A study of admissions to Ward 1, Port of Spain General Hospital for early pregnancy loss: May-June 1999 - Poster abstract

OBJECTIVE: To compare early pregnancy loss in spontaneous versus induced abortions and determine the most common methods of pregnancy termination. DESIGN AND METHODS: In this prospective study, 205 patients admitted to Ward 1, Port of Spain General Hospital from May 1 to June 31, 1999 were interviewed with respect to age and circumstances surrounding thier pregnancy loss. Patient records were subsequently examined to obtain results of investigations and medical or surgical interventions undertaken. RESULTS: Patient were placed into 3 groups: spontaneous abortions (SA), induced abortions (1A) (all types) and mosprostol-induced abortions (MA). Patients' ages ranged from 14 to 43 years (mean 25 years). Length of hospital stay ranged from 1 to 24 days (mean 2.1 days). There was no difference in patient age or length of hospital stay among the three groups. Patients in the MA group exhibited increased rates of sepsis (53.7 percent vs 34.5 percent in the SA group), more episodes of blood transfusion (18.5 percent, MA vs 8.8 percent, SA) and had a higher rate of incomplete abortions (79.8 percent, MA vs. 59.0 percent SA). This led to an increased need for surgical intervention (72.2 percent, MA vs 49.1 percent, IA). Patients in the SA group display intermediate values in all parameters. CONCLUSIONS: Self-medication with Misoprostol is by far the most popular method of termination of unwanted pregnancy in this population. It was associated with increased rates of sepsis, anaemia and necessity for surgical evacuation of the uterus when compared with IA in the same population.(AU)

Vasopressin use in myomectomy a community hospital experience

Perivascular vasopressin as a haemostatic agent in myomectomy has recently been shown to be very useful in reducing the amount of bleeding during operation. The published data have, however, come from work done in university or large hospital settings. The aim of this case series was to establish that vasopressin can be used effectively in a small community hospital setting, to reduce the need for blood transfusion, especially in the small countries of the Caribbean where blood banking is not often available. Twenty-two patients were evaluated in this case series. Vasopressin 1 unit/ml solution was injected into the broad ligament posteriorly, inferior to the insertion of the ovarian ligament and anteriorly, inferior to the insertion of the round ligament. The drug was also injected along the line of of the incision in the myometrium. Of the twenty-two patients evaluated three were excluded, two because of degenerating fibroids while the other had adenomyosis. None of the nineteen patients required transfusion. The average blood loss was 240 ml; three patients had losses greater than 500 ml. Intraoperative changes in vital signs in these patients were minimal and no patient required reoperation because of post-operative haemorrhage. As has been reported previously, vasopressin can be used effectively as a haemostatic agent in myomectomy. The reduction in the need for blood transfusion in this community hospital setting is a major clinical advantage (AU)

Intravenous leiomyomatosis with massive ascites

A case of intravenous leiomyomatosis with massive ascites is reported. This is the first such recorded case. The patient was treated with a subtotal abdominal hysterectomy and bilateral salpingo-onphorectomy, pathological examination established a vessel wall origin. There is no evidence of recurrence up to 20 months after initial treatment.(AU)

The obstetric outcome of patients with previous myomectomy or hysterotomy

Fifty-four pregnancies were managed in women who had had a previous myomectomy or hysterotomy. Rupture of the uterus occurred, prior to the onset of labour, in one of 8 post-hysterotomy pregnancies (12.5 percent), and in 3 of 24 pregnancies (12.5 percent) when the uterine cavity was opened at the time of myomectomy. Careful monitoring during the last trimester of pregnancy with a view to elective Caesarean section is advocated in patients with hysterotomy or myomectomy scars extending into the endometrial cavity (AU)

Uterine leiomyoma: incidence of degenerative change and a correlation of associated symptoms

A clinical and pathologic study of 298 patients with uterine leiomyomas revealed no significant relationship between the presenting symptoms and degenerative changes in the tumors. Some form of degeneration was demonstrated in 65 percent of specimens. Hyaline degeneration occurred most frequently, accounting for 63 percent of all types of degeneration. Sarcomatous change occurred in two tumors, giving a corrected incidence of 0.37 percent.(AU)

Cavernous haemangioma in a post partum uterus

A case of haemangioma of the uterus in a 37-year old woman who died of intraperitoneal haemorrhage from a massive primary liver-cell carcinoma is presented. The relationship of the haemangioma with the placental site and pregancy is discussed (Summary)

Advanced extrauterine pregancy

Ten cases of advanced extrauterine pregnancy are described. All the mothers and four babies survived. The difficulties of diagnosis are discussed and are illustrated by the report of an additional case which had many of the characteristics of extrauterine pregnancy but which proved to be normal and intrauterine. Attention is directed to the frequent presence of a loud souffle heard over the small area of abdominal wall overlying the hypertrophied vessels supplying the placenta. While most cases should be dealt with by immediate laparotomy, it may be justifiable on some occasions and with adequate safeguards to allow the pregnancy to continue until the foetus is certainly viable. When the foetus has just died it may be safer to defer operation until the placenta has became avascular. It is suggested that, whenever possible, the placenta should be removed together with the structures to which it is attached. The special case of the placenta situated within the broad ligament is described. Severe retroplacental bleeding seems inevitable in such circumstances. A preliminary report of histological studies of the implantation of the extrauterine placenta is included. The problem of how the placenta maintains its precarious attachment until late pregnancy is raised but not solved (AU)

Carcinoma of the uterine cervix: some epidemiological data from a hospital in Jamaica

Epidemiological data collected at the University College Hospital of the West Indies have been examined in an attempt to determine the cause of cervical cancer. The risk of contracting the disease has been demonstrated to be high over a much wider range of ages than in a British population. Some deductions from the observed data lead to the conclusion that the predisposing factor is probably related to childbearing but not necessarily to the first pregnancy (Summary)

An unusual content of a hernial sac

Hernial sac found with right ovary, fallopian tube and uterus inside. (AU)