Pelvic floor and anal sphincter trauma should be key performance indicators of maternity services.

There is an increasing awareness of maternal somatic birth trauma, which affects many more women than previously thought, primarily in the form of anal sphincter and levator ani tears. Given that such trauma occurs in about one-third of all women giving birth vaginally for the first time, and given that it has serious long-term consequences, it should be audited by all maternity services with a view to providing remedial therapy to delay or prevent subsequent morbidity, and to facilitate practice improvement. The increasing availability of modern imaging equipment and the skills of using it for pelvic floor assessment means that it is now becoming possible to provide such services postnatally.

The legal status of the fetus in New South Wales.

The issue of how to define the legal status of the fetus is complex. Three clinical cases with fetal losses following motor vehicle accidents raise important issues regarding the legal status of the unborn child. Legislation was submitted to the New South Wales Parliament in the form of the Crimes Amendment (Grievous Bodily Harm) Bill 2005 (NSW) but was subsequently repealed. Medical technological advances make the viability of a fetus a shifting standard and encourage the comparison between newborns and late-term fetuses, offer increased fetal health status information and provide greater capacity to maintain the life of babies born prematurely. In view of the sophisticated state of medical care available in New South Wales, the three cases reviewed highlight the discrepancy between the medical recognition of the fetus as a patient and its lack of legal recognition.

Management of women referred to an acute gynecology unit: impact of an ultrasound-based model of care.

OBJECTIVE: To assess the impact of the introduction of an ultrasound-based model of care for women with acute gynecological complications. METHODS: This was a prospective comparative study of women attending an ultrasound-based acute gynecology unit (AGU) at the Nepean Hospital during a 6-week period 4 months after the unit's inception (new model of care), and a group of women presenting at the hospital during a similar period 6 months immediately prior to the unit's inception (traditional model). In the new model of care, ultrasound was performed at the time of the initial assessment by a senior clinician. The main outcome measures were admission rates and occupied bed days. RESULTS: The study included 290 consecutive women with complete data, 133 before and 157 after the introduction of the AGU. Compared with the group presenting before establishment of the AGU, the group who attended the AGU had significantly lower admission rate (7% vs. 36%, P < 0.0001) and significantly shorter time to see a trainee gynecologist (mean, 172 vs. 205 min, P = 0.00089), time to ultrasound examination (mean, 199 vs. 533 min, P < 0.0001), length of stay as an outpatient (mean, 45 vs. 248 min, P < 0.0001), fewer occupied bed days (total, 30 vs. 85 days, P < 0.0001) and lower surgical intervention rates (12% vs. 29%, P = 0.00025). They also had significantly higher expectant management rate (26 vs. 8%, P = 0.00023). The extrapolated annual reduction in occupied bed days represented a total financial saving of $ 257 617 Australian dollars. CONCLUSIONS: In the AGU, the availability of ultrasound carried out by a senior clinician with an interest in gynecological emergencies may lead to a reduction in admissions and improved outcomes.

Sleep studies of adults with severe or profound mental retardation and epilepsy.

Sleep patterns of people with mental retardation have received little research attention. This is an important gap in knowledge because understanding the relation between sleep and wakefulness may be critical to care provision. Descriptive sleep information on 28 people with severe or profound mental retardation and epilepsy was presented here. Sleep EEG data, studied both conventionally and by means of a neural network-based sleep analysis system suggest atypical sleep stages with significant depletion of REM sleep and a predominance of "indiscriminate" non-REM sleep. Sleep diaries completed by caregivers reveal lengthy sleep period times, especially among those with profound mental retardation. Possible explanations for these results and their implications were discussed.

Endometrial resection after radiotherapy for cervical carcinoma.

A patient with persistent chaotic menses during hormone replacement therapy after radiotherapy for cervical cancer was rendered amenorrheic by transcervical endometrial resection.

A review of parametric modelling techniques for EEG analysis.

This review provides an introduction to the use of parametric modelling techniques for time series analysis, and in particular the application of autoregressive modelling to the analysis of physiological signals such as the human electroencephalogram. The concept of signal stationarity is considered and, in the light of this, both adaptive models, and non-adaptive models employing fixed or adaptive segmentation, are discussed. For non-adaptive autoregressive models, the Yule-Walker equations are derived and the popular Levinson-Durbin and Burg algorithms are introduced. The interpretation of an autoregressive model as a recursive digital filter and its use in spectral estimation are considered, and the important issues of model stability and model complexity are discussed.

A new approach to the analysis of the human sleep/wakefulness continuum.

The conventional approach to the analysis of human sleep uses a set of pre-defined rules to allocate each 20 or 30-s epoch to one of six main sleep stages. The application of these rules is performed either manually, by visual inspection of the electroencephalogram and related signals, or, more recently, by a software implementation of these rules on a computer. This article evaluates the limitations of rule-based sleep staging and then presents a new method of sleep analysis that makes no such use of pre-defined rules and stages, tracking instead the dynamic development of sleep on a continuous scale. The extraction of meaningful features from the electroencephalogram is first considered, and for this purpose a technique called autoregressive modelling was preferred to the more commonly-used methods of band-pass filtering or the fast Fourier transform. This is followed by a qualitative investigation into the dynamics of the electroencephalogram during sleep using a technique for data visualization known as a self-organizing feature map. The insights gained using this map led to the subsequent development of a new, quantitative method of sleep analysis that utilizes the pattern recognition capabilities of an artificial neural network. The outputs from this network provide a second-by-second quantification of the sleep/wakefulness continuum with a resolution that far exceeds that of rule-based sleep staging. This is demonstrated by the neural network's ability to pinpoint micro-arousals and highlight periods of severely disturbed sleep caused by certain sleep disorders. Both these phenomena are of considerable clinical value, but neither are scored satisfactorily using rule-based sleep staging.

Transabdominal ultrasound as an aid to advanced hysteroscopic surgery.

At the Nepean Hospital transabdominal ultrasound has been used to assist the hysteroscopic surgeon when performing complicated transcervical operations. The 2 main areas of use appear to be either to direct the surgeon within the uterus to the site of pathology or to prevent inadvertent perforation of the uterine wall. The cases vary from haematometra following endometrial ablation to Asherman syndrome and subseptate uteri.