Congenital trifurcation of the trachea.

"Tracheal trifurcation" is a veritable and rare finding. We illustrate a unique case that demonstrates the complexity and broad variability that congenital tracheobronchial anomalies can take. Appreciation of these is important at intubation, bronchoscopy, and surgery.

Twenty years of Cochrane reviews in menstrual disorders and subfertility.

The past three decades have seen considerable change in the understanding of clinical research methods. There has been an acceptance that RCTs are the best way of establishing treatment effectiveness and a recognition that, while single studies are useful, pooling knowledge from a complete body of work is likely to provide the best evidence. Advances in methodology have been mirrored by the many advances in the field of reproductive medicine, such as assisted reproduction, assessment of male fertility, ovulation induction and laparoscopic surgery.

Placenta praevia after prior caesarean section: an exploratory case-control study.

Objective: To identify additional risk factors for placenta praevia in women with prior caesarean section.

Method: A retrospective case-control study of 53 cases and 157 controls was performed. Information was obtained from the National Women's database between 2004 and 2009.

A Case of Breathlessness during Pregnancy: The Difficulty in Diagnosing Heart Failure.

We present the case of a 33-year-old woman in her second pregnancy who was transferred to our unit following a one-month history of worsening fatigue and a three-day history of worsening symptoms of heart failure. Shortly after presentation she developed ventricular fibrillation and arrested. At an emergency caesarean section a placental abruption was noted and the baby was stillborn, unable to be resuscitated.

Screening and follow up of vulval skin disorders.

Vulval squamous cell carcinoma is relatively rare; however, up to 20% of women have significant vulval symptoms during their lifetime. Formal screening programmes for vulval disease have not been established. The evidence for the use of vulval cytology and vulvoscopy is reviewed.

Multifocal multicentric squamous cell carcinomas arising in vulvovaginal lichen planus.

Objective: To describe a case of squamous cell carcinoma (SCC) arising in vulvovaginal lichen planus (LP) and to highlight difficulties in occult cancer surveillance in the setting of severe vaginal stenosis.

Case: A 67-year-old woman with long-standing systemic and vulvovaginal LP presented with multifocal vulvar SCC. Four months after radical vulvectomy and bilateral groin node dissection for stage IB carcinomas, she presented with stage III vaginal SCC arising in an obliterated vagina.

Glycemia and its relationship to outcomes in the metformin in gestational diabetes trial.

Objective: To determine how glucose control in women with GDM treated with metformin and/or insulin influenced pregnancy outcomes.

Research Design And Methods: Women randomly assigned to metformin or insulin treatment in the Metformin in Gestational Diabetes (MiG) trial had baseline glucose tolerance test (OGTT) results and A1C documented, together with all capillary glucose measurements during treatment. In the 724 women who had glucose data for analysis, tertiles of baseline glucose values and A1C and of mean capillary glucose values during treatment were calculated.

Customised birthweight centiles are useful for identifying small-for-gestational-age babies in women with type 2 diabetes.

Background: Customised birthweight centiles identify small-for-gestational-age (SGA) babies at increased risk of morbidity more accurately than population centiles, but they have not been validated in obese populations.

Aims: To compare the rates of SGA by population and customised birthweight centiles in babies of women with type 2 diabetes and examine perinatal outcomes in customised SGA infants.

Methods: Data were from a previous retrospective cohort study detailing pregnancy outcomes in 212 women with type 2 diabetes.

Women's perception of the outcome of the surgical management of vulvar intraepithelial neoplasia.

Objective: To assess women's perception of the effects of vulvar surgery for vulvar intraepithelial neoplasia (VIN).

Study Design: Women attending a vulvar clinic for routine follow-up after surgical treatment of VIN were invited to respond to a brief questionnaire relating to their perception of vulvar appearance and sexual function. Clinical details, including the patients' age, parity, the focality and size of the lesion, types of treatment and length of follow-up, were extracted from the medical records.

A medical journal editor's role in exposing an unethical research study.

The involvement of Dr. Richard Mattingly, Editor of Obstetrics & Gynecology between 1972 and 1985, in the publication of an article on carcinoma in situ (CIS) of the cervix, facilitated exposure of an unethical study into the natural history of CIS of the cervix (now termed cervical intraepithelial neoplasia 3) by Dr. Herbert Green.

Human papilloma virus vaccines and their role in cancer prevention.

The introduction of the human papilloma virus (HPV) vaccine is the single most important advance in the prevention of cervical cancer since the introduction of cervical cytology half a century ago. Vaccination should ideally occur prior to a female's first sexual experience. This article suggests that the HPV vaccine should be publicly funded in New Zealand.

Guidelines for the follow-up of women with vulvar lichen sclerosus in specialist clinics.

It is recommended that women with vulvar lichen sclerosus be followed in specialist clinics where difficulty exists with symptom control or where there is clinical evidence of localized skin thickening. Follow-up is also recommended for women who have previously been treated for squamous cell carcinoma of the vulva (arising in lichen sclerosus or vulvar intraepithelial neoplasia) or where the pathologist expresses concern and is unable to make a definitive diagnosis of differentiated vulvar intraepithelial neoplasia.

Local oestrogen for vaginal atrophy in postmenopausal women.

Background: Vaginal atrophy is a frequent complaint of postmenopausal women; symptoms include vaginal dryness, itching, discomfort and painful intercourse. Systemic treatment for these symptoms in the form of oral hormone replacement therapy is not always necessary. An alternative choice is oestrogenic preparations administered vaginally (in the form of creams, pessaries, tablets and the oestradiol-releasing ring).

Epithelioid trophoblastic tumor: a case report.

Epithelioid trophoblastic tumor is a rare and distinctive pathologic entity within the complex family of gestational trophoblastic disease. We describe a case of epithelioid trophoblastic tumor occurring in a 34-year-old woman, who presented with a large uterine tumor 3 years following an uncomplicated pregnancy. The clinicopathologic findings in this case are typical of this unusual entity and consistent with current literature, with the exception of negative beta-human chorionic gonadotrophin levels.

A clinical audit of a nurse colposcopist. Colposcopy: cytology: histology correlation.

The role of the nurse colposcopist has been established in some countries for a number of years. At National Women's Health the first New Zealand nurse colposcopist training programme was developed in 2000. A clinical audit was undertaken to assess the diagnostic skills of the nurse colposcopist measuring colposcopy: histology: cytology correlation.

A prospective study of 3 years of outcomes after hysterectomy with and without oophorectomy.

Objective: This study was undertaken to determine the outcomes of hysterectomy with and without conservation of the ovaries.

Study Design: Data were collected prospectively for 3 years from 257 women undergoing hysterectomy (group 1) and 57 women undergoing hysterectomy with oophorectomy (group 2).

Results: Pelvic pain, abdominal pain, and depression scores were reduced in the 3 years after hysterectomy.

A randomised trial comparing the levonorgestrel intrauterine system and thermal balloon ablation for heavy menstrual bleeding.

Objective: To compare the levonorgestrel intrauterine system (LNG-IUS) (Mirena); Schering Co., Turku, Finland) and thermal balloon ablation (Thermachoice; Gynecare Inc., Menlo Park, CA, USA) for the treatment of heavy menstrual bleeding.

Vulvar intraepithelial neoplasia: aspects of the natural history and outcome in 405 women.

Objective: To determine the clinical characteristics, outcome following surgical treatment, and natural history of cases of untreated vulvar intraepithelial neoplasia (VIN).

Methods: Four hundred five cases of VIN 2-3 seen between 1962 and 2003 were reviewed.

Results: The mean age of women with VIN decreased from 50.

Chronic inflammation of the vagina: treatment and relationship to autoimmunity.

Objective: To investigate noninfective, symptomatic, chronic inflammation (CI) of the vaginal mucosa to determine its prevalence and immunologic basis and to initiate an immunologic approach to treatment and assess the response.

Study Design: A prospective, observational, clinical study of 55 women with dyspareunia and/or discharge of vaginal mucosal origin. Vaginal biopsies and immune investigations were carried out.