Misdiagnosis of interstitial pregnancy followed by uterine cornual rupture during induced midtrimester abortion.

We present a case of interstitial pregnancy causing uterine cornual rupture during induction of prostaglandin midtrimester abortion. As the clinical and ultrasonographic diagnosis of advanced ectopic gestation may be difficult, the possibility of ectopic pregnancy should be considered in cases of unsuccessful attempts of induced abortion.

PIP: A 30-year old primigravida with a history of drug addiction came to the Rigshospitalet in Copenhagen, Denmark for prenatal care at 15 weeks gestation. Physicians did an amniocentesis because of family history of trisomy 21. Ultrasound examinations in the 17th and 18th weeks of gestation indicated a living fetus with the placenta on the right lateral wall of the uterus, but there was an insufficient amount of amniotic fluid. Maternal alpha fetoprotein serum levels were extremely high (298 kIU/L). Physicians predicted a poor fetal prognosis and advised the woman to undergo an abortion. On the first day, they inserted 4 vaginal pessaries of 1 mg gemeprost and administered 25-30 mg bupivacain through an epidural catheter to control abdominal pain. 8 hours after first insertion, they began intravenous (IV) administration of oxytocin. Her cervix remain closed and uterine tension did not increase. 2 hours after beginning the oxytocin IV, she suffered from an abrupt severe abdominal pain which was transferred to the right shoulder. Heart rate and blood pressure remained normal. 4 hours later, her body temperature rose, so she received 500 m pivampicillin 3 times/day. She experienced no vaginal bleeding and no uterine contractions. Her cervix had still no opened. On the third day, health workers inserted 5 more pessaries. On the fourth day, they administered 75 ml isotonic saline/hour transcervically, but she still did not abort. Her temperature vacillated even though she received antibiotics and the pain continued despite epidural analgesics. On day 5, health workers administered 3.75 mcg prostaglandin F2 alpha/minute transcervically. After 6 hours of no progress, they performed a laparotomy and observed a macerated, malodorous fetus in the peritoneal cavity which continued 1200 ml of blood. The medial part of the left fallopian tube an the left uterine corner had ruptured. They removed the fetus via wedge resection; it had no malformations. Physicians should consider ectopic pregnancy when attempts at induced abortion do not succeed.

[Extrauterine pregnancy in Denmark in 1981-1986]. / Ekstrauterine graviditeter i Danmark i årene 1981-1986.

A uniform increase has been observed in the incidence of extrauterine pregnancies in Denmark from 11.7 per 1,000 known conceptions in 1981 to 16.9 per 1,000 known conceptions in 1986. This increase is significant. The incidence of extrauterine pregnancies increases with increasing maternal age until the age of 40 years. The main increase occurred in the age group 20-39 years, where the increase is significant. The same age-related tendency has been demonstrated regionally and in Denmark as a whole. Where all Danish counties are concerned, an increasing frequency of extrauterine pregnancies was demonstrated from 1981 to 1986. The risks are greater in urban regions than in the rural regions. The etiology of the increase at a national level and the age-related and regional variations are unknown.

[Sexology and epidemiological methods. A pilot study of sexual behavior, experience, knowledge and attitudes in women]. / Sexologi og epidemiologisk metode, En pilotundersøgelse af kvinders seksuelle adfaerd, oplevelse, viden og holdning.

PIP: A pilot study on the feasibility of giving sexological interviews to various groups of women is presented. 225 forty-year-old women were interviewed about various aspects of their sexual knowledge, attitudes and practice. Other groups which also participated were: 20 women over 60 years of age; 30 women under 18 years of age who belonged to a lower socioeconomic stratum; and 5 women over 18 years of age who had chronic pelvic pains with no apparent organic cause. A questionnaire was also sent out to 2 groups of 100 women, asking if they would take part in a sexological survey. The names of the first group (group I) were taken from a physician's journal archive, the names of the second group came from a doctor's appointment list. The subjects in group II failed to answer the questionnaire significantly more often than those from group I. 56.5% answered the questionnaire positively, i.e., they would take part in a survey, while 22% answered negatively. It was found that it is harder to motivate older women and women who regard sex as a taboo subject to take part in a sexological study. It is important that the interviewer be female. 90% of those interviewed allowed the interview to be tape recorded. A personal interview has many advantages over a questionnaire and allows the respondents to clarify the terminology before answering the questions.^ieng