Laparoscopic management of ovarian endometriomas comparative study incision peeling versus incision coagulation

To compare the effect of incision-peeling versus incision coagulation of pelvic endometriomas. Prospective, blind, randomized controlled study was performed on 88 patients diagnosed as having bilateral ovarian endometriomas. All patients were subjected to three puncture operative laparoscopy. In each patient one endometrioma was randomly chosen for mechanical peeling of its wall [peeled group] while the lining of the other endometrioma was coagulated. The records were blind to the observers of the results. No statistically significant difference between the two groups was found regarding the recurrence rate. While coagulated group is statistically better than peeled group regarding ovarian volume, ovarian dominance and response to clomphine citrate and ovarian dominance and number of occytes retrived during IVF and ICSI. Also there was statistically significant difference between the two groups regarding periovarian adhesions and distal tubal affection. No difference of the rate of recurrence of endometriomas either treated by laparoscopic excision of cyst wall or by coagulation. Ovarian endometriomas treated by incision, evacuation and coagulation provides for a more favourable outcome than peeling of cyst wall, with regard to the ovarian volume, the ovarian dominance and yield of follicles and the ovarian dominance and yield of oocytes. Peeling causes more periovarian adhesions and fimbrial affection of the ipsilateral tube

Attempted induction to prevent postdatism

To evaluate some different methods of attempted induction and cervical ripening to prevent postdatism. The study was performed on 60 primigravidae women with low Bishop score and at 41 weeks gestation. They were divided into 4 groups. The first group received oxytocin drip infusion [2.5 ml unit in 500 c.c. glucose at a rate of 20 drops/minute- only one bottle]. The second group received 50 micro g misoprostol vaginally every 6 hours for 2 days. The third group were subjected to membrane stripping every 24 hours for 2 days. The fourth group were subjected to gentle examination for 2 days [expectant]. The induction-contraction interval [in hours] and induction-delivery interval for patient of group II [misoprostol] were statistically significantly shorter than the other groups. Regarding the abnormal uterine contraction group II [misoprostol] showed abnormal changes than other groups while group I [oxytocin] showed significant changes in foetal heart rate than the other groups. Group I [oxytocin] showed highest frequency of complications compared to the other groups. The study also showed no significant differences among the studied 4 groups with regard to normal and assisted delivery. Induction of labour to prevent postdatism by vaginal misoprostol is the easiest, safest, most convenient way and results in a shorten induction delivery interval. Yet with misoprostol there is an associated risk of hyperstimulation