Methotrexate infusion followed by uterine artery embolisation for the management of placental adhesive disorders: a case series.

AIM: To evaluate the efficacy and safety of the uterine artery embolisation (UAE) in combination with methotrexate (MTX) for conservative management of placental adhesive disorders. MATERIAL AND METHODS: Patients with placental adhesive disorders (including accreta, increta, and percreta lesions) that were treated with UAE in combination with MTX were identified and were followed prospectively for outcomes including uterine preservation and complications. RESULTS: Twenty-six patients were identified who had the diagnosis of abnormal placenta implantation during this study. Fourteen patients were excluded because they were treated by a caesarean hysterectomy. Among remaining 12 patients, the successful uterine preservation observed in seven (58%) cases. Menstruation cycles returned in all successfully treated patients, although they did not have desire to get pregnant. Five (42%) patients underwent primary or delayed hysterectomy due to severe post-partum haemorrhage in three cases, and intestinal adhesion/peritonitis and secondary post-partum haemorrhage/sepsis in two patients, respectively. CONCLUSION: Although this interventional method is relatively successful in uterine preservation, the possibility of treatment failure cannot be ignored. Given that there are too few data regarding its efficacy and safety, this method should be reserved to patients who have a strong desire to maintain the uterus and their fertility, or if it is technically difficult to perform hysterectomy due to the extent of the invasion.

The value of negative Chlamydia trachomatis antibody in prediction of normal tubes in infertile women.

OBJECTIVE: To evaluate the value of Chlamydia trachomatis antibody testing in prediction of at least one normal tube in infertile women. MATERIALS AND METHODS: Eighty infertile women without any history of abdominal or pelvic surgery, pelvic inflammatory disease, and endometriosis were recruited in this cross-sectional study from 2009 to 2010. The patients underwent hysterosalpingography, laparoscopy, and anti Chlamydia trachomatis IgG antibody (CAT) testing. We compared laparoscopy findings and CAT regarding sensitivity, specificity, accuracy, and predicting value of tubal conditions. RESULTS: The CAT was positive in 50 patients (62.5%) and laparoscopy was positive in 32 patients (40%). The CAT was significantly higher in women with tubal disease (1.88 +/- 0.34) versus in women with normal tubes (1.21 +/- 0.28) (p = 0.003). Five out of 30 sero-negative women had unilateral tubal abnormality and none of them had bilateral tubal obstruction or severe pelvic adhesion. The sensitivity, specificity, positive and negative predictive value, and accuracy of the CAT in prediction of one normal tube were 100%, 42.25%, 18%, 100%, and 48.75%, respectively. CONCLUSION: The negative predictive value of CAT to predict at least one normal tube in infertile women without history of abdominal or pelvic surgery, pelvic inflammatory disease, and endometriosis was 100%.

Intravaginal isosorbide dinitrate or misoprostol for cervical ripening prior to induction of labour: a randomised controlled trial.

In this randomised double-blind controlled trial, 130 healthy pregnant women with term pregnancy who scheduled for labour induction with Bishop's score < 5, were recruited. They were assigned randomly to vaginal administration of isosorbide dinitrate (ISDN) (40 mg) or misoprostol (25 µg), which were repeated after 4 h as needed. The efficacies of medications were evaluated by predetermined primary and secondary outcome variables for cervical ripening and induction of labour and delivery. There was no significant difference in Bishop's score 8 h after drug administration between the ISDN and misoprostol groups. However, in the ISDN group, labour induction was needed more frequently and the time from start of medication to the beginning of active phase of labour was significantly longer.