Colo-uterine fistula of diverticular origin is an extremely rare disease due to the resistance of uterine tissue. Methods for diagnosis remain to be established. Non-invasive imaging like magnetic resonance imaging (MRI) may help to establish a proper diagnosis, but confirmation may be reached by diagnostic hysteroscopy or even surgical exploration. We report a 78-year-old female who presented with continuous dull aching pain associated with increasing constipation. MRI suspected a fistula between the posterior aspect of the uterine body and the sigmoid colon which contained extensive diverticulosis. Hysteroscopy confirmed the fistulous opening, but colonoscopy confirmed diverticular disease with no evidence of malignancy. The patient had en block surgical treatment of the uterus and the adjacent colon, followed by an uneventful recovery. The sensitivity and specificity of non-invasive imaging procedures to diagnose such cases remain to be established. As imaging procedures cannot rule out neoplasia, endoscopic procedures need to be added.
The objective of this study was to compare maternal and midwifery manpower effects of policies for induction of labour (IOL) postdates, using a retrospective cohort design, in a level two maternity unit in a district hospital in South-West England. Primary outcome measures included mode of delivery, admission-delivery interval, midwifery manpower use. Group I consisted of 124 women who underwent IOL at 40+10. Group II were 104 women who underwent IOL at 42 weeks' gestation and 123 women who laboured spontaneously between 40+10 and 42 weeks' gestation. The nulliparous women had a shorter admission-delivery interval when induction was planned for 42 weeks, compared with 40+10 (p = 0.003), and required less frequent use of syntocinon (p = 0.04) and of continuous fetal monitoring (p = 0.02). The caesarean rate was higher in Group I than in Group II (p = 0.04) for nulliparous women only. The earlier induction policy was associated with a higher midwifery manpower requirement for nulliparae (p = 0.002). For parous women, the only difference was the greater use of oxytocin in labour. There was no difference between the groups in duration of labour, analgesia, Apgar scores, admission to neonatal care and meconium aspiration. In conclusion, delaying planned induction by three days was associated with lower medicalisation of labour and manpower needs for nulliparous women.
Patients who are suitable for non-surgical therapy, T2-weighted MR imaging may, in conjunction with serial beta-hCG assays, provide an alternative treatment modality for cases of placenta percreta.
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