Balloon endometrial thermoablation--an alternative management of adenomyosis with menorrhagia and dysmenorrhoea.

A 45 years old Chinese housewife presented with menorrhagia and dysmenorrhoea due to adenomyosis failed to respond to various medical treatments. She was treated with balloon thermoablation. The total menstrual blood loss (MBL) decreased from 96.94 ml before to 37.57 ml, six months after thermoablation. The pictorial blood loss chart (PBLC) showed similar decrease in blood loss. Dysmenorrhoea was also cured. At three year follow up, there was no recurrence. This is the first report which shows thermoablation decreases MBL objectively and can be tried to treat adenomyosis.

A phenotypically normal female with pseudodicentric X: correlation for statural genes.

A 14-year-old Chinese female presenting with primary amenorrhoea and poorly developed secondary sexual characteristics is described here. Cytogenetic analysis showed the presence of one normal X along with a dicentric X which had a duplication of the entire chromosome from the band Xp22.1 to Xqter. She was karyotyped as 46, XX, psu dic X (p22.1) (Xqter:Xp22.1::Xp22.1:Xqter), a variant of Turner syndrome. Both parents and a younger sister had normal karyotypes. FISH with X centromeric probes was a useful test for confirmation of the two centromeres and also in ruling out the presence of a monosomic or normal diploid X cell line.

External cephalic version at term with tocolysis and vibroacoustic stimulation.

OBJECTIVE: This study compared the obstetric outcome in women who had external cephalic version (ECV) for breech presentation after 36 weeks gestation with those who did not, to see whether ECV reduces breech deliveries and cesarean section rates with reduced complications. METHOD: External cephalic version was attempted in 200 women (study group) with the use of tocolysis and vibroacoustic stimulation. The control group (ECV not attempted) comprised of 278 women with breech presentation after 36 weeks. RESULT: The cesarean section rate was 14.0% in the successful version group compared with 55.2% in the unsuccessful version group. The overall cesarean section rate in the study group was 32.5%. In the control group of 278, the fetus remained in the breech presentation in labor in 269 women with a cesarean section rate of 51.4% which was not different from the unsuccessful version group (55.2%). CONCLUSION: This study supports the randomized trials conducted earlier in that ECV after 36 weeks gestation reduced the number of breech deliveries and cesarean sections (32.5% in the study group compared with 51.4% in the control group) (P > 0.00001).

Early fetal blood sampling--another available option for early prenatal diagnosis.

Fourteen cases had early fetal blood sampling (FBS) performed between 13 and 18 weeks gestation in the Antenatal Diagnostic Centre, National University Hospital, Singapore from Jan 1988 to December 1994. The indications were: a) ultrasound abnormality (n = 6), b) hydrops (n = 1), c) screening for blood disorders (n = 2), d) amnio results inconclusive or to confirm abnormal amnio results (n = 5). This article analyses retrospectively the early FBS procedure and its outcome. There were no procedure related fetal losses in this study. The reliable rapid results obtained following the procedure enabled the obstetrician to counsel the couple regarding the current pregnancy and advise them accordingly for the subsequent pregnancy. Thus we found it useful not only in our patients but also for patients from overseas who get their results within a week to plan their stay.

Management of non-immune hydrops: 8 years' experience.

During a period of 8 years (1985-92), 100 fetuses were diagnosed to have non-immune hydrops on the basis of ultrasonographic findings and absence of rhesus isoimmunization. Both the mother and the fetus were thoroughly evaluated by a set protocol that included a detailed fetal abnormality scan with echocardiography and fetal blood sampling. A cause for non-immune hydrops could be identified in 81% of the fetuses. Cardiovascular abnormalities (23%) and alpha(1)-thalassemia (22%) were almost equally common etiological factors in the South-East Asian population under investigation. A chromosomal abnormality was detected in 10% of the fetuses with non-immune hydrops. Twenty-six fetuses were found to be suitable for in utero therapy. In utero therapy included one or more of the following: (1) fetal intravascular blood transfusion; (2) direct fetal drug therapy; and (3) fetal pleuroamniotic shunting. Eighteen of the 26 babies (69.2%) were alive and well at 1 month after delivery. It is concluded that in well-selected cases appropriate in utero fetal therapy can lead to significant improvement in fetal salvage.

Evaluation of auditory system in preschool children whose mothers had mid-second trimester amniocentesis.

A prospective study was conducted in the Otorhinolaryngology department, National University Hospital, Singapore to evaluate the effects of mid-trimester amniocentesis on the auditory system in preschool children of about four years of age. Fifty-nine children whose mothers had mid-second trimester amniocentesis and 63 children (control group) whose mothers did not have amniocentesis in that pregnancy were recruited. The children were subjected to audiological tests to assess hearing impedance abnormalities. The incidence of prematurity, neonatal admissions, ear and respiratory infections, auditory function, speech and language development in children were evaluated because these factors have a bearing on the development of auditory impedance abnormalities. There was no significant increase in the neonatal admission rates, impairment of speech and language development and auditory function in children whose mothers had mid-second trimester amniocentesis compared with the control group whose mothers did not have amniocentesis. An incidental finding in this study was an increased incidence of respiratory illnesses in the children in the amniocentesis group (57.6%) compared with the control group (30.1%). This needs further evaluation with a properly designed study.

Fetal blood sampling and its complications related to the indications for fetal blood sampling.

A prospective study on fetal blood sampling (FBS) was conducted in the Fetomaternal Medicine Division of the Department of Obstetrics and Gynaecology at the National University Hospital, Singapore. FBS was performed on 159 occasions in 156 women between January, 1988 and December, 1991. The aim of this study was to identify the factors that were associated with an adverse outcome following the procedure. Twenty four abnormal pregnancies were terminated; of the remaining 132 desired pregnancies the overall pregnancy loss was 44 (33.3%), which included those within 2 weeks and those after 2 weeks of the procedure and neonatal deaths. Fetal loss occurring within 2 weeks of the procedure is considered a procedure-related loss which occurred in 19 (14.3%) of the 132 pregnancies. When the fetal loss occurred within 2 weeks of the procedure 89% had a major abnormality on ultrasonographic scanning. The conclusion from our study is that the risks of FBS were increased in abnormal pregnancies, most likely due to the underlying pathology.

Amniocentesis and its complications.

This study was conducted in order to evaluate whether the performance of an experienced operator had any significant influence in reducing the incidence of complications in amniocentesis; 1,459 women had amniocentesis performed under ultrasound guidance; 1,324 were performed by experienced operators and 135 cases by less experienced operators. Complications like fetal loss, blood-stained amniotic fluid, culture failure, multiple needle puncture, leaking liquor, fetal trauma and error in results were compared in the 2 groups. This study demonstrated that amniocentesis performed by an experienced operator decreased the various complications associated with amniocentesis.