors involved in the development of post-Caesarean section wound infection. During this period there were 4,857 deliveries, 428 by Caesarean section (8.8%). Complete data were available on 328 (76.6%) patients. Wound infection occurred in 25.3% of women and was confirmed by positive bacteriology in 77.1%; 36% of wound infections were diagnosed following the patients' discharge from hospital. A negative correlation was found between maternal age and development of wound infection up to age 40 (p = 0.03). Maternal weight was a highly significant indicator of subsequent wound infection development (p = 0.0001), the relationship between increasing maternal weight and infection appearing linear. Antibiotic prophylaxis was found to be the most significant protective factor (p = 0.0007) in the reduction of postoperative wound infection. This relationship was independent of maternal weight.
78 citations
TL;DR: The clinical and urodynamic findings in 1,193 consecutive women referred for investigation of urinary incontinence and other urinary symptoms were reviewed and voiding disorders are a common cause of lower urinary tract dysfunction.
Abstract: The clinical and urodynamic findings in 1,193 consecutive women referred for investigation of urinary incontinence and other urinary symptoms were reviewed. Impaired bladder emptying was defined as a repeated maximum flow rate below 15 ml/second or a residual urine volume of 150 ml or more. One hundred and sixty-five women were diagnosed as having voiding dysfunction. Fifty-six of the 165 women (34%) had a residual urine volume of 150 ml or more. Voiding dysfunction was the only abnormal urodynamic finding in 27 women and was associated with genuine stress incontinence, detrusor instability or bladder hypersensitivity in a further 138 patients. Overflow incontinence was diagnosed in 7 women (0.5%). Symptoms of impaired bladder emptying were significantly more common in women with proven voiding dysfunction but were absent in a third of these patients. One in 4 women with normal micturition had symptoms of voiding difficulty. Neurological disease, pelvic surgery and psychological factors were important causes of voiding dysfunction. Voiding disorders are a common cause of lower urinary tract dysfunction and should be an important consideration in future patient management.
51 citations
TL;DR: The synergistic action of magnesium sulphate and nifedipine in the dosage employed in this study may be used to reduce maternal and perinatal mortality and morbidity in women with eclampsia.
Abstract: In a prospective controlled trial 91 consecutive women with eclampsia were randomly allocated either to a magnesium sulphate and nifedipine regime or to a lytic cocktail and nifedipine group. The type and severity of disease, details of labour and delivery, and the maternal and perinatal outcomes and complications related to the 2 treatment regimens were compared. Recurrence of fits, aspiration pneumonia and sudden hypotension were significantly reduced when patients were treated with the new magnesium sulphate and nifedipine regimen compared with the lytic cocktail plus nifedipine regimen. No patient treated with the new regimen died or had respiratory depression; in the other group there were 2 maternal deaths plus 1 case of severe hypoxic brain damage. No difference was observed in duration of labour or mode of delivery. Perinatal mortality was significantly lower in the magnesium sulphate plus nifedipine treated group. The synergistic action of magnesium sulphate and nifedipine in the dosage employed in this study may be used to reduce maternal and perinatal mortality and morbidity in women with eclampsia.
45 citations
TL;DR: The interview research formed the basis for a large, recently completed study of sexuality and pregnancy by questionnaire, which surveyed 25 couples at a large hospital antenatal clinic in the first trimester.
Abstract: Summary: This paper reports the interview research which formed the basis for a large, recently completed study of sexuality and pregnancy by questionnaire. Semistructured interviews were conducted with 25 couples who presented at a large hospital antenatal clinic in the first trimester. Of these couples, 15 participated in second trimester interviews and 12 couples were interviewed between 38 and 40 weeks' gestation.
The results showed a substantial decline in sexual interest amongst women that was not matched by their male partners but was reflected in a marked reduction in frequency of intercourse. The range of sexual activities also diminished during pregnancy. The majority (19 or 76%) regularly practised oral sex and 3 men (12%) regularly practised anal intercourse. A key observation is that 7 males (28%) did not always achieve orgasm during sexual intercourse per se.
44 citations
TL;DR: The uterine cervix is a vital structure for the success of pregnancy that must remain firmly closed to contain the developing conceptus within the uterus until the fetus has grown to a stage of maturity appropriate for extra‐uterine survival.
Abstract: The uterine cervix is a vital structure for the success of pregnancy. It must remain firmly closed to contain the developing conceptus within the uterus until the fetus has grown to a stage of maturity appropriate for extra-uterine survival. During the birth process itself, the cervix must undergo the rapid opening known as dilatation to allow the fetus to travel through the birth canal with a minimum of stress and trauma. The process of cervical dilatation must be preceded by the phenomenon of effacement whereby the substance of the cervix shortens and thins out. Both effacement and dilatation would be impossible unless the dense fibrous connective tissue of the cervix had undergone a radical modification. Cervical ripening requires a change of the collagen within the cervical stroma from a highly organised network of tightly bound collagen fibrils to a much looser arrangement whereby the tissue becomes more compliant. This is associated with profound changes in the composition of the ground substance of the cervical stroma with an alteration in the concentration and type of glycosaminoglycans (GAGs) which constitute the proteoglycan complexes. It was formerly assumed that these changes were under the control of those cellular elements within the cervical stroma (fibroblasts and smooth muscle cells) but it seems quite possible that the ripening process is associated with an infiltration of inflammatory cells especially neutrophils. Currently much interest is centering on the possible role of cytokines such as interleukin-8 and there may also be a role in cervical ripening for leukotrienes.(ABSTRACT TRUNCATED AT 250 WORDS)
42 citations
TL;DR: The purpose of this study was to determine the prevalence of postnatal depression (PND) and to assess self‐esteem in the early postnatal period and at 6 weeks post partum and PND at 6 months postpartum.
Abstract: Summary: The purpose of this study was to determine the prevalence of postnatal depression (PND) and to assess self-esteem in the early postnatal period and at 6 weeks postpartum and PND at 6 months postpartum.
Women giving birth to term babies over a 6-month period, completed an Edinburgh postnatal depression scale (EPDS) and a Rosenberg self-esteem scale in hospital, at 6 weeks postpartum and an EPDS only at 6 months postpartum. A total of 235 women participated in the study of which 222 (95%) returned their questionnaire at 6 weeks postpartum and 192 (82%) at 6 months postpartum. Characteristics of the women and their pregnancy outcome are presented.
The EPDS identified a depressed mood in 9% of women in hospital and at 6 weeks postpartum (95% CI 5.3%-12.8%). At 6 months this had increased to 10% (95% CI 7.8%-12.2%). Postnatal depression was significantly correlated with low self-esteem in hospital and at 6 weeks postpartum.
42 citations
TL;DR: It should be routine to review women 6 months or so following pelvic floor surgery to review the anatomical and physiological results, and problems with discharge or postcoital bleeding from vault granulomas are best excluded some time after resumption of coital activity.
Abstract: EDITORIAL COMMENT: We accepted this paper for publication since it will remind readers to discuss the possibility of postoperative sexual dysfunction. It should go without saying that sexual function before surgery should also be discussed, particularly since it may determine the type of surgery selected for genital prolapse with or without associated urinary incontinence. Our reviewer stressed the point that in spite of the oft-quoted opinion of Francis and Jeffcoate (reference 4 in this paper), posterior colporrhaphy will not cause dyspareunia if excessive narrowing of the vagina is avoided. Narrowing in the mid-vagina is caused either by excessive excision of vaginal epithelium or by excessive approximation of paravaginal connective tissue. Moreover failure to perform posterior colporrhaphy after anterior colporrhaphy, with or without vaginal hysterectomy, can accentuate weakness of the vaginal vault and posterior vaginal wall and result in rapid development of an enterocele or even eversion of the vagina. A final comment is that it should be routine to review women 6 months or so following pelvic floor surgery to review the anatomical and physiological results. The 4–6 week postoperative visit is too soon since many have not recommenced coitus at this time. Furthermore, problems with discharge or postcoital bleeding from vault granulomas are best excluded some time after resumption of coital activity.
Summary: To assess the prevalence of sexual dysfunction after pelvic floor surgery for nonmalignant conditions, a retrospective survey was performed. Replies from a postal survey were received from 66 of the 200 women canvassed. Dyspareunia developed in 10 patients who had never had it before the operation, however of those who had it preoperatively the pain stopped completely in 12 of 23. Reduced libido was noted in 16 of 54 (29%), reduced lubrication in 21 (38%), and reduced genital sensation in 10 (18%). Lack of information about the potential effects of surgery on sexual function was identified as a major deficit and of considerable concern to 35 of the 66 women. Sexual function after surgery should be evaluated more intensively, and the subject discussed openly before any contemplated operation.
39 citations
TL;DR: The incidence of gestational diabetes in the Illawarra area is 7.2% (95% CI: 6.0–8.4); the highest incidence rate was found in women of Asian background.
Abstract: The incidence of gestational diabetes in the Illawarra area is 7.2% (95% CI: 6.0-8.4). This was determined by data collected by 2 prenatal clinics and 3 private practitioners during 1993. The incidence rate varied between 5.1% at one hospital to 11.3% with a private practitioner. This variation was mainly due to differences in age and ethnic background. The highest incidence rate of 11.9% was found in women of Asian background.
TL;DR: 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 is compared.
Abstract: 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).
TL;DR: The take‐away message for readers is that the authors must continue antenatal vigilance to detect the signs of preclampsia and manage these patients appropriately and the series reported here contains a very high proportion of cases of antepartum eClampsia.
Abstract: EDITORIAL COMMENT: We accepted this paper for publication to remind readers of the savage toll on maternal life that can be claimed by eclampsia when there is inadequate antenatal care in the detection and management of cases of preeclampsia. In the 22 years from 1971–1993 there were 108,476 deliveries and 60 cases of eclampsia at the Mercy Hospital for Women, an incidence of 0.06% or 1 in 1,808 deliveries and the maternal mortality rate was 5% (3 of 60). In this large series from India of 271 cases, the maternal mortality rate was 7.8% and the incidence of eclampsia was 1 in 115 deliveries (0.87%). The authors refer to other series of eclampsia in India where the incidences of eclampsia were as high as 4.6% of all deliveries. These high incidences of eclampsia are largely explained by referral of complicated cases to major centres and expectedly the series reported here contains a very high proportion of cases of antepartum eclampsia. Where antenatal care facilities are better most cases of eclampsia occur intrapartum and the distribution of the 60 cases at the Mercy Hospital for Women was 19 (32%) antepartum, 14 (23%) intrapartum and 27 (45%) postpartum whereas in the series from India the distribution was 128 (47%) antepartum, 85 (31%) intrapartum and 58 (22%) postpartum. The causes of death in these cases of eclampsia were similar to those which occur in developed countries. The take-away message for readers is that we must continue our antenatal vigilance to detect the signs of preclampsia and manage these patients appropriately.
Summary: Two hundred and seventy-one pregnant mothers with eclamptic seizures admitted in a tertiary level teaching institution in South India over a period of 9 years from 1984 to 1992 were critically analysed with a particular reference to maternal mortality. The incidence of eclampsia was 0.87% of the total hospital deliveries (1 in 115 deliveries) and was increasing in consecutive years. Seventy per cent of the patients were primagravidas and more than 95% of them had not received antenatal care and were alarmingly unaware of any kind of examination during pregnancy. Eclampsia accounted for 20.9% of all maternal deaths during the same period and the case mortality rate was 7.8%. There is an urgent need to impart special training in antenatal care to non-obstetrician doctors as well as paramedical staff working in the community and to provide health education to the community to reduce mortality from eclampsia.
TL;DR: Examination of the medical literature describing pregnancies following ovulation induction with one of the drugs used to induce superovulation, clomiphene citrate, and compares their outcomes with Australian IVF and GIFT pregnancy outcomes shows adverse perinatal outcomes are more common.
Abstract: Data from Australia and elsewhere have shown consistently that adverse perinatal outcomes such as preterm birth and perinatal mortality are more common in pregnancies resulting from assisted conception with IVF and GIFT than normally conceived pregnancies. Factors that may contribute to the excess of poor outcomes include maternal factors, the assisted conception procedures themselves and possibly the influence of drugs used to induce superovulation. This review examines the medical literature describing pregnancies following ovulation induction with one of the drugs used to induce superovulation, clomiphene citrate, and compares their outcomes with Australian IVF and GIFT pregnancy outcomes. The review shows that whilst some studies have suggested higher rates of ectopic pregnancy, spontaneous abortion and congenital malformations in clomiphene citrate induced pregnancies, the findings are inconsistent and the data are flawed. There are only very poor data available on the incidence of preterm birth. Multiple pregnancy is a well-recognized adverse outcome of clomiphene citrate induced pregnancies. Attempts to improve perinatal outcomes of pregnancies following assisted conception will be helped by a better understanding of the relative contributions of maternal and treatment factors and further studies of pregnancy outcome after ovulation induction are needed.
TL;DR: A further case of endocervicosis of the urinary bladder is described and it is important to be aware of this entity and its possible relationship to previous Caesarean section to avoid confusion with a neoplastic process.
Abstract: Summary: A further case of endocervicosis of the urinary bladder is described. It is important that gynaecologists and pathologists be aware of this entity and its possible relationship to previous Caesarean section to avoid confusion with a neoplastic process.
TL;DR: Cryptomenorrhoea associated with vaginal agenesis is uncommon, however, when laparoscopy or ultrasound reveal the uterus to be present early laparotomy is mandatory unless there is clear evidence of haematocolpos, in order to define the cervix and undertake reconstructive surgery.
Abstract: Summary: Cryptomenorrhoea associated with vaginal agenesis is uncommon. However, when laparoscopy or ultrasound reveal the uterus to be present early laparotomy is mandatory unless there is clear evidence of haematocolpos, in order to define the cervix and undertake reconstructive surgery. Once a uterovaginal tract has been established prolonged use of a mould is necessary to maintain patency of the neovagina. If the cervix is absent or atretic then immediate hysterectomy is required.
TL;DR: A case of intrahepatic cholestasis of pregnancy (ICP) treated with dexamethasone was presented, and rapid elevation in transaminases was observed, beyond levels usually reported in this condition.
Abstract: We present a case of intrahepatic cholestasis of pregnancy (ICP) treated with dexamethasone. Rapid elevation in transaminases was observed, beyond levels usually reported in this condition. The world literature is reviewed, with particular reference to a recently suggested treatment protocol using dexamethasone.
TL;DR: The efficacy of antibiotic chemoprophylaxis in labour for all maternal carriers of Group B streptococcus with respect to the neonatal mortality and morbidity was analyzed.
Abstract: The efficacy of antibiotic chemoprophylaxis in labour for all maternal carriers of Group B streptococcus with respect to the neonatal mortality and morbidity was analyzed. The intervention consisted of a policy of maternal screening for Group B streptococcus at 28 weeks' gestation by a low vaginal swab, cultured on to nonselective media. If positive, all carriers were treated with intrapartum ampicillin regardless of other obstetric risk factors. The main outcome measures were studied prospectively for 16 months before and for 32 months after instituting the intervention. These included the incidence of early-onset Group B streptococcal infection as defined by either a blood culture or a symptomatic neonate with a positive urinary streptococcal antigen test, the mortality and the morbidity. Intrapartum ampicillin significantly reduced the incidence of early-onset Group B streptococcal disease, from 2.0 to 0.37 per 1,000 livebirths for neonates with a positive blood culture (p < 0.03), and from 4.9 to 1.5 per 1,000 livebirths for symptomatic infants with a positive urinary antigen test (p < 0.004) and the attributable morbidity, namely, neonates who were: admitted to a level 2 or 3 unit (p < 0.004); treated with antibiotics (p < 0.004); preterm (p < 0.04); ventilated (p < 0.01). Seventy five per cent of the maternal population was overall actually screened and the carriage rate was 12%. No serious adverse reactions to ampicillin were observed. Significant reduction in early-onset neonatal Group B streptococcal disease has occurred concurrent with antepartum screening and nonselective intrapartum chemoprophylaxis.
TL;DR: Silver nitrate application for Bartholin cysts or abscesses was found to be an effective, simple, inexpensive and the least anaesthetic requiring procedure, which can easily be carried out in the outpatient setting.
Abstract: Summary: This study reports results of 52 patients with Bartholin abscesses or cysts who were managed by silver nitrate stick insertion into the cyst or abscess cavity for 48 hours. All patients showed complete healing within 15 days. However, 2 (3.8%) had recurrences within the first 2 months; 1 of these patients was treated with excision and the other by repetition of the same method with no further complaints. Silver nitrate application for Bartholin cysts or abscesses was found to be an effective, simple, inexpensive and the least anaesthetic requiring procedure, which can easily be carried out in the outpatient setting.
TL;DR: It was found that no ERPC was necessary in the management of 118 out of 212 (55.6%) women who presented with spontaneous abortion, which has important implications in patient management and economical use of hospital resources.
Abstract: The conventional management of spontaneous abortion is surgical evacuation of the uterus to prevent complications which may arise from retained products of conception (POC). This procedure is not without complications and also demands operating theatre resources. The purpose of this study was to determine the efficacy of a medical approach to the management of spontaneous abortion using the prostaglandin analogue, gemeprost. From an initial 212 women presenting with spontaneous abortion, 4 groups were defined according to what they required in the way of initial management. A group of 20 women were excluded from conservative medical management at presentation because they were bleeding heavily and judged to be unsuitable. Sixty women initially required no further management other than determining that they had a complete abortion using transvaginal sonography (TVS). The 132 women were treated with the prostaglandin analogue, gemeprost. Sixty were judged to need no further management afterwards and were initially discharged. The remaining 72 women underwent evacuation of retained products of conception (ERPC) after the gemeprost treatment as medical evacuation of the uterus appeared to had been incomplete. In each of these 4 groups so defined, there was 1 case where an ERPC was required after the patients have been discharged because of complications attributable to retained POC. We therefore found that no ERPC was necessary in the management of 118 out of 212 (55.6%) women who presented with spontaneous abortion. This has important implications in patient management and economical use of hospital resources.
TL;DR: The outcome of 19 triplet pregnancies delivered at Waikato Women's Hospital is analyzed, with particular regard to the mode of delivery.
Abstract: The outcome of 19 triplet pregnancies delivered at Waikato Women's Hospital is analyzed, with particular regard to the mode of delivery During the period 1981-1992 the incidence of triplets was 1:1,945 Twelve sets of triplets were delivered by Caesarean section (63%) with 6 perinatal deaths occurring in this group, compared to none in 7 sets of triplets delivered vaginally (37%) All triplet pregnancies were correctly diagnosed antenatally by ultrasound examination at a mean gestational age of 19 weeks (range 11-28 weeks) The most common antenatal complications were preterm labour in 18 pregnancies (95%) and preeclampsia in 4 (21%) The mean gestation at delivery was 33 weeks (range 25-39 weeks) The outcome of triplet pregnancies was better in the group that delivered vaginally than those delivered by Caesarean section Greater maturity of the infants delivered vaginally appeared to be the major factor for the lower neonatal morbidity and mortality
TL;DR: Outpatient management in this cohort of patients diagnosed with placenta praevia in the third trimester of pregnancy may be a safe and cost‐effective means of care, and warrants randomized prospective study.
Abstract: Patients with placenta praevia in the third trimester are routinely confined to hospital for fear of major haemorrhage. Whilst this is arguably necessary for those who have had an episode of antepartum haemorrhage (APH), it is uncertain whether these same management principles are valid for those with placenta praevia without antepartum haemorrhage. A retrospective study was undertaken reviewing the case records of 69 consecutive patients diagnosed with placenta praevia in the third trimester of pregnancy. The outcome of 15 who had had no episodes of bleeding were compared with those who had at least 1 antepartum bleeding episode. Patients with placenta praevia without evidence of APH spent a significantly shorter amount of time in hospital and had a significantly lower rate of emergency delivery, with a neonatal outcome as good if not better than the APH group. We conclude that outpatient management in this cohort of patients may be a safe and cost-effective means of care, and warrants randomized prospective study.
TL;DR: The operative time depended on the experience of the surgeon and size of the tumour and it dropped progressively within the first 10 cases and then remained static until after 40 cases when there was a further decline.
Abstract: Summary: Fifty two consecutive patients undergoing laparoscopic surgery for ovarian masses were reviewed. The operative time depended on the experience of the surgeon and size of the tumour. It dropped progressively within the first 10 cases and then remained static until after 40 cases when there was a further decline. Postoperative pain was minimal and the median hospital stay was 2 days (range 1–7 days). The majority of patients returned to full activity within 2 weeks. The overall morbidity was 7.8% and was mild in nature without sequelae.
TL;DR: EMACO is a well tolerated regimen with a high cure rate in patients with high‐risk gestational trophoblast disease (GTD) and the remaining 61 (94%) remain free of disease up to 10 years later.
Abstract: Summary: Sixty-five patients with high-risk trophoblast disease have been treated with the EMACO combination split regimen therapy in the 10 year period, 1981 to 1990. Four patients died but the remaining 61 (94%) remain free of disease up to 10 years later. Toxicity was manageable in most cases with minimal delay in treatment from myelosuppression. EMACO is a well tolerated regimen with a high cure rate in patients with high-risk gestational trophoblast disease (GTD).
TL;DR: The study demonstrated that outpatient hysteroscopy is valuable to the patient by avoiding hospitalization and general anaesthesia, valuable for nursing and medical staff by increasing job satisfaction and valuable for the hospital by reducing expensive inpatient costs.
Abstract: Summary: This study is a report of the first 200 diagnostic hysteroscopic procedures undertaken on 191 patients, in the Gynaecological Outpatient Department of a busy general hospital. One hundred and sixty examinations were conducted successfully. The study demonstrated that outpatient hysteroscopy is valuable to the patient by avoiding hospitalization and general anaesthesia, valuable to the nursing and medical staff by increasing job satisfaction and valuable to the hospital by reducing expensive inpatient costs. The potential reduction to the Australian national health budget, by the adoption of outpatient hysteroscopy instead of inpatient dilatation of the cervix and curettage, is calculated to be in excess of $60,000,000 per annum.
TL;DR: Autoimmune diseases are relatively common in women, and tend to occur in the childbearing years, and fall broadly into two groups: celiac disease and rheumatoid arthritis.
Abstract: Autoimmune diseases are relatively common in women, and tend to occur in the childbearing years These disorders fall broadly into two groups: (i) Multisystem diseases such as systemic lupus erythematosus (SLE) and related connective tissue disorders (CTD) This group includes the 'pre-clinical' antiphospholipid or lupus obstetric syndrome which may first manifest itself as a pregnancy disorder causing recurrent abortion, fetal death, fetal growth retardation and early onset severe pre-eclampsia (ii) Tissue- or organ-specific disorders such as autoimmune thrombocytopaenic purpura (ATP), autoimmune thyroid disease (Graves' disease, Hashimoto's autoimmune thyroiditis, and post-postum thyroiditis), autoimmune haemolytic anaemia, and the very rare myasthenia gravis The study of autoimmune diseases against the background of pregnancy as an experimental system of nature has provided important insights into the nature of the disease processes and the relevance or otherwise of circulating autoantibodies to pathological effects Thus, for example, if neonatal manifestations of adult disease are causally related to the transfer of autoantibodies across the placenta, they will disappear over a time course consistent with the catabolism of IgG, providing no permanent damage is produced Conversely, if autoantibodies are demonstrable in the neonate, in the absence of clinical effects, they may only be an epiphenomenon of the maternal disease In addition, on occasions, disease manifestations may be seen in the baby when the mother shows none This may occur when the mother is in remission, but still has circulating antibodies, or when she has an occult form of the disease(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: Experimental evidence supporting the idea that maturation of structure is least as important as enhanced surfactant synthesis in the prenatal response to hormones is supported.
Abstract: Accelerated maturation of the fetal lung is usually considered mainly in terms of effects of hormones on the synthesis and release of pulmonary surfactant. Yet it has been apparent from the earliest reports of accelerated maturation by glucocorticoids that structural changes played a significant part in the response. Some of these reports (1) containing photomicrographs of histological sections of lung tissue fixed in formalin show distended alveoli in the treated lungs compared to the untreated. In such airless lungs lacking an aidwater interface, surfactant plays no part in compliance which is determined solely by the structural elements of the alveoli, particularly the connective tissue. With the advent of postnatal surfactant instillation in preterm infants (which alleviates surfactant deficiency but does nothing for structural deficiency), renewed interest has been taken in prenatal acceleration of structural maturation in the expectation that the combination of prenatal and postnatal treatment will yield optimal prophylaxis of respiratory distress syndrome (RDS) and chronic lung disease (CLD). Controlled trials of prenatal glucocorticoid plus thyrotropinreleasing hormone (TRH) treatment (2,3) and of surfactant instillation have made clear the shortcomings of each treatment in preventing RDS and CLD but their proven efficacy has ruled out the possibility of placebocontrolled studies that might demonstrate the added advantages of combining prenatal and postnatal treatment. This paper is concerned with only certain aspects of the response of surfactant biosynthesis to exposure to ghcocorticoids and other hormones but particularly with experimental evidence supporting the idea that maturation of structure is least as important as enhanced surfactant synthesis in the prenatal response to hormones.
TL;DR: The editorial committee agree with the basic investigational survey of the infertile couple, although many would recommend laparoscopy after 6 rather than 12months ‘trying’ when the listed tests are normal.
Abstract: Laparoscopy was used to evaluate 130 women whose basic infertility survey revealed no abnormalities. Overall 75 (57.7%) patients were found to have evidence of pelvic disease while the remainder were completely normal. Pelvic endometriosis was the most common pathology accounting for 27.7%, pelvic adhesions 20.8% and mild pelvic inflammatory disease 6.2%. Appropriate treatment of the pelvic conditions resulted in 31 (42.5%) pregnancies compared with 7 (12.3%) pregnancies in the no treatment group. The outcome of this study suggests that additional pregnancies do occur as a direct result of laparoscopic examination and subsequent therapy. We believe that laparoscopy should be performed on all women to search for a tubal or pelvic cause of infertility when all other examinations have been normal.
TL;DR: In nondiabetic women, the relationship of plasma glucose values obtained 2 hours after a 75 g oral glucose challenge test (GCT) at 16–20 weeks' gestation, with the incidence of macrosomia in term deliveries is determined.
Abstract: We determined in nondiabetic women, the relationship of plasma glucose values obtained 2 hours after a 75 g oral glucose challenge test (GCT) at 16-20 weeks' gestation, with the incidence of macrosomia in term deliveries (37-41 weeks' gestation). From 1988-1990, in a systematic screening programme data collected prospectively from 1,331 women were analysed retrospectively. Women with gestational diabetes or impaired glucose tolerance (n = 53) were excluded. The rest (n = 1,278) had no evidence of glucose intolerance including 1,215 women with normal plasma glucose by GCT ( 7.8 mmol/L). The variables studied were age, parity, gestational age at delivery and incidence of macrosomia. Using > 4 kg birth-weight as the definition of macrosomia, the incidence increased from 1.2% to 9.5% with increasing plasma glucose values in the GCT from Group A (> 4.5 mmol/L) to E (> 7.8 mmol/L). Similar trends of increasing incidences from 7.2% to 15.8% and 2.9% to 9.5% were noted when 90th and 95th birth-weight percentiles, respectively were used as definitions of macrosomia. The test of linear trend in this association was significant (p < 0.01). These results were not influenced by parity or gestational age at delivery.(ABSTRACT TRUNCATED AT 250 WORDS)