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Biomedical subjects

A J Guillaume

Publications and source records attributed to A J Guillaume.

3 recordsLinked to original sources
PubMed1998

Myomectomy performed concurrently with tuboplasty.

OBJECTIVE: To determine whether women who require tuboplasty for infertility and have associated uterine leiomyomas that require removal should have the myomectomy done concurrently. STUDY DESIGN: Eighty-nine infertility patients underwent tuboplasty alone for proximal tubal obstruction, 30 others were treated by both myomectomy and tuboplasty during the same operation, and 15 others underwent tuboplasty, leaving the myomas in situ. The tuboplasty in all cases consisted of tubal resection and anastomosis (TRA). The pregnancy rates and outcomes in the three groups were compared. RESULTS: Of the 89 patients who underwent TRA alone, 74.2% (66 patients) became pregnant, and of those 66, 15.2% had a spontaneous miscarriage, 24.2% developed an ectopic pregnancy, and 60.6% achieved a viable birth. By comparison, of 30 patients who had both TRA and myomectomy, 63.6% (19 patients) conceived, and of those 19, 15.8% miscarried, 26.3% developed ectopic pregnancies, and 57.9% achieved viable births. Of 15 patients who underwent TRA leaving the myomas in situ, 73% (11) became pregnant, and of those 11, 45% (5) miscarried, 18% (2) had ectopic pregnancies and 36% (4) gave birth to viable infants. The incidence of pregnancies, ectopic gestations, miscarriages and viable births in the three groups showed no statistical differences. CONCLUSION: When myomectomy is indicated, because of the lack of disadvantages of performing it at the time of tuboplasty, the combined surgical approach should be the procedure of choice rather than leaving the myomas in situ for their removal in a separate operation at a later date.

Abortion, Spontaneous↗
PubMed1995

Luteal phase defects and ectopic pregnancy.

OBJECTIVE: To determine whether luteal phase defect (LPD) may be an etiologic factor in ectopic pregnancy (EP). DESIGN: All patients who were seen over a 6-year period with the chief complaint of infertility underwent an extensive infertility workup and were followed prospectively. The diagnoses of the causes of infertility were assigned retrospectively. SETTING: Two hospital-based tertiary care reproductive endocrine-infertility units. PATIENTS: A total of 1,077 infertility patients were evaluated. Of the 633 who became pregnant, the infertility had been due to LPD in 51 and to anovulation in 210. MAIN OUTCOME MEASURES: All the infertility patients who became pregnant were followed to determine whether they miscarried, developed an EP, or had a viable birth. The incidence of EP and miscarriage in the patients whose infertility was found to be due to LPD were compared with a control group in whom the infertility was due to anovulation. RESULTS: The EP rate in the patients with LPD was significantly higher than in a control group whose infertility was due to anovulation (6 of 51 pregnancies versus 6 of 210 pregnancies, respectively). The spontaneous abortion rate in LPD cases also was highly significantly greater than in the control group (19 of 51 pregnancies versus 12 of 210 pregnancies, respectively). The EP and spontaneous abortion rates also were higher in patients with LPD who were untreated than in those who were treated. CONCLUSIONS: This study suggests that there is a significantly increased incidence of tubal EP in patients with LPD and that when patients with LPD become pregnant early ultrasound should be performed to rule out EP. The study also indicated that spontaneous abortion occurs in a significantly high percentage of LPD cases.

Female↗