Ectopic pregnancy: histopathology and assessment of cell proliferation with and without methotrexate treatment.

OBJECTIVE: To evaluate tubal morphology, trophoblast proliferation, and inflammatory reaction in response to methotrexate (MTX) treatment of ectopic pregnancy (EP). DESIGN: Nonrandomized controlled study. SETTING: Academic hospital. PATIENTS: Archival specimens from 10 EP unsuccessfully treated with MTX and 10 cases primarily treated by surgery. INTERVENTIONS: Ki67/hCG and Ki67/human placental lactogen double immunohistochemical methods were used to examine trophoblastic spread, placentation, hormone production, decidualization, vascular invasion, hemorrhage, rupture, and proliferative index of the cytotrophoblast. B and T-lymphocyte responses were evaluated by CD3 and CD20. RESULTS: Trophoblastic spread and placentation were confined to the tubal mucosa after MTX treatment, whereas invasion of the muscularis and subserosa was common in the controls. The proliferative index was reduced (19 percent versus 93 percent), although a high proliferative index was found in two of three cases complicated by rupture. Polar proliferation of Ki67-positive cytotrophoblast toward the implantation site was abolished in MTX-treated cases. Decidual reaction was not observed. No correlation was observed between the above-mentioned findings and gestational age, level of beta-hCG, dose of MTX, or interval to surgery. CONCLUSION: Trophoblastic spread, differentiation, and invasion were compromised by MTX treatment. Methotrexate seems to decrease cytotrophoblast proliferation. Whether a missing decrease in proliferation index reflects treatment failure awaits a larger population-based study.

Diagnostic accuracy of cytology and colposcopy in cervical squamous intraepithelial lesions.

OBJECTIVE: To evaluate the diagnostic accuracy of cytology and colposcopy in women with an abnormal cervical smear using histology as the 'gold standard'. DESIGN: Survey of consecutively referred women with abnormal smear. SETTING: The out-patient colposcopical clinic of Herning Hospital, Denmark. PATIENTS: 813 women with a median age of 29.0 years (range 15-71 years) with their first abnormal smear. RESULTS: For detecting cervical high-grade lesions (HGL) the sensitivity of cytology was 41% (36-47%), of colposcopy 67% (62-72%) and in combination 75% (70-80%), so at least 25% of HGL were underestimated. Colposcopy underestimated more CIN-2 than CIN-3 lesions and more small lesions and lesions in smaller transformation zones. Cytology underestimated more CIN-2 lesions but equal numbers of small and large lesions and transformation zones. CONCLUSIONS: Colposcopy was a better tool for diagnosing HGL than cytology, but even in combination too many HGL were missed. All women with abnormal cytology should therefore have colposcopical and histological investigation and prospective studies of the natural history of cervical squamous lesions should include histological evidence.

[Diabetes mellitus and pregnancy. Treatment and results from a central hospital]. / Diabetes mellitus og graviditet. Behandling og resultater fra et centralsygehus.

During the years 1972-1988, 166 pregnant diabetics gave birth to 178 children at Herning Central Hospital. A regimen of meticulous diabetologic and obstetric control was used. The mean duration of pregnancy at delivery was 37 weeks. Induced vaginal delivery was used in 31%, Caesarean section was preferred in 51%. The total perinatal mortality was 3.9%. Among the 171 pregnancies, three developed diabetic precoma, 15 developed preeclampsia and 41 had urinary tract infection. Birth weight over the 90th centile was seen in 15.3%. The frequency of congenital malformations was 2.8%; 1.1% slight and 1.7% severe malformations.

Medical treatment of ectopic pregnancy.

Methotrexate is an alternative to surgical treatment of unruptured tubal pregnancy. Among 39 women with the diagnosis of tubal pregnancy there were ten10 cases without rupture of salpinx. Nine9 out of these treated with Methotrexate. In one1 case there was rupture immediately after the termination of the treatment. There were no experiences of major side effects from the treatment with Methotrexate. The passage through the tubes was examined laparoscopically 3 months after the treatment. There was passage through all affected tubes.

Medical treatment of ectopic pregnancy.

Methotrexate is an alternative to surgical treatment of unruptured tubal pregnancy. Among 39 women with the diagnosis of tubal pregnancy there were ten (10) cases without rupture of salpinx. Nine (9) out of these treated with Methotrexate. In one (1) case there was rupture immediately after the termination of the treatment. There were no experiences of major side effects from the treatment with Methotrexate. The passage through the tubes was examined laparoscopically 3 months after the treatment. There was passage through all affected tubes.

Medical treatment of ectopic pregnancy.

Methotrexate is an alternative to surgical treatment of unruptured tubal pregnancy. Among 39 women with the diagnosis of tubal pregnancy there were ten cases without rupture of the salpinx. Nine out of these were treated with methotrexate. In one case there was a tubal rupture immediately after the termination of the treatment. There were no major side effects from the treatment with methotrexate. Tubal patency was tested for laparoscopically three months after the treatment. There was patency of all previously affected tubes.

[Upper abdominal pain and pre-eclampsia--HELLP syndrome]. / Ovre abdominalsmerter og praeeklampsi--HELLP-syndrom.

A 26 year old primiparous woman in the 30th gestational week presented with upper right abdominal pain. Clinical examination revealed direct tenderness under the right curverture, oedema, hypertension and proteinuria. Ultrasound scanning showed a normal gallbladder. Laboratory findings revealed Hemolysis, Elevated Liver enzymes and Low Platelet count. On account of suspected HELLP-syndrome cesarean section was performed. We suggest screening of all pregnant with upper abdominal symptoms suspected for preeclampsia by measuring platelet count and liver enzymes.