Careers in medicine: Appointment to specialist training posts in Queensland in 1988

Appointments to accredited specialist training positions in the State of Queensland, Australia in 1988 were analysed to show the success rates of applicants. Women were less likely to apply for training, but gained proportionately more appointments than men. Other factors in success were application from a major teaching hospital, graduation from the State medical school and, for new applicants, an honours degree. The success rates in various specialties differed significantly as did their appeal to women and to honours graduates. It is concluded that new graduates need better information and advice on career choice and that individual disciplines need to look carefully at the image and organization of their training programmes

The rise of the caesarean section: A review

Summary: Caesarean section is of recent development as a credible procedure. A rapidly increasing incidence in many countries has led to far‐ranging concern. Proposed causes for the increase include insistence on repeat operations and a resultant cumulative effect, more frequent diagnoses of disproportion and ineffective labour, the use of fetal heart monitoring, and a steady trend away from vaginal breech delivery. Increased perinatal morbidity is seen in Caesarean section, together with a qualified increase in perinatal mortality. Maternal morbidity is greater and maternal death rates are reportedly 2–4 times greater in Caesarean section births. More work is needed on the psychosocial sequelae of abdominal delivery

Progress in fetal assessment

The growth areas in fetal assessment in late pregnancy have been studied by making a quantitative review of the papers in four obstetric journals. Of the 130 relevant pa pers published in 1973, the most common subject treated was the phospholipid test of fetal lung maturity. Other important tests reviewed were estrogen assays, ultrasonic studies, human placental lactogen and alpha-fetoprotein measurements. The clinical value of phospholipid tests was demonstrated, liquor creatinine assays are much inferior in assessing fetal maturity. Plasma estriol assays are likely to be of increasing importance in clinical practice. Some caution should be applied in the interpretation of ultrasonic measurements of biparietal diameter as a test of fetal development and well-being

Polycystic ovarian disease: Current concepts

Summary: The Stein Leventhal syndrome, now commonly referred to as polycystic ovarian disease (PCOD) has provided a focus for application of new methods of investigation of the ovary. The first description of the condition referred to 7 women; subsequent large‐scale studies have confirmed menstrual irregularity, hirsutism and infertility as the principal symptoms. PCOD has been shown to be associated with certain histopathological changes in the ovaries, notably capsular thickening, subcapsular follicular cysts and hyperplasia of the theca interna, with or without follicular atresia. The development of urine hormone assays allowed the endocrine basis of PCOD to be described. Urine determinations have now been largely replaced by assays in blood and profiles of hormone changes in PCOD have been proposed. The significant changes are high, fluctuating levels of luteinizing hormone, raised oestrone and androgen concentrations. Oestradiol and follicle stimulating hormone levels are often reduced. Other abnormalities underlying PCOD include defects in steroidogenic enzymes, especially aromatase, this leading to blocked conversion of oestrogen precursors and a resulting accumulation of androgenic steroids. The origin of the disease is unknown. The abnormal gonadotrophin release which is found, however, leads to deficient follicular development and androgen excess at the expense of oestradiol production. The disordered gonadal steroid secretion results in altered pituitary sensitivity to gonadotrophin releasing hormone and abnormal gonadotrophin production. Once established, the disease is self‐perpetuating. Current management problems include the uncertain value of ovarian resection, the best method of treatment where infertility is no longer a problem, and the risks of endometrial cancer in the presence of chronically‐raised endogenous oestrogen levels. The inadequacy of treatment of hirsutism in these women is a particular problem. More work is needed to establish the factors which initiate PCOD and to resolve the problems in its management. Copyrigh

Absence of effect of LH-RH on progesterone production by human luteal cells in vitro

In acute incubation (3 h) LH-RH, at concentrations of 10-10 pg/ml, failed to affect either basal or hCG-induced progesterone production by human luteal cells, from tissue taken in the early, mid or late luteal phase

Undergraduate education in obstetrics and gynaecology in Australia and New Zealand, 1989

Medical schools in Australia and New Zealand provide an average of 10.7 weeks for instruction in obstetrics abd gynaecology. The stated aims and objectives in 14 clinical schools vary from none at all to those which establish the programme with great clarity. The learning exercises provided vary from the conventional, ward and clinic-based to those with an accent on observing closely a mother, her baby and her family. Newer methods for learning about pelvic examination have not been widely adopted. Schools expect students to gain experience in an average of 9 vaginal deliveries. Competition with midwives for available deliveries was described by 9 clinical schools. The survey shows a need for greater emphasis in text books on communication skills and psychological aspects of patient care