Transvaginal ultrasound after first-trimester uterine evacuation reduces the incidence of retained products of conception.

OBJECTIVE: To assess the incidence of retained products of conception (RPOC) in relation to transvaginal ultrasound performed after first-trimester uterine evacuation. METHODS: This was a prospective randomized study involving 809 women undergoing first-trimester uterine evacuation. The study group included 404 women in whom transvaginal sonography was performed at the end of the surgical procedure and the control group contained 405 women who did not undergo ultrasound examination. Initially, in the study group, recurettage was immediately performed if the endometrium appeared irregular but latterly only if endometrial thickness was > or = 8 mm. The patients were followed up by gynecological and ultrasound examinations 5-8 days following the surgical procedure. RESULTS: The total complication rate was 4.3%. RPOC presented in three women in the study group (0.7%) and in 15 women in the control group (3.7%, P < 0.05). Vaginal bleeding requiring hospitalization occurred in two women in the study group (0.5%) vs. seven in the control group (1.7%, P = 0.2). Endometritis was diagnosed in one woman in the study group (0.2%) vs. six in the control group (1.5%) and uterine perforation occurred in one woman in the control group vs. none in the study group. There were no cases of RPOC in women who had an endometrial thickness of < 8 mm as demonstrated by ultrasound at the end of the surgical procedure. CONCLUSION: Transvaginal sonography immediately following first-trimester uterine evacuation may reduce the incidence of RPOC and the total complication rate. When the endometrial thickness is > or = 8 mm at the end of suction curettage, an attempt at re-evacuation of the uterine cavity is indicated.

Bedside test for diagnosis of oedema fluid after extradural anaesthesia.

PURPOSE: To consider and differentiate oedema fluid from other fluids in the performance of epidural block. CLINICAL FEATURES: A patient underwent placement of an epidural catheter for vaginal delivery of twins. Following a loss of resistance technique using air a small amount of fluid was aspirated through the needle and subsequently through the epidural catheter. The epidural block and delivery followed uneventfully. After delivery oedema fluid oozed from the puncture site for a number of days. Laboratory investigation revealed that this fluid was of oedematous origin. Bedside determination of alkaline pH by Combur 10 Test M urine stick appeared to be a simple and useful test for distinguishing the oedema fluid from fluids of other possible sources. CONCLUSION: When performing an epidural blockade the return of fluid may be due to oedematous fluid. Differentiation of the pH by a simple bedside test can aid in the differential diagnosis and prevent unnecessary additional attempts at needle repositioning.

Parental management of fear in chronically ill and healthy children.

This study was undertaken to determine the impact of children's health status on parental management of fear and avoidance, as well as the relationship between parenting strategies and children's fear and anxiety levels. Thirty-one children with a chronic life-threatening illness, 30 children with chronic non-life-threatening conditions, and 28 healthy children, and their mothers, were studied. Children's health status, by diagnosis, was not a significant determinant of maternal fear-management strategies. For chronically ill children, clinical health status, in terms of illness course, prognosis, physical impairment, and time since diagnosis were related to maternal parenting strategies and to children's levels of medically related fears. For the sample as a whole, maternal fear-management strategies were related to child sex, socioeconomic status, and mothers' trait anxiety. These results are discussed in terms the interactive effects of child characteristics, health status, fear/anxiety, and parenting strategies.