Prenatally diagnosed fetal brain injuries with known antenatal etiologies.

Periventricular leukomalacia of pre- or postnatal onset is responsible for severe neurological and intellectual impairment and cerebral palsy later in life. The etiology is multifactorial, involving hypoxic-ischemic insults of various origin. The disorder is characterized by multiple necrotic foci of the white matter found most frequently adjacent to the lateral ventricles. In the past, intrapartum factors were thought to be the major cause of neonatal brain damage, but recent investigations highlighted the role of antenatal risk factors. We present 4 cases of antenatally diagnosed brain injury with known and unusual etiology.

Factors affecting reproductive outcome following abdominal myomectomy.

PURPOSE: Fibroids may cause infertility and recurrent pregnancy loss. Studies have analysed the reproductive results after myomectomy according to the size, location and number of fibroids removed, but data are insufficient about comparison of opening the uterine cavity or not during surgery. MATERIALS AND METHODS: Two hundred twenty-nine abdominal myomectomies with the indication of infertility and/or recurrent pregnancy loss were analysed retrospectively. The main purpose was to compare postoperative pregnancy, delivery and miscarriage rates according to either the uterine cavity was opened or not during the surgery. As a secondary outcome postoperative pregnancy rates were assessed by location, size and number of fibroids. RESULTS: There was no significant difference in reproductive results according to either the uterine cavity was opened or remained closed. Preoperative location, size and number of fibroids did not influence significantly the postoperative pregnancy rates. CONCLUSION: Opening the uterine cavity does not impair postoperative pregnancy rates. Preoperative location, size and number of fibroids do not influence postoperative reproductive results.

Can myomectomy be suggested for perimenopausal women before administering hormone replacement therapy?

OBJECTIVES: The aim of this study was to evaluate whether abdominal myomectomy could be a choice for patients with symptomatic fibroids above the age of 48 years, who wish to get hormonal replacement therapy and desire to retain their uterus. METHODS: We performed 504 abdominal myomectomies between 1990 and 2004. The mean age was 33+/-4.09 years, 9 (1.8%; 9/504) patients were above 48 years and 6 (1.19%; 6/504) of them requested hormonal replacement therapy (HRT) after the enucleation of fibroids. Data of these nine cases were compared to a matched control group of patients who had hysterectomy in the same year in 3 months to those who underwent abdominal myomectomy with same indications for surgery, same location, size and number of fibroids. The main aim of our study was to compare perioperative morbidity, duration of hospital stay between myomectomy and hysterectomy groups and determine the recurrence of fibroids and/or symptoms in 1 year with HRT in the myomectomy group. RESULTS: The perioperative morbidity did not differ between the compared groups. In the myomectomy group with 1-year HRT we did not observe the recurrence of fibroids and symptoms. CONCLUSION: Our data suggest that abdominal myomectomy may be a satisfactory option for perimenopausal women with symptomatic fibroids who wish to retain their uterus and get HRT.

[Fetal ischaemic brain injury in the second trimester of pregnancy]. / Magzati ischaemia okozta agykárosodás a terhesség középso harmadában.

Based on clinical, epidemiologic, and experimental studies, the aetiology of white matter damage, specially periventricular leukomalacia (PVL), is multifactorial and involves pre- and perinatal factors. Each of these factors is supposed to be a major precursor for neurological and intellectual impairment, and cerebral palsy (CP) in later life. Antenatal rather than intrapartum factors are now emerging as the major determinants of cerebral palsy. In this case report maternal trauma, benign tumour, severe anaemia and fetal cerebral vascular malformation are supposed as causative factors in intrauterine periventricular leukomalacia resulting from hypoxic-ischaemic injury.

Reproductive performance after transabdominal metroplasty: a review of 157 consecutive cases.

OBJECTIVE: To evaluate the impact of conventional transabdominal metroplasty on the reproductive outcome of symmetric uterine anomalies and to determine the complications of this procedure. STUDY DESIGN: A retrospective clinical analysis of 157 consecutive women who underwent surgery during a 25-year period. One hundred fifty-seven patients with a subseptate, septate or bicornuate uterus and history of recurrent abortions (124 cases) or infertility (33 cases) were included in this study. Operative technique was similar to the procedure first described by Bret and Guillet and by Tompkins. RESULTS: The fetal survival rate increased from 0.0% before surgery to 81.9% postoperatively in the recurrent abortion group and to 92.8% in the infertility group. Among women having undergone surgery, 63.8% gave birth to at least 1 healthy child, the proportion of previous habitually miscarrying and infertile women was 70.2% and 32.0%, respectively. No uterine rupture or any other complication was observed. CONCLUSION: Conventional transabdominal metroplasty seems to be a safe procedure in women with symmetric uterine anomalies and a history of recurrent miscarriages or otherwise unexplained primary infertility. No perioperative or subsequent peripartum complications were observed. Even in the era of operative hysteroscopy, transabdominal metroplasty remains the only approach in cases of bicornuate uterus.

[Abdominal myomectomy as an alternative to hysterectomy: analysis of 504 cases]. / Abdominalis myomectomia, mint a hysterectomia alternatívája: 504 eset analízise.

UNLABELLED: Surgical management of symptomatic uterine fibroids by abdominal myomectomy. MATERIAL AND METHODS: Authors review their experiences and surgical methods for 504 abdominal myomectomies performed over the last 15 years. They retrospectively analyze the annual number of myomectomies, the age distribution, the most frequent indications, the location, size, and number of leiomyomas, the number of cases in which the uterine cavity was opened, the frequency of post-operative complications, and the number and outcome of post-myomectomy pregnancies. RESULTS: The annual number of myomectomies increased 26 times over the 15 year period, the average age at myomectomy was 33 years, 1.8% of post-fertile patients desired surgery which allowed for conservation of the uterus. The three most frequent indications for myomectomy were abdominal pain, infertility and menorrhagia. Regarding location, size and number; 82.7% of fibroids were submucosal/intramural and/or larger than 7 cm and/or greater than three in number. The uterine cavity was opened in 112 cases (22.2%). Post-operative complications occurred in 67 cases (13.3%): 7.7% required transfusions, 2.2% needed repeat laparotomy, two of which resulted in hysterectomy, and fever occurred in 13 cases (3.0%). There were 122 (24.2%) pregnancies in 105 patients following myomectomy. Eighty-nine patients conceived once, 15 patients conceived twice and 1 patient conceived three times post-myomectomy. There were 26 spontaneous abortions representing 5.2% of the post-myomectomy patients and 21.3% of the conceived pregnancies. There were 96 deliveries in 19.0% of the patients who had myomectomy and 78.7% of the total conceived pregnancies. CONCLUSION: Authors suggest that abdominal myomectomy for the therapy of symptomatic uterine fibroids is an effective surgical alternative to hysterectomy one, which preserves fertility and femininity. In cases where the fibroids have well-defined borders, the success of surgery does not depend on the location, size or number of fibroids. In cases with adenomyosis, myomectomy alone is not sufficient to alleviate the symptoms. When the uterine cavity is opened during surgery, post-operative transcervical drainage is suggested to prevent hematometra, post-operative adhesions inside the uterus, infection, fever and wound dehiscence.

[Bilateral hypogastric artery ligation for control of pelvic hemorrhage, reduction of blood flow and preservation of reproductive potential. Experience with 117 cases]. / Az arteria hypogastrica ligatura helye a kismedencei vérátáramlás csökkentésében, a vérzés csillapításában es a reproduktív képesség megorzésében 117 esetünk kapcsán.

MATERIAL AND METHOD: The topography of the hypogastric (internal iliac) artery, its pelvic collateral anastomoses, the procedure and physiological consequences of hypogastric artery ligation are described. Indications and clinical findings in 117 cases of bilateral hypogastric artery ligation for uncontrollable pelvic bleeding are presented. RESULTS: In all 37 obstetric cases, hemorrhage was effectively controlled. There was no need for reoperation, and in 13 cases even the uterus could be preserved, with 4 women having delivered mature infants up until now. The uterus was successfully preserved even in cases such as cervical pregnancy, placenta previa, placental abruption, uterine atony, and uterine rupture. Out of 80 gynecological cases, hypogastric ligation was performed to control intractable hemorrhage in 41 patients, while prophylactic reduction of pelvic blood flow was the indication of the procedure in 39 cases. Prophylactic ligation was performed in 34 women because profuse bleeding was expected. In the remaining 5 cases, the procedure was done for requests of patients who were members of Jehova's Witnesses. Out of cases with preserved uterus one woman delivered mature infant up until now. Apart from a slight lesion of the hypogastric vein, no complications have been observed in relation to these 117 cases of bilateral hypogastric artery ligation. CONCLUSION: It is emphasized that hypogastric artery ligation is indicated if (1) life-threatening pelvic hemorrhage cannot be controlled by conservative methods, (2) prophylactic reduction of pelvic blood flow is needed, (3) during the management of uncontrollable massive hemorrhage, preservation of reproductive functions and/or female identity is desirable. Ligation of the hypogastric artery has proven to be a safe and usually effective method. This easy-to-acquire technique should be practiced by most gynecologists and should be an integral part of obstetric and gynecological training.