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Three of 2000 diagnostic hysteroscopies revealed residual fetal bony fragments in women with abnormal uterine bleeding. Removal of bony fragments by hysteroscopy is associated with therapeutic success.
BACKGROUND: Term delivery of the second twin after miscarriage of the first twin is rare. There is always a risk of preterm delivery as well as infection leading to chorioamnionitis. CASE: The second twin was delivered at term after miscarriage of the first twin at 17 weeks'gestation. The pregnancy was carefully monitored for prevention and early detection of chorioamnionitis. Delivery was delayed to 30 weeks after the miscarriage of the first twin, with a good outcome. CONCLUSION: Delayed delivery of the second twin with conservative management clearly is of benefit.
A case reported of simultaneous intrauterine and extrauterine pregnancy, is presented, accompanied by a spontaneous abortion, in the 8th week of gestation, and 3 weeks later, rupture of left tubal pregnancy. Frequency and etiologic factors, as well as diagnostic possibilities are discussed.
The study presents 93 patients in whom tubal surgery was carried out for primary or secondary mechanical infertility. A classification of these patients into five groups is suggested. Twenty-four uterine pregnancies were recorded, eighteen of which reached term. A plea for enlarging the scope and number of interventions in more patients of the older group and of the more complex pathologic group is presented and discussed. This approach may lower the the over-all success rate but may benefit some of this group of patients. Last but not least, the follow-up of these patients, who constantly move from one physician to another, seeking more treatment, is difficult. Liaison with referring gynecologists and standardization of methods would be of great help in the follow-up.
We report here a case of post-abortal clostridium prefringens infection in which there was severe intravascular hemolysis with black urine, but only minor abnormalities of the clotting mechanism and mild renal failure. The patient recovered following supportive therapy only.
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The histopathology of the liver in idiopathic portal hypertension (IPH) associated with autoimmune disease (15 cases), was examined and compared with that of IPH without autoimmune disease (31 cases). It was found that hepatic histopathology was heterogeneous in the cases with autoimmune disease. That is, the hepatic histopathology in 7 cases was similar to that of classic IPH without autoimmune disease, and the remaining 8 cases disclosed unusual lesions such as focal non-suppurative cholangitis, nodular parenchymal hyperplasia, moderate portal inflammation, and intrahepatic ductopenia. These unusual lesions, which frequently coexisted in the same case, were not typical ones for making other diagnoses such as primary biliary cirrhosis or nodular regenerative hyperplasia of the liver. These findings suggest that unusual histologic lesions in the livers of IPH patients with autoimmune disease may represent an accentuated immunologic reaction inherent in IPH, or that such cases may be an abortive or incomplete form of primary biliary cirrhosis or nodular regenerative hyperplasia of the liver.
Although association between moderate or severe endometriosis and infertility is fairly well established, the link between lesser disease stages and infertility is more tenuous. The proposed mechanisms underlying this association are reviewed. These include mechanical factors, changes in the peritoneal fluid environment, activation of local or systemic immune response, and abnormalities of ovulation, fertilization, and early pregnancy.
Selected data from 4,554 cases of amniocentesis performed in Johannesburg over a decade are presented. The demand for the service increased fivefold over the 10 years. The indications were: chromosome defects (83%), neural tube defects (11%), other disorders (4%) and parental anxiety (2%). A correct prenatal diagnosis was made in 99.9% of cases and sexing was correct in 99.6% of cases. Abnormalities were detected in 3.2% of pregnancies. The rate of 'spontaneous' abortion within 1 week after amniocentesis was 0.7%, and the total 16-28-week fetal loss rate is not much increased over the risk for such an event in any second-trimester pregnancy. The procedure has become a safe and a successful one in expert hands.
Using nationally representative sample survey data collected in 1986, this study evaluates the training and service programs for menstrual regulation (MR), and estimates the number of MR procedures performed during 1986, in Bangladesh. The results show that most of the MR providers, who received either formal or informal training, were physicians and family welfare visitors (paramedics) employed by the government. They were trained in various aspects of MR performance, including contraindications and complications associated with MR, the techniques of MR performance and follow-up procedures, and maintenance and sterilization of MR equipment. Averages of 20.5 and 13.0 MR procedures were performed by formally and informally trained physicians, respectively, in the three-month period preceding the date of interview. The corresponding average numbers for formally and informally trained family welfare visitors were 11.6 and 9.1, respectively. A total of 241,442 MR cases were estimated to have been performed between August 1985 and July 1986.
The incidence of ectopic pregnancy is rising. All patients with a diagnosis of spontaneous abortion should be observed until they have been proved not to have an ectopic pregnancy. To help in identifying patients with an ectopic pregnancy, sensitive human chorionic gonadotropin tests, ultrasound, and laparoscopy have been used, yet there has been a tendency to forget the simple method of looking for chorion villi. In material specimens of 272 patients with the initial diagnosis of spontaneous abortion, the gynecologist could identify villi in 50% and the pathologist could identify another 30%. Thus, only 20% had to be observed by other methods and one-third proved to have an ectopic pregnancy.
1-2% of women has abnormal uterine development due to nonunification of the Müllerian ducts in the embryonal period. At the RWTH Aachen, in the department of gynaecology and obstetrics, between January and June 1987, we had searched systematically for maldevelopment of the uterus in 2299 echosonografies. In 13 cases we found maldevelopment of internal genital; 5 of these cases were diagnosed by an echosonografic routine-examination. The echografic criteria of the different grades of uterine malformations have been determined, systematized and discussed in relation to the symptoms. The most frequent malformations as uterus subseptus, uterus septus, uterus bicornis and uterus duplex are subject of a detailed discussion. This work demonstrates that echosonografic is a very efficient instrument to diagnose uterine malformations and gives us a very exact anatomic interpretation of malformations.
A case of uncommon combined intra- and extrauterine pregnancy is reported. Diagnostic difficulties and predisposing factors are discussed.
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