Endometrial ablation using hysteroscopic instillation of hot saline solution into the uterus.

OBJECTIVE: To evaluate the clinical effectiveness and safety of endometrial ablation by hysteroscopic instillation of hot saline using the Hydro-Therm-Ablator (HTA) system. METHODS: A total of 14 patients with menorrhagia, underwent the HTA procedure under general anethesia. Follow up of 9-18 months is reported. Three patients had undergone tubal ligation years before the procedure and one underwent it immediately after HTA at the same session. RESULTS: One procedure was cancelled due to technical problems, and roller-ball ablation was performed. There were no procedure related complications. A total of 11 patients reported significant reduction in bleeding, or amenorrhea, 9-18 months after the HTA procedure. One patient, although eumenorrheic after the ablation, considered the procedure a failure and requested hysterectomy. One patient with menorrhagia 3 months after the procedure, had a second HTA ablation and is now amenorrheic. CONCLUSIONS: This series of patients who underwent HTA ablation had successful reduction of menorrhagia to oligomenorrhea or amenorrhea.

Randomised trial of outpatient induction of labor with vaginal PGE2 at 40-41 weeks of gestation versus expectant management.

Two hundred consecutive women with uncomplicated pregnancies, at or within 4 days of their expected date of confinement, were prospectively randomized into 2 groups. One group had expectant management, with twice weekly surveillance tests, while the other group had 3 mg of vaginal prostaglandin E2 as outpatient treatment. There were 104 women in the expectant group and 70 in the induction group (26 women allocated to induction preferred no treatment). The average number of days to delivery was 1.6 in the induction group and 5.2 in the expectant group (p < 0.001). While meconium was much less frequent in the induction group (p < 0.002), all other outcome measures, including cesarean section rates, incidence of macrosomia, and Apgar scores, were similar in the two groups.

The antenatal diagnosis of fetal atrial septal aneurysm.

Fetal atrial septal aneurysm (ASA) is uncommon and little is known regarding its prevalence and clinical significance. In this report we describe 2 cases of fetal ASA diagnosed by ultrasonography. They were referred for examination because of fetal tachyarrhythmia in 1 case, and polyhydramnios in the other. The first case had a normal outcome, while the other was associated with other congenital heart malformations. The literature as regards the diagnosis, prevalence, pathology, and clinical implications of ASA is discussed.

Pemphigus vulgaris and pregnancy.

Pemphigus vulgaris (PV), an autoimmune bullous dermatosis, is rarely encountered in pregnancy. Two women with PV and their three pregnancies are described. Pregnancy outcome was generally good, although one of the neonates had characteristic PV skin lesions that resolved spontaneously. The pathophysiology, clinical manifestations, and special issues of PV pertaining to pregnancy are discussed. With our cases added, there are now 23 reports in the English literature on PV in pregnancy. From these data it seems that transient skin lesions may occasionally appear in the neonate regardless of the severity of maternal disease. Such lesions are due to passive transplacental transfer of PV antibodies and do not have long-lasting clinical implication. On the other hand, and contrary to past traditional thinking, PV may be associated with poor neonatal outcome including prematurity and fetal death. Such complications seem to be restricted to pregnancies with clinically severe PV.

Laparoscopic detorsion of adnexa in childhood: a case report.

A case of adnexal torsion in premenarchal child is presented. Prompt diagnosis was made with the use of pelvic ultrasound and laparoscopy. The later was used for establishing the diagnosis and furthermore for untwisting the adnexa. We suggest that laparoscopy should precede laparotomy and that conservative detorsion should be done more liberally in the young patient.