A Case of Successful Use of Reproductive Technology for a Couple with Subfertility Due to Retrograde Ejaculation, Where Artificial Insemination had Failed

Summary: A case history of a couple where the infertility was due to retrograde ejaculation is presented; when conventional treatment with artificial insemination using sperm isolated from postejaculatory urine failed, IVF and GIFT technology was applied. This resulted in a pregnancy which unfortunately failed at 3 months, unrelated to the method of conception. This case report highlights the possible use of IVF/GIFT for yet another type of male subfertility.     

Intrapartum Cardiotocography and the Expert Witness

Summary: Fetal heart rate changes occur in the majority of labours and correlate poorly with perinatal outcome and subsequent neurological development. Obstetricians giving expert evidence related to the interpretation of intrapartum cardiotocographs are advised to exercise caution when expressing their opinions.     

Update of Growth Percentiles for Infants Born in an Australian Population

Summary: 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.     

Prediction of Caesarean Section from Ultrasound and Clinical Assessment of Fetal Size

EDITORIAL COMMENT: We accepted this paper for publication because the authors have explored the possible value of ultrasound versus clinical assessment of fetal size to see whether they can predict the need for Caesarean section when the baby is large. In this study both the ultrasound and the clinical assessment were impressively accurate and fetal femur length was the most accurate of the ultrasound parameters in assessing fetal weight in predicting the need for Caesarean section. However, as the authors indicate, none of these methods of assessment of fetal size are recommended as an absolute indication for Caesarean section. Every obstetrician uses clinical assessment of the fetus when evaluating management of the patient but the need for clinical judgment remains.
Summary: One hundred and five women with singleton pregnancies and cephalic presentation were assessed. Fundal height and a clinical estimate of fetal weight were recorded. The fetal biparietal diameter, abdominal circumference and femur length were measured with ultrasound. Ultrasound estimated fetal weight was calculated using 3 different formulas (Shepard, Campbell and CUHK). The liquor volume was assessed using the amniotic fluid index.
Ultrasound was able to predict Caesarean section with more reliability than clinical assessment of fetal size or weight. The biparietal diameter, fundal height and amniotic fluid index were poor predictors of mode of delivery. The measurements which best predicted the mode of delivery were the fetal femur length and abdominal circumference. Femur length, but not abdominal circumference, was a statistically better predictor of Caesarean section than clinical estimation of fetal weight. There was no improvement in prediction using ultrasound estimated fetal weight.     

Maximum Effort in the Management of Ovarian Cancer, Including Pelvic and Para-aortic Lymphadenectomy

Patients treated for ovarian cancer at the Mercy Hospital for Women, Melbourne over a 5 1/2 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.     

Prospective Study of the Quality of Survival of Infants with Critical Fetal Reserve Detected by Antenatal Cardiotocography

From 1981 to 1986 antenatal cardiotocographic monitoring was performed on 9,992 high-risk pregnancies selected from a total obstetrical population of 31,518 patients (31.7%). A critical fetal reserve pattern was detected in 89 patients (0.9%) whose pregnancies resulted in 68 surviving infants, 19 perinatal deaths and 2 sudden infant deaths. Since 47.4% of the infants who died in the perinatal period did so because of a related congenital malformation, such a defect should be excluded in the fetus with critical fetal reserve, by ultrasonography, before delivery (there is usually insufficient time for fetal karyotyping). Sixty-three (92.6%) of the surviving children were assessed at our Growth and Developmental Clinic and disabilities were detected in 16 (25.4%); however, the disability was major in only 5, including 2 children with Down syndrome. The quality of survival of infants born from pregnancies complicated by critical fetal reserve was satisfactory as 60 of 63 children (95.2%) had neither a major disability related to intrauterine hypoxia identified by the cardiotocographic pattern, or had one likely to significantly interfere with their quality of life. Our results suggest that pregnancies can be continued until the cardiotocographic pattern becomes critical in order to gain fetal maturity, without compromise to the fetal brain.     

Major Gynaecological Surgery in Patients with Severe Coronary Artery Disease — the Combined Approach

The gynaecologist today is likely to encounter elderly patients with severe coronary heart disease requiring major gynaecological surgery. The successful outcome in 2 such patients with compromised coronary circulation and impaired left ventricular function emphasized the importance of combined care with the cardiologist and the anaesthetist. The insertion of a Swan-Ganz catheter for close perioperative monitoring is vital. The intra-and postoperative problems are discussed.     

A Controlled Trial on Wound Drainage in Caesarean Section

A randomized controlled trial was carried out to investigate the influence of drainage on wound infection following Caesarean section. The incidence of clinical wound infection was significantly reduced if a Redivac suction drain was placed beneath the rectus sheath. Subcutaneous corrugated drains were found to offer no advantage. Three different degrees of postoperative pyrexia are examined for their predictive value for the development of wound sepsis. The influence of duration of amnion rupture and the number of vaginal examinations in labour on the postoperative incidence of wound infection and pyrexia are examined.