Spontaneous heterotopic pregnancy presenting with tubal abortion.

Heterotopic pregnancies are rarely spontaneous. We present the case of a woman who presented with acute abdominal pain. Emergency laparotomy was performed. Intraoperative finding showed right tubal pregnancy and right salpingectomy was performed. Six weeks post-operation, the patient's symptoms and signs of pregnancy persisted and ultrasound showed an intrauterine single viable fetus. The pregnancy was continued to term and a healthy female baby was delivered.

Effect and safety of 17 beta-estradiol vaginal tablet in postmenopausal women with urogenital symptoms.

OBJECTIVE: To evaluate the effects of a 17 beta-estradiol vaginal tablet on urogenital symptoms, vaginal pH, vaginal cytology, endometrial thickness, and plasma estradiol level in postmenopausal women with urogenital symptoms. METHOD: Twenty-seven postmenopausal women with urogenital symptoms received 25 microg of a 17 beta-estradiol tablet intravaginally daily for the first 2 weeks, followed by 10 weeks of twice a week dosage. The results of urogenital symptoms, vaginal pH, vaginal cytology, endometrial thickness, and plasma estradiol level were analysed. RESULTS: The urogenital symptoms improved significantly in all women. The mean vaginal pH was significantly decreased. The vaginal cytology showed estrogenic effect on the karyopyknotic index and the maturation value. There was no significant difference in endometrial thickness and level of plasma estradiol before and after treatment. There was one case of vaginal bleeding from endometrial proliferation. CONCLUSION: Local vaginal treatment of 17 beta-estradiol (25 microg) had a positive effect on the urogenital symptoms, vaginal pH, and vaginal cytology. No elevation of plasma estradiol level was detected after treatment.

Pattern of bone loss in surgical menopause: a preliminary report.

The objective of our study was to assess bone mineral density between surgical menopausal women without hormonal replacement and perimenopausal women. This randomized study group included fifty surgical menopausal women and fifty perimenopausal women. Both groups were assessed in body height, body weight and body mass index. The bone mineral density of the distal radius, midradius, femoral neck, lumbar spine and total body in both groups was determined by dual energy X-ray absorptiometry (DEXA). Data analysis was used ANOVA test and rate of bone loss equation. Both groups were similar with respect to body height, body weight and body mass index. As compared with the values in perimenopausal group, bone mineral density of the surgical menopausal group was significantly lower at distal radius, midradius, femoral neck, lumbar spine, and total body (0.267 vs 0.312 g/cm2, 0.609 vs 0.692 g/cm2, 0.762 vs 0.930 g/cm2, 0.980 vs 1.153 g/cm2, and 1.029 vs 1.141 g/cm2). In the postmenopausal period less than 9 years, the estimated rate of bone loss at the lumbar spine and the distal radius were higher than the other sites (3.05, 2.70 per cent/year). While the postmenopausal period more than 9 years, the estimated rate of bone loss at the femoral neck was higher than the other sites (2.70 per cent/year). Pattern of bone loss in the surgical menopause is responsible for type I osteoporosis in the first 9 years postmenopause and type II osteoporosis in the after 9 years postmenopause. Prevention of bone loss in the surgical menopausal women should be instituted immediately after surgery.

Urological injury during gynecologic surgical procedures.

Urological injury during gynecologic surgical procedures is an infrequent but serious complication. The incidence from this study is less than other studies. There are 25 cases of urological injuries consisting to twenty-one bladder injuries and four ureteral injuries. The associated factors of the urological injury are previous pelvic operation, distorted anatomy in the pelvis from various diseases and full bladder. Prompt intraoperative recognition of the injury is the best way to prevent serious postoperative complication. Four had vesicovaginal fistulae that were recognized postoperatively. Three had spontaneous closure of fistulae with conservative management and one required surgical management. Patients who had urological injury during the gynecologic surgical procedures had a longer hospital stay. The most important factor in prevention of this injury is a clear exposure of structures at risk.

Manual removal of placenta at Ramathibodi Hospital 1985-1988.

In obstetrics, the need to perform manual removal of placenta is not infrequent. This was a retrospective study of placental removal among all vaginal deliveries at Ramathibodi Hospital from 1985 to 1988. The incidence of manual removal of placenta was 2.1 per 100 parturients which was higher than other reports. The reason for this is still unclear. The patients' age was mostly 26-30 years with multiparity accounting for 73.1 per cent and most deliveries occurred between 38-40 weeks of gestational age. The indication for manual removal of placenta was mostly placental retention. Previous history of curettage in the last gravida accounted for 34.7 per cent of cases. In two cases (0.5%), the procedure failed due to placenta accreta and hysterectomy was required.