Laparoscopic removal of a dermoid cyst in pregnancy. A case report.

BACKGROUND: Laparoscopy in pregnancy can endanger the fetus. It is now being reexamined because of our experience with complex operative procedures and new laparoscopic equipment. CASE: A decision was made to perform laparoscopy instead of laparotomy for a pelvic mass in a pregnant woman. The patient was admitted to the emergency room with a temperature of 38.9 degrees C and was 15 4/7 weeks pregnant. Over several hours she developed septic shock, with the blood pressure and white blood cell count dropping. Bedside ultrasound revealed a complex mass suspicious for an abscess. A dermoid cyst was found and removed by pelviscopic techniques. Blood cultures revealed typhoid fever, and the patient responded to antibiotics. She was discharged on the 10th postoperative day. CONCLUSION: This case demonstrates the value of laparoscopy in pregnancy not only for diagnosis but also for treatment. Laparoscopy in pregnancy should be added to the armamentarium of the gynecologist.

Sexuality during the menopause.

Although the evidence is not conclusive, overall many sexual changes seem to occur in the climacteric years. It would be easy to propagate and perpetuate longstanding beliefs and myths that would do a great disservice to all of the women to whom our care is dedicated. In the coming years it is hoped that we shall learn more about how to understand these changes. In recent years the International Menopause Society has actively encouraged work in this area. An entire issue of its journal Maturitas is devoted to a series of scientific papers on sexuality in the climacteric years. For those who desire further reading that issue is strongly recommended. All medical professionals who come into contact with women during the climacteric years should be prepared to ask about sexuality and to deal with any concerns that arise. Taking a good sexual history along with a good general medical history and full social background is the best starting point for coping with these concerns. How to take a comprehensive sexual history is well described by Munjack and Oziel. Of course, it is not usual to take this full history on every woman with menopause symptoms. A few key questions should identify the woman who has sexual problems and facilitate selection of appropriate questioning for each patient (Table 2). Often, taking such a history allows the physician to identify a problem area that may be helped by medication or, more often, by education and simple office counseling. When it is clear that these simple approaches will not be adequate, the physician should have good resources for referral to the appropriate specialist, whether it be gynecologist, menopause center, psychologist, family therapist, or sex therapist.

Electrophoretic analyses of secreted human endometrial proteins: identification and characterization of luteal phase prolactin.

Endometrial protein synthesis and secretion throughout the menstrual cycle was studied by slab gel electrophoretic analysis of [35S]methionine incorporation into protein during short term culture of human endometrial tissue. A minimum of five protein bands that fluctuate during the menstrual cycle were identified on one-dimensional gels. Those with mol wt of 28K, 35K, 51K, and 59K decreased in the luteal phase, whereas a broad 25K band was induced in the luteal phase. This broad band was identified as two species of glycosylated PRL by antihuman PRL immunostaining and [3H]glucosamine incorporation.

Abortion counselling by nurse specialists.

This paper describes additional training given to nurse specialists in family planning to cover abortion counselling. The primary counselling was carried out by general practitioners or family planning clinic doctors, following this the patient was referred to hospital for counselling by nurse specialists. Of the first 742 patients seen, 3.2% were not pregnant and a further 25 patients (3.4%) decided against termination, 21 after counselling, and 4 because of advanced gestation. The interval between nurse counselling and termination (TOP) was 3 to 9 days, and of 682 TOPs 566 (83%) were in the first trimester. The additional training for nurse specialists prevented the unnecessary wastage of resources as only 42 (5.1%) required a second visit to confirm blood test results, e.g. rubella titres, and only a further 44 (5.3%) required referral to medical social workers.

PIP: 6 nurse specialists in family planning, working in London, all of whom had completed at least 2 years of family planning clinic work, were accepted for abortion counseling training and completed a 2-day theoretical course. Each lecture was followed by group discussion during which "role play" of interview situations was encouraged. A daily clinic was organized for abortion counseling. At the clinic the nurse counselor initially conducted a detailed interview and completed a standardized protocol. During this interview the nurse made sure that the client had all the necessary information for reaching a decision; the objective was to reduce the stress of this situation, to allay anxiety, and to cover all aspects of pregnancy continuation and abortion. At this stage the nurse counselor decided whether the client needed to see a medical social worker, and the patient was seen immediately if this was deemed necessary. The method of contraception to be used after the abortion was discussed. For patients who were to have an abortion, the nurse counselor continued to discuss "further preparation" for admission. The first 742 referrals seen between January and September 1978 are presented. Abortion was carried out in 682 of these cases. The usual time interval between counseling and abortion was 3-9 days. Of the total patients seen, 44.6% were in their 1st pregnancy, 19.8% had had 1 previous pregnancy, 17.4% 2 previous pregnancies, 10.4% 3, and 7.8% 4 or more pregnancies. Only 166 patients had previously had an abortion.