A simple device prevents hysterotomy extensions during cesarean delivery for failed second stage of labor.

BACKGROUND/AIMS: [corrected] During arrest of descent, maternal tissues conform to the fetal head, resulting in a suction-cup like effect during cesarean delivery. We hypothesize that breaking this suction might ease delivery. A novel device was designed for this purpose and tested in this series of 23 patients. METHODS: University-based retrospective cohort feasibility study. Term pregnant women with second-stage labor arrest (n = 23) provided written consent for use of the experimental device, inserted vaginally prior to cesarean delivery. Delivering obstetricians rated device effectiveness. Following case collection, the presence of hysterotomy extensions in study patients was retrospectively compared with controls (n = 49) from the same study period. RESULTS: On a 7-point Likert scale, consultant obstetricians rated overall device effectiveness as 6.0, and resident obstetricians rated it 6.3, consistent with a moderate improvement in ease of delivery. The device performed optimally at mid-pelvic stations (0 to +1), with no hysterotomy extensions (n = 0/17), which was significantly better than controls (n = 14/41, 34%, p < 0.01). CONCLUSION: A simple device prevented hysterotomy extension during second-stage cesarean delivery at 0 and +1 station. Obstetricians perceived that the device afforded a moderate improvement in delivery compared with previous deliveries in which the device was not used.

Hyperosmolar glucose injection for the treatment of heterotopic ovarian pregnancy.

BACKGROUND: Heterotopic pregnancy describes the relatively rare coexistence of one or more intrauterine gestations and one or more extrauterine (ectopic) gestations. We describe a unique clinical case involving successful treatment of an ovarian heterotopic pregnancy through gestational sac aspiration and injection of hyperosmolar glucose. CASE: A 31-year-old woman presented with an ovarian ectopic pregnancy and a viable intrauterine pregnancy after ovulation induction with oral medications. The ovarian gestational sac was aspirated and then injected transvaginally with a small volume of 50% glucose in water. The ectopic pregnancy resolved, and the intrauterine pregnancy was delivered at term without complication. CONCLUSION: Gestational sac aspiration and injection of hyperosmolar glucose into an ovarian ectopic pregnancy was simple and efficacious without compromising a coexisting intrauterine pregnancy.

Management of first trimester pregnancy loss can be safely moved into the office.

MANAGEMENT OF FIRST TRIMESTER PREGNANCY LOSS HAS CONVENTIONALLY INVOLVED TWO OPTIONS: expectant management or dilation and curettage in the operating room. New options in the outpatient setting are providing women with alternatives that can be less expensive and performed in more private settings. This review discusses the available approaches to expectant, medical, and surgical management of first trimester loss and the comparative efficacy of each method.

Recurrent first trimester pregnancy loss: revised definitions and novel causes.

PURPOSE OF REVIEW: First trimester pregnancy loss affects up to 15% of clinically recognized pregnancies. Whereas most couples will proceed to have successful subsequent pregnancies, 2-4% will suffer recurrent losses, often with no identifiable cause. In fact, up to 40-50% of patients suffering recurrent pregnancy loss (RPL) will have no identifiable cause for their losses. Whereas the high incidence of spontaneous fetal aneuploidy will ensure that this number will never fall to zero, its level suggests that additional causes and appropriate diagnostic testing await discovery. The definition, diagnostic work-up and appropriate interventions among patients with RPL remain controversial. Here, we will review those papers published in the last 1-2 years that improve our understanding of the definition of RPL, that confirm the utility of present testing paradigms or that pose novel causes and diagnostic approaches to patients with a history of RPL. RECENT FINDINGS: Standard definitions of RPL have been suggested by the American Society of Reproductive Medicine. Suggested potential diagnostic testing for RPL has been expanded to include male factors and new paradigms that address placental function, including the role of vascular endothelial growth factor, thrombosis and maternal-fetal immunology. SUMMARY: Standardized definitions for RPL and standardized approaches to initiating the RPL work-up will aid in study design and improve the applicability and implications of published findings. Appropriate investigation of novel causes for RPL may decrease the percentage of patients carrying the diagnosis of unexplained RPL.