Constriction of the umbilical cord as a cause of fetal demise following midtrimester amniocentesis.

Two cases of constriction of the umbilical cord resulting in fetal demise following midtrimester amniocentesis are presented. In both cases, real-time ultrasonography prior to amniocentesis revealed a viable fetus. Fetal demise was identified immediately following the procedure in the first case and one month later in the other. A localized constriction at the fetal end of the umbilical cord in both, with torsion of the constricted segment in the second case, was observed. Wharton's jelly was noted to be deficient in this segment of the cord in the first case. The mechanism of fetal demise is discussed. It is suggested that this abnormality should be considered when fetal demise follows midtrimester amniocentesis.

Perforation of the exocervix by an IUD tail.

PIP: 30 days following the normal insertion of a Copper 7 IUD in a patient with a gravidity of 1 and a parity of 0, a routine follow-up check revealed that the IUD string was protruding through the exocervix 6mm away from the os. The patient was asymtomatic. Examination prior to the insertion revealed a normal genital tract. The IUD was inserted with release technique. The IUD was removed upon request of the patient. The perforation was perhaps related to the curved memory which the string develops while wound around the inserter tip. It is unlikely that this problem could produce serious complication; however, the risk of infection could be enhanced. Retraction of the string of Copper 7 IUDs into the uterus was observed previously.^ieng

Elective sterilization in childless women.

Follow-up data on a series of 35 nulliparous women sterilized by laparoscopic tubal ligation have been analyzed for changes in menstrual pattern, motivation, and poststerilization adjustment problems with particular interest in feelings of regret. There was no significant change in menstrual function in these patients following surgery. There did not appear to be a significantly higher rate of regret in nulliparous women undergoing tubal ligation than that seen in studies of parous women. Feelings of unhappiness with regard to sterility were not related to age at the time of the request and may be more likely to occur in women choosing tubal ligation for medical reasons.

PIP: A follow-up study was conducted on 35 nulliparous women who underwent sterilization by laparoscopic tubal ligation. The women were questioned at 18-48 months postoperative. 2 of the patients had suffered postoperative complications of wound infection and 2 had endured pain of more than 48 hours. 1 failed procedure resulted in an ectopic pregnancy. The interval, duration, and amount of menstrual flow was unchanged following sterilization. For most of the patients, their sex lives and partner relationships were unchanged. At the time of follow-up, 80% were willing to repeat the operation and there had been no requests for reversal. Most had requested the sterilization because of their inability to tolerate or distrust of other contraceptive methods. Those who had requested sterilization for medical reasons were more likely to be unhappy with the resultant sterility than were the others in the group. Age was, in fact, less of a factor for regret than medical indications for the procedure.

Menstrual patterns and women's attitudes following sterilization by Falope rings.

Follow-up data on 147 women sterilized by laparoscopic Falope ring application were analyzed for changes in menstrual patterns, postoperative complications, patient feelings about surgery, and incidence of regret. Twelve to twenty-eight months after surgery, there were no consistent changes in interval, length, or amount of menstrual flow, and only 4% of women developed transient episodes of dysfunctional uterine bleeding. Analysis of feelings after sterilization showed that 90% of women were satisfied with the sterilization, 3% were unhappy, and 7% were ambivalent. Feelings of regret were not associated with postoperative complications and appeared to be related to the reasons for sterilization. Individual counseling not only helped to identify the population at risk for regret but also served to reduce the incidence of poststerilization ambivalent feelings.

Pituitary gonadotropin response to LHRH in human pregnancy.

The effect of synthetic LHRH on serum levels of FSH, LH, and hCG was determined during early and midgestation. Eight healthy volunteers were studied during the first (8--9 weeks) and second (15--20 weeks) trimesters of pregnancy with 4 patients in each group. Serum samples, obtained before and 15, 30, 45, 90, 120, 150, and 180 minutes after an intravenous bolus of 100 microgram LHRH, were assayed for LH, FSH, and hCG by specific radioimmunoassays. Serum levels of estradiol, progesterone, and 17 alphahydroxyprogesterone were also measured in samples obtained prior to and 3 hours after LHRH injection. The serum levels of LH and FSH were undetectable in all samples, and no increase was observed after administration of LHRH. Levels of chorionic gonadadotropin, estradiol, progesterone, and 17alpha-hydroxyprogesterone did show slight fluctuations, but there was no significant effect from LHRH administration. These results support the concept that pituitary gonadotropic function is markedly suppressed during early human pregnancy.

Laparoscopic tubal sterilization: long-term postoperative follow-up.

PIP: 93 women who underwent laparoscopic tubal coagulation during 1972-1973 were followed up for periods of 18 months to 3 years. Ages ranged from 17 to 47 years (mean 30.7) and 71% had 2-4 children. 8 requested sterilization prior to conception and 5 had pregnancy previously terminated by abortion. Most common postoperative complaints were tenderness at the incision site and shoulder or neck pain. In the 64 cases in which sterilization alone was performed average blood loss was less than 50 cc. In 8 cases it was associated with diagnositc dilatation and curettage, in 20 with therapeutic abortion, and in 1 with laparotomy. Complications included 1 case each of bleeding mesosalpinx controlled by cautery, wound hematoma, hematoma epiploic appendix, and peritoneal burn. A detailed menstrual history 18-36 months after operation found 73 of the 93 had regular periods with amount of bleeding and length of cycle generally unchanged. Of the 20 with menstrual changes, 2 developed amenorrhea within 1 year and 8 with preoperative menstrual irregularities were unchagned. 10 developed longer periods and/or shorter intervals. 5 related these changes to discontination of oral contraceptives. Of the remaining 1 had an abnormal Pap smear, 2 were 40-45 years of age (1 of whom refused vaginal hysterectomy for stress incontinence), and 2 were 35-40 with no previous history of cesarean sections or pelvic complaints. The majority (77%) of the women were satisfied with the procedure, 16% uncertain, and 5 patients expressed regret. 4 of the 5 who regretted the operation reported gynecological complaints. 5 required subsequent surgery. In 3 of the 5 the indication preexisted the sterilization and a more thorough screening might have prevented 2 surgical procedures. In this series the incidence of postoperative gynecological disease 18-36 months after laparoscopic tubal ligation is significantly lower than that reported in the literature for conventional tubal ligation.^ieng