In order to evaluate pipelle endometrial sampling combined with ultrasound measurement of endometrial thickness as an initial diagnostic procedure in the assessment of endometrial pathology in patients presenting with postmenopausal bleeding, 50 consecutive patients were studied prospectively. In each patient measurement of endometrial thickness and pipelle endometrial biopsy were performed as an out-patient procedure before hysteroscopy and dilatation and curettage (D&C). The diagnostic sensitivity with pipelle endometrial sampling alone in detecting endometrial pathology was 25% with a specificity of 100%. The measurement of endometrial thickness had a sensitivity of 62% with a specificity of 87.8%. Pipelle sampling combined with endometrial thickness increased the sensitivity to 87.5% with a specificity of 87.8%. Therefore, we suggest that pipelle sampling combined with sonographic measurement of endometrial thickness is an acceptable, less invasive alternative to hysteroscopy and D&C as a first-line investigation in the management of post-menopausal bleeding.
Maternal plasma alpha-fetoprotein (AFP) screening for fetal neural tube defects (NTD) was used as a part of routine antenatal care in three hospitals over a 26 month period. Blood samples were obtained for plasma AFP measurement at 15 to 20 weeks gestation from 6377 women, representing 79 per cent of antenatal bookings. The outcome of pregnancy was ascertained in 96 per cent of patients: 13 cases of anencephaly and 7 of open spina bifida were detected by plasma screening and a further 3 cases of open NTD through the mother's previous medical history and amniotic fluid determination. Four fetuses with open NTDs and four with closed NTDs were not detected by plasma AFP measurement and the detection efficiency for open NTDs was thus 83 per cent. Integration of screening into the existing pattern of antenatal care required only minor alterations in clinic schedules. Some extra time was needed for explanation of the objectives of the study, for ultrasound examination and for amniocentesis. Eight patients declined the offer of a plasma test, while only one refused an amniocentesis.ANENCEPHALY and open spina bifida may be be at increased risk. Thus there is a case for diagnosed early in pregnancy by measurement screening all pregnancies for NTD by measuring of alpha-fetoprotein (AFP) in the amniotic AFP in maternal blood (Brock et a/, 1973; fluid (Brock and Sutcliffe, 1972; Leek et al,
Summary
The outcome of 82 pregnancies associated with failure of an intrauterine device is reported. Four of the pregnancies were extrauterine, and 31 per cent of the 78 intrauterine pregnancies were legally terminated. Spontaneous or missed abortion occurred in 57 per cent of the remainder and over half of these abortions were in the second trimester. Threatened abortion, antepartum haemorrhage and manual removal of an adherent placenta were encountered more frequently than expected. One neonatal death due to prematurity was recorded, and there was one congenital fetal abnormality.
The outcome of 82 pregnancies associated with failure of an intrauterine device is reported. Four of the pregnancies were extrauterine, and 31 per cent of the 78 intrauterine pregnancies were legally terminated. Spontaneous or missed abortion occurred in 57 per cent of the remainder and over half of these abortions were in the second trimester. Threatened abortion, antepartum haemorrhage and manual removal of an adherent placenta were encountered more frequently than expected. One neonatal death due to prematurity was recorded, and there was one congenital fetal abnormality.
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