Obstetrics and Gynaecology

Objective Mediolateral episiotomy is associated with lower rates of significant perineal tears than midline episiotomy. However, the relationship between precise angle of episiotomy from the perineal midline and risk of third-degree tear has not been established. This study quantifies this relationship.

The association of fetal sex with pregnancy induced hypertension and pre-eclampsia, the interaction between sex and risk factors for fetal growth restriction, and the increased likelihood of second stage arrest with male sex have all been studied. 1-3 However, a Medline search (1966 to August 2002) using the search terms fetal gender, fetal sex, labour, delivery, and childbirth found no studies on the effect of fetal sex itself on labour outcomes and events. We set out to determine the effect of fetal sex on birth weight, duration of labour, mode of delivery, and birth outcome.

Youssef's syndrome' is characterised by cyclical haematuria, the absence of vaginal bleeding and complete urinary continence. It is a rare complication of caesarean section when bladder injury occurs and a fistula develops. While operative repair may be required, we describe a case that was managed conservatively and resolved without surgical intervention. #

Most drug discovery efforts have focused on finding new DNA-damaging agents to kill tumor cells preferentially. An alternative approach is to find ways to increase tumor-specific killing by modifying tumor-specific responses to that damage. In this report, we ask whether cells lacking the G,-S arrest in response to X-rays are more sensitive to X-ray damage when treated with agents that override G2-M arrest. Mouse embryonic fibroblasts genetically matched to be (+) or (-) p53 and rat embryonic fibroblasts (+) or (â€")for wild-type p53 function were irradiated with and without caffeine, a known checkpoint inhibitor. At low doses (500 UM), caffeine caused selective radiosensitization in the p53' ' cells. At this low dose (where no effect was seen in p53(+) cells), the pS3'~' cells showed a 50% reduction in the size of the G2-M arrest. At higher doses (2 HIM caffeine), where sensitization was seen in both p53l+> and p53'~' cells, the radiosensitization and the G2-M override were more pronounced in the p53' ' cells. The greater caffeine-induced radiosensitization in p53' ' cells suggests that p53, already shown to control the G,-S checkpoint, may also influence aspects of G2-M arrest. These data indicate an opportunity for therapeutic gain by combining DNA-damaging agents with compounds that disrupt G2-M arrest in tumors lacking functional p53.

Methods: Transvaginal 2D and 3D pelvic ultrasound was performed during the early follicular phase of the cycle (day 2 to 5) in 36 women with PCOS, as defined by the Rotterdam guideline, and sub-group analysis conducted based on the subjects' body mass index (BMI), ovulation status, and hirsutism score. Results: Fourteen lean PCOS women with a BMI < 25 kg/m 2 had significantly higher ovarian stromal vascularity as measured by 3D power Doppler (vascularisation index, VI: 4.678 0.415% versus 3.260 0.375%, p < 0.05; and vascularisation flow index, VFI: 1.753 0.227 versus 1.059 0.134, p < 0.05) than the 10 obese PCOS women with a BMI ≥ 30 Kg/m 2 . Twenty-three PCOS women with hirsutism requiring weekly shaving had significantly higher stromal blood flow as measured by 3D (flow index, FI: 36.233 1.266 versus 30.311 1.862, p < 0.05) than the eight anovulatory normoandrogenic women with polycystic ovaries. Endometrial blood flow was also significantly lower in the hirsute group (endometrial VI and VFI: 0.572 0.064% versus 1.009 0.129% and 0.198 0.027 versus 0.363 0.058 respectively, p < 0.01; and subendometrial 5-mm outer shell VI and VFI: 1.778 0.245 versus 3.083 0.447 and 0.717 0.105 versus 1.283 0.204, p = 0.01). There were no differences in blood flow between the groups when assessed with 2D pulsed wave Doppler. The ovulatory status did not affect any index. Conclusions: Ovarain vascularity is selectively increased in women with PCOS who are lean and/or hirsute. Hirsute women with PCOS also have impaired endometrial perfusion compared to their normoandrogenic counterparts. These features are only evident with 3D ultrasound and are not seen with conventional pulsed wave Doppler.

Methods: Transvaginal 2D and 3D pelvic ultrasound was performed during the early follicular phase of the cycle (day 2 to 5) in 36 women with PCOS, as defined by the Rotterdam guideline, and sub-group analysis conducted based on the subjects' body mass index (BMI), ovulation status, and hirsutism score. Results: Fourteen lean PCOS women with a BMI < 25 kg/m 2 had significantly higher ovarian stromal vascularity as measured by 3D power Doppler (vascularisation index, VI: 4.678 0.415% versus 3.260 0.375%, p < 0.05; and vascularisation flow index, VFI: 1.753 0.227 versus 1.059 0.134, p < 0.05) than the 10 obese PCOS women with a BMI ≥ 30 Kg/m 2 . Twenty-three PCOS women with hirsutism requiring weekly shaving had significantly higher stromal blood flow as measured by 3D (flow index, FI: 36.233 1.266 versus 30.311 1.862, p < 0.05) than the eight anovulatory normoandrogenic women with polycystic ovaries. Endometrial blood flow was also significantly lower in the hirsute group (endometrial VI and VFI: 0.572 0.064% versus 1.009 0.129% and 0.198 0.027 versus 0.363 0.058 respectively, p < 0.01; and subendometrial 5-mm outer shell VI and VFI: 1.778 0.245 versus 3.083 0.447 and 0.717 0.105 versus 1.283 0.204, p = 0.01). There were no differences in blood flow between the groups when assessed with 2D pulsed wave Doppler. The ovulatory status did not affect any index. Conclusions: Ovarain vascularity is selectively increased in women with PCOS who are lean and/or hirsute. Hirsute women with PCOS also have impaired endometrial perfusion compared to their normoandrogenic counterparts. These features are only evident with 3D ultrasound and are not seen with conventional pulsed wave Doppler.

This is a retrospective review of the Rotunda Hospital Emergency Room (ER) documentation with respect to attendances for a 4-month period (August-November) in both 2009 and 2012. The aim was to quantify the workload and assess the quality of care offered to patients attending the ER over the two time periods and to highlight any improvements in care after changes were implemented following the initial 2009 review. This study was done comparing the ER patient attendances over two time periods (1st August 2009 to 30th November 2009 and same period in 2012). SPSS version 20 was used to make statistical analysis along with simple percentage calculation. Comparing the two time frames, a decrease in the number of antenatal patients attending ER was seen (p &lt; 0.001) [7,128 (91.0 %) in 2009 and 6,890 (89.4 %) in 2012], waiting times fell (p &lt; 0.001) [4,351 (55.5 %) in 2009 seen within 2 h and 5,855 (76.2 %) in 2012], less women left ER without being seen (p &lt; 0.001) [151 (1.9 %) in...

Objective. Antenatal perineal massage has been shown to reduce the incidence of perineal tears in primiparous women. The aim of this study was to determine whether perineal massage impacts on primary prevention of symptomatic disruption of the fecal continence mechanism.

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