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SUMMARY Background : Helicobacter pylori infection has been associated with growth restriction in young children. Aim : To determine whether there is an association between H. pylori infection and intrauterine growth restriction. Methods : Four hundred and forty-eight consecutive pregnant women (aged 15–44 years), attending for routine examinations in the third trimester, were enrolled. Clinical, demographic and previous obstetric data, as well as smoking history, were collected. At delivery, the weight, height, gender and status of the neonate were recorded; intrauterine growth restriction was defined if the birth weight was below the 10th percentile according to the gestational age for infants born in Australia. Results : Eighty-nine (20%) women were seropositive for H. pylori . The prevalence of H. pylori was significantly lower in Caucasians (17%) vs. non-Caucasians (42%, P < 0.0001). There were 34 (7.5%) cases of intrauterine growth restriction (7% Caucasians, 16% Asians, 12% Aborigines and 0% Pacific Islanders). Intrauterine growth restriction was more common in H. pylori -seropositive women than in H. pylori -seronegative women [13.5% vs. 6%; odds ratio (OR)=2.41; 95% confidence interval (CI), 1.14–5.08; P =0.018]. A multiple logistic regression model revealed that smoking (OR=3.55; 95% CI, 1.62–7.79; P =0.002), maternal height (OR=0.48; 95% CI, 0.28–0.80; P =0.005) and H. pylori seropositivity (OR=2.59; 95% CI, 1.12–5.95; P =0.025) were all independent risk factors for intrauterine growth restriction. Conclusions : H. pylori infection in pregnant women may affect foetal intrauterine growth. [ABSTRACT FROM AUTHOR]

Two hundred women with abnormal Pap smears and/or vulvar symptoms and 30 with normal Pap smears were investigated to determine the association between symptoms and (i) human papilloma virus infection of the vulva, and (ii) a spongiotic tissue reaction or a spongiotic dermatitis of the vulva. All had vulvar colposcopy and biopsy Human papilloma virus infection was diagnosed by histopathology and in situ hybridisation technique. HPV infection was present in biopsies of 48% of asymptomatic women and 33% with symptoms (p = 0.13) and HPV DNA in 37% of asymptomatic women and 31% with symptoms (p = 0.72). Spongiotic tissue reaction was diagnosed in 53.5% of asymptomatic women compared to 74% of symptomatic women (p = 0.007). This study suggests that vulvar symptoms are not clinical manifestations of HPV infection, but may be caused by dermatitis rather than HPV infection per se.

This is a multicentre, blocked, randomized trial to compare the efficacy of oral misoprostol 400 microg with current injectable uterotonic agents (oxytocin/ Syntometrine) used prophylactically in the third stage of labour. Main outcome measures were blood loss, use of a second uterotonic agent and difference in haemoglobin level from antepartum to postpartum. Data analysis from 863 women showed a statistically significant increase in both the mean blood loss (p < 0.001) and the rate of postpartum haemorrhage > 500 mL, (RR 2.72: 95% C1 1.73-4.27) in the misoprostol group compared to the oxytocin/Syntometrine group. The use of a second uterotonic agent was higher in the misoprostol group (RR 2.89: 95% Cl 2.00-4.18) as well as a greater decrease in postpartum haemoglobin (p = 0.015). Oral misoprostol 400 microg is significantly less effective than the traditional intramuscular uterotonic agents currently used and therefore cannot be considered as a viable option to these agents in the management of the third stage of labour.

We wished to inquire into the reasons why obstetricians choose Caesarean section as the preferred delivery mode and how they make that decision in individual settings. We therefore surveyed obstetricians to ascertain the obstetrical events at the time of decision and the reasons for the decision. Two hospitals with the same consultant medical staff were chosen for the study, The Jamison Private Hospital and the Nepean Hospital. The study group was analyzed using hospital, classification, parity, whether the procedure was elective or in labour, the stage of labour at which the Caesarean section was performed, and the primary and secondary reasons for the decision. Six hundred and twenty-four women were studied. When comparing the 2 institutions, there were 2 statistically significant findings. Firstly, the women at The Nepean Hospital were younger (27.9 +/- 5.6) than at Jamison Private Hospital (30.5 +/- 4.4; p < 0.001). Secondly, in the numbers of women undergoing Caesarean section in the 'failure to progress' category, there was a higher incidence (p < 0.001) at the private hospital. Apart from these differences, the 2 groups were remarkably similar.

This paper describes factors associated with singleton stillbirths weighing 2,500 g or more, born in 1987 and reported to the NSW Midwives' Data Collection (MDC), a statewide perinatal data collection system. A total of 136 singleton stillbirths in this weight range were notified to the MDC, representing one-quarter of all singleton stillbirths in NSW. MDC records on these stillbirths were linked with perinatal death registrations for 125 of the 136. The death registrations indicated that fetal death occurred during labour in 20 cases, prior to the onset of labour in 98, and at an unknown time in the remaining 7 cases. Placental complications, including haemorrhage and functional abnormalities of the placenta, were the most frequent group of conditions associated with the stillbirths, being recorded as the underlying cause of death in 42 (34%) of the 125 cases. Cord complications (such as cord compression or cord around the neck) were given as the underlying cause of death in 30 cases (24%). The death certificate diagnosis was confirmed by autopsy in only 27 of the 125 cases (22%), although autopsies may have been done on a further 45 cases (36%). An adequate explanation of the cause appeared to be lacking for many of the fetal deaths. This highlights the importance of a thorough and systematic investigation of stillbirths. A list of standard investigations to be carried out following a stillbirth is proposed.

Cervical cytology has a high false negative rate, especially for adenocarcinoma and its precursors. This study compares the traditional spatula with the cytobrush. Both the modified Ayre spatula and the cytobrush were found to be inadequate in a significant number of patients with known cytological atypia. It is concluded that inadequate sampling instruments make a contribution to false negative rates and that brush cytology is superior to rigid instrument cytology in routine cervical screening.