Ectopic pregnancy loss during fertility management

Using qualitative techniques, data were obtained from seven women who experienced an ectopic pregnancy loss while undergoing fertility management. Ectopic pregnancy is a risk factor associated with fertility management, but unlike early miscarriage in fertility management, an ectopic pregnancy has additional potential negative sequelae for the women, including risk for severe hemorrhage and death and threat to future fertility. The purpose of this study was to describe women's experiences of loss following diagnosis and treatment of an ectopic pregnancy while undergoing fertility management. A thematic analysis of the data derived from semistructured interviews was conducted. Themes emerging from the women's discussion of their pregnancy loss and fertility plans included physical pain and shutdown, emotional protection, grief, and pressure, endpoints, and decision making. For women continuing fertility management, both the life-threatening risks of future ectopics and time allowances for grieving were minimized.

Use of the Edinburgh Postnatal Depression Scale to identify postpartum depression in a clinical setting

The Edinburgh Postnatal Depression Scale (EPDS) is a validated instrument developed specifically to identify women experiencing postpartum depression (PPD). This study sought to determine the extent of postpartum depression in our population and the maternal characteristics associated with it and to also determine if the scale increased practitioner awareness and treatment of PPD. Two hundred eighty-seven women from the total population completing the EPDS in 1991 (n = 1,139) were randomly selected for retrospective chart review to identify relationships between maternal characteristics and elevated EPDS scores. Charts were also reviewed for outcomes related to depression for the six-month period after delivery. Statistical analysis of the data revealed that 17.4% of the total population had an EPDS score of > or = 10, indicating a potential risk of developing PPD. Eight percent scored > or = 13, suggesting that further assessment was necessary. Marital instability, lack of medical insurance and a history of depression were the factors found to correlate most significantly with elevated EPDS scores. The physicians and midwives providing service for our population were interviewed, and 83% reported that the EPDS had increased their awareness of PPD, while 92% reported having referred for treatment patients with high EPDS scores. Use of the EPDS scale can improve practitioner awareness and aid in the diagnosis of PPD. Several easily identifiable variables are associated with PPD.

Evaluating the thirty minute interval in emergency cesarean sections

BACKGROUND

This study was done to evaluate what percent of emergency cesarean sections are begun within the 30 minute interval between decision and incision time and to evaluate morbidity associated with this time interval.

STUDY DESIGN

A retrospective patient-control study of records from 75 patients undergoing emergency cesarean sections and two different control groups was undertaken.

RESULTS

Sixty-three percent of emergency cesarean sections were begun in less than 30 minutes. A significantly greater number of infants in the group that delivered in less than 30 minutes experienced five minute Apgar scores less than six. There was no significant differences in maternal morbidity associated with emergency cesarean sections.

CONCLUSIONS

The 30 minute interval is obtainable in a large number of patients but did not have a beneficial effect on neonatal morbidity. There was no significant morbidity seen in the patients who underwent emergency cesarean section. Other measurements of emergency preparedness should be considered other than the 30 minute rule.

Reproductive outcome after 143 laparoscopic procedures for ectopic pregnancy

OBJECTIVE

To analyze reproductive outcome after laparoscopic procedures for ectopic pregnancy, with particular attention to laparoscopic salpingectomy.

METHODS

In a 260-physician multispecialty clinic in the rural upper midwestern United States, 143 patients were followed prospectively after undergoing laparoscopic procedures for ectopic pregnancy. Ninety-five who sought further pregnancies during the study period were analyzed for reproductive outcome. Intrauterine pregnancy rates were compared by age, parity, size of ectopic gestation, and evidence of prior tubal damage. Life table analysis was also performed.

RESULTS

The overall intrauterine pregnancy rates for laparoscopic salpingostomy (60%) and laparoscopic salpingectomy (54%) were not significantly different from each other. However, intrauterine pregnancy rates differed significantly by history of prior tubal damage. The pregnancy rate was 79% among women without tubal damage and 42% among women with damage.

CONCLUSIONS

Our intrauterine pregnancy rates after both laparoscopic salpingectomy and laparoscopic salpingostomy are similar to those reported in the literature for similar procedures performed at laparotomy. In predicting pregnancy outcome after laparoscopic procedures for ectopic pregnancy, the major variable seemed to be evidence of prior tubal damage. With no evidence of previous damage, we found similarly high pregnancy rates for laparoscopic salpingostomy and salpingectomy.

Outpatient microsurgical reversal of tubal sterilization by a combined approach of laparoscopy and minilaparotomy

A prospective study of 17 cases of microsurgical reversal of tubal sterilization by a combined approach of laparoscopy and minilaparotomy was performed. Inclusion criteria included age less than 43; weight less than ideal body weight plus 20%; documentation of ovulation; 2 cm of proximal oviduct on hysterosalpingography; and a normal semen analysis or postcoital test. A comparison group of the 5 cases of sterilization reversal performed by a standard inpatient technique during the same period was analyzed. The study technique was performed on an outpatient basis in 15 of the 17 cases, 12 patients (71%) conceived 13 intrauterine pregnancies, one ectopic pregnancy occurred, and total patient costs and time until return to work were significantly less with the study versus standard technique.

Early crown-rump length. A good predictor of gestational age

With the increased resolution of newer transabdominal and transvaginal imaging equipment, ultrasound is being used more frequently for the diagnosis of early pregnancy complications. Extrapolation of gestational age from early crown-rump lengths (CRLs) has been difficult because previously established tables of CRL versus gestational age have contained few measurements at less than seven to eight weeks from the first day of the last menses. Accordingly, the relationship between early CRL (in millimeters) and calculated menstrual age (CMA) (in days) in 36 patients with a known date of conception was studied with transvaginal sonography and found to have a linear relationship, defined by the equation CMA = 0.99 x CRL + 40.0 (r = .95, P less than .001). The relationship can be used to date pregnancies as early as 26 days after conception.