Royal Women Research Articles

Matilda, Leonor and Joanna: the Plantagenet sisters and the display of dynastic connections through material culture

ABSTRACTThe material culture related to Duchess Matilda of Saxony, Queen Leonor of Castile and Countess Joanna of Toulouse (and former Queen of Sicily) offers a rich resource that allows us to understand how, when and why they connected themselves to their father, Henry II of England. The objects studied in this article prompt significant questions regarding the relation between material culture and royal women, which allow us to explore the formative phases in women’s lives as well as their roles in the promotion and construction of a dynastic consciousness. Even though the sisters probably acted separately, they did so with a shared awareness of their positions as royal daughters and the need to communicate this collectively. By centring on the three sisters’ objects, this article proposes that the study of material culture is crucial for a better understanding of the co-operation between siblings and can contribute to a more nuanced interpretation of power.

Antenatal assessment and postnatal outcome of fetal echogenic lung lesions: a decade’s experience at a tertiary referral hospital

Introduction: Fetal echogenic lung lesions (ELL) are the commonest pulmonary pathology diagnosed on antenatal sonography, and include congenital pulmonary airway malformations (CPAMs) and bronchopulmonary sequestrations. This study aimed to evaluate the predictive utility of the CPAM volume ratio (CVR) at presentation in a series of fetuses with ELLs at a tertiary Australian referral hospital.Material and methods: Retrospective cohort study of all pregnancies with a prenatal diagnosis of an isolated fetal echogenic lung lesion managed at the Royal Women’s Hospital, Victoria, Australia, between 2005 and 2015. Data were obtained from electronic ultrasound image databases and medical records.Results: Sixty-five cases were included in the final analysis. The mean gestation at presentation was 22 weeks and 6 d, and the mean CVR was 0.66. Hydrops was evident in four cases at presentation, and did not develop subsequently in any other case. Significant perinatal concerns – fetal/neonatal demise, hydrops, requirement for neonatal intubation/ventilation, or surgery in the first year of life – did not occur with or following a CVR at presentation of <0.45. The survival rate at 1 year was 95%.Discussion: The CVR is a potentially useful tool to assess all fetal ELLs, and not just those presumed to be CPAMs. A CVR at presentation of <0.45 was associated with favourable outcomes.

My Kite Will Fly: Improving Communication and Understanding in Young Children When a Mother Is Diagnosed with Life-Threatening Gynecological Cancer.

The My Kite Will Fly (MKWF) research program is built on the well-documented need for effective clinical communication tools and therapeutic interventions where a child's mother is diagnosed with life-threatening gynecological cancer. The Dignity Model and Child-Centered approach were two key study foundations in this pilot cohort. Quantitative survey and qualitative semistructured methods were employed to gather data from patient families at three distinct phases: Diagnosis, Treatment, and Palliative care. Participants were identified from patient groups at The Royal Women's Hospital and Peter MacCallum Cancer Center, Melbourne, Australia. A purposive sample (n = 36 children) (24 girls and 12 boys aged between 3 and 12 years) drawn from 19 families completed structured art therapy workbook activities. The principal researcher and a specialist educational assistant undertook cross-case thematic analysis of all interviews and children's drawings. Five central themes were profiled in six illustrative case studies. Interviews with all families (n = 19) showed 86.1% positive evaluation of the MKWF workbook template at diagnosis. During treatments, 66.6% of parents reported better understanding of the chemotherapy process and better communication with younger family members. At palliative care, 97.3% of families reported stabilization of family routines and improved illness coping. Exit interviews with six children and surviving parents (n = 4) showed that the program substantially prepared them for parental bereavement. Results from this pilot cohort confirm the importance of enhanced parent-child communication and stabilized family routines. Current results provide an important platform for future evaluative research among larger patient-family populations across multisite oncology settings.

How Pre-modern State Rulers Used Marriage to Reduce the Risk of Losing at War: A Comparison of Eight States

Approaching warfare in pre-modern states from the perspective of risk reduction, we see that royal marriage was one strategy rulers used to reduce the probability that they would lose a war. Judicious marriage exchanges intensified and prolonged patron-client relations between rulers or between rulers and societal elites. Clientelism could affect the size and composition of their armies. The more warriors and troops one could field, the greater the chance of not losing a war (Otterbein 2004; LeBlanc 2006). Examination of eight pre-modern states suggests that their rulers used the same patterns of wife exchange even though most states developed independently. Marriage secured long-term patron-client relationships, which they used to support their military efforts. When rulers married their kin or married them to rulers outside the system (“foreigners”), they did not gain military support. Analysis of these marriage-military patterns reveals several characteristics of pre-modern states. First, marriage alliances helped rulers form networks of support that helped them win wars. Therefore, marriage—and by extension, royal women—is a key component to the study of warfare and a critical mechanism of network formation, as Blanton et al. (1996) write. Second, alliances were based on a different organizing principle from Levi-Strauss’ tribal societies, for rulers selected main wives (for themselves or their kin) based on relative rank rather than particular kinship ties. Third, marriage alliance reveals an important difference between alliance and patron-client relationships, a distinction that is often blurred in the archaeological literature.

OP 18 Comparing the sflt-1/plgf ratio with other biomarkers as a predictive test for pre-eclampsia – A clinical audit

Introduction The recently published PROGNOSIS study (NEJM 2016 374:1:13–22) demonstrated the sFlt-1/PlGF ratio biomarker test to have significant clinical utility as a stand-alone predictive investigation for the assessment of patients with suspected pre-eclampsia (PE). Before implementation of the sFlt-1/PlGF test into routine local practice, clinical superiority and cost-effectiveness compared to current alternate investigations for the evaluation of patients with suspected pre-eclampsia must be demonstrated. Objective To compare the test characteristics of investigations currently utilised in the assessment of suspected pre-eclampsia with the sFlt-1/PlGF ratio in a retrospective audit of such cases managed in a pregnancy day care centre (PDCC) setting in a tertiary perinatal centre in Melbourne, Australia. Methods The audit was performed over 4 months at the Royal Women”s Hospital, Melbourne, Australia. Patients included in the audit were greater than 20 weeks gestation and were admitted to the PDCC following an initial observation of hypertension. Four repeat one-hourly blood pressure measurements were taken for each patient. Urine protein-creatinine ratio (PCR), blood platelets, hepatic enzymes (ALT, ALP, GGT), haemoglobin (Hb) and the sFlt-1/PlGF ratio investigation were performed. The test characteristics of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were determined for each investigation. Results 197 women were included in the audit. Of these, 67 were classified as normal, 72 as pregnancy-induced hypertension (PIH), 52 as PE and 6 as HELLP syndrome cases. Normal and PIH cases were combined into a ”non-PE” group for control analysis. PE and HELLP cases were combined for ”PE” case analysis. The prevalence value for PE utilised in analysis was 29.4%. Based on the investigation result nearest to delivery, test characteristics for each investigation were calculated (Fig. 1). The sFlt-1/PlGF ratio biomarker demonstrated the best negative predictive value with 94.07%. Conclusion This audit validates the superiority of the sFlt-1/PlGF ratio biomarker test in the prediction of PE compared with current alternate investigations in an Australian pregnancy day care setting. Download : Download high-res image (205KB) Download : Download full-size image

Clothing Characteristics of Royal Women in Historical Dramas during the ‘Kang-Qian’ Heyday in ‘Qing Dynasty’ -Focus on &lt;Empresses in the Palace&gt;-

Clothing Characteristics of Royal Women in Historical Dramas during the ‘Kang-Qian’ Heyday in ‘Qing Dynasty’ -Focus on &lt;Empresses in the Palace&gt;-

The Role of Lesser Aristocratic Women in Twelfth-century Yorkshire Society — The Rumilly, Arches, and St Quentin Charters

This article argues that lesser aristocratic women were an active part of twelfth-century society and that as landholders and alienators they were able to significantly shape and mould local monastic society, family wealth and relationships, and other secular social networks. The influence women could have on these areas was on the material and physical geography of the land as well as on the social relationships. As landholders, women could and did maintain social networks with the ecclesiastical and secular societies. This was, however, limited by the geographic location of their landholding and thus demonstrates a social world that is defined by localities and regions. The three families of Rumilly, Arches and St Quentin provide cases whereby women’s activities can be evidenced in a range of events and actions. They also demonstrate a level of independence in women’s agency that did not rely on their male kin before land alienations or grants could be made. The available charter evidence for the three families studied is also illustrative of the existing charter material that can be identified for lesser aristocratic women and allows the paper to address twelfth-century women outwith the traditionally studied groups of royal and comital women or religious women.

Immediate birth – an analysis of women and their babies undergoing time critical birth in a tertiary referral obstetric hospital

BackgroundAt our institution, the emergency obstetric ‘code green’ activates the system for immediate birth, usually by caesarean section. This study aimed to determine the incidence of immediate birth, indications, modes of anaesthesia, and short-term neonatal and maternal outcomes. MethodA review was performed for all women at the Royal Women’s Hospital, Parkville, Australia who underwent immediate birth over a two-year period: January 1, 2013 to December 31, 2014. ResultsWithin the study period 14,115 women gave birth, of which 387 women underwent an immediate birth, the majority (83%) by caesarean section. The commonest indication for immediate birth was prolonged fetal bradycardia (53%), however cord prolapse (4%) produced the most rapid decision-to-delivery interval, with a median [IQR] time of 14 [13–16] min versus 18 [14–23] min for all immediate births (P<0.01). Epidural top-up was the most common anaesthesia method. Conversion to general anaesthesia following inadequate neuraxial anaesthesia occurred in 6.2% of women. Among 103 general anaesthetics, there was one failed intubation (successful ventilation) and one dental injury. Nine women (2.3%) were admitted to the high dependency or intensive care units, and there were no maternal deaths. Babies born by caesarean section with a decision-to-delivery interval of less than 30min were more likely to have longer times to establish respiration (22.6% vs 16.7%, P<0.001). ConclusionRequest for immediate delivery is a common obstetric emergency. Epidural top-up has become the most common anaesthetic technique. Rapid delivery times can be achieved with an integrated emergency response system.

Schutte, Mary I and the Art of Book Dedications: Royal Women, Power, and Persuasion (Palgrave Macmillan, 2015)

Schutte, Mary I and the Art of Book Dedications: Royal Women, Power, and Persuasion (Palgrave Macmillan, 2015)

Associations of Newborn Brain Magnetic Resonance Imaging with Long-Term Neurodevelopmental Impairments in Very Preterm Children

To determine the relationship between brain abnormalities on newborn magnetic resonance imaging (MRI) and neurodevelopmental impairment at 7 years of age in very preterm children. A total of 223 very preterm infants (<30 weeks of gestation or <1250 g) born at Melbourne's Royal Women's Hospital had a brain MRI scan at term equivalent age. Scans were scored using a standardized system that assessed structural abnormality of cerebral white matter, cortical gray matter, deep gray matter, and cerebellum. Children were assessed at 7 years on measures of general intelligence, motor functioning, academic achievement, and behavior. One hundred eighty-six very preterm children (83%) had both an MRI at term equivalent age and a 7-year follow-up assessment. Higher global brain, cerebral white matter, and deep gray matter abnormality scores were related to poorer intelligence quotient (IQ) (Ps < .01), spelling (Ps < .05), math computation (Ps < .01), and motor function (Ps < .001). Higher cerebellum abnormality scores were related to poorer IQ (P = .001), math computation (P = .018), and motor outcomes (P = .001). Perinatal, neonatal, and social confounders had little effect on the relationships between the MRI abnormality scores and outcomes. Moderate-severe global abnormality on newborn MRI was associated with a reduction in IQ (-6.9 points), math computation (-7.1 points), and motor (-1.9 points) scores independent of the other potential confounders. Structured evaluation of brain MRI at term equivalent is predictive of outcome at 7 years of age, independent of clinical and social factors.

"신라 중고기 왕실여성과 불교 ― 영흥사의 창건과 도유나랑을 중심으로 ―"

"신라 중고기 왕실여성과 불교 ― 영흥사의 창건과 도유나랑을 중심으로 ―"

Finding Hama: On the Identification of a Forgotten Queen Buried in the Nimrud Tombs

Finding Hama: On the Identification of a Forgotten Queen Buried in the Nimrud Tombs

Outcomes and predictive tests from a dedicated specialist clinic for women at high risk of preterm labour: A ten year audit.

Preterm birth continues to be a major cause of infant morbidity and mortality worldwide, but advances have recently been made in its prediction and prevention. A short cervix (<25mm) in the second trimester on transvaginal ultrasound scan and fetal fibronectin are important predictive tests. For over ten years, the Preterm Labour Clinic at the Royal Women's Hospital, Melbourne, Australia has provided care for women at high risk of preterm birth, including those with a previous preterm birth, previous cervical surgery, uterine malformation or incidental finding of short cervix at routine ultrasound. The purpose of this study was to review this clinic's outcomes for the first decade. This was a retrospective cohort study of all referrals to the Preterm Labour Clinic during the period 2004-2013 inclusive. Seven hundred and fifty-six cases met the study inclusion criteria of appropriate risk factor, singleton pregnancy, surveillance undertaken and outcome data available. The preterm birth rate (<37weeks) was 21.4%. The rate of preterm birth by year decreased significantly when adjusted for risk (P=0.002). A short cervix was diagnosed in 32% of the sample, and positively correlated with lower gestational age at delivery. Fetal fibronectin and serum alkaline phosphatase were independent predictors of preterm birth <34weeks and <37weeks. The adjusted preterm birth rate at the Royal Women's Hospital's Preterm Labour Clinic has decreased significantly over the decade studied. Positive fetal fibronectin at 26weeks and elevated serum alkaline phosphatase are independent predictors of preterm birth.

Chorionic villus sampling in the cell‐free DNA aneuploidy screening era: careful selection criteria can maximise the clinical utility of screening and invasive testing

To quantify the impact of cell-free DNA (cfDNA) screening on chorionic villus sampling (CVS) test indications and outcomes in a tertiary maternity service. Retrospective cohort study of all CVS procedures performed for any indication on singleton pregnancies at The Royal Women's Hospital, Melbourne, and at Women's Ultrasound Melbourne, Australia, between August 2008 and February 2015. Karyotypes were classified according to pathogenicity and detectability by standard cfDNA screening panels. A total of 2051 CVS procedures, 25 373 twelve-week scans and 2394 cfDNA tests were performed. The CVS rate per 12-week scan fell from 9.8 to 3.9% following introduction of cfDNA screening. The yield of pathogenic chromosomal anomalies per CVS increased from 12.9 to 25.2%, with 70% of pathogenic results now comprising T21, up from 52%. Sixteen (5.3%) of the pathogenic chromosomal abnormalities identified on CVS would not have been predicted by current cfDNA tests. There is an evolving tension between improved screening performance for common aneuploidies offered by cfDNA testing, and the increasing diagnostic utility of molecular karyotyping. However, the risk of not identifying pathogenic chromosomal abnormalities is low if cfDNA screening is offered in the absence of a structural fetal anomaly, increased nuchal translucency or relevant family history. © 2017 John Wiley & Sons, Ltd.

Opus Anglicanum: Masterpieces of English Medieval Embroidery: Victoria and Albert Museum, LondonOctober 1, 2016–February 5, 2017CatalogueEnglish Medieval Embroidery: Opus AnglicanumEdited by Clare Browne, Glyn Davies, and M. A. MichaelNew Haven, CT, and London: Yale University Press in association with the Victoria and Albert Museum, 2016.336 pp.; 270 color ills.Cloth $75.00ISBN 9780300222005The Age of Opus AnglicanumEdited by M. A. MichaelLondon: Brepols

<i>Opus Anglicanum</i>: Masterpieces of English Medieval Embroidery: Victoria and Albert Museum, LondonOctober 1, 2016–February 5, 2017Catalogue<i>English Medieval Embroidery: <i>Opus Anglicanum</i></i>Edited by Clare Browne, Glyn Davies, and M. A. MichaelNew Haven, CT, and London: Yale University Press in association with the Victoria and Albert Museum, 2016.336 pp.; 270 color ills.Cloth $75.00ISBN 9780300222005<i>The Age of <i>Opus Anglicanum</i></i>Edited by M. A. MichaelLondon: Brepols

Incidence of Malignancy and Myoma Variants at Surgery for Presumed Benign Symptomatic Myomas

Study ObjectiveTo estimate the incidence of leiomyosarcoma; other uterine pathologies; and the frequency of use of morcellation, both mechanical and manual in laparoscopic, vaginal, and laparotomy operative routes in women undergoing hysterectomy or myomectomy for benign gynecologic indications when myomas were present. DesignA retrospective study (Canadian Task Force classification II-3). SettingThe Royal Women's Hospital, Melbourne, Australia. PatientsAll hysterectomies and myomectomies (any route) for a 10-year period from January 1, 2004, to December 31, 2013, for presumed benign gynecologic indications. InterventionsHysterectomy or myomectomy, any route. Measurements and Main ResultsFrom January 1, 2004, to December 31, 2013, a total of 2790 hysterectomies and myomectomies were performed for presumed benign disease. Myomas were present in 1878 cases. There were no cases of leiomyosarcoma identified, giving an incidence of 0% (95% confidence interval, 0%–0.20%). There were 73 (4%) cases of benign variants, of which 2 (3%) displayed metastatic behavior. There were 11 cases of unexpected malignancy (0.6%). ConclusionThere were no confirmed cases of leiomyosarcoma over the 10-year period in women requiring surgery for presumed benign disease in the presence of myomas. There was a low but significant rate of unexpected gynecologic malignancy and a higher than expected rate of clinically significant adverse outcomes with manually morcellated cellular myoma variants.

Association Between Moderate and Late Preterm Birth and Neurodevelopment and Social-Emotional Development at Age 2 Years

Moderate and late preterm (MLPT) births comprise most preterm infants. Therefore, long-term developmental concerns in this population potentially have a large public health influence. While there are increasing reports of developmental problems in MLPT children, detail is lacking on the precise domains that are affected. To compare neurodevelopment and social-emotional development between MLPT infants and term-born control infants at age 2 years. This investigation was a prospective longitudinal cohort study at a single tertiary hospital. Participants were MLPT infants (32-36 weeks' completed gestation) and healthy full-term controls (≥37 weeks' gestation) recruited at birth. During a 3-year period between December 7, 2009, and November 7, 2012, MLPT infants were recruited at birth from the neonatal unit and postnatal wards of the Royal Women's Hospital, Melbourne, Australia. The term control recruitment extended to March 26, 2014. The dates of the data developmental assessments were February 23, 2012, to April 8, 2016. Moderate and late preterm birth. Cerebral palsy, blindness, and deafness assessed by a pediatrician; cognitive, language, and motor development assessed using the Bayley Scales of Infant Development-Third Edition (developmental delay was defined as less than -1 SD relative to the mean in controls in any domain of the scales); and social-emotional and behavioral problems assessed by a parent questionnaire (Infant Toddler Social Emotional Assessment). Outcomes were compared between birth groups using linear and logistic regression, adjusted for social risk. In total, 198 MLPT infants (98.5% of 201 recruited) and 183 term-born controls (91.0% of 201 recruited) were assessed at 2 years' corrected age. Compared with controls, MLPT children had worse cognitive, language, and motor development at age 2 years, with adjusted composite score mean differences of -5.3 (95% CI, -8.2 to -2.4) for cognitive development, -11.4 (95% CI, -15.3 to -7.5) for language development, and -7.3 (95% CI, -10.6 to -3.9) for motor development. The odds of developmental delay were higher in the MLPT group compared with controls, with adjusted odds ratios of 1.8 (95% CI, 1.1-3.0) for cognitive delay, 3.1 (95% CI, 1.8-5.2) for language delay, and 2.4 (95% CI, 1.3-4.5) for motor delay. Overall social-emotional competence was worse in MLPT children compared with controls (t statistic mean difference, -3.6 (95% CI, -5.8 to -1.4), but other behavioral domains were similar. The odds of being at risk for social-emotional competence were 3.9 (95% CI, 1.4-10.9) for MLPT children compared with controls. Moderate and late preterm children exhibited developmental delay compared with their term-born peers, most marked in the language domain. This knowledge of developmental needs in MLPT infants will assist in targeting surveillance and intervention.

Predictors of Cephalic Vaginal Delivery Following External Cephalic Version: An Eight-Year Single-Centre Study of 447 Cases.

Introduction. Our study aims to investigate and evaluate (1) rates of success of ECV for breech presentation at term at the Royal Women's Hospital in comparison to international standards; (2) mode of delivery following ECV; (3) factors influencing success rates of ECV at the Royal Women's Hospital. Methods. An audit of all women who underwent ECV between the years 2007 and 2014 at the Royal Women's Hospital as public patients was completed. Data parameters were collected from paper and electronic patient files at the Women's Hospital. Data was collected to analyse the effect of the following parameters on ECV success and birth outcome: age, parity, gestational age, BMI, AFI, and tocolytic use. These parameters were analysed to determine their effect on ECV outcome and birth outcome. Results. The Women's Hospital, Melbourne, has an ECV success rate of approximately 37%. Of the patients undergoing ECV, 29% proceeded to normal vaginal delivery. Predictors of successful ECV included low BMI, multiparity, and AFI more than 16 (P < 0.05). The only predictor of cephalic vaginal delivery following ECV was multiparity. Negative predictors of cephalic delivery were low AFI and nulliparity. Conclusions. The success rate of ECV at the Women's Hospital, Melbourne, is in line with global standards.

A Case Series of Intravenous Leiomyomatosis and Literature Review

Intravenous leiomyomatosis (IVL) is an uncommon benign smooth-muscle tumour of the uterus which invades into uterine and systemic veins. Although benign, this tumour may grow in the absence of, or beyond the confines of a uterine leiomyoma or fibroid, and has the potential to behave aggressively via extension of growth in the venous vasculature, upwards into the inferior vena cava (IVC) and into the right cardiac chambers. This can lead to serious cardiac and pulmonary sequelae. Rarer neurological sequelae and fatal cases have also been reported. Unless there is obvious IVC or intracardiac spread on preoperative imaging, IVL poses a diagnostic challenge. IVL has been reported in the literature as a rare event and is postulated to be more common than previously reported. Potentially this change is related to increased histopathological diagnosis following hysterectomy or fibroid excision. The prognosis of the cases is unknown but requires follow up as recurrence is possible. This paper presents a case series of 12 patients who were diagnosed on post-operative histopathology with IVL in a 20-month period at The Royal Women's Hospital, Victoria, Australia and a literature review of the current management of this unusual disease.

Portraying The Royal Self: Maurice-Quentin De La Tour’s 1761 Portrait Of Marie-Josèphe Of Saxony And Her Son

My analysis of Maurice-Quentin de La Tour’s Portrait of Marie-Josèphe of Saxony and Her Son (1761) in the context of Salic Law and eighteenth-century French gender politics suggests the future queen’s negotiation of her own identity in royal portraiture. While the dauphine’s representation adheres to rigidly structured codes of queenship in French art, I argue that Marie-Josèphe paradoxically sought to assert her selfhood amidst the depicted glory of the Bourbon dynasty. Likely to be the portrait’s direct patron instead of the King’s Household, Marie-Josèphe adopted sartorial and ideological elements from Jean-Marc Nattier’s more private portrayal of Queen Marie Leszczinska (1748) to construct her image, suggesting a visual fellowship between royal women as they confronted gender constraints within French absolutism in art. Also, unlike most official portraits that formally represented royal sitters in oils, La Tour’s more personal approach to painting through the intimacy of the pastel medium undermines the principles of royal portraiture to indicate a degree of the dauphine’s agency. With imagery that falls in-between what was typical for official and private portraits of royalty, La Tour’s pastel painting alludes to mounting ambiguities in representations of queenship in eighteenth-century France.