Are placental lakes of any clinical significance?

The aim of this study was to determine prospectively whether an association exists between the finding of placental lakes at the 20 week scan and an increased risk of uteroplacental complications or a poor pregnancy outcome. We studied the placental appearances in 1,198 consecutive second trimester ultrasound scans performed for routine foetal abnormality screening at our institution. The placental thickness was measured at its widest diameter in the sagittal plane and the presence or absence of placental lakes was recorded. The birth weight in each case was plotted against the centile charts in use at the hospital and recorded. Specific outcome measures included foetal growth restriction (IUGR) with a birth weight below the 5th centile, pre-eclampsia, placental abruption, and perinatal deaths. Placental lakes were seen in 17.8 per cent of the scans. There was no significant association with either maternal socio-demographic factors or perinatal mortality (OR 0.94, 95 per cent CI 0.35-2.51). No association was seen with maternal cigarette smoking (OR 1.07, 95 per cent CI 0.75-1.52), a birth weight below the 5th centile (OR 0.68, 95 per cent CI 0.39-1.18), the development of pregnancy induced hypertension (OR 0.68, 95 per cent CI 0.35-1.32), severe pre-eclampsia (OR 0.72, 95 per cent CI 0.21-2.50), or placental abruption (OR 1.79, 95 per cent CI 0.46-6.99). A finding of placental lakes was six times more likely with a thick placenta >3 cm at 20 weeks gestation (OR 6.30, 95 per cent CI 4.39 to 9.05). A finding of placental lakes during the second trimester ultrasound scan does not appear to be associated with uteroplacental complications or an adverse pregnancy outcome. The lesions are more prevalent with increasing placental thickness.

The value of routine endometrial biopsy in gynaecological practice in Nigeria.

A review of 7,211 endometrial biopsy reports in a University Teaching Hospital in Nigeria, over a 6 year period revealed that 90.5% of samples from 5,795 patients with infertility and 83.4% of 1,416 patients with abnormal uterine bleeding were essentially normal. The yield for tuberculosis endometritis (0.49%) and uterine corpus malignancy (0.58%) was low. Eighty percent of patients with uterine malignancy were aged 40 years and above. In an era of medical audit and scarce human and financial resources, the wisdom of routine endometrial biopsy in all women with infertility and those with abnormal uterine bleeding who are younger than 40 years, is called to question.

PIP: To evaluate the need for continued performance of endometrial biopsy in all patients with infertility and abnormal uterine bleeding in Nigeria (a country with both low rates of endometrial malignancies and declining health care resources), pathology reports of 7211 endometrial biopsies conducted at University College Hospital in Ibadan in 1984-89 were reviewed. The majority of specimens examined--5795 (80.36%)--were from infertile patients; 90.5% of these samples were essentially normal and secretory phase endometrium was found in 80.2%. 83.4% of women with abnormal uterine bleeding had normal endometrium. The yield of tuberculosis endometrium was 0.49%, while that of uterine corpus malignancy was 0.58%. Among the latter group of patients, 80% were aged 40 years and older. These findings suggest that many women with infertility and abnormal uterine bleeding are subjected to unnecessary curretages whose results do not influence the course of management. In developing countries with few trained histopathologists, careful selection of patients for endometrial biopsy (especially those under 40 years of age) is recommended.