History Of Dilatation Research Articles

Uterocervical angle: a novel ultrasound screening tool to predict spontaneous preterm birth

Mechanical alteration of the cervical angle has beenproposed to reduce spontaneous preterm birth. Performance of the uterocervical angle as measured by ultrasound for predicting spontaneous preterm birth is poorly understood. We sought to determine whether a novel ultrasonographic marker, uterocervical angle, correlates with risk of spontaneous preterm birth in a general population. We conducted a retrospective cohort study from May 2014 through May 2015 of singleton gestations between 16 0/7-23 6/7 weeks undergoing transvaginal ultrasound for cervical length screening. Images were remeasured for uterocervical angle between the lower uterine segment and the cervical canal. Primary outcome was prediction of spontaneous preterm birth <34 weeks and <37 weeks by uterocervical angle and secondary outcome evaluated cervical length and spontaneous preterm birth. A total of 972 women were studied. The rate of spontaneous preterm birth in this cohort was 9.6% for delivery <37 weeks and 4.5% for <34 weeks. Uterocervical angle of ≥95 degrees was significantly associated with spontaneous preterm birth <37 weeks with sensitivity of 80% (P < .001; confidence interval, 0.70-0.81; negative predictive value, 95%). Uterocervical angle of ≥105 degrees predicted spontaneous preterm birth <34 weeks with sensitivity of 81% (P < .001; confidence interval, 0.72-0.86; negative predictive value, 99%). Cervical length ≤25 mm significantly predicted spontaneous preterm birth <37 weeks (P < .001; sensitivity, 62%; negative predictive value, 95%) and <34 weeks (P< .001; sensitivity, 63%; negative predictive value, 97%). Regression analysis revealed a significant association of maternal age, nulliparity, race, and obesity at conception with spontaneous preterm birth and uterocervical angle. There was no correlation identified between history of dilation and curettage, abnormal Pap smear results, excisional cervical procedures, smoking, or obesity at delivery on spontaneous preterm birth and uterocervical angle. A wide uterocervical angle ≥95 and ≥105 degrees detected during the second trimester was associated with an increased risk for spontaneous preterm birth <37 and <34 weeks, respectively. Uterocervical angle performed better than cervical length in this cohort. Our data indicate that uterocervical angle is a useful, novel transvaginal ultrasonographic marker that may be used as a screening tool for spontaneous preterm birth.

A Retrospective Review: Vaginal versus Abdominal Hysterectomy for Benign Gynecological Diseases in a Tertiary Canter

The aims are to review respectively 229 cases of hysterectomy and to find the factor affecting the decision of vaginal hysterectomy. Data collected from medical charts include age, nationality, parity, menopause, history of Dilation and curettage. The following data were obtained: the clinical presentation and the indication for hysterectomy. Postoperative complication includes the estimated blood loss, the number of days in hospital and ICU admission recorded. The route of hysterectomy found that 187 (82%) were abdominal and only 42 (18%) were vaginal. Factors significantly associated with the choice of vaginal approach: age, parity, smaller uterine size and prolapse. Factors affecting the decision of vaginal hysterectomy for treatment of benign diseases are identified as follows: if the age is more than 35 years or if the women already reach menopause, the presenting symptoms are not vaginal bleeding but prolapsed uterus and uterine size is less than 12 weeks.

Vascular uterine abnormalities: Comparison of imaging findings and clinical outcomes

ObjectiveTo retrospectively compare the imaging findings and the outcomes for patients with vascular uterine abnormalities (VUA) and to identify prognostic factors. Material and methodsBetween 2007 and 2012, 38 patients with vaginal bleeding and abnormal ultrasonographic (US) findings consistent with acquired VUA were consecutively included (mean age 31.6 years, range 19–62). Follow-up was 32 months in mean (1–78 months). Seventeen women (44.7%) started bleeding immediately after curettage, spontaneous miscarriage, trophoblastic disease, or section scars, with the remainder starting bleeding after 8 days to 2 years. All US, CT (n=2), MR (n=5) and angiographic (n=26) images were reviewed and compared to medical reports in order to identify severe VUA requiring treatment, and predictive factors. ResultsNo information about severity was provided by US, MRI or CT. Twelve patients were successfully managed conservatively. Angiography identified 6 non-severe VUA, corresponding to an isolated uterine hyperemia, and 20 severe VUA, corresponding to an association of a nidus and early venous drainage. Recurrences were more often observed for severe VUA (p=0.001). The hemoglobin level was significantly lower (below 11g/L) in these cases (p=0.004). Recurrences were significantly more frequently observed for patients with history of dilatation and curettage (p=0.02). Hysterectomy was performed for three patients only (8%). Among the women who wished to have children, 14 (77.8%) were pregnant after 9 months in mean (range 2–23). ConclusionsRecurrence happens more frequently after curettage and in case of anemia or severe VUA findings on angiography, justifying adequate embolization for these patients.

Laparoscopically diagnosed invasive mole presenting as acute hemoperitoneum.

A young multipara presented with acute abdominal pain. She had history of dilatation and evacuation for a missed miscarriage 2 months back. The diagnosis of ectopic pregnancy was made on the basis of clinical presentation and laboratory investigations. Laparoscopy was performed which revealed features of invasive mole. The procedure was converted to laparotomy and hysterectomy was performed. Patient recovered well. Histopathology confirmed the diagnosis of invasive mole. Follow-up till 12 weeks reported return to normal ßhCG (beta subunit of human Chorionic Gonadotropin) levels.

Facteurs prédictifs d’échec d’entrée en travail par dinoprostone en cas de grossesse prolongée et de conditions locales défavorables

To identify predictive factors for unsuccessful induction of labor within 24hours after dinoprostone insertion in post-term pregnancy with unfavorable cervix. We retrospectively reviewed 325 singleton pregnancies with a diagnosis of post-term pregnancy and unfavorable cervix (Bishop score<6) during the period January 2012-Decembre 2012. Patients were classified into 2 groups: successful labor, defined as cervical ripening, within 24hours after dinoprostone insertion (Group R; n=248; 76.3 %) or failure group (Group E; n=77; 23.7 %). Antepartum and perpartum characteristics of women were compared. Nulliparity (74.0 versus 56.0 %; OR=2.23; 95 % CI: 1.27-4.00; P=0.005), gestational age ≤41 SA+4 (53.2 versus 33.9 %; OR=2.22; 95 % CI: 1.32-3.74; P=0.003) and history of dilatation and curettage (27.3 versus 10.5 %; OR=3.19; 95 % CI: 1.66-6.11; P=0.0005) were significantly associated with unsuccessful induction of labor. Bishop score was significantly higher in Group R (3.6 versus 1.9; P=0.001). Also, consistency (74.0 versus 44.4 %; OR=3.57; 95 % CI: 2.04-6.40; P<10(-5)) and absence of dilatation of the cervix (59.7 versus 23.0 %; OR=4.97; 95 % CI: 2.89-8.56; P<10(-6)) were identified as significant predictive factors for unsuccessful induction of labor. Nulliparity, gestational age ≤41 SA+4, history of dilatation and curettage and Bishop score, in particular consistency and dilatation, are correlated with failure of cervical ripening in post-term pregnancy with unfavorable cervix.

English

Uterine rupture is a potentially catastrophic event during childbirth by which the integrity of the myometrial wall is breached (1) . It can occur in an unscarred uterus or a uterus with a surgical scar. The incidence of uterine rupture in patients with history of a single caesarean section ranges from 0.2% to 1.5% which increases to 3.9% with two or more previous caesareans (2). Here is a case of a 38 year old Mrs. X G2A1 at 28 weeks of gestation with history of dilatation and curettage in the past. Now admitted for correction of anaemia and later diagnosed to have posterior wall uterine rupture. The incidence of uterine rupture has been increasing due to increasing rate of caesarean sections. WHO data indicated that 75% of uterine ruptures still occurred in unscarred uteri with maternal mortality rate of 1-13% and perinatal mortality rate between 74% and 92% (4) .

Dilatation and Curettage Effect on the Endometrial Thickness

BackgroundEndometrial receptivity is required for successful implantation and pregnancy. Despite the remaining controversy, many studies have shown that ultrasonographic endometrial thickness can be considered as an indicator of endometrial receptivity.ObjectiveThe study objective was to investigate the effect of dilatation and curettage on the endometrial thickness.Materials and MethodsEnrolled in the study were 444 patients visited in Obstetrics & Gynecology clinic of Shahid Sadoughi hospital between Jan. 2011 to Sep. 2012. Only patients whose menstrual cycle was regular were included in study. Patients with myoma, adenomyosis, endometrial polyps or other uterine anomaly, those who smoked, whose BMI was greater than 30 and who were taking medications that could affect endometrial thickness were excluded. Endometrial thickness was measured one day before evolution (n = 444) and 5-7 days after it (n = 444) using transvaginal ultrasonography. The endometrial thicknesses were correlated to the patients’ history of dilatation and curettage. Data analysis was done through SPSS software version 16 and using descriptive statistics, independent T-test and Anova.ResultsEndometrial thickness in patients who had 0, 1, 2, 3 and 4 D&C were 10.00 ± 0.58, 9.83 ± 0.47, 8.90 ± 0.92, 7.42 ± 0.18 and 7.40 ± 0.07, respectively one day before ovulation (spearman’s correlation coefficient = -0.33) and 10.62 ± 0.68, 9.64 ± 0.49, 8.48 ± 0.96, 6.32 ± 0.15 and 6.90 ± 0.04, respectively, 5-7 days after ovulation (spearman’s correlation coefficient = -0.66) estradiol and progesterone levels, measured in the day of 2nd ultrasonography had not statistic relation with endometrial thickness (P = 0.27 and 0.31). The relation of endometrial thickness and age was not significant (P = 0.54 and 0.06).ConclusionsDilatation and curettage has a significant effect on the endometrial thinning.

Uterine Arteriovenous Fistula Treated With Repetitive Transcatheter Embolization: Case Report

Uterine arteriovenous fistula (AVF) is a rare entity, but may lead to life-threatening hemorrhage. Although transcatheter embolization, surgical ligation, or hysterectomy would be considered for treatment of uterine AVF, there is poor knowledge as to how gynecologists can manage the uterine AVF with multiple large inflow arteries. Herein we report a uterine AVF successfully treated using multiple-step transcatheter embolization. The patient, a 58-year-old postmenopausal woman with a history of dilation and curettage, had intermittent massive uterine bleeding. Radiologic imaging revealed the presence of a large vasculature mass. The mass occupied the entire pelvis, and the source of hemorrhage was identified as an accompanying AVF. We thought that surgical intervention was contraindicated because of the potential risk of uncontrollable intraoperative bleeding. Multiple-step transcatheter embolization was performed, with complete resolution of the AVF. Thereafter, the patient had no further uterine bleeding. Multiple-step transcatheter embolization might be the most beneficial and efficient treatment option for a uterine AVF with multiple large inflow arteries.

128: The interaction between preeclampsia and race-ethnicity as a factor in the preterm delivery of twin gestations

and race-ethnicity as a factor in the preterm delivery of twin gestations Judith Chung, Yvonne W. Cheng, Jonathan M. Snowden, Rachel Pilliod, Amy E. Doss, Aaron Caughey University of California, Irvine, Obstetrics and Gynecology, Orange, CA, University of California, San Francisco, Department of Obstetrics, Gynecology, and Reproductive Sciences, San Francisco, CA, Oregon Health Sciences, Obstetrics and Gynecology, Portland, OR, Oregon Health and Science University, Department of Obstetrics and Gynecology, Portland, OR OBJECTIVE: Multiple gestations and African-American women have been shown to have an increased risk of preeclampsia. The purpose of this investigation was to evaluate the incidence of preeclampsia among twin gestations delivering prior to 37 weeks gestation and to evaluate the interaction between preeclampsia and racial-ethnic group in this preterm population. STUDY DESIGN: This is a retrospective cohort study of twin gestations delivered at 24 0/7-36 6/7 weeks gestation in the state of California during the year 2006. Using logistic regression, odds ratios (OR) and 95% confidence intervals (CI) for preeclampsia were then determined as a function of gestational age at delivery, divided into three categories: 24-27, 28-31, 32-37 weeks. For each gestational age category, the impact of racial-ethnic group on the odds of preeclampsia were then evaluated. RESULTS: The highest odds of preeclampsia was seen among twin gestations delivered between 32-37 weeks (aOR, 1.75; 95% CI, 1.571.95), while there was a reduced odds of preeclampsia among twins delivering between 24-27 weeks (aOR, 0.74; 95% CI, 0.61-0.90) and 28-32 weeks (aOR, 0.42; 95% CI, 0.27-0.65). Racial-ethnic differences in the odds of preeclampsia were most apparent among deliveries at 32-37 weeks, with the highest odds seen among Caucasian women (aOR, 1.19; 95% CI, 0.78-1.83). African-American women delivering at any of the preterm gestations did not have an increased odds of preeclampsia. CONCLUSION: Preeclampsia appears to be a significant contributor to the preterm delivery twin pregnancies only at the later preterm gestations (32-37 weeks). While African-Americans may have an overall higher incidence of the disease, Caucasian women with twin pregnancies, who require delivery at these later preterm gestations, seem to have the highest burden of disease. Preeclampsia is reduced among all race-ethnic groups if delivery occurs at before 32 weeks. 129 Obstetrical outcomes in patients with low-lying placenta in the second trimester Justin Bohrer, William Goh, Cori-Ann Hirai, James Davis, Ivica Zalud University of Hawaii John A Burns School of Medicine, Obstetrics, Gynecology & Women’s Health, Honolulu, HI, University of Hawaii John A Burns School of Medicine, Clinical Research Center, Honolulu, HI OBJECTIVE: The objective of our study was to determine if women with a history of a low-lying placenta (LLP) in the second trimester have increased blood loss at delivery. STUDY DESIGN: IRB exemption was obtained. A total of 178 electronic charts were reviewed of patients referred for an ultrasound examination at a single institution between January 2009 and February 2011. 89 patients with a LLP on ultrasound between 16 and 22 weeks gestation were compared with 89 time-matched controls. A placenta was designated low-lying if its edge was within 2 cm proximity to the internal cervical os on transvaginal ultrasound. Data was analyzed using JMP (SAS Institute Inc, Cary, NC). RESULTS: Of the 89 patients in the LLP cohort, all but one resolved on repeat ultrasound in the third trimester. Age (OR 1.07, 95% CI 1.021.13) and history of dilation and curettage procedures (OR 1.55, 95% CI 1.04-2.45) were indentified as risk factors for LLP using univariate analysis. Gravity, parity, ethnicity, smoking status, number of prior cesarean deliveries, and uterine surgeries were similar between groups. Age remained the only independent predictor of LLP after controlling for potential confounders (adj OR 1.07, 95% CI 1.021.13). Mean change in hemoglobin following delivery in the LLP cohort ( 1.56 g/dL, SD 1.13) was greater than that in the control group (1.22 g/dL, SD 0.94, p .0358). Mean change in hemoglobin remained significantly different between groups after excluding the patient with persistent LLP and controlling for differences in parity and mode of delivery (p .0098). 6 patients (6.7%, 95% CI 3.1-13.9%) with LLP required inpatient admission for antepartum bleeding compared with 0 (0%, 95% CI .02-4.0%) admissions in the control group (p .029). Birthweight, incidence of preterm birth, umbilical artery pH, estimated blood loss, incidence of postpartum hemorrhage, mode of delivery, and gestational age at delivery were similar between groups. CONCLUSION: Patients with a LLP in the second trimester are at increased risk for antepartum admissions for bleeding and have increased blood loss at the time of delivery.

Clinical and Demographic Characteristics of Women with Intrauterine Adhesion in Abuja, Nigeria

Objective. Infertility menstrual abnormalities continue to constitute a significant bulk of gynecological consultation in Africa. Both of these problems are sometimes traced to intrauterine adhesions which are preventable in the majority of cases. Study Design. A retrospective analysis of intrauterine adhesions at the National Hospital Abuja, Nigeria, was carried out, covering the period from 1st September 1999 to 1st September 2004. A total of 72 cases were analyzed. Statical analysis was done using X 2. Results. The incidence of intrauterine adhesions was 1.73% of new patients. Mean age ± SD was 29.97 ± 4.82 years. Patients who were Para 0 to 1 constituted 81.9% of the total. Intrauterine adhesions significantly (P < 0.02) occurred in nulliparae. The majority (68%) were educated only up to secondary level which was significant (P < 0.05). Menstrual abnormalities were present in 90.3%. The commonest predisposing factor identified was a history of dilatation and curettage or uterine evacuation. Conclusion. Intrauterine adhesions are associated with lower educational status and low parity. Increasing educational targets nationally, poverty alleviation, nationwide retraining in manual vacuum aspiration, and wider application of this technique are recommended.

Computed tomography for the preoperative diagnosis of pelvic actinomycosis

The aim of this study was to review the clinical manifestations of pelvic actinomycosis in order to aid clinicians in its diagnosis and treatment. We retrospectively reviewed the histopathology and clinical records of all cases confirmed by surgery as pelvic actinomycosis from 1996 to 2006. A total of 16 cases of pelvic actinomycosis were selected and evaluated. The median age was 51 years (range, 36-66 years). All patients experienced childbirth, and had risk factors including use of an intrauterine device (93.8%) or pessary (6.2%), and/or a history of dilatation and curettage (68.8%), or previous abdominal surgery (31.3%). Nine patients (56.3%) were correctly diagnosed before surgery with computed tomography. Other common preoperative diagnoses were intra-abdominal malignancy (18.8%) and tubo-ovarian abscess (25%). The most common initial laboratory abnormalities were anemia (68.8%) and leukocytosis (62.5%). In six patients (37.5%), the preoperative values of carbohydrate antigen-125 were elevated. All patients were cured by surgery and no recurrence or mortality was noted. The correct initial diagnosis of pelvic actinomycosis is important for decreasing treatment-related morbidity. Imaging studies, especially computed tomography, might have assisted the diagnoses of actinomycosis.

Relationship between ultrastructural features with the expression of connexin 43 in the uterine junction zone and pathogenesis of adenomyosis

to investigate the relationship between the ultrastructural features combined with the expression of connexin (Cx43) protein in uterine junction zone and pathogenesis of adenomyosis. from Nov. 2008 to Nov. 2009, 30 patients with adenomyosis (including 14 cases with proliferative endometrium and 16 cases with secretory endometrium) as study group matched with 30 women with cervical intraepithelial neoplasia (CIN) III treated by hysterectomy as control group were enrolled in this study in Affiliated Hospital to Inner Mongolia Medical College. The expression of Cx43 in uterine junction zone of patients with adenomyosis was detected by immunohistochemisty staining. The ultrastucture of eutopic endometrium, uterine junction zone and outer 1/3 myometrium in both groups without history of dilatation and curettage, C-section and uterine surgery were observed by using transmission electron microscopy. (1) the expression of Cx43 in proliferative and secretroy uterine junction zone were 0.133 ± 0.018 and 0.137 ± 0.021 in study group and 0.154 ± 0.016 and 0.141 ± 0.018 in control group, which reached statistical difference (P < 0.05). However, it didn't show significant expression of Cx43 between proliferative and secretory uterine junction zone in study or control group (P > 0.05). The expression of Cx43 in proliferative and secretory of eutopic endometrium of 0.067 ± 0.017 and 0.062 ± 0142 in study group were significantly lower than 0.094 ± 0.005 and 0.080 ± 0.005 in control group. It didn't show statistical difference of Cx43 expression between proliferative and secretroy eutopic endometrium in both group. The expression Cx43 in outer myometrium of proliferative phase were 0.184 ± 0.022 in study group and 0.188 ± 0.028 in control group, which did not show significant difference (P > 0.05). It also did not exhibit statistical difference of Cx43 expression in outer myometrium of secretory phase (0.178 ± 0.022, 0.191 ± 0.025, P > 0.05). (2) Morphological changes: the area of uterine smooth muscle cells of the uterine junction zone of (24.3 ± 1.6) microm(2) in study group were significantly increased than (21.8 ± 2.0) microm(2) in control group (P < 0.01). The length of the cell membrane dense plaques of (1.07 ± 0.17) microm in study group was significantly increased than (0.71 ± 0.07) microm in control group (P < 0.01). The myocytes exhibited cellular hypertrophy and disordered arrangement and fewer caveolae. There was cylindrical and dentate, chromatin margination, more heterochromatin in which muscle cells of nuclear surface of the uterine junction zone. Less cytoplasmic myofilaments and more intermediate filaments. Mitochondria were increased, the volume increased significantly vacuolization. The rough endoplasmic reticulum and Golgi apparatus were more prominent. Otherewise, mast cells and fibroblasts were close and glandular epithelial cells showed desmosome connection which villus thickening and dense. All features were more prominent at the junctional zone. the down-regulation of Cx43 expression and ultrastructure changes in the junction zone might play an important role in pathogenesis of adenomyosis.

Is size-reducing ascending aortoplasty with external reinforcement an option in modern aortic surgery?

Enlargement of the ascending aorta is often combined with valvular, coronary, or other cardiac diseases. Reduction aortoplasty can be an optional therapy; however, indications regarding the diameter of aorta, the history of dilatation (poststenosis, bicuspid aortic valve), or the intraoperative management (wall excision, reduction suture, external reinforcement) are not established. In a retrospective study between 1997 and 2005, we investigated 531 patients operated for aneurysm or ectasia of the ascending aorta (diameter: 45-76mm). Of these, in 50 patients, size-reducing ascending aortoplasty was performed. External reinforcement with a non-coated dacron prosthesis was added in order to stabilize the aortic wall. Aortoplasty was associated with aortic valve replacement in 47 cases (35 mechanical vs 12 biological), subvalvular myectomy in 29 cases, and CABG in 13 cases. The procedure was performed with low hospital mortality (2%) and a low postoperative morbidity. Computertomographic and echocardiographic diameters were significantly smaller after reduction (55.8+/-9mm down to 40.51+/-6.2mm (CT), p<0.002; 54.1+/-6.7mm preoperatively down to 38.7+/-7.1mm (echocardiography), p<0.002), with stable performance in long-term follow-up (mean follow-up time: 70 months). As demonstrated in this study, size reduction of the ascending aorta using aortoplasty with external reinforcement is a safe procedure with excellent long-term results. It is a therapeutic option in modern aortic surgery in patients with poststenotic dilatation of the aorta without impairment of the sinotubular junction of the aortic valve and root.

Ectopic pregnancies in a Caesarean scar: review of the medical approach to an iatrogenic complication.

Implantation of a pregnancy within a Caesarean fibrous tissue scar is considered to be the rarest form of ectopic pregnancy and a life-threatening condition. We conducted a computer search of the English literature of all studies since 2002 to gather updated data on the outcome of such pregnancies. Sixty-six new cases were reported since 2002, possibly reflecting the increasing number of Caesareans currently being performed as well as the more widespread use of the transvaginal scan allowing their earlier detection. Analysis of these women's obstetric history revealed that those at risk for pregnancy in a Caesarean scar appear to have a history of dilatation and curettage, placental pathology, ectopic pregnancy, and IVF. Twenty-one out of 39 for which this information was available (54%) had undergone multiple (> or =2) Caesareans and 13 had previous dilatation and curettage, which might also be an associated factor. We review and discuss the features of contemporary work-ups, including a high index of awareness, a detailed history and a skillful ultrasound examination for an early and accurate diagnosis. Healthcare professionals should be familiar with the possibility of untoward sequelae and how a modern work-up can help in guiding conservative options, thus reducing morbidity and preserving fertility.

Analysis of the prevalence of bacterial vaginosis and Chlamydia trachomatis infection in 6083 pregnant women at a hospital in Otaru, Japan.

Our aims were to evaluate the prevalence of bacterial vaginosis (BV), Chlamydia trachomatis (C. trachomatis) infection and Mobiluncus spp. infection among pregnant women in Otaru, Hokkaido, Japan according to the month and year of the first prenatal visit, and to evaluate their risk factors. Six thousand and eighty-three pregnant women who were seen consecutively at our hospital between 1993 and 2000, were enrolled in the study. Vaginal and endocervical swabs were subjected to Gram stain and detection of C. trachomatis. Univariate and multivariate methods were used to investigate the association between each infection and potential risk factors including age, gravidity, parity, history of dilatation and curettage (D & C), and history of natural abortion. The annual rate of BV increased from 13.6% in 1993 to 21.4% in 2000. The annual rate of C. trachomatis infection was relatively constant. The prevalence of bacterial vaginosis, C. trachomatis infection and Mobiluncus spp. infection over the 8-year period was 18.2%, 4.2%, and 4.1%, respectively. The prevalence of the three infections was significantly higher among teenagers and among women with a history of D & C. The prevalence of C. trachomatis and Mobiluncus spp. infections was significantly higher among women with no history of delivery. BV was not associated with parity on multivariate analysis. The monthly prevalence of BV was significantly higher in May than in December, and the monthly prevalence of C. trachomatis infection was high in August. The differences in the annual and monthly infection patterns between BV and C. trachomatis infection suggest that the etiologies of the two infections differ.

P174: Complete hydatidiform mole co existing with 21 weeks normal live fetus. A case report

A 20 years old Indian woman, gravida3, para1, aborta1, without positive family history, was scanned for menstrual gestational age at 21 weeks, as uterine size was larger than expected for the estimated gestational age. There was no positive history of pervaginal bleeding or hyperemesis. Detailed Ultrasound examination with 4 MHZ transabdominal & 7 MHz endocavity transducers (Acuson-Aspen), revealed a normal fetus of 21 weeks with no congenital anomalies. But there was a large co existing intrauterine hypoechoic mass with multiple anechoic spaces, along the posterior wall. A small normal placenta was seen adjacent to the mass. A presumptive diagnosis of Hydatidiform mole co existing with a normal live fetus of 21 weeks was made on sonographic findings. After counseling, the parents decided to terminate the pregnancy, as the patient had a history of dilatation & evacuation for hydatidiform mole of at 12 weeks in the last pregnancy. A still-born fetus weighing 386 grams was delivered. Histopathological examination of the mass confirmed the diagnosis of complete hydatidiform mole. The incidence of co-existence of normal live fetus with a complete hydatidiform mole is uncommon, (1%–2% of cases). This condition is usually the result of dizygotic twinning, thus fetus is chromosomally normal. However, the fetal survival until term is unlikely because of the maternal complications of the mole itself. Women who have had a previous molar gestation are at increased risk to develop a similar subsequent lesion.

Intrauterine shelves in pregnancy: sonographic observations.

Twenty-five shelves of tissue, all having a free edge within the uterine cavity, were identified by sonography in 24 singleton pregnancies. In no case did the shelf attach to the fetus or restrict fetal motion. The fetus was sonographically normal in 23 pregnancies, and no fetus developed amniotic-band syndrome. One fetus had anencephaly, probably unrelated to amniotic-band syndrome. Although these shelves may be due to synechiae, only eight (32%) of the patients had a history of dilatation and curettage or cesarean delivery, which predispose the patient to formation of synechiae. This experience suggests that when a shelf of tissue with a free edge is present within the pregnant uterus, there should be no concern for the development of amniotic-band syndrome as long as a complete sonographic survey of the fetus reveals no abnormalities.