A 34-year-old Asian woman was referred to the General Surgeons by her General Practitioner with a 2-day history of lower abdominal pain and ‘inability to lie flat’. She was taking Marvelon for cont...

BACKGROUND:On the basis of clinical impression that the number of cases of ectopic pregnancy seen in the City and Hackney Health District, London, was changing, a retrospective study of the years between 1990 and 1999 was carried out.METHODS:From the histopathology databases, cases of ectopic pregnancy and early pregnancy failure were identified. The number of deliveries at The Homerton Hospital was obtained from the Labour Ward register; the number of terminations of pregnancy and the number of fertile women was obtained from the Office for National Statistics, UK.RESULTS:There were 73 cases of ectopic pregnancy in 1990 rising to 96 in 1991 and then a fall to 52 cases in 1999. In terms of ectopic pregnancy per 100 deliveries, per all known pregnancies and per 1000 fertile women per year, there was a peak in 1991 and a fall to 1999. With regard to relative incidence per deliveries and per all known pregnancies, these falls were significant (P < 0.05). In 1991, there were 2.4 ectopic pregnancies per 100 deliveries, falling to 1.6 in 1999, a 33% fall. The reasons for this large decline are uncertain.CONCLUSIONS:There has been no change in patient population, diagnostic aids used or management protocols for patients with ectopic pregnancies.

SummaryTo assess the obstetric risk of grand multiparity we conducted a retrospective case control study over a two-year period. Defining grand multiparity as parity >5 we identified 229 cases; matched controls were within 5 years of age and parity 1. We found significantly more Jewish and Muslim patients, a discrepancy of greater than 2 weeks between menstrual date and dating ultrasound scan at 16 weeks, and significantly higher anaemia rates in the grand multi-parae (P<0–01). Antenatal admission rates including antepartum haemorrhage were similar, but the grand multiparous group had significantly less analgesic use in labour, a shorter second stage and a higher intact perineum rate. Mode of delivery, gestation, age, birth weight, Apgar scores and postpartum haemorrhage rates did not differ. There were three stillbirths in the 229 grand multiparous group, with none in the control group, with no neonatal deaths in either group. With modern obstetric management protocols, grand multi-parity does not appear to be an obstetric risk factor.

SummaryIn a retrospective study in the City and Hackney Health District, between 1 September 1990 and 31 August 1991, there were 106 ectopic pregnancies, 474 histologically confirmed spontaneous pregnancy failures, 2244 legal abortions and 4047 deliveries. The incidence of ectopic gestation was 1.54 per cent of all known pregnancies, 2.62 per cent of all deliveries, and 2.13/1000 per year of all women of childbearing age. These rates are among the highest reported in the world literature. There was a greater percentage of Afro-Caribbeans in the ectopic pregnancy patients (56.8 per cent, compared with 34.5 per cent in a control group, P < 0.001), and the patients with ectopic pregnancies were more likely to have had suction terminations of pregnancy – 30.8 per cent, compared with 12.5 per cent of the controls (P < 0–001). Previous ectopic pregnancy was more common in the ectopic pregnancy group, 9–9 per cent versus 2.0 per cent in controls (P < 005).

"Spontaneous vaginal delivery following previous hindquarter amputation and chemotherapy for osteogenic sarcoma." Journal of Obstetrics and Gynaecology, 13(1), pp. 40–41

Summary. Transvaginal ultrasound scanning was performed on 111 postmenopausal women. Of these women, 103 had postmenopausal bleeding, and eight were undergoing hysterectomy. Of the 103 women with bleeding, 93 had dilatation and curettage (D&C) and 10 patients were treated conservatively with a repeat scan in six months. A correlation of ultrasound findings and endometrial histopathology was possible in 94 patients. In 59 of these (63%) the endometrium was atrophic and the ultrasound endometrial thickness was 5 mm or less. In 29 (31%) patients the endometrial histology was abnormal and ultrasound endometrial thickness was greater than 5 mm. In six patients the endometrium was atrophic, but the ultrasonic endometrial thickness was apparently greater than 5 mm due to intracavity fluid. We suggest that an endometrial thickness of 5 mm is an appropriate cut‐off level for conservative management of patients with postmenopausal bleeding, or in screening for endometrial carcinoma.

SummarySummaryBetween 40 and 81 days of pregnancy, menstrual history was accurate in dating a pregnancy ± 10 days (95 per cent confidence limits), serum human placental lactogen ± 16 days, compared with dating by ultrasound crownrump length.

The thickness of the endometrium was measured in postmenopausal women by both the transvaginal and transabdominal ultrasound approaches in two separate groups of patients. The first group consisted of 90 women who received a transabdominal scan of the endometrium before dilatation and curettage or hysterectomy for either postmenopausal bleeding or uterine prolapse. The second group consisted of 111 women who underwent a transvaginal scan of the endometrium for similar postmenopausal conditions. Both methods suggested that an endometrial thickness of 5 mm may be used as a cut-off level in the conservative management of patients with postmenopausal bleeding or in a screening program for endometrial carcinoma. Patient acceptance and image quality were better in the group examined transvaginally. The proximity of the transvaginal probe to the endometrium, in the absence of a full bladder compressing the endometrium, revealed a unique group of patients with atrophic endometrium but thick endometrial cavity caused by intracavity fluid. In the presence of uterine fibroids distorting the uterine cavity, transvaginal scanning was better than transabdominal scanning for visualizing the endometrium. The transabdominal full-bladder technique can be of value in detecting asymptomatic bladder pathology.

SummarySummaryA transvaginal scan was performed on 53 women with suspected ectopic pregnancy and a positive serum hCG. In 22 patients, ectopic pregnancy was correctly ruled out, and the diagnosis of ectopic pregnancy was proved at laparotomy in 30 patients. Only one false positive diagnosis was made. The sensitivity of diagnosis of ectopic pregnancy with transvaginal ultrasound was 100 per cent and the specificity was 96 per cent. The positive and negative predictive values of this approach were 97 and 100 per cent respectively. Laparoscopy was avoided in 12 patients (51 per cent) with early intra-uterine pregnancies and corpus luteum cyst complications. The addition of transvaginal ultrasound scan as an aid in the management of ectopic pregnancy gives improved accuracy of pre-operative diagnosis, reduces the number of unnecessary laparoscopies and allows the potential for use of non-surgical methods of treatment.

BJOG: An International Journal of Obstetrics & GynaecologyVolume 98, Issue 5 p. 485-486 Transvaginal ultrasound. A reliable basis for clinical management? Case reports M. N. NASRI, Corresponding Author M. N. NASRI Clinical Research Registrar St Bartholomew's Hospital, West Smithfield, London EC1 7BEM. N. Nasri, Senior Registrar, Department of Obstetrics and Gynaccology, Whipps Cross Hospital, London E11 1NRSearch for more papers by this authorJ. H. SHEPHERD, J. H. SHEPHERD Consultant Department of Gynaecological OncologySearch for more papers by this authorM. E. SETCHELL, M. E. SETCHELL Head of Department Department of Obstetrics and GynaecologySearch for more papers by this authorD. G. LOWE, D. G. LOWE Consultant Department of HistopathologySearch for more papers by this authorT. CHARD, T. CHARD Department of Reproductive Physiology, The Medical SchoolSearch for more papers by this author M. N. NASRI, Corresponding Author M. N. NASRI Clinical Research Registrar St Bartholomew's Hospital, West Smithfield, London EC1 7BEM. N. Nasri, Senior Registrar, Department of Obstetrics and Gynaccology, Whipps Cross Hospital, London E11 1NRSearch for more papers by this authorJ. H. SHEPHERD, J. H. SHEPHERD Consultant Department of Gynaecological OncologySearch for more papers by this authorM. E. SETCHELL, M. E. SETCHELL Head of Department Department of Obstetrics and GynaecologySearch for more papers by this authorD. G. LOWE, D. G. LOWE Consultant Department of HistopathologySearch for more papers by this authorT. CHARD, T. CHARD Department of Reproductive Physiology, The Medical SchoolSearch for more papers by this author First published: May 1991 https://doi.org/10.1111/j.1471-0528.1991.tb10346.xCitations: 3Read the full textAboutPDF 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 Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume98, Issue5May 1991Pages 485-486 RelatedInformation

Summary. Uterine malformations were detected in 8 of 300 patients (3%) referred for transvaginal ultrasound scan (TVS) for different indications. Six of them had a partially septate uterus and two had a uterus didelphys. As uterine malformations can be associated with both sterility and reproductive failure, we suggest that the study of uterine morphology and structure could be a part of routine TVS examination.

Alphafetoprotein (AFP) levels were determined in 62 patients undergoing termination of first-trimester pregnancy in order to ascertain the incidence of fetomaternal haemorrhage. The apparent frequency of this phenomenon (58%) was higher than that previously reported. There was no evidence of fetomaternal haemorrhage associated with simple bimanual examination.