Cervical cerclage for the incompetent cervical Os. Improving the fetal salvage rate.

The precerclage and postcerclage term delivery rate (TDR), premature delivery rate (PDR) and late abortion rate (LAR) were evaluated in 260 parturients undergoing elective cerclage at 12-16 weeks' gestation. The TDR increased from 0.49 to 0.78, the PDR dropped from 0.35 to 0.18, and the LAR dropped from 0.16 to 0.04. The rate of early and late complications was acceptable, and the fetal survival rate was significantly improved. The fetal salvage rate increased from 0.73 to 0.92, establishing a fetal salvage ratio of 1.26. Based on this experience, cerclage placement in cases of incompetent cervical os may prolong the duration of pregnancy and improve the outcome.

Outpatient versus inpatient cervical cerclage.

The outcomes in 125 cases of elective, outpatient cerclage placement were compared to those in 101 cases of elective, inpatient cerclage placement with the same technique at the same institution. There was no difference between the two groups in the rates of early and late complications or in the effect of the procedure on the duration of gestation. As expected, a statistically significantly shorter hospital stay occurred in the outpatient group. The outpatient procedure is as effective as the inpatient one, with no increased risk of early and late complications, and offers patients a shorter absence from home, thus possibly decreasing their anxiety, and considerable financial savings.

The effect of the hypoestrogenic state, induced by gonadotropin-releasing hormone agonist, on Doppler-derived parameters of aortic flow.

The effect of the hypoestrogenic state, induced by a GnRH agonist (GnRH-a), on cardiac function in healthy young women, was evaluated by Doppler echocardiography performed before treatment and when serum 17 beta-estradiol levels were suppressed by GnRH-a to 36.7 pmol/L. The following parameters of aortic flow were measured: peak flow velocity, ejection time, and acceleration time. Additional parameters calculated were flow velocity integral, cardiac index, and mean acceleration. The study group included 15 menstruating women, aged 25-42 yr (mean, 33 yr), with symptomatic fibroids, endometriosis, or scheduled for in vitro fertilization, who were treated with a GnRH-a. There were significant decreases in peak flow velocity (99 +/- 11 vs. 86 +/- 11 cm/s; P = 0.0004) and cardiac index (3.0 +/- 0.7 vs. 2.5 +/- 0.5 L/min.m2; P = 0.002). A decrease that did not reach statistical significance was noted in flow velocity integral (18.9 +/- 2.7 vs. 16.5 +/- 3.4 cm; P = 0.07). Mean acceleration was decreased significantly (12.6 +/- 2.6 vs. 10.8 +/- 1.8 m/s.s; P = 0.01), but no significant changes in acceleration time (81 +/- 16 vs. 83 +/- 10 ms; P = 0.7) or ejection time (296 +/- 25 vs. 295 +/- 27 ms; P = 0.8) were observed. These results indicate that estrogen deprivation is associated with smaller stroke volume and flow acceleration and might suggest that hypoestrogenism has a direct effect on cardiovascular performance.

Combined transvaginal tubal catheterization and adhesiolysis of filmy uterine synechiae performed with a newly developed device under the guidance of digital road mapping fluoroscopy.

Transcervical fallopian tube catheterization is rapidly gaining favor as a minimally invasive diagnostic and therapeutic technique. On occasion, the presence of filmy adhesions not identified on HSG obstruct the passage of the cannula to the cornual angle. We describe the design and operative characteristics of a new transcervical adhesiolysis device that if used under the guidance of DRM mapping, can restore the shape of the uterine cavity and allow completion of the procedure during the same session.