Chronic pelvic pain. Laparoscopic and cystoscopic findings.

OBJECTIVE: To study the laparoscopic and cystoscopic findings in women with chronic pelvic pain referred to the Gynecology Clinic at Sultan Qaboos University Hospital. METHODS: Women referred to Sultan Qaboos University Hospital, Sultanate of Oman from October 1998-September 2000 with pelvic pain of more than 6 months duration were clinically evaluated. Laparoscopic examination was always combined with cystoscopy. Bladder biopsy was performed only if there were doubts regarding the nature of pathology that was found. RESULTS: The mean age of the patients was 31 years and mean parity was 3.0. The minimum duration of symptoms was 6 months, but one 3rd of the patients had pain for more than 2 years. Bladder symptoms were present in 50% and bowel symptoms in 25% of patients. Laparoscopic examination revealed pathological findings in 80% of the cases. Adhesions of the omentum to the uterus or to the laparotomy or laparoscopy scar were the most common pathology (50%). Cystoscopy revealed one case of trigonitis and one case of cystitis. CONCLUSION: Pelvic adhesions were the most common cause of pelvic pain in our study group. Cystoscopy was normal in most of the patients.

A randomized controlled study of peritoneal closure at cesarean section.

OBJECTIVE: To assess the benefits or problems that may be associated with peritoneal closure at cesarean section. METHODS: A randomized-controlled study of women undergoing cesarean section in Sultan Qaboos University Hospital Maternity Unit. After the decision is taken for cesarean section, women were randomized to either repair of peritoneum using standard technique or non-repair of peritoneum. Duration of operation, maternal morbidity, blood loss assessed by post-operative hemoglobin change and requirement of transfusion, post operative infection, thromboembolic disease, and length of hospital stay were analyzed in 2 groups of patients. Sixty women were randomized into the study, 30 group A, had peritoneal closure and 30, group B, and had non-closure. RESULTS: The average duration of operation for group A was 61.9+/-12.734, and for group B was 53.56 +/-11.209 (p< 0.01 statistically significant). There was no statistically significant difference in the length of stay, estimated blood loss, the mean drop in hemoglobin, postoperative pyrexia, and wound infection rate between the 2 groups. CONCLUSIONS: Our study has confirmed the previous study findings, and has shown that there are no advantages in suturing of the peritoneum in terms of blood loss, blood transfusion, operation duration, postoperative pyrexia and wound infection. In fact non-suturing of the peritoneum was associated with shorter operation duration (p< 0.01 significant), and reduced cost.

Minimal stimulation protocol: a cheap and effective method of ovulation induction.

OBJECTIVE: To determine the effectiveness and cost of Minimal Stimulation Protocol (MSP), a new combination of human menopausal gonadotrophin (hMG) and clomiphene citrate (CC), for controlled ovarian hyperstimulation. METHOD: The ovulation rates, pregnancy rates, abortion rates and the cost of medication were assessed in respect of 67 women who underwent MSP. RESULTS: Ovulation rate in the study group was 82%, pregnancy rate 21% and multiple pregnancies 7%. Spontaneous abortion occurred in 36% of the pregnancies. The average cost of MSP stimulation was one-third of hMG protocol. CONCLUSION: MSP protocol, while substantially cheaper than hMG, gives comparable pregnancy rates with less need for monitoring and better patient comfort. These justify further evaluation of its role in the treatment of infertility.

Unilateral uterine artery embolization and systemic methotrexate therapy in cervical pregnancy.

The authors report a case of cervical pregnancy successfully treated with combined methods of uterine artery embolization and systemic methotrexate therapy. Unilateral selective embolization may play a role in preserving reproductive functions.

The use of the Rectus abdominis muscle to suspend the bladder in the treatment of uretero-vaginal fistulae.

This study evaluates a new and simpler technique for suspending the bladder during uretero-neocystostomy, using the posterior surface of the Rectus abdominis muscle rather than an vesico-psoas hitch. The technique was employed in six consecutive patients who presented with ureteric injuries following hysterectomy or caesarean section. Each patient was fully evaluated preoperatively, and the results of surgery evaluated after three months in five out of six women. All the patients were Zulu women who had sustained injuries to the lower five centimetres of a ureter at hysterectomy or caesarean section. This study was conducted in the obstetric and gynaecological unit of Eshowe Hospital, a 460 bed sub-regional hospital in northern KwaZulu Natal. The technique described in this paper proved to be easy to perform. Every patient was continent following surgery. All those who returned for follow up had normal drainage of the affected ureter. We conclude that this is a useful alternative to vesico-psoas hitch for suspending the bladder during uretero-neocystostomy.

Laparoscopic and cystopic findings in patients with chronic pelvic pain in Eshowe, South Africa.

Forty two Zulu women who reported pelvic pain of more than six months duration were evaluated using laparoscopy and cystoscopy. Chronic pelvic inflammatory disease (57 pc) and pelvic adhesions (12 pc) involving the reproductive organs were the most common pathologies found. An interesting associated finding was a very high incidence (21.5 pc) of schistosomiasis. We are not able to find any pelvic pathology in only 14.4 pc of patients. This study confirms the opinion that chronic pelvic pain is usually associated with organic pathology.

Asherman syndrome caused by schistosomiasis.

BACKGROUND: Rare causes of Asherman syndrome include infections of the endometrium, such as tuberculosis and schistosomiasis. CASE: A 27-year-old Zulu woman, para 1, presented with secondary amenorrhea after an uncomplicated cesarean delivery. Hormone levels were in the normal ranges. Laparoscopy revealed some pelvic adhesions with patent fallopian tubes, and biopsy of the ovary showed schistosomiasis. Diagnostic D&C revealed a uterine cavity partially obliterated by adhesions. The patient was treated with praziquantel. CONCLUSION: Schistosomiasis should be considered as a possible cause of infertility and Asherman syndrome in those parts of the world where it is endemic.

Termination of pregnancy using extra-amniotic prostaglandin F2a--experience in a peripheral hospital.

Extra-amniotic injection of prostaglandin F2a has proved to be an effective method of termination of pregnancy, although its use has been associated with serious complications including rupture of the uterus and maternal death. In this retrospective study of 45 patients who required termination of pregnancy in Eshowe Hospital for intra-uterine death or missed abortion two patients developed minor complications of this method. Forty four patients aborted between four hours 30 minutes and 18 hours 15 minutes after the injection. There was one patient who had a failed induction and who developed serious sepsis. It is not clear whether the sepsis was a result of the method used to induce labour or whether it was the primary pathology causing the intra-uterine death and failed induction.

[Spontaneous torsion of the greater omentum in full-term pregnancy. A case report]. / Samoistny skret sieci wiekszej w ciazy donoszonej. Opis przypadku.

The article presents a case of spontaneous twisting and necrosis of the greater omentum in a 27-year old multipara. The pregnancy was terminated by Cesarean section, the necrotic omentum was removed. The authors did not find the reason for the disease.