Biomedical subjects
Publications and source records attributed to J T Goh.
A personal series of 130 genital tract fistula repairs in 116 women is presented. All fistulas were repaired vaginally. The majority of the fistulas were due to obstetric injuries, especially prolonged obstructed labour. Obstetric fistula continue to be a cause of personal and social morbidity to sufferers.
STUDY OBJECTIVES: To determine the safety and efficacy of endometrial resection, and to provide an indicator of the operative problems and treatment outcomes. DESIGN: Prospective study. SETTING: Academic practice tertiary care setting. PATIENTS: One hundred twenty-six consecutive women undergoing endometrial resection because of menorrhagia, who wished to retain their uterus. INTERVENTION: Hysteroscopic endometrial resection performed as a day procedure. MEASUREMENTS AND MAIN RESULTS: In 126 women, 2 cases of uterine perforation were readily identified on the operating monitor screen; they had no serious sequelae. Three patients had heavy uterine bleeding, which was controlled by intrauterine tamponade. No women had other serious complications. CONCLUSION: Hysteroscopic endometrial resection is a safe, successful, and cost-effective treatment of menorrhagia.
The case presented highlights the risk of fetomaternal haemorrhage in ectopic pregnancy. With the current shortages of anti-D, it may be necessary to reduce administration of anti-D, but this may result in an increase in rhesus isoimmunization. As Kleihauer testing may be of limited value (1), recommendations by deCrespigny and Davison (2) for the use of a reduced dose of 30 mcg anti-D in all rhesus negative women with early pregnancy complications including ectopic pregnancy, would seem appropriate.
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Three cases of female circumcision are presented together with a literature review. Unfortunately, this procedure frequently results in genital mutilation. Treatment with deinfibulation enables restoration of the external genitalia and vagina. Obstetric and gynaecological complications have been documented, but emotional and psychological effects may be difficult to assess. These women should be treated without bias and with sensitivity.
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A new method for aspirating benign dermoid cysts enables removal of the collapsed cyst wall without the need for extending laparoscopic incisions or opening the pouch of Douglas. The technique has been used by one of the authors in 10 patients with good effect and minimal or no spillage of dermoid cyst contents into the peritoneal cavity.
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A case of active peptic ulcer disease in a primigravida at 29 weeks' gestation is presented, with a literature review. This particular case was complicated by gastric outlet obstruction, a complication which has not been previously reported in the obstetric literature. Although an uncommon diagnosis in pregnancy, the investigations for peptic ulcer disease should be actively pursued. Treatment can prevent serious complications.
The case notes of women with singleton term (37 weeks' gestation and beyond) breech presentation and delivery were retrospectively reviewed. Thirty-two of the 72 women in the study group had attempted external cephalic version at term, with a success rate of 53% (17 women). The Caesarean section rate was significantly lower in the group which had attempted ECV compared to the group which did not.
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This case of postmenopausal endometrioma following hormonal replacement therapy (HRT) demonstrates the often forgotten possibility of reactivation of endometriosis with HRT. The diagnosis of endometriosis should be considered in a postmenopausal woman who presents with pelvic pain and mass whilst on HRT.
First antenatal visit haematocrit values during the first and second trimesters were retrospectively collected from 546 nulliparas with singleton pregnancies. The results were analysed for correlation with development of pregnancy induced hypertension (PIH) later in pregnancy. It was found that women with higher haematocrit values, especially over 0.40, had an increased risk of developing PIH. However, there appeared to be no absolute level of haematocrit which had sufficient discriminative value to be useful in clinical practice.