[Results and complications of vaginal correction of vaginal and uterine prolapse with or without urinary incontinence; a prospective study]. / Resultaten en complicaties van vaginale correctie van prolapsus vaginae et uteri, met of zonder incontinentia urinae; een prospectief onderzoek.

Between 1985 and 1987, 191 consecutive patients with a genital prolapse combined in 50% of the cases with urinary incontinence, underwent a vaginal repair with or without hysterectomy in the Ikazia hospital, Rotterdam. In a prospective study design, results and complications were assessed 4 and 12 months after the procedure. Mortality was 1%, morbidity was low; bladder or bowel injury did not occur. Vaginal prolapse recurred after 4 and 12 months in 4 and 6% of the patients, respectively. Of patients with involuntary loss of urine 31% still complained of incontinence 4 months after the operation; after one year this percentage was 49. Dyspareunia was a frequent complaint (41%), probably as a result of the posterior vaginal repair which was performed in all patients. We conclude that vaginal repair, with or without hysterectomy, allows successful treatment of genital prolapse, but is less satisfactory for the treatment of urinary incontinence, and a frequent cause of dyspareunia.

Malignant leiomyomatosis peritonealis disseminata.

Leiomyomatosis peritonealis disseminata is a rare condition characterized by the presence of multiple intraabdominal nodules that consist of benign smooth muscle. We found 42 documented cases in the literature. Malignant degeneration appears to be extremely rare. We describe the second case with proved malignancy.

Effect of external cephalic version in late pregnancy on presentation at delivery: a randomized controlled trial.

The effect of repeated external cephalic version, performed at between 33 and 40 weeks gestation, on presentation at delivery was studied in a randomized controlled trial comprising 180 pregnant women with breech presentation. No tocolysis, analgesia or anaesthesia was used. Approximately 25% of all attempts in the study group of 90 women were successful; repeated external version resulted in cephalic presentation at delivery in 48% of patients. Spontaneous version to cephalic presentation occurred in 23 (26%) of the 90 women in the control group in whom version was not attempted, indicating a therapeutic gain from the procedure of 22%, with a 95% confidence interval of 8 to 35%. No severe complications of external cephalic version were noted. We conclude that external cephalic version reduces the frequency of breech presentation at delivery. This mainly benefits the mother because of the decrease in the number of caesarean sections and their inherent maternal morbidity.

Relationship between amniotic fluid optical density and L/S ratio.

Determination of the lecithin-sphingomyelin (L/S) ratio to predict fetal lung maturation requires rather complicated laboratory techniques which are not always available on a 24-hour basis in all hospitals. For that reason more simple tests have been developed. One of these tests, the determination of amniotic fluid optical density at 650 nm (OD 650), was initially reported to correlate well with the L/S ratio, but later studies gave varying and conflicting results. To assess the possible usefulness of measurement of amniotic fluid OD 650 we determined the correlation between L/S ratio and OD 650 in 90 amniotic fluid samples from 90 pregnant women. All samples were obtained by transabdominal amniocentesis between 26 and 39 weeks' gestation. Indications for amniocentesis were threatened premature labor (n = 49), fetal growth retardation (n = 25), and rhesus sensitization (n = 16). The OD 650 and the L/S ratio were determined in the same amniotic fluid sample using standard techniques. A statistically significant positive correlation was found between the OD 650 and the L/S ratio. Considering an OD 650 reading of 0.15 or greater and an L/S ratio of 2.0 or higher as indicative of fetal lung maturation, 25.5% of the OD 650 readings appeared to be false positive, and 28% were false negative as compared with the L/S ratio. It is concluded that the low predictive values of positive and negative optical density readings preclude the clinical application of this simple test.