The role of transvaginal ultrasonography in pre-operative case selection and post-operative follow up of endometrial resection.

50 patients undergoing transcervical endometrial resection (TCRE) for abnormal uterine bleeding underwent transvaginal ultrasonography (TVUS) before danazol therapy, immediately pre-operatively, and 3 months post-operatively. There were no significant changes in the uterine dimensions but as expected the endometrium became thinner (p < 0.0005) after treatment with danazol facilitating endometrial resection. 12 cases (24%) continued to have menstrual problems. In those cases TVUS showed unchanged endometrium (4), minimum residual endometrium (5), irregular uterine cavity (5), and fibroids (2) as probable causes of failure. These findings guided the choice of further management as follows: conservative for minimum residual endometrium, repeat TCRE for unchanged endometrium, and hysterectomy for irregular uterine cavity and fibroids. The value of TVUS in diagnosing the cause of post-operative pain was limited to the cases (2) of haematometra. The smaller transverse (< 6 cm) and anteroposterior (AP) (< 4.5 cm) dimensions of the uterus (p < 0.05, < 0.05), a significant reduction in these dimensions after the operation (p < 0.0005, p < 0.01) along with the absence of endometrium (p < 0.0001), fibroids and irregular uterine cavity (p < 0.005) predicted a favourable outcome of TCRE. This study substantiates the role of TVUS in TCRE for proper selection of cases, determination of the causes of failure and their subsequent management, leading to an improved outcome.

The histopathology of transcervical resection of the endometrium: an analysis of 200 cases.

The results of a series of 200 patients treated by transcervical resection of the endometrium are presented. The failure rate was 20% with a minimum follow up period of 18 months, although seven women (3.5%) had treatment beyond this interval. A second resection was performed in 14 patients with two later requiring a hysterectomy. An additional 26 women proceeded to hysterectomy following the initial resection. Specimen weight was inversely related to the need for further surgery with no secondary operations performed when more than 12 g of endometrium and myometrium had been resected. Age was also correlated with clinical outcome with patients under 35 years of age more likely to require further operative treatment. No histological feature could be identified which predicted failure of the procedure. The main role for histopathological assessment of transcervical resection specimens is in the provision of an accurate weight and the identification of the relatively rare cases harbouring endometrial or myometrial malignancy. Although endometrial resection appears to have resulted in fewer hysterectomies in the treatment of dysfunctional uterine bleeding, long-term follow-up is required before an accurate assessment of success can be established.

Plasma progesterone in the umbilical vessels at term--an overview.

This paper reports the results of umbilical cord vein and artery, and maternal peripheral vein plasma progesterone levels in over 300 term human deliveries, individual aspects of which have previously been reported. An attempt was made to assess the fetal status objectively, and the results confirm that cord progesterone levels are correlated with the mode of delivery, the clinical indications for the mode of delivery and the clinical condition of the fetus after delivery. No relation was found to fetal sex, induction of labour or maternal antenatal complications.

Plasma progesterone in the umbilical vessels at vaginal delivery of term infants.

The influence of stress and related factors on umbilical-cord vessel progesterone concentrations have been investigated in 150 vaginal deliveries. Cord vein progesterone levels were greater in breech deliveries than in forceps deliveries and in vaginal deliveries by maternal effort alone. Within the forceps group there was no difference in cord vessel progesterone concentrations between lift-out, mid-cavity or rotational forceps deliveries. Levels of progesterone were significantly greater in forceps deliveries where the infant was clinically distressed (P less than 0.01). Similarly, within the normal group progesterone levels were greater in a stressed group of infants, where cord vein pH, artery pH, Apgar score at 1 min or birthweight fell below the 10th centile for the study group. No differences in plasma progesterone concentration were found with labour commencing spontaneously or by induction, nor did the sex of the infant appear to influence this hormone. Progesterone levels were higher in samples from primiparae than in those from multiparae due to a small number of primiparae who had excessively long labours and high progesterone concentrations. There was, however, no strong statistical correlation between length of labour and progesterone concentrations.

Umbilical-cord plasma progesterone in term infants delivered by caesarean section.

Plasma progesterone concentration was measured by radioimmunoassay in blood samples taken from 67 patients delivered by lower-segment caesarean section (LSCS). Blood samples were taken from umbilical-cord artery and vein and from a peripheral maternal vein. Cord venous progesterone levels were higher (c400 ng/ml) in those patients where the fetus was clinically in jeopardy and this was the principal indication for section. Patients in whom the fetus was not in jeopardy had lower cord venous progesterone concentrations (c300 ng/ml) regardless of whether or not they were in labour. Maternal levels of progesterone were similar in all patients. The advantage to the fetus of these varying progesterone concentrations is not clear, but the evidence lends support to the hypothesis that the fetus exercises control over placental progesterone production during parturition.

Fetal death immediately following normal antenatal fetal heart rate pattern. Case report.

A fetal death occurred during antenatal non-stressed cardiotocography in a woman with gestational diabetes. The death occurred immediately following 30 minutes of normal fetal heart rate tracing with an active baby and with normal biochemical tests of placental function.

The value of laparoscopy in the management of cystic paravaginal masses.

Gartner's duct cysts and unilateral hematocolpos are unusual conditions presenting as a paravaginal cystic mass. They are frequently mismanaged. Previous authors have cast doubt on the value of laparoscopy and have suggested that primary vaginal drainage is contraindicated. Laparotomy has been performed invariably. In our experience, laparoscopy and primary vaginal drainage has been a safe and successful method of treatment. Three recent cases are reported together with an earlier case.

Pseudo-obstruction of the bowel in pregnancy: case reports.

Two patients with intestinal obstruction in pregnancy are presented and discussed. In neither case was there any obvious cause for the intestianl obstruction. Pseudo-obstruction of the bowel has not previously been described as a complication of pregnancy.

Disopyramide in pregnancy: a case report.

Disopyramide (200 mg 8-hourly) was given to a pregnant patient from the 26th week onwards for the treatment of bigeminy and paroxysmal ventricular tachycardia. Labour was spontaneous and normal. Although disopyramide was demonstrated in the foetal blood there was no evidence of congenital abnormality or growth retardation. The drug treated the mother satisfactorily with no apparent ill effects to the child.