Post-menopausal bleeding.

PMB is a common symptom, which is associated with approximately a 20% incidence of malignancy in the genital tract. Every effort, therefore, needs to be made to exclude adenocarcinoma of the uterus, a condition with a good prognosis if an early diagnosis is made. In most other patients the cause of PMB is minor and can readily be controlled.

The use of a computer in an obstetric department.

Experience with a computer in an obstetric department is presented. A regular statistical analysis of the work of the department was readily available and computer printed summaries were produced for 86 per cent of the patients within one week of their discharge home. Solutions to problems encountered are discussed. It is concluded that a computer can be used economically and advantageously in this way even in hospitals without a computer on site. Future developments in the use of the computer are outlined.

Successful pregnancy in patient on regular dialysis.

A pregnancy in a patient undergoing regular dialysis treatment was successfully managed. Premature labour occurred at 32 weeks. Fetal nutrition was satisfactory and the infant developed normally and showed no congenital abnormality during 12 months' observation.

Intrauterine death treated with intrauterine extra-amniotic prostaglandin E2.

PIP: This paper presents 2 cases of intrauterine death induced satisfactorily using intrauterine extraamniotic Prostin E2. The 1st case involved a 39-year old woman with severe hypertension and superimposed toxemia. She was admitted at 24 weeks with a blood pressure of 175/100 mm Hg, albuminuria, and edema. Ultrasonic biparietal measurement showed increasingly retarded fetal growth. Intrauterine death occured at 32 weeks. Labor was induced with intrauterine extraamniotic Prostin E2 introduced by a Foley catheter. This was the method of choice because of the patient's hypertension, albuminuria, and impaired renal function. The patient delivered uneventfully after 5 hours and 3 doses of 2 ml. There was no puerperal pyrexia. The 2nd case involved a 38-year old woman who suffered intrauterine death at 28 weeks due to severe Rhesus isoimmunization. Intravenous oxytocin and intravenous prostaglandin were initially used unsuccessfully to induce labor. Labor was induced rapidly using PGE2 via the intrauterine extraamniotic route. Full dilation was achieved with intravenous oxytocin. Induction delivery interval was 9 hours. There was no puerperal pyrexia. It is suggested that intrauterine but extraamniotic PGE2 is a reasonable method of induction in cases of intrauterine death because of the short induction delivery interval. Active management of intrauterine death is needed to avoid potentially serious complications, the most serious of which is the risk of coagulation disorder if the dead fetus is left in utero. Other important considerations are the patient's hospital beds. Intrauterine extraamniotic PGE2 may be safer and more effective than amniotomy and intravenous oxytocin and intraamniotic hypertonic saline because the membranes are left intact and because of the rapid induction time.^ieng

Ovarian cytology. An application of cytology in an attempt at the early detection of ovarian carcinoma.

The possibility of detecting pre-clinical ovarian carcinoma by ovarian cytology taken at the time of laparotomy has been studied in 472 patients. Malignant cells have been recovered from ovarian carcinomas but never from macroscopically normal ovaries. It is suggested that this simple, inexpensive technique of sampling cells from the ovarian surface should be continued to be practised on all occasions at which ovaries present such as at laparotomy or at laparoscopy, as with further experience this technique may prove to be of help in the early diagnosis of ovarian carcinoma.