Persistent omental trophoblastic implantation following salpingostomy, salpingectomy and methotrexate for ectopic pregnancy: A case report.

2% of all pregnancies are ectopic. Optimal surgical management is currently salpingectomy over salpingostomy, secondary to the risks of persistent trophoblastic tissue or omental implants (15%). However, rare cases of omental trophoblastic implants following laparoscopic salpingectomy have been noted in the literature. Current practice dictates that serial determinations of human chorionic gonadotropin (beta-hCG) levels after salpingectomy are not required, as it is considered a definitive treatment. However, given that these cases are hard to interpret through ultrasound and are almost always detected via sudden-onset abdominal pain and acute haemoperitoneum (33%), an argument can be made for post-operative beta-hCG assessment.

Medical management of miscarriage: Predictive factors of success.

Medical management of miscarriage is an acceptable option available to women, and has advantages of providing timely treatment, while avoiding exposure to surgery and anaesthesia. This retrospective cohort study aimed to determine factors predictive of successful medical management, utilising a single dose protocol of 800 µg vaginal misoprostol. In this cohort, the success rate was 67% (199/296), and smaller mean gestational sac diameter independent of gestational age predicted success (P = 0.046). Success is not significantly related to parity, miscarriage type, pelvic pain or vaginal bleeding at the outset of treatment.

The effect of extending dinoprostone pessary placement from 12 to 24 h on the need for further mechanical cervical ripening.

Dinoprostone pessaries (DP) are widely used for cervical ripening, and while licensed for 12-h administration in Australia, 24-h use is also reported. We examined 396 consecutive women before and after a protocol change from 12-h to 24-h DP use to determine whether extended DP use decreases the need for additional mechanical cervical ripening. No significant difference in cervical ripening balloon (CRB) requirement or vaginal birth rates was detected, showing that prolonged DP use does not reduce subsequent use of CRB.