Treatment of unruptured ectopic pregnancy with single-dose of methotrexate

The purpose of this study was to determine success rate with single-dose intramuscular methotrexate therapy for the treatment ectopic pregnancy. This was a retrospective review of patient who were treated with methotrxate from may 2003 to April 2006. Successful treatment was defined as resolution of ectopic pregnancy without surgical intervention. Tertiary centre. Our overall success rate was 90% [90/100 patient]. The median pre treatment serum beta-human chorionic gonadotropin level was lower in those women in whom treatment was successful compared with those women with treatment failure [3158 Vs 9249mIU/ml, p<0.0001]. The median time till resolution of ectopic was 30.7 days. A positive correlation was found between pre treatment beta hCG level and time to resolution [r=0.844]. Eight patients with positive ectopic cardiac activity were treated with an 75% success rate. This large series indicates that single-dose methotrexate for treatment of ectopic pregnancy is associated with an excellent rate

Preoperative vaginal preparation with povidone-iodine and post-cesarean infectious morbidity

Objective: to determine whether vaginal preparation with povidone-iodine before cesarean section decrease the incidence of postpartum infectious morbidity

Methods: a randomized, controlled study was performed on 304 women undergoing non-emergency cesarean delivery. The subjects received either standard abdominal scrub alone or abdominal scrub with an additional vaginal preparation with povidone-iodine solution. All subjects received prophylactic antibiotics at the time of umbilical cord clamping. Each subject's postoperative course was reviewed for development of febrile morbidity [temperature >38.0 degree C], endometritis [temperature >38.4 degree C accompanied by fundal tenderness occurring beyond the first postoperative day, in absence of evidence of other infection], and wound infection

Results: post-cesarean endometritis occurs in 4.7% of subjects who received a preoperative vaginal preparation and 14.1% of controls [p=0.0097]. There was no measurable effect of a vaginal scrub on development of postoperative fever or wound infection. The adjusted odd ratio [OR] for developing endometritis after a vaginal preparation was 0.33 [95% confidence interval [CI] 0.287-0.831]. Multivariate analysis showed an increased risk of developing endometritis in association with severe anaemla [adjusted OR 1.22, 95% CI 0.755- 1.975]. Use of intraparturn internal monitors [adjusted OR 1.03, 95% CI 0.601 -1.756], or history of antenatal genitourinary infection [adjusted OR 0.988, 95% CI 0.612-1.596]

Conclusion: preoperative vaginal scrub with povidoneiodine decreases incidence of post-cesarean endometritis. This intervention does not seem to decrease the overall risk of postoperative fever or wound infection