OBJECTIVE:We sought to demonstrate the usefulness of ultrasonography for the in utero identification of different types of intrauterine contraceptive devices.METHODS:We used sonography to differentiate among types of intrauterine contraceptive devices.RESULTS:Each type of intrauterine contraceptive device had typical sonographic characteristics, in most cases, best demonstrated in the axial plane. Photographs of each type are shown and their sonographic appearance is discussed.CONCLUSION:Sonographic identification of intrauterine contraceptive devices is accurate and specific. Sonography may serve as a useful method for determining the time to change the device and to identify those types that are more prone to complications.

the anterior cervical lip attached only to the anterolateral aspect of the cervix. The whole anterior cervical lip was excised under general anaesthesia, and haemostatic sutures were placed at the base of the amputated part. No sutures were placed along the line of separation in the anterior lip, since there was no bleeding. The postoperative course was uneventful, and the patient was discharged on the 3rd post-delivery day in good condition. Pathologic study showed that the excised cervical material was a piece of the cervix uteri. There were decidual changes in the stroma and extremely congested blood vessels. Follow-up examination 8 weeks after delivery showed a healed cervix with a shortening of the anterior lip.

Persistent fetal bradycardia is rarely encountered during pregnancy. When it is associated with a complete atrio-ventricular (A-V) block, it may prove dangerous to the fetus or newborn. The prenatal diagnosis is vital because it necessitates close follow-up during pregnancy to detect fetal compromise and proper preparation for delivery. We describe a woman who was found to be suffering from systemic lupus erythematosus during pregnancy. The fetus was diagnosed as having persistent fetal bradycardia due to complete A-V block at 28 weeks of gestation and was delivered at term with conservative management. The problems entailed in managing pregnancy and delivery of such fetuses are discussed.

Transcutaneous electrical nerve stimulation (TENS) has been proven effective in pain relief of primary dysmenorrhea (PD). We evaluated the efficacy of a new TENS device (Freelady, Life Care, Tiberias, Israel), designed to correct disadvantages of older models used in previous studies, in 102 nulliparous women with PD, who were treated with various types of pain relief medications. Marked pain relief was reported by 58 patients (56.9%) and moderate relief by 31 (30.4%). These subjective findings were supported by the fact that the same number of patients (58 and 31) either stopped analgesic use altogether during the trial or reduced the quantity of analgesics, respectively. The device examined proved to be efficient and safe in controlling the pain and disability caused by PD.

Laparoscopy, using a two-puncture technique, has been used for a variety of gynecologic indications for more than two decades. The procedure is considered safe and effective, although rare complications, such as incisional hernias, have been reported. In this review, the issue of postlaparoscopic incisional hernias is discussed in terms of incidence, predisposing factors, time of appearance, and preventive measures. With the evolvement of operative laparoscopy, larger trocars and cannulas have been introduced, increasing the incidence of postlaparoscopic incisional hernias. Awareness of the possibility of this complication will lead to the use of proper surgical techniques, as suggested, while knowledge of the postoperative signs and symptoms will lead to early diagnosis and prevention of sequelae.

Dilatation and curettage is the usual procedure implemented in cases of incomplete or missed abortion in the first trimester of pregnancy. The management of complete abortion depends on pregnancy age. We examined the possibility that conservative management of complete abortion can be effective and does not affect future fertility. A total of 172 women who presented with complete abortion to our Ambulatory Gynecological Clinics of the Dan Region, Israel, were managed conservatively. Of 161 who desired to become pregnant, 118 (73%) conceived within 18 months. We conclude that it is possible to avoid curettage in the management of complete abortion of<8 weeks' gestational age with little or no effect on future fertility.

Failure to locate the strings of an intrauterine contraceptive device may mean that the device is within the uterine cavity, was expelled or, worst of all, has perforated the uterine wall. We describe a 36-year-old woman complaining of infertility in whom two missing devices were found within the pelvis after having perforated the uterus. This report demonstrates the need to investigate every case of a missing intrauterine contraceptive device. An algorithm for the proper management of such cases is suggested.

BACKGROUND:We present the first case of abdominal pregnancy after in vitro fertilization and embryo transfer in a patient without oviducts.CASE:A 38-year-old woman, who previously had had two salpingectomies because of two tubal pregnancies, was admitted to our department with intermittent vaginal bleeding and abdominal pain, 21 days after embryo transfer. Exploratory laparotomy revealed a moderate amount of blood in the peritoneal cavity and a mass consisting of blood clots and tissue fragments attached to the posterior aspect of the right broad ligament. Pathologic examination confirmed the diagnosis of abdominal pregnancy.CONCLUSION:Abdominal pregnancy may be the outcome of embryo transfer and should hence be considered a potential complication of the procedure.

Acta Obstetricia et Gynecologica ScandinavicaVolume 75, Issue 5 p. 506-507 Endometrioma of the vagina in menopause David Rabinerson, David Rabinerson The Departments of Obstetrics and Gynecology and Beilinson Medical Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this authorOri Avrech, Ori Avrech The Departments of Obstetrics and Gynecology and Beilinson Medical Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this authorBoris Kaplan, Boris Kaplan The Departments of Obstetrics and Gynecology and Beilinson Medical Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this authorDiana Braslavsky, Diana Braslavsky The Departments of Pathology, Beilinson Medical Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this authorGil A. Goldman, Gil A. Goldman The Departments of Obstetrics and Gynecology and Beilinson Medical Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this authorAlexander Neri, Corresponding Author Alexander Neri The Departments of Obstetrics and Gynecology and Beilinson Medical Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelDepartment of Obstetrics and Gynecology Beilinson Medical Center, Petah Tiqva, 49100, IsraelSearch for more papers by this author David Rabinerson, David Rabinerson The Departments of Obstetrics and Gynecology and Beilinson Medical Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this authorOri Avrech, Ori Avrech The Departments of Obstetrics and Gynecology and Beilinson Medical Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this authorBoris Kaplan, Boris Kaplan The Departments of Obstetrics and Gynecology and Beilinson Medical Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this authorDiana Braslavsky, Diana Braslavsky The Departments of Pathology, Beilinson Medical Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this authorGil A. Goldman, Gil A. Goldman The Departments of Obstetrics and Gynecology and Beilinson Medical Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this authorAlexander Neri, Corresponding Author Alexander Neri The Departments of Obstetrics and Gynecology and Beilinson Medical Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelDepartment of Obstetrics and Gynecology Beilinson Medical Center, Petah Tiqva, 49100, IsraelSearch for more papers by this author First published: May 1996 https://doi.org/10.3109/00016349609033364Citations: 6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume75, Issue5May 1996Pages 506-507 RelatedInformation

Objectives: To develop a conservative protocol for the treatment of echo-free findings in the pelvis, diagnosed by sonography in post-menopausal women, in order to avoid unnecessary surgical intervention. Methods: A prospective study where each post-menopausal patient underwent sonographic evaluation of the pelvic mass, serum Ca-125 levels, ambulatory aspiration of the cyst, and operative laparoscopy if necessary. Results: One hundred and eighty-two women were included in the 3 years of the study. Only two cases of malignancy were diagnosed. There were no false-negative results. Conclusion: Although the results of our protocol of conservative management look promising, we cannot draw final conclusions because of the small sample size. Perhaps as our knowledge increases, physicians will feel more confident in handling adnexal findings conservatively.

Vulvovaginitis presents a therapeutic challenge. Treatment of vulvovaginal candidiasis with topical imidazole preparations is well accepted. In our work we tested a new cream combining antifungal Bifonazole with a corticosteroid agent (Fluocinonide). The results suggest that most of the patients with vulvovaginitis can benefit from treatment with this new combination cream.

SummarySummaryCervical smears, vaginal smears and bacteriological cultures of the uterine cavity were taken in 458 patients using intrauterine devices, selected at random. The tests demonstrated that inflammatory, hyperplastic or degenerative changes were more frequent following intrauterine removal than before insertion. Indirect evidence was found of a local oestrogenic effect on the endometrium in women fitted with the devices.

Second-trimester amniocentesis of a twin gestation revealed one normal karyotype, whereas the other had a 46XY, 10q+, indicating an excess of genetic material on chromosome number 10. A selective reduction of the affected twin was carried out on the 20th week of gestation; the outcome of pregnancy and delivery at term of the normal twin were both uneventful.

Ovarian cancer of epithelial origin is associated with the highest mortality rate of all gynecologic malignancies. Since no symptoms or signs are manifested at the early stages of the disease, it is no surprise that in 75% of patients peritoneal metastases are found during primary surgery. Despite advances in conservative treatment methods (invasive and noninvasive), screening for early detection of the disease is not yet available, and the overall survival rate is as low as 5-15%. Recent studies in molecular biology have drawn attention to different research directions in ovarian cancer and have contributed much to our understanding of this disease and its underlying pathologic mechanisms. This review is intended to highlight some of the new aspects of this research, specifically: hereditary ovarian cancer, genetic background in terms of chromosomal changes, DNA anomalies, oncogenes, tumor-suppressor genes, peptide growth factors and cytokines, invasiveness and metastasis, and finally, drug resistance. No breakthrough has as yet occurred in any of the subjects screened in this review, but results are promising. The clinical application of the steadily increasing knowledge in the biology of ovarian cancer may assist in the development of new treatment modalities that will improve survival.

The present study was designed to measure angiotensin-converting enzyme (ACE) activity in the human ovary and in serum and to relate this activity to age, serum estradiol levels, and uterine and endometrial pathology. ACE activity was determined in 56 females by a radiometric assay using [3H]hippuryl-glycyl-glycine as substrate. Ovarian ACE activity, but not serum ACE, was found to increase with age (P < 0.01) and was significantly greater in postmenopausal subjects (n = 31; 1.35 +/- 0.05 nmol/mg.min) than in subjects with active ovaries (n = 21; 0.65 +/- 0.2 nmol/mg.min; P = 0.0033). Ovarian ACE activities in fertile women in the preovulatory phase (n = 14) and the postovulatory phase (n = 7) were not statistically different (0.66 +/- 0.23 and 0.63 +/- 0.17 nmol/mg.min, respectively). Serum ACE activities were similar in females with active and nonactive ovaries (87.6 +/- 5.0 vs. 81.7 +/- 5.3 nmol/mL-min, respectively). Serum estradiol levels in fertile women were significantly higher than those in postmenopausal women (P = 0.0023). Serum estradiol levels were negatively correlated with age (r = -0.46; P = 0.0041) and were not correlated with either serum ACE activity (r = 0.080; P = NS) or ovarian ACE activity. In summary, human ovarian ACE activity, but not serum ACE, is positively correlated with age. Serum estradiol levels decrease with age, but are not correlated with either ovarian or serum ACE activity. Endogenous serum estradiol levels had no apparent effect on ovarian or serum ACE activity. The presence of uterine pathology affects ovarian ACE activity. The cause of the increased ovarian ACE activity is not clear, but may be related to the aging process.

Acta Obstetricia et Gynecologica ScandinavicaVolume 75, Issue 8 p. 768-769 Recurrent bilateral dermoid cysts in accessory ovaries Hanoch Levavi, Hanoch Levavi Gynecological-Oncological Unit, Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tikva, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this authorBoris Kaplan, Boris Kaplan Gynecological-Oncological Unit, Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tikva, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this authorGad Sabah, Gad Sabah Gynecological-Oncological Unit, Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tikva, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this authorJardena Ovadia, Jardena Ovadia Gynecological-Oncological Unit, Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tikva, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this authorAlexander Neri M.D, Corresponding Author Alexander Neri M.D Gynecological-Oncological Unit, Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tikva, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelDepartment of Obstetrics and Gynecology Beilinson Medical Center Petah, Tikva, 49100, IsraelSearch for more papers by this author Hanoch Levavi, Hanoch Levavi Gynecological-Oncological Unit, Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tikva, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this authorBoris Kaplan, Boris Kaplan Gynecological-Oncological Unit, Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tikva, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this authorGad Sabah, Gad Sabah Gynecological-Oncological Unit, Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tikva, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this authorJardena Ovadia, Jardena Ovadia Gynecological-Oncological Unit, Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tikva, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this authorAlexander Neri M.D, Corresponding Author Alexander Neri M.D Gynecological-Oncological Unit, Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tikva, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelDepartment of Obstetrics and Gynecology Beilinson Medical Center Petah, Tikva, 49100, IsraelSearch for more papers by this author First published: August 1996 https://doi.org/10.3109/00016349609065745Citations: 5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References Grohe F.. Uterus mit drei ovarien. Cited from Monatsschrift für Geburtshilfe Frauenheilkd 1864; 23: 67. Wharton L.. Two cases of supernumerary ovary and one of accessory ovary with an analysis of previously reported cases. Am J Obstet Gynecol 1959; 78: 1101– 19. Printz J. L., Choate J. W., Townes PL. Embryology of supernumerary ovaries. Obstet Gynecol 1973; 41: 246– 52. Gabbay-Mor M., Ovadia Y., Neri A.. Accessory ovaries with bilateral dermoid cysts. Eur J Obstet Gynecol Reprod Biol 1982; 14: 171– 3. Lachman M. F., Berman M. M.. The ectopic ovary. A case report and review of the literature. Arch Pathol Lab Med 1991; 115: 233– 5. Schultze H., Fenger C.. Accessory ovary. Acta Obstet Gynecol Scand 1986; 65: 503– 4. Heller D. S., Harpaz N., Breakstone B.. Neoplasms arising in ectopic ovaries: A case of Brenner tumor in an accessory ovary. Int J Gynecol Pathol 1990; 9: 185– 9. Simon A., Ohel G., Neri A., Schenker J. G.. Familial occurrence of mature ovarian teratomas. Obstet Gynecol 1985; 66: 278– 9. Abell M. R., Johnson V. J., Holtz F.. Ovarian neoplasms in childhood and adolescence. Am J Obstet Gynecol 1965; 92: 1059– 81. Levi A. A.. Reformation of an ovarian dermoid cyst. N Engl J Med 1951; 245: 99. Engel T., Greeley A. V., Sweeney W. J.. Recurrent dermoid cysts of the ovary. Report of two cases. Obstet Gynecol 1965; 26: 757– 9. Vaccari A.. Cysti dermoid ovarische bilaterali. Folia Gynecol 1910; 3: 345– 6. Anteby E. Y., Ron M., Revel A.. Germ cell tumors of the ovary arising after dermoid cyst resection: A long-term follow-up study. Obstet Gynecol 1994; 83: 605– 8. Reid H., Van der Valt J. D., Fox H.. Neuroblastoma arising in mature cystic teratoma of the ovary. J Clin Pathol 1983; 36: 68– 73. Citing Literature Volume75, Issue8August 1996Pages 768-769 ReferencesRelatedInformation

Grandmultiparity (GMP) has long been considered an obstetric complication for both mother and fetus, although recent studies indicate that, with proper perinatal care, women with high-parity rates are no longer at high risk. The current study examines the outcome of delivery in 1700 women in their fifth or more delivery, as compared with two control groups: 622 primiparas and 735 multiparas (two to three previous deliveries). Excellent prenatal care was available free of charge to all parturients. Our objectives were to evaluate the management of GMP in contemporary obstetrics and to assess whether grand multiparas are still high-risk patients. The age of the grandmultiparas was significantly higher compared with the control groups, which may explain the higher incidence among them of antenatal medical disorders, such as diabetes mellitus and hypertensive disease. No significant differences were found among the three groups for preterm or post-term births, small-for-gestational-age infants, polyhydramnios, oligohydramnios, perinatal death, fetal distress, multiple births, placenta previa, abruptio placentae or cord prolapse. Macrosomia was markedly higher in the grandmultiparas and multiparas than in nulliparas. Thus, our results indicate that good perinatal care can ensure better results in grandmultiparas, and that grandmultiparity no longer needs to be considered a high-risk obstetric category in our population.

Breech presentation is prevalent among preterm deliveries and contributes to neonatal mortality far beyond its prevalence. The management of a preterm breech delivery is controversial. We present our retrospective experience with 185 consecutive preterm breech deliveries, part delivered by cesarean section and part delivered vaginally as assisted breech delivery or total breech extraction), and compare the perinatal outcome between these two groups in terms of perinatal mortality (PPD) and perinatal morbidity (neonatal asphyxia). No statistically significant difference was found for either variable in the two examined groups. We therefore conclude that the method of delivery of low birth weight (1000-2500) breeches has no effect on perinatal outcome.