Ultrasound-Guided Extraction of Intrauterine Devices With Nonvisible Threads: 254 Consecutive Cases: An Effective, Noninvasive Technique.

Intrauterine devices (IUDs) are among the most efficient and widely used contraceptive methods available. Removal is recommended after a certain time or in some cases when adverse effects are observed. A considerable number of patients have nonvisible guides or "lost threads" on speculum examinations, hindering the extraction. In this article, we report a consecutive series of 254 nonpregnant patients referred to our center after 1 or more failed attempts at IUD removal. We describe a novel ultrasound-guided approach, using a laparoscopic forceps to safely and effectively remove IUDs in nonpregnant patients.

Fetal evaluation of the modified-myocardial performance index in pregnancies complicated by diabetes.

OBJECTIVE: To evaluate the fetal cardiac function by modified myocardial performance index (Mod-MPI) in pregnant diabetic patients. METHODS: Modified myocardial performance index was measured in fetuses of patients with diabetes (DM) between 30 and 40 weeks of gestation. The isovolumetric contraction time, isovolumetric relaxation time and ejection time were measured. Mod-MPI was calculated as (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. Results were analyzed by using one-way analysis of variance (post hoc Bonferroni correction), Chi-square and Student's test. RESULTS: Modified myocardial performance index values of fetuses from DM mothers were significantly higher than controls (0.43 vs 0.37, P < 0.0001), and it was not different between gestational versus pregestational DM (0.42 vs 0.45, P = 0.18). Mod-MPI was also higher in the presence of polyhydramnios (0.49 vs 0.41, P < 0.0001), insulin use (0.46 vs 0.40, P < 0.05), and large for gestational age fetuses (0.49 vs 0.40, P < 0.0001). There were no significant differences in Mod-MPI between newborns with versus without neonatal complications such as hypoglycemia or polycythemia. CONCLUSIONS: In fetuses of DM mothers, evaluation of the Mod-MPI identifies those with worse maternal disease and large fetal size.

Cervicovaginal fluid changes to detect ovulation accurately.

OBJECTIVE: The purpose of this study was to evaluate changes in cervicovaginal fluid characteristics to identify ovulation. STUDY DESIGN: Several ovulation indicators were studied in a university-based natural family planning center. Fifteen parous women during 29 ovulatory cycles detected cervicovaginal fluid at the vulva. They self-aspirated their upper vaginal fluid, described it, and kept it for later checking. They also took basal body temperature, collected timed first morning urine samples for estrone and pregnanediol glucuronide enzyme immunoassays, and submitted to serial ovarian transvaginal ultrasound scans. RESULTS: Considering a +/-1-day period since ultrasound ovulation detection or allowing an extra day (-1 to +2), women perceived ovulation from cervicovaginal fluid at the vulva in 76% or 97% of cycles, on the basis of their visual description of vaginally extracted fluid in 76% or 90%, which rose to 90% or 97% for the instructor's description, and in 76% or 86% with a rapid drop in glucuronide ratio. Basal body temperature was less precise (71% or 79%). CONCLUSION: Evaluation of cervicovaginal fluid changes is an accurate ovulation indicator.