Aims-To define, in a prospective study, the risk of hypoglycaemia-defined as blood glucose concentration < 1.8 mmol/ l-in term infants exposed in utero to valproate and to describe the withdrawal symptoms. Methods-Twenty epileptic women were treated with valproate only during pregnancy and two were treated with valproate and carbamazepine. In the first trimester, the daily median dose of valproate was 1.0 g (range 0.3-4.2) and in the third trimester 1.2 g (range 0.3-4.8).Results-Thirteen of the 22 infants became hypoglycaemic. One infant had eight episodes of hypoglycaemia, one had three episodes, two had two episodes, and nine had one episode each. The lowest blood glucose concentration was 1.0 mmol/l. All episodes were asymptomatic. The maternal mean plasma concentration of total valproate during the third trimester correlated negatively with blood glucose concentration one hour after delivery (p < 0.0003) and with the development of hypoglycaemia (p < 0.0001). There was no evidence for hyperinsulinaemia as the cause of hypoglycaemia. Ten infants developed withdrawal symptoms, which correlated positively with the mean dose of valproate in the third trimester and the concentration of the free fraction of valproate in maternal plasma at delivery (p < 0.02). Conclusions-Infants exposed to valproate in utero had a significantly elevated risk of hypoglycaemia, and withdrawal symptoms were often observed. (Arch Dis Child Fetal Neonatal Ed 2000;83:F124-F129)

Objective To compare the risk of complications associated with benign hysterectomy according to surgical procedure. Design Register‐based prospective cohort study. Setting Danish Hysterectomy Database, 2004–2015. Population All Danish women with benign elective hysterectomy (n = 51 141). Methods Multivariate log‐binomial regression to compute relative risks (RRs) stratified by calendar period, and adjusted for age, height, weight, smoking habits, use of alcohol, comorbidity, indications, uterine weight and adhesions. Multiple imputation and ‘intention to treat’ analyses were performed. Main outcome measures Major (grades III–V) and minor (grades I–II) Clavien–Dindo modified complications within 30 days. Results Overall, major complications occurred in 3577 (7.0%) hysterectomies and minor complications occurred in 4788 (9.4%). The proportions of major and minor complications according to type of hysterectomy were: 10.3 and 9.6% for abdominal hysterectomy (AH); 4.1 and 12.1% for laparoscopic hysterectomy (LH); and 4.9 and 8.0% for vaginal hysterectomy (VH) for non‐prolapse, and 2.3 and 6.4% for prolapse. In multivariate analyses, compared with VH for non‐prolapse, the risk of major complications was higher for AH (RR 1.82, 95% CI 1.63–2.03) but lower for both LH (RR 0.78, 95% CI 0.68–0.90) and VH for prolapse (RR 0.55; 95% CI 0.41–0.75). For LH, the risk of major complications reduced from a RR of 0.96 (95% CI 0.75–1.22) in the time period 2004–2009 to an RR of 0.72 (95% CI 0.60–0.87) between 2010 and 2015. Conclusion Laparoscopic hysterectomy and VH for uterine prolapse are associated with fewer major complications, and AH is associated with more major complications, compared with VH performed in the absence of uterine prolapse. Tweetable abstract Laparoscopic hysterectomy has fewer major complications compared with vaginal hysterectomy, in the absence of uterine prolapse.

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Thirty-one patients with microinvasive carcinoma of the uterine cervix (less than 3.0 mm invasion, no lymph vascular involvement), were treated with combination laser conization. The mean follow-up period was 36 months. No cases of invasive disease have been diagnosed during follow-up. Examination during follow-up revealed atypical columnar epithelium in one case, but the hysterectomy specimen was normal. Based on these short-term results, combination laser conization for microinvasive carcinoma of the cervix seemed a sufficient therapy. A precise and careful histopathologic evaluation, and the patient acceptance of a strict follow-up schedule are mandatory to a decision to employ conservative management of microinvasive cervical carcinoma. Only long-term follow-up in patients treated by conservative therapy will be able to finally justify this approach.

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