Severe Asherman's syndrome complicated with placenta increta conceived by intracytoplasmic sperm injection following hysteroscopic surgery.

Although severe Asherman's syndrome is a disease that may cause infertility, pregnancy and childbirth are possible by performing hysteroscopic surgery. However, the obstetrical outcome is not always satisfactory. We report a case where severe Asherman's syndrome occurred following a cesarean section. Hysteroscopic surgery was performed due to secondary infertility, and pregnancy was achieved through a subsequent intracytoplasmic sperm injection. At 23 weeks of gestation, the patient was hospitalized due to the threat of premature labor, and a cesarean section was performed at 29 weeks of gestation after pregnancy-induced hypertension occurred. It was determined to be abnormal adherent placentation such as placenta increta through intraoperative findings, and a cesarean hysterectomy was performed. The pathological diagnosis of the uterus was placenta increta. Due to the risk of complications from placenta increta in pregnancies following hysteroscopic surgery in patients with severe Asherman's syndrome, it is important to realize the high risk involved in such cases during the pregnancy course, and careful perinatal management should be required.

Prediction of preterm delivery by combined use of simple clinical tests.

OBJECTIVE: To investigate the usefulness of 4 clinical tests in detecting both the major symptoms (premature uterine contractility and cervical change) and causes (intrauterine infection) of preterm delivery (PTD). These were performed simultaneously on 683 pregnant women at 26 to 28 weeks of gestation. METHODS: The following four tests were performed at study entry: 1) uterine contractility by the nipple stimulation test (NST); 2) cervical length (CL) measured by transvaginal ultrasonography; 3) measurement of granulocyte elastase in cervical secretion; and 4) measurement of oncofetal fibronectin in vaginal secretion. Pregnancy outcomes were followed up and recorded for the 683 women. RESULTS: Those women with a CL <25 mm showed a significantly higher PTD rate than those with a CL > or =30 mm (13.3 vs. 2.3%). This difference was dominant in primiparous women. Those women with a CL of 25 to 29 mm formed a potentially high-risk group in which a positive NST was associated with a high incidence of PTD. In contrast, granulocyte elastase in cervical secretion had no predictive efficacy for PTD during these weeks of gestation. The oncofetal fibronectin test had a very low (0.5%) positivity rate and proved to be unsuitable for routine clinical use. CONCLUSION: The data demonstrated the usefulness of the uterine contraction induction test by nipple stimulation (NST) and cervical length (CL) measurement by transvaginal ultrasonography. The combined evaluation of the NST, CL measurement, and fibronectin assay, when necessary, was useful for the prediction of PTD.

Successful one-stage complete removal of an entire intravenous leiomyomatosis in the heart, vena cava, and uterus.

The patient was a 61-year-old woman who had intravenous leiomyomatosis (IVL) extending into the right ventricle of the heart from the uterus. Tumors in the heart and the inferior vena cava were removed under cardiopulmonary bypass and then after terminating the cardiopulmonary bypass, tumors in the abdominal cavity including uterine leiomyoma were removed. This is the first case of extended IVL in which all tumors were successfully removed at one time. If a tumor is found in the right ventricle in a woman who had or currently has uterine leiomyoma, IVL should be suspected. Complete one-stage removal of tumors can be performed using cardiopulmonary bypass, and the present patient has shown a favorable outcome.