Pipelle versus fractional curettage for the endometrial sampling in postmenopausal women.

The experimental and cross over design study was performed to compare the pain, ability to sample the endometrial issue, and pathological results from pipelle and fractional curettage in post menopausal patients. Thirty naturally menopausal patients who visited King Chulalongkorn Memorial Hospital with abnormal bleeding per vagina from June 1 to December 31, 1997, were enrolled in the study. In group A,endometrial tissue sampling was first conducted by Pipelle and followed by fractional curettage. In group B, the fractional curettage was performed before Pipelle. The results showed that the pain derived by the visual analogue scale of Pipelle and fractional curettage were 3.34 +/- 1.44 (mean +/- SD) and 6.58 +/- 1.75 respectively (p<0.01). The sensitivity and specificity of Pipelle in endometrial tissue samplings compared with fractional curettage were 87.5 and 100 per cent, respectively. One from 3 cases of adeneocarcinoma of the endometrium could not be detected by Pipelle. In conclusion, Pipelle significantly produced less pain than fractional curettage. Even though Pipelle is a simple and easy method for endometrium sampling, the use of Pipelle to replace fractional curettage in the management of postmenopausal bleeding should be done with caution. False negative could occur in the focal disease of malignancy of the endometrium.

The role of maternal serum C-reactive protein and white blood cell count in the prediction of chorioamnionitis in women with premature rupture of membranes.

This study was performed to evaluate the diagnostic performance of maternal serum C-reactive protein, maternal white blood cell (WBC), and neutrophil counts in the detection of histologic chorioamnionitis. One hundred and twenty six pregnant women after at least 28 weeks of gestation with premature rupture of membranes (PROM) were studied. Blood samples for C-reactive protein, WBC and neutrophil counts were taken at delivery. Placental histology was evaluated for histologic chorioamnionitis. Maternal and neonatal complications were observed. Among women with and without histologic chorioamnionitis, the maternal WBC and neutrophil counts were different (P<0.05) but the maternal serum C-reactive protein was not. Cutoff values for C-reactive protein, WBC, and neutrophil counts were 0.5 mg/dL, 15,000 cell/mm3, and 80 per cent, respectively. Sensitivity and specificity were 56 per cent and 58 per cent for C-reactive protein, 60 per cent and 63 per cent for WBC count, and 62 per cent and 54 per cent for neutrophil count, respectively. In conclusion, the maternal serum C-reactive protein, WBC, and neutrophil counts have poor diagnostic performance for histologic chorioamnionitis.