Menstrual patterns after laparoscopic sterilization using a spring-loaded clip.

Details of the menstrual cycles in 504 women were recorded before laparoscopic sterilization with a spring-loaded clip and at six months and one year after the procedure. The operation did not affect the length of the menstrual cycle or duration of menstrual flow, nor the patient's assessment of the amount of blood losss or the incidence of dysmenorrhoea. The previous method of contraception was significantly related to subsequent menstrual patterns.

PIP: Before, 6 months after, and 1 year after the operation, 504 women who underwent laparoscopic sterilization with tubal occlusion by a spring-loaded clip were asked to report the amount of menstrual bleeding (scanty, normal, or excessive), the degree of dysmenorrhea (nil, mild, moderate, or severe), number of days of menstruation, and length of the cycle. The operation did not affect any of these variables, but previous method of contraception did. 6 months after the operation, women who had previously used oral contraceptives reported a significant increase in days of menstruation, more dysmenorrhea, and an increase in excessive bleeding. Former IUD users reported a significant decrease in days of menstruation, improvement in dysmenorrhea, and decrease of excessive menstrual bleeding. Women who used other methods of contraception before sterilization reported no significant changes.

Laparoscopic sterilization with spring-loaded clips: double-puncture technique.

The application of a spring-loaded clip to each fallopian tube using a second-incision clip applicator is a safe and effective method of laparoscopic sterilization. The operation is quick and easy to perform and is suitable for use with local anesthesia. The method avoids the dangers of hemorrhage, for the clip only alters 3 mm of the fallopian tube and does not transect the tube or mesosalpinx. No pregnancies have followed the sterilization procedure. An intrauterine pregnancy has occurred after a reversal procedure in one patient.

PIP: 533 women undergoing laparoscopic sterilization were studied in an effort to determine the feasibility and safety of a second-puncture clip applicator. The operation was done on an outpatient or overnight basis and a choice of general or local anesthesia was offered. Results indicated that 97.7% of the cases were uncomplicated while 1.2% resulted in bowel perforation; .4% in hematoma and .7% in tubal ligation. None of the complications were due to clip or applicator design. 85% of the cases had no complaints while 5% of the patients experienced abdominal discomfort lasting 48 to 72 hours. This was the only side effect related to the procedure with a spring-loaded clip. No pregnancies occurred at the 6-month follow-up and 1 reanastomosis occurred supporting existing evidence about successful reversal after sterilization with a spring-loaded clip.

Placental lactogen levels in rhesus isoimmunization.

A prospective study of the plasma levels of human placental lactogen (HPL) in pregnancies complicated by rhesus isoimmunization showed that in mild and moderately affected cases the levels were normal, while in severely affected cases they were raised. Serial levels of HPL before the 26th week provide a valuable indication of fetal outcome, and we suggest that this estimation should be used routinely as an adjunct to other tests in the management of rhesus isoimmunization.

Placental lactogen levels as guide to outcome of threatened abortion.

The clinical value has been assessed of circulating placental lactogen levels as a pointer to the outcome in a patient with vaginal bleeding in early pregnancy. By using a semiautomated radioimmunoassay the normal range of values for the first and second trimesters has been established. In patients admitted with vaginal bleeding after the eighth week of gestation estimation of plasma human placental lactogen showed that patients with low levels were those in whom the abortion was completed during the first admission. Women whose pregnancies continued normally or who aborted after their first discharge from hospital had normal levels. In a small group sampled before the onset of bleeding but who later aborted the mean levels were lower than normal. This simple and inexpensive test can indicate those women in whom abortion is inevitable and could be used to reduce substantially the length of hospital stay in this common complication of early pregnancy.