Unilateral laparoscopic tubal reversal versus IVF.

BACKGROUND: Tubal sterilization is one of the most important surgical techniques for sterilization. There is a dilemma for women who wish to undo this procedure in the choice between tubal reversal or in vitro fertilization (IVF). PATIENTS AND METHODS: In this retrospective cohort study, 134 patients who had had tubal sterilization previously and wished to have another child were enrolled in this study. Primary outcome was clinical pregnancy. The outcomes of 58 women who had had laparoscopic unilateral tubal reversal (Group 1) were compared with those of 76 women who had had IVF (Group 2). RESULTS: Clinical pregnancy rates were higher in the tubal reversal group (55.2% in Group 1 and 15.8% in Group 2). Ectopic pregnancy rates were similar (1.7% in Group 1 and 1.3% in Group 2) between the two groups. Clinical pregnancy rates were higher in all age, body mass index, and interval from ligation categories. CONCLUSIONS: Laparoscopic unilateral tubal reversal is an important alternative to IVF. However, this is an advanced laparoscopic operation, and more surgeons skilled in this microsurgical operation are still needed.

Misoprostol for midtrimester termination of pregnancy in women with 1 or more prior cesarean deliveries.

OBJECTIVE: To evaluate the safety and efficacy of vaginal misoprostol for midtrimester termination of pregnancy (TOP) in women with 1 or more prior cesarean deliveries (CDs). METHODS: A retrospective study was conducted with 279 women undergoing TOP with vaginal misoprostol between 14 and 26 weeks of gestation. Of these, 193 had no uterine scars (group 1), 60 had 1 prior CD (group 2), and 26 had 2 or more prior CDs (group 3). The primary outcome was the success rate of TOP. Secondary outcomes were time from induction to abortion, total dose of misoprostol used, and occurrence of uterine rupture. RESULTS: The success rates were 96.4% in group 1, 81.7% in group 2, and 76.9% in group 3 (P=0.001). Time from induction to abortion, total dose misoprostol, and duration of hospital stay differed significantly among the groups (P=0.001 for all variables). There were 3 cases (11.5%) of uterine rupture in group 3, for an overall rate of 1.1%. CONCLUSION: Misoprostol inserted vaginally was effective for midtrimester TOP but the safety of using misoprostol in women with 2 or more prior CDs cannot be confirmed from the present study. Misoprostol should be used carefully, particularly in women with 2 or more prior CDs.

Factors that influence morbidity and mortality in severe preeclampsia, eclampsia and hemolysis, elevated liver enzymes, and low platelet count syndrome.

OBJECTIVE: To evaluate the prognostic factors affecting morbidity and mortality in severe preeclampsia, eclampsia and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome cases. METHODS: We retrospectively evaluated, 2245 cases who delivered in the Department of Obstetrics and Gynecology, Faculty of Medicine, Cukurova University, Turkey between January and December 2002. Ninety-three cases had severe preeclampsia, 26 cases eclampsia, 19 cases HELLP syndrome, and 6 cases with eclampsia and HELLP syndrome were included in this study. The pregnancy induced hypertension cases were evaluated retrospectively for socioeconomic status, obstetrical history, biochemical parameters, and maternal complications. RESULTS: The incidence of preeclampsia was 20.1% (453/2245), the incidence of severe preeclampsia, eclampsia, and HELLP syndrome was 6.4% (144/2245). These ratios are higher than that reported in the English literature. The complication rate was 38% in severe preeclampsia cases. Among the severe preeclampsia cases, 32 had eclampsia (22.1%), and 25 had HELLP syndrome (17.3%). CONCLUSION: The most important biochemical marker for maternal mortality is bilirubin levels. Maternal mortality was statistically higher in cases with jaundice. Also, there was a statistically significant relation between maternal complications and liver function tests, lactate dehydrogenase levels, and low platelet levels.