Fetal extremity kinetics quantified with Doppler ultrasonography

AIMS

To assess the responsive fetal extremity movement to vibro-acoustic stimulation test (VAST).

METHODS

The moving velocity of fetal femur was assessed after VAST by pulsed Doppler device. The ultrasonic beam was insonated at a right angle to the fetal femur. The following parameters were determined: limb retreat velocity in accelerative slope (Pk1); limb replenishment velocity in decelerative slope (Pk2); mean flexion to extension velocity; and the response time to VAST. Among 80 normal singleton pregnancies in 33-41 weeks, 68 were weekly evaluated and the others were assessed for two or more times during the study period, for a total of 680 studies of fetal kinetics.

RESULTS

The Pk1 declined from 9.6 to 6.26 cm/s; Pk2 decreased from 2.6 to 1.3 cm/s; mean velocity was reduced from 6.0 to 4.25 cm/s; whereas the response time increased from 0.1 to 0.3 s throughout the study period, i.e., fetal response reduces and the response time increases as maturation progresses.

CONCLUSION

The pulsed Doppler may assess fetal activity in any body structure. Reflex responses become slow and complex on both the velocity and response time as maturation increases with gestational age. Our observations have resulted in a novel and easy method for the quantitative assessment of fetal reflex reactivity to external stimuli.

Torsion of the fallopian tube and acute pelvic pain: an unusual presentation of genital tuberculosis

A case of a genital tuberculosis found during laparoscopic evaluation for recurrent acute pelvic pain is presented. The symptoms of genital tuberculosis can vary greatly, and a laparoscopic approach is effective for making the diagnosis. Clinicians should consider tuberculosis as a differential diagnosis when encountering clinical presentations of pelvic pain and ascites.

Laparoscopic creation of a neovagina in Mayer-Rokitansky-Küster-Hauser syndrome by modified Vecchietti's procedure

OBJECTIVE

The objective was to apply Vecchietti's principles to laparoscopy for the creation of a neovagina in patients diagnosed with Rokitansky syndrome.

STUDY DESIGN

The setting was a university tertiary hospital. The design was a descriptive study to describe the outcome in 18 patients diagnosed with Rokitansky syndrome after laparoscopic creation of a neovagina applying Vecchietti's principles and implementing some useful modifications.

RESULTS

In 17 patients the result was considered successful when a new neovagina measuring at least 10cm long was obtained. Less satisfactory in the 18th patient was when a shortened neovagina was found at the 2-year follow-up as the patient did not follow the postoperative recommendations.

CONCLUSION

Laparoscopic creation of a neovagina is a safe, minimally invasive treatment with good functional and sexual results.

Endometrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine insemination: a prospective, randomized study

BACKGROUND

It was our intention to determine whether hysteroscopic polypectomy before intrauterine insemination (IUI) achieved better pregnancy outcomes than no intervention.

METHODS

A total of 215 infertile women from the infertility unit of a university tertiary hospital with ultrasonographically diagnosed endometrial polyps (EP) undergoing IUI were randomly allocated to one of two pretreatment groups using an opaque envelope technique with assignment determined by a random number table. Hysteroscopic polypectomy was performed in the study group. Diagnostic hysteroscopy and polyp biopsy was performed in the control group.

RESULTS

Total pregnancy rates and time for success in both groups after four IUI cycles were compared by means of contingency tables and life-table analysis. A total of 93 pregnancies occurred, 64 in the study group and 29 in the control group. Women in the study group had a better possibility of becoming pregnant after polypectomy, with a relative risk of 2.1 (95% confidence interval 1.5-2.9). Pregnancies in the study group were obtained before the first IUI in 65% of cases.

CONCLUSIONS

These data suggest that hysteroscopic polypectomy before IUI is an effective measure.

Endometrial intraepithelial neoplasia diagnosed at endometrial resection

The literature has no reported cases of isolated endometrial intraepithelial neoplasia found at endometrial resection. If endometrial cancer is occult it might not be detected at diagnostic hysteroscopy or during resection, especially if destructive techniques are used. A 51-year-old woman had history of menorrhagia, with diagnostic hysteroscopy showing benign functional endometrium and diagnosed as dysfunctional uterine bleeding. Endometrial resection was performed and the pathologic examination in one stripe of resected tissue found focal, isolated endometrial intraepithelial neoplasia. This case reinforces the importance of pathologic tissue examination after endometrial ablation. Care must be taken when performing second-generation nonhysteroscopic ablation techniques, as even with direct visualization a premalignant lesion can be missed.

Tibolone and risk of endometrial polyps: a prospective, comparative study with hormone therapy

OBJECTIVE

To assess the incidence of endometrial polyps during postmenopausal replacement therapy with tibolone, using an appropriate control group.

DESIGN

A total of 485 postmenopausal women were included in this open, prospective, comparative study for a duration of 36 months. Of this group, 249 women received 2.5 mg/day of tibolone and 244 women served as controls, receiving continuous-combined estrogen-progestogen therapy (HT). Transvaginal ultrasound, hysteroscopy, and directed biopsies were performed before treatment was initiated and at the end of the study.

RESULTS

Two hundred twenty-one of the women receiving tibolone and 203 receiving continuous-combined HT completed the study. Endometrial polyps were detected in 74 women (33.4%) from the tibolone group and in 22 women (10.8%) from the HT group (P < 0.01). The vaginal bleeding rate did not differ between the groups. The frequency of atrophic polyps was significantly higher in the tibolone group (P < 0.01). No difference was found in the size of the polyps.

CONCLUSIONS

Tibolone increases by threefold the risk for endometrial polyps.