Sections of tissue from 256 patients on which a histological diagnosis of hydatidiform mole had been made were reviewed by a visiting pathologist. There was agreement between the reporting pathologists and the visiting pathologist in only 55.1 per cent of cases, a less severe diagnosis was made by the visiting pathologist in 42-2 per cent of cases. The disagreement was as high as 66.6 per cent with pathologists who rarely worked in the gynaecological field. This study casts serious doubt on the consistency of the histological diagnosis of hydatidiform mole made in any one laboratory and between different laboratories. It is suggested that in epidemiological studies the diagnosis should be made by a panel of pathologists using strict histological criteria and in an individual laboratory diagnosis should be made or confirmed by a pathologist experienced in gynaecological pathology.
A statistical review of 113 cases of hydatidiform mole (HM) seen at Pahlavi University Hospital from January 1970 to December 1975 is presented. The incidence of the disease was found to be 1:314 pregnancies. In this study, 73.5% of the patients presumably had acceptable socioeconomic circumstances. The highest incidence of the disease was found in patients 15-25 years old, and it increased with parity. All patients presented with a period of amenorrhea and vaginal spotting. More than 50% of the patients sought treatment after 1-2 weeks of uterine bleeding. Signs and symptoms of the disease are discussed. The management of patients with HM and coexisting difficulties are presented.
A second progress report on maternal mortality in South Iran is presented. The maternal mortality rate among hospitalized women for the period 1970 to 1976 was 248.7/100 000 live births, which was significantly lower than the rate for the period from 1963 to 1969 (391.8/100 000). However, the overall distribution of diseases leading to death remains unchanged. The causes of death were classified as direct obstetric in 60.4% of the cases, indirect obstetric in 13.5% and unrelated to obstetric events in 26.0%. Infection was the leading cause of death in all categories. Among the direct obstetric causes, hemorrhage, pulmonary embolism and eclampsia were the major causes of death. About 76% of the patients were from rural districts and 24% from urban areas. None of the mothers had antenatal care.
A review is presented of 96 cases of ectopic pregnacy over a 7-year period. It is noted that in recent years the incidence of this problem has increased. Inadequately diagnosed and treated pelvic inflammatory disease has been found to be the main predisposing factor (40%). The rate of extra-uterine gestation was 1:336 deliveries. In this study, previous fertility was high, and primigravidae constituted only 10.4% of the total. The effect of previous pelvic operations and pelvic infection is discussed; a statistical review of signs and symptoms is tabulated, and the management of the patient and of concomitant problems is presented.
A completely extraperitoneal abdomino-vaginal operation for vaginal inversion, using Mersilene mesh, is described. There were no major postoperative complications and at follow-up of the 13 patients at 10 to 26 months after operation the results were satisfactory.THE difficulty of curing vaginal vault prolapse is evidenced by the large number of operative procedures proposed over the past 40 years (see list of references). I describe a new operation which is aimed at correcting the inversion and allowing normal coitus. Details of the 13 patients treated are shown in Table I. In 12 patients the apex of the vaginal vault was outside the vulva and in one it was at the introitus.
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