Gynecologists' patterns of prescribing pessaries.

OBJECTIVE: To determine how gynecologists in the United States prescribe pessaries. STUDY DESIGN: A 34-question (long) survey was sent to 2,000 gynecologists. Those who did not respond were then sent a five-question (short) survey. RESULTS: Nine hundred forty-seven (47.3%) long and short questionnaires were returned. Eighty-six percent of gynecologists prescribe pessaries. Most received minimal or no training in pessaries in their residencies. The most common pessaries used were the ring and doughnut. Uterine prolapse was treated most often with the Gellhorn and doughnut pessaries. The cube and Gellhorn pessaries were thought to be the most effective for vaginal vault prolapse. The Gehrung and ring pessaries were thought to be most effective for correction of cystocele. However, the ring pessary was considered the easiest to use. Follow-up visits were most often performed at one week, one month and then every three months. Estrogen was used in most cases. CONCLUSION: Most gynecologists prescribe pessaries. The ring pessary is used most often and is deemed the easiest to use. Pessaries are thought to work for all pelvic organ prolapse defects but are thought to be less effective for posterior defects. Follow-up of patients differs from manufacturers' recommendations.

Ampullary tubal hydatidiform mole treated with linear salpingotomy. A case report.

BACKGROUND: While tubal pregnancies are common, only approximately 30 tubal hydatidiform moles have been reported. Most have been treated with salpingectomy. This case entails a tubal hydatidiform mole treated with salpingotomy without complications, persistence or recurrence. CASE: A 25-year-old woman with an ampullary tubal pregnancy at 8 weeks' gestation underwent a laparoscopic salpingotomy. Preoperative human chorionic gonadotropin (hCG) was 6,909 mIU/mL. Pathology confirmed a partial hydatidiform mole. Three weeks postoperatively the hCG was 6 mIU/mL. CONCLUSION: Tubal hydatidiform molar pregnancies are rare. Those which occur in the ampullary portion of the fallopian tube can be treated with linear salpingotomy.