To describe the use of recombinant activated factor VII (rFVIIa) in patients with life-threatening haemorrhage. We report a case series of Australian patients with life-threatening haemorrhage who were treated with rFVIIa prior to August 2002 namely 21 patients, median age 45 years (range 22-79 years), 33% (seven of 21) female. The major causes for bleeding were multi-trauma, cardiac or vascular surgery, or orthoptic liver transplantation. In the 24 h prior to the administration of rFVIIa, the median blood usage was 22 U packed cells (range 3-66 U), the median International Normalized Ratio was 1.6 (range 1.4-3.6) and the median activated partial thromboplastin time was 55 s (range 31-180 s). During the 24 h after administration of rFVIIa, the median blood usage was 2 U packed cells (range 0-16 U), the median International Normalized Ratio was 1.0 (range 0.9-1.2) and the median activated partial thromboplastin time was 40 s (range 30-94 s); P < 0.001 for each comparison. Sixteen of the 21 patients were discharged from hospital or were alive at 30 days. There were no thrombotic complications following the administration of rFVIIa. These uncontrolled data suggest a role for rFVIIa as an adjunctive haemostatic measure in surgical patients with life-threatening haemorrhage for whom conventional measures to achieve haemostasis have failed.

We present two cases of proteinuric hypertension in the early second trimester of pregnancy, associated with partial mole and triploidy karyotyping. This demonstrates the complementary nature of ultrasound in the diagnosis and management of this rare association.

Purpose of investigation:To report a ten-year experience in management of a highly morbid obstetrical condition in placenta accreta (PA) at a tertiary referral centre, uniquely equipped with an integrated Interventional Radiology theatre, with a primary aim to guide best practice. Materials and Methods: Retrospective analysis of all histologically proven PA cases at a tertiary centre in Australia between January 2004 and December 2013. Medical records were reviewed for obstetrics history, operative details, post-operative management and neonatal outcome. Results: Sixteen cases of PA were identified during the time period; 75% had identifiable risk factors for PA and 87.5% of patients were diagnosed antenatally. Mean gestational age at time of delivery was 34 ± 3.4 weeks. Ten cases were performed electively, while the remaining underwent emergency caesarean section. One patient was managed conservatively with placenta left insitu; time to complete resolution of placenta was 71 days. Among patients who underwent hysterectomy (15/16), the proportion of total (n=8) vs. subtotal (n=7) hysterectomy was similar. Average operating time was 123 ± 45.9 minutes. Compared to emergency cases, patients who underwent elective surgery had significantly lower blood loss (2.2 vs. 3.1 L, p < 0.05). Common iliac artery balloons were deployed in eight cases, with a non-statistically significant reduction in intraoperative blood loss (2 vs. 3.2 L, p < 0.05). Fifty percent of patients required ICU admission. Neonatal survival at six months was 93.75% (15/16). Conclusion: The present report demonstrates the importance of timely diagnosis and comprehensive preparation in the surgical management of patients with placenta accreta. The availability of relevant services in the peri-operative phase, including: obstetricians, interventional radiology facility and personnel, intensive care, and neonatology teams, are crucial in achieving optimal outcome for the patient and neonate. In line with reports in the literature, the authors advocate a team-based multidisciplinary approach in a tertiary-level centre for management of this high-risk condition.

Though there is a growing body of evidence to suggest a role for metformin in GDM management, further large-scale, multicentre RCTs are needed before guidelines can be altered.

We describe a series of cases where microlaparoscopic left upper quadrant (LUQ) entry was used as the primary peritoneal entry site in patients considered unsuitable for initial port placement through the umbilicus. Microlaparoscopic LUQ entry is becoming a standard technique in gynaecological laparoscopic surgery and appears to provide a safe alternative entry site in selected patients.