[Accordance between serum beta-hCG and vaginal ultrasonography in confirming a complete abortion]

Considering that there is no general agreement on use of misoprostol as the best method for the termination of pregnancy in first trimester, this study aimed to compare the vaginal ultrasonography and serum beta-hCG in the confirming of a complete abortion. This study was performed on 133 patients with a missed abortion or the blighted ovum diagnosed by vaginal ultrasonography, and a 12 week gestational sac admitted to Shabih-Khani hospital of Kashan in 2010. The patients' serum beta-hCG levels were measured. They were assessed for the tissue discharge [abortion] after taking one or two doses of vaginal misoprostol suppositories and the oral contraceptive pills prescribed after confirming the abortion. Then vaginal ultrasonography and the serum beta-hCG measurement were performed to diagnose the complete abortion in the second and fourth weeks of pregnancy. Among 133 patients, a complete abortion was diagnosed for 116 [87.2%] and 80 cases [60.15%] based on beta-hCG level and vaginal ultrasonography, respectively in the second week of pregnancy. In other cases, a complete abortion was diagnosed using both beta-hCG level and vaginal ultrasonography in the fourth week. Therefore, beta-hCG level was more effective [98.75%] than the vaginal ultrasonography to diagnose a complete abortion in the second week of pregnancy. The accordance between the two methods was 0.327 at the end of the second week of pregnancy. The measurement of beta-hCG level and vaginal ultrasonography are equally effective to confirm a complete abortion. Hence, to diagnose the complete abortion, determining the beta-hCG level followed by clinical examination is recommended

[Term delivery following successful treatment of choriocarcinoma with brain metastases a case report]

Cerebral metastases from choriocarcinoma are poor prognostic indicator of outcome in both the World Health Organization and FIGO classification systems. Although gestational trophoblastic neoplasia has become the most curable gynecological malignancy, failure rate among 'high-risk' patients is still high despite the use of aggressive multidrug regimens. A 27 year old woman [G4P2Ab1] presented with hemiplegia due to brain metastases of choriocarcinoma one year after spontaneous abortion. She underwent craniotomy and was treated with nine courses of multiple agent etoposide, methotrexate, actinomycin-etoposide and cisplatinum [EMA-EP] regimen combined with whole brain irradiation. She delivered a term healthy child two years after termination of treatment. Multiagent EMA-EP chemotherapy and whole brain irradiation with craniotomy in selected patients preserves fertility and may improve a patient overall prognosis

Diagnostic value of endometrial sampling with pipelle suction curettage for identifying endometrial lesions in patients with abnormal uterine bleeding

Background: while determining the cause of abnormal uterine bleeding, sampling from the endometrium is necessary. Considering that pipelle suction curettage can be performed on an out patient basis and does not require hospitalization, using anesthesia and cervical dilatation, we performed this study. The aim of this study was to compare the diagnostic value of dilatation and curettage [D and C] with pipelle suction curettage

Methods: this study was quasiexperimental on 200 pre and postmenopausal patients with abnormal uterine bleeding who refered to Shabihkhani hospital in Kashan, Iran. Endometrial sampling was performed in all patients with two methods namely pipelle and D and C. A pathologist examined the samples each having a predetermined code

Results: the mean age of subjects was 46.2 +/-6.2 years, minimum age was 35 years and the maximum was 70 years. The various pathological lab findings were proliferative endometrium, secretory endometrium, athrophic, decidua, cystic and adenomatous hyperplasia. The reports were the same in two methods except for 2 cases where they were different: secretory endometrium with D and C but cystic hyperplasia in pipelle method

Conclusions: the result of our study shows the comparability of obtaining endometrial sample by pipelle with D and C. Due to comfort and convenience of patients in pipelle methode especially in the office setting which does not need anesthesia, pipelle method can easily be employed instead of D and C