Fibroids may give rise to specific obstetrical complications such as pain due to degeneration, fetal malpresentation, or placenta previa. For all these reasons, surgical resection of the fibroid may be indicated before a pregnancy is pursued. The occurrence of a uterine rupture is a rare but severe complication of myomectomy. This study seeks to review the risk of uterine rupture during pregnancy and/or labor after laparoscopic myomectomy in comparison with laparotomic myomectomy. A systematic search of the literature through search strategies in MEDLINE (PubMed) and Embase (Embase.com) from January 1970 up to March 2013 was performed. We used the following MeSH terms and free text words: gynecologic surgical procedures, gynecologic surgery, leiomyoma, fibromyoma, fibroids, myoma, uterine tumors, and pregnancy complication. Our data show that the risk of uterine rupture during labor and delivery is low (0.75 %). Compared with traditional open myomectomy, the risk of uterine rupture during pregnancy is not significantly higher after a laparoscopic approach (P=0.119). More elective cesarean sections are performed after laparoscopic myomectomy compared with the conventional open technique (P= 0.001). Our conclusions are supported by statistical pooling of observational studies of generally low methodological quality. The risk of uterine rupture after myomectomy is low (0.75 %). The available evidence in the literature does no allow discouraging attempts for childbirth per viam naturalem after previous myomectomy, regardless of the technique used.Randomized studies are needed before definitive evidencebased recommendations can be given.

Our results indicated that plasma glucose levels that are within the normoglycemic range have a small but systematic effect on F-18 FDG uptake in the brain (following an inverse relationship). Normalizing plasma glucose levels to a standard glucose concentration successfully reduced the intra-subject variability of SUV measures. Inter-subject variability, however, remained high suggesting that other factors have an influence as well.

l IntroductionA differential analysis of the cardiotocogram allows conclusions äs to the functional state of the fetus. However, the interpretations of changes in the heart rate depend to a large extent on the experience of the examiner because of the poorly defined deliminations of specific pattems of heart rate changes. New techniques enable the recording of the pre-ejection period (PEP) of the human fetal heart; i.e., the time between ventricular excitation and aortic pressure rise, continuously parallel with the CTG [3,12,16,24,27]. The PEP is a measure of the myocardial contractility. Thus, with adrenergic Stimulation the cardiac contractility increases and the PEP is shortened. On the other hand, an increase in peripheral resistance leads to a lengthening of the PEP äs does a decrease of ventricular filling. Recent experiments in fetal lambs [20,21,37,52,53] showed in acute and chronic experiments [20,29] that in acute hypoxia the PEP falls below the normal ränge, and that with compression the PEP is increased while the relation of the PEP to duration of systole (relative PEP = PEPr) is constant. Furthermore, with umbilical cord complications characteristic PEP changes are seen and chronic and acute hypoxia lead to changes in the baseline level of the PEP. This study de als with the question whether the results of animal experiments from PEP recording together with the CTG apply to the human fetus during birth and whether the characteristics of the PEP and heart rate allow conclusions äs to the pathophysiology of umbilical cord complications. Curriculum vitae THOMAS BÄRTLING was born in 1947 in Material and methodDuring the delivery of 115 fetuses the course of the absolute and relative PEP was recorded for at least 50-90 minutes simultaneously with the CTG. Of the 115 fetuses, 38 had anuchal umbilical cord noted at birth. The CTG and PEP recordings of these 38 fetuses are the subject of the study. During or shortly after PEP recording a blood sample was obtained from the fetal scalp for the analysis of pH, base excess and pC0 2 . Blood gas analysis from umbilical artery blood was performed immediately postpartum. In five fetuses with documented cord complication the transcutaneous oxygen tension was recorded from the presenting part according to the method of HUCH [28,29,30] and recorded together with the PEP and

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