Small bowel obstruction during pregnancy.

The authors report the case of a 28-year old pregnant woman with abdominal pain and contractions at 37 weeks of gestation. After labour and delivery, abdominal pain persisted and laparoscopy was performed. A bowel obstruction was diagnosed and surgically corrected. The authors discuss the clinical and therapeutic consequences of bowel obstruction during pregnancy.

Prenatal diagnosis of a constitutional interstitial deletion of chromosome 5 (q15q31.1) presenting with features of congenital contractural arachnodactyly.

Prenatal diagnosis of a constitutional interstitial deletion of chromosome 5 (q15q31.1) in a 30-year-old woman is reported. At 21 weeks of pregnancy, routine fetal ultrasounds showed the presence of apparently isolated bilateral club feet. Fetal karyotyping documented an interstitial deletion of the long arm of chromosome 5: 46,XX,del(5) (q15q31) in all 50 analyzed metaphases. Because such deletion is associated with severe psychomotor retardation, the pregnancy was terminated. Postmortem karyotyping of skin fibroblasts confirmed the presence of this interstitial de novo deletion in all mitoses. The breakpoints on 5q were analyzed by fluorescent in situ hybridization and were localized at 5q15 and q31.1. This case illustrates the importance of fetal karyotyping in cases of isolated club feet. At autopsy, the fetus presented had minor anomalies and contractures of knee and hip joints. These clinical findings could fit the diagnosis of congenital contractural arachnodactyly (CCA) or Beals syndrome. CCA is caused by a defect in the fibrillin-2 (FBN2) gene. This gene was previously mapped on 5q23-31. Our molecular studies of both parents and the fetus, using an intragenic polymorphic GT repeat, showed that the FBN2 gene was deleted in the fetus and that the de novo interstitial deletion occurred on the paternally inherited chromosome 5. Thus, CCA may be caused by a loss of function of the FBN2 gene. Clinical findings in this fetus and those of other described cases with interstitial 5q deletions are reviewed, and similarities with CCA are stressed.

Antenatal fetal death in twin pregnancies: a dangerous condition mainly for the surviving co-twin; a report of four cases.

The outcome of four twin pregnancies with fetal death of one twin during the late second and the third trimester is described. A review of the complications occurring after antepartal fetal death of one twin is presented. A management plan for this rare complication of pregnancy is established.

A case report of unusual complication of myomatous uterus in pregnancy: spontaneous perforation of myoma after red degeneration.

An unusual complication of myomatous uterus in pregnancy is presented. It shows spontaneous perforation of a myoma after red degeneration, presenting as an acute abdomen. To our knowledge spontaneous perforation of a necrotising leiomyoma has not been reported earlier. A review of the literature is given.

The gonadotropin-resistant ovary syndrome in association with secondary amenorrhea.

A young patient with secondary amenorrhea and primary infertility is described. After a gynecological-endocrinological exploration including laparoscopy, the diagnosis indicates secondary hypergonadotropic, hypo-estrogenic normo-androgenic amenorrhea. The anatomopathological examination of an ovarian biopsy revealed an intact follicular apparatus, thus disproving the suspected diagnosis of climacterium praecox. Since very high gonadotropin doses could not induce an ovulation, it was concluded that the rare combination of secondary amenorrhea and the gonadotropin-resistant ovary syndrome must be present. The pathogenesis of this syndrome is discussed.

[Peri-operative problems in laparoscopic sterilization of women]. / Peri-operatieve problemen bij de laparoscopische sterilisatie van de vrouw.

PIP: Perioperative problems of laparoscopic sterilization of women are reported. Various techniques of sterilization are described and evaluated as to safety, reliability, and complication rates on the basis of 490 laparoscopic tubal sterilizations. The dangers of electrocoagulation with or without resection of a tubal fragment from the coagulated area are pointed out. The major complications are bleeding and burns. Therefore, it should be attempted to find a technique of laparoscopic sterilization that eliminates these risks. A promising technique may be Yoon's silicone band.^ieng

[First results with a new (reversible?) technique for female sterilization]. / Eerste resultaten met een nieuwe (reversibele?) sterilisatietechniek bij de vrouw.

PIP: Laparoscopic tubal sterilization by silicone ring was performed on 75 women, 25-49 years of age (average age 38.5). Over half of the women had 2, 3, or 4 children. There were 9 preoperative complications (3 misplaced rings, 2 cases of unilateral hematoma, 2 cases of tubal laceration, 1 case of mesosalpingeal bleeding, and one case of a tube section which was too small). There were 3 cases of bilateral salpingitis. In 340 control cycles, no pregnancies were reported.^ieng