Icodextrin reduces adhesion formation following gynecological surgery in rabbits

Adhesion is a common complication of gynecology surgery so different barrier agents and solutions have been used during these operations to separate and protect tissues from adhesion after surgery. Adept is one of these solutions that have been postulated to reduce the chance of adhesion following gynecolgy surgery. To evaluate the effect of 4% icodextrin in reducing adhesion formation in comparing with sterile water and human amniotic fluid in rabbits. In this prospective experimental study 30 white Newzealand female rabbits were selected and randomized in to three treatment groups. The rabbits were anesthetized and an abdominal incison was made, uterine horns were abrated with gauze until bleeding occurred. Before closing the abdomen, the traumatized area was irrigated either by 30cc of sterile water, 30cc of 4% Adept or 30cc of human amniotic fluid. The solutions were labeled only as solutions A [steriel water], B [icodextrin], or C [human amniotic fluid]. On the seventh day after surgery, second laparotomy was performed to determine and compare adhesion formation in rabbits. There was significant difference between mean score of adhesions in 4% icodextrin group [2.1 +/- 0.70] in comparison to sterile water group [10.4 +/- 0.60] and amniotic fluid group [8.7 +/- 0.84]. But the difference between mean score of adhesions in amniotic fluid group in comparison to sterile water group was not significant [8.7 +/- 0.84] versus [10.4 +/- 0.60]. The use of 4% icodextrin solution was more effective than human amniotic fluid and sterile water in reducing adhesion formation in a gynecological surgery model in rabbits

Heterotopic abdominal pregnancy following ovulation induction with clomiphene citrate

Heterotopic abdominal pregnancy is a rare entity which poses unique management challenges. A 24-year-old Gravida 1 woman with history of two years infertility and treatment with clomiphene citrate presented with acute right lower quadrant abdominal pain. Heterotopic abdominal pregnancy was recognized at 16 weeks gestation by transvaginal ultrasound scan. We aimed to remove ectopic pregnancy with prevention of maternal complications and preservation of intrauterine pregnancy [IUP]. Surgical removal of the ectopic fetus and placenta was done. Abdominal pregnancy removed successfully without intra-or post-procedural complications, but the IUP was aborted spontaneously on the second postoperative day. Gynecologists should consider the possibility of heterotopic pregnancy following ovulation induction with clomiphene citrate which is increasing in recent years. A high index of suspicion to heterotopic pregnancy may be followed by a nonsurgical approach safely and affectively, if they are clinically stable and the abdominal pregnancy is recognized early in gestation