Fetal surveillance. Should it begin at 40 weeks' gestation in a low-risk population?

We evaluated the possible benefits of antepartum surveillance during the 41st week of pregnancy in a low-risk population. Three hundred low-risk patients (study group) underwent a nonstress test (NST) at the beginning of the 41st week of pregnancy. Outcomes in study group patients who delivered during the 41st week were compared to those in 100 similar control patients who were not tested. One antepartum fetal demise occurred in each group: study group rate, 1/300 (0.3%); control group rate, 1/100 (1%), P > .05. During the 41st week, 158 of 300 (53%) study patients and 59 (59%) control patients delivered. Four of 158 (2.5%) study patients had labor induced for the indication of an abnormal antepartum test during the 41st week. Cesarean delivery for distress during the 41st week was performed on 1/157 (0.6%) study and 1/58 (1.7%) control patients (P > .05). No statistically significant improvement in outcome occurred in the study group even though 4 of 300 study group patients required induction of labor for abnormal antepartum testing during the 41st week of gestation. The current practice of not evaluating low-risk pregnancy with an NST until after the completion of 41 weeks is supported by the results of this study.

Ultrasonic and magnetic resonance imaging diagnosis of placenta accreta managed conservatively.

Placenta accreta, a rare but life-threatening complication of pregnancy, is generally treated by hysterectomy and is histologically proven. We report a case that was managed conservatively and the diagnosis was confirmed by ultrasound and magnetic resonance imaging.

Transvaginal ultrasonographic quantitative assessment of accumulated cul-de-sac fluid.

Preoperative quantitative assessment of pelvic fluid is an important diagnostic tool in clinical decision making. In this study, we used high-frequency transvaginal ultrasonography in 10 healthy women to assess both the correlation between various amounts of fluid installed in the cul-de-sac and ultrasonic imaging and to determine whether correct estimation of fluid volume can be reached. No fluid could be ultrasonically detected when the volume was less than 35 to 40 ml. Between 35 and 100 ml there was a clear image of accumulated fluid in the cul-de-sac with good correlation between volume and image, whereas with larger amounts no clear correlation between the amount of fluid introduced and size of fluid area visualized by ultrasonography was possible. Transvaginal ultrasonography may enable quantitative evaluation of certain volumes of pelvic fluid, although amounts less than 35 ml cannot be visualized.

Conservative approach to multiple pregnancy with intrauterine fetal death of one or more fetuses.

One of the less common complications of multiple gestation is intrauterine demise of one or more fetuses. Despite the many case reports in the literature, there are no firm guidelines regarding the management of this problem. We herein report the favorable outcome of the conservative approach we chose for managing four patients; two with twins, one with triplets and one with quadruplets (first report in the literature). Strict follow-up based on frequent physical examinations, ultrasonographic assessment of fetal growth and well being, and coagulation profiles is mandatory. Individualization of delivery dates and mode is recommended.

The use of PGE2 for induction of labor in parturients with a previous cesarean section scar.

Controversy still dominates the discussion of the correct method for delivering patients with a previous cesarean section (C/S) scar. Although many have abandoned the slogan of "once a cesarean, always a cesarean", repeat cesareans are still the rule in many institutions. We have abandoned this dogma, and are now advancing to new ideas and are promoting a new protocol. Nineteen post-one cesarean section patients were induced on various indications by means of PGE2 pessaries. Close surveillance revealed no complications and 16 were delivered vaginally. All neonates had good Apgar scores, and all scars were found to be intact upon examination. We recommend cautious use of prostaglandins for selected post-cesarean patients.

An unusually aggressive verrucose carcinoma of the uterine cervix.

An unusual case of Verrucose Carcinoma of the uterine cervix is described. The tumor characteristics, as well as its aggressively malignant potential nature are presented. The unique response to irradiation therapy is discussed, hence the great difficulty in treating the tumor and the importance of early diagnosis to achieve a good prognosis. The literature regarding this unique tumor is reviewed.

Bilateral unruptured tubal pregnancies. A case report.

A rare case of bilateral unruptured tubal pregnancy, which was confirmed on laparotomy and histological examination, is presented.

Chronic ectopic pregnancy. A survey of 54 cases.

The diagnosis of chronic ectopic pregnancy is very often difficult. The subtle and long-standing symptoms, the relative paucity of clinical signs and the high incidence of false-negative results of relevant investigations contribute to the mimicry of many other intraabdominal conditions by chronic ectopic pregnancy. Surgery for chronic ectopic implantation is frequently difficult since chronic inflammatory changes involving the bladder, bowel and ureters distort the normal anatomy, and the incidence of postoperative complications is high. There is a surprising shortage of literature in which this disease is recognized as an entity separate from the condition of acute ectopic pregnancy.

Spontaneous rupture of a uterus at 16 weeks' gestation.

A case report of spontaneous rupture of a normal unscarred uterus at 16 weeks' gestation due to no apparent cause is presented. This is the earliest spontaneous rupture of the uterus documented and similar cases reported in the literature are reviewed. The aetiology and methods of treatment are discussed.