Symphysis fundal height (SFH) is currently used in the UK as a screening test to identify which pregnancies may require additional investigations including the use of ultrasound fetal biometry. The routine use of SFH has been subjected to extensive research assessing its sensitivity and also inter and intraobserver variation. This study's aim was to assess the current UK practice of SFH measurement and particularly looked at methods used in its measurement. A total of 250 healthcare professionals (doctors and midwives) were asked to complete a structured anonymous questionnaire of which 211 health professionals agreed to participate. The results revealed that SFH is used less frequently by the professionals with less than 10 years clinical experience compared to professionals with more than 10 years clinical experience. In addition there was significant variance in the methods used to measure SFH that would increase the interobserver error.
A 37-year-old woman with a previous diagnosis of Mayer-Rokitansky-Kuster-Hauser syndrome at 18 years of age was referred from a primary healthcare physician to a gynaecology appointment in our centre. She presented with a 2-year worsening pelvic pain and dyspareunia, symptoms that were previously absent and, at the time, with inadequate relief with oral analgesia. Physical examination showed absent uterine cervix and hypoplastic superior vagina. Transvaginal ultrasound and MRI suggested the presence of an hypoplasic uterus in left rotation. Laparoscopically, two asymmetric rudimentary horns were found, united by a fibrous central band, with an enlarged and congestive left horn. The three structures were removed as a whole. Histopathological examination reported the presence of multiple adenomyotic foci along the full thickness of the left rudimentary horn. The patient had an uneventful postoperative recovery and full remission of her symptoms.
Uterine atony is identified as one of the major causes of postpartum hemorrhage and therefore associated with significant maternal morbidity and mortality. Understanding the population specific risk factors for uterine atony would be of great importance in order to prevent this clinical
In pregnant women, low molecular weight heparin is recommended as the preferred agent for venous thromboembolism prophylaxis and treatment. Despite their widespread application, heparin-induced skin lesions are probably under-reported and under-estimated. We present a case report of a primigravida treated with low molecular weight heparin for deep vein thrombosis, who developed a delayed-type hypersensitivity reaction to enoxaparin, tinzaparin and dalteparin. As the patient was pregnant, treatment options were restricted. Tolerance was achieved with dalteparin with adjuvant administration of prednisolone. An attempt to decrease prednisolone dose triggered delayed-type hypersensitivity reaction recurrence that was solved by keeping the initial prednisolone prescription. To the best of our knowledge, there are no described cases using this approach. In cases of delayed-type hypersensitivity reaction to low molecular weight heparin during pregnancy our case suggests that switching low molecular weight heparin and adjuvant administration of prednisolone can be an option.
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