ABSTRACT
OBJECTIVE: To evaluate safety and efficacy of systemic or local methotrexate(MTX) injection to patients with unruptured ectopic pregnancy METHODS: From October 1995 to October 1999, 35 unruptured ectopic pregnancies were eligible for the conservative management. 25 tubal pregnancies, 4 cervical pregnancies, 4 pregnancies of previous cesarean section scar, and 2 cornual pregnancies diagnosed by ultrasonography & serumbeta-hCG were evaluated. Patients were treated with one of following three protocols : (1) A single-dose of 50mg/m2 of intramuscullar(IM) MTX(7 cases) (2) Two to four doses of 1.0mg/kg of IM MTX with citrovorum rescue(20 cases) (3) Transvaginal ultrasonogram-guided intra-amniotic instillation of 50mg methotrexate (8 cases) The mean age of these patients was 30.8 yrs (range 24-42) and gestational age at diagnosis ranged from 22-75 days (mean 47). Initial level of serumbeta-hCG ranged from 166.4-55363.8 mIU/mL (mean 9069.2). Patients were monitored with serumbeta-hCG titers three times per week ,and then weekly until the serumbeta-hCG level was less then 10 mIU/mL. RESULT: 31 of 35 patients (88.6%) were successfully treated and remaining 4 patients failed conservative therapy and so required surgery. Mean duration of resolution was 38.5 days (range 11-105). Side effect rate was 45.7% but severity of symptoms were so mild that no treatment was needed in most cases. CONCLUSION: Nonsurgical conservative management of MTX appears to be effective and safe treatment modality for some selected unruptured ectopic pregnancy. But further comparative studies and long-term follow-up are needed to evaluate reproductive outcome and reduce side effects of MTX.
Subject(s)
Female , Humans , Pregnancy , Cesarean Section , Cicatrix , Diagnosis , Follow-Up Studies , Gestational Age , Methotrexate , Pregnancy, Ectopic , Pregnancy, Tubal , UltrasonographyABSTRACT
We report a case of a 13-year-old girl who was noted to have combined malformation of complete septate uterus, obstructed hemivagina and ipsilateral renal agenesis with complaints of dysmenorrhea. Hematometrocolpos was developed in the result of retained menstrual blood since menarche. This rare congenital anomaly is supposed to be derived from disorders of mesonephric and M llerian developement in embryogenesis of female genitouinary tract. An accurate preoperative diagnosis of this syndrome is critical because of the difference in therapeutic strategy and prognosis. Simple and definite treatment of the condition is excision of the obstructed vaginal septum with prompt exit of retained blood. We present here a interesting case of M llerian anomaly in attempt to alert gynecologist to the possible occurrence of such a malformation with a brief review of concerned literatures.
Subject(s)
Adolescent , Female , Humans , Pregnancy , Diagnosis , Dysmenorrhea , Embryonic Development , Menarche , Prognosis , UterusABSTRACT
OBJECTIVE: To compare the safety and efficacy of intravaginal misoprostol versus intracervical dinoprostone (prostaglandin E2 gel) for cervical ripening and labor induction. METHODS: 60 patients with indication for labor induction and unfavorable cervices were randomly assigned to receive either intravaginal misoprostol or intracervical dinoprostone. 50 microgram tablets of misoprostol were placed in the posterior vaginal fornix every 4 hours for a maximum of 3 doses or dinoprostone 0.5mg was placed into the endocervix every 6 hours for a maximum of 2doses. No more medication was given after either spontaneous rupture of membranes or beginning of active labor. RESULTS: Among 60 patients enrolled, 30 received misoprostol and 30 received dinoprostone. The average interval from start of induction to active labor was shorter in misoprostol group (6.5+/-3.2 hours) than in the dinoprostone group (10.7+/-7.3 hours) (p<0.05). Oxytocin augmentation of labor occurred more often in the dinoprostone group (36.7%) than in the misoprostol group (10.0%) (p<0.05). There was a higher prevalence of fetal distress (23.3% versus 3.3%) and tachysystole (16.6% versus 6.6%) in the misorprostol group than in the dinoprostone group(p<0.05). CONCLUSIONS: Vaginally administered misoprostol is an effective agent for cervical ripening and induction of labor. Furthermore, the cost of misoprostol ( 360/200microgram) is much less than that of dinoprostone ( 42,000/0.5mg). Cost benefits from administration of misoprostol are evident, especially in clinics under system of diagnosis-related group (DRG) : however when given at this dosage, it is associated with a higher prevalence of fetal distress and tachysystole than dinoprostone. Further studies to compare the safety of misoprostole to that of dinoprostone and to delineate an optimal dosing regimen for misoprostol are needed.
Subject(s)
Female , Humans , Pregnancy , Cervical Ripening , Cost-Benefit Analysis , Diagnosis-Related Groups , Dinoprostone , Fetal Distress , Membranes , Misoprostol , Oxytocin , Prevalence , Prospective Studies , Rupture, Spontaneous , TabletsABSTRACT
Leiomyoma of vagina is relatively rare benign tumor. And majority of these lesions occur in labia major and anterior vaginal wall. The recurrence of this tumor is extremely rare and its cellular atypism, mitotic activity, tumor size and contour are known as important factors in its recutrence. A case of recutrent leiomyoma causing urinary frequency in vesicovaginal septum was reported with a brief review of literature.