gestation, the intensity and frequency of contractions increased. At this time, atosiban tocolysis was administered. An initial bolus dose was followed by a continuous infusion, and maternal and fetal observations remained satisfactory. An antiseptic vaginal pack was also inserted in this case. Following a 48-hour infusion of atosiban, the woman's pains had settled completely. Gestation was now 25 weeks and again it was felt that, on an individual basis, this woman would benefit from a more prolonged infusion of tocolysis. Regular cardiotocographs remained reassuring.At 25 weeks and 5 days (1 week after starting tocolysis), spontaneous rupture of the membranes occurred and the atosiban infusion was discontinued. On vaginal examination, the breech was at the pelvic brim and a rim of cervix was present. It was felt that caesarean section would be the safest way to deliver this preterm fetus and the woman was counselled regarding the possible need for a classical uterine incision. Informed consent was obtained and general anaesthetic was administered. A lower-segment caesarean section was performed and a female infant weighing 745 g was delivered easily. No complications were associated with the procedure or the woman's postoperative course. As with the previous case study, this baby continues to do well in neonatal intensive care. DiscussionThese two cases show that, in selected cases of spontaneous preterm labour at very early gestation, there can be a benefit in prolonging the pregnancy with tocolysis. In addition, our cases show that, rather than limit the treatment to a 48-hour infusion to facilitate corticosteroid administration and/or in-utero transfer, in selected cases longer infusions can be administered to further improve outcome. However, this was made possible only by the favourable safety profile of atosiban, which allowed prolonged infusion, and may have contributed to the successful outcome (The Worldwide Atosiban versus Beta-agonists Study Group 2001). We have no doubt that the outcomes for the six babies in these two cases could have been very different had their deliveries occurred when they first presented in labour.
Urological and colorectal complications following surgery for rectovaginal endometriosisSir, We read with interest the article by Slack et al. 1 and have several comments to make about this important area of research. First, we would like to point out that working at a busy district general hospital, we see a large number of women who have either minimal symptoms from rectovaginal endometriosis or, in a few cases, are entirely asymptomatic and are diagnosed incidentally at the time of another procedure. The women who have been selected by the study group are likely to represent a small percentage of women who actually have this disease, and thus the estimated incidence is far from accurate. Second, the authors do not state whether any of the women underwent hysterectomy at the same time. If the age range includes women who are likely to have completed their family, then reasons for not performing this step should be explained. Many women with rectovaginal endometriosis have coexisting adenomyosis and thus complain of persistent pelvic pain following surgery to remove extrauterine endometriosis. We also presume that none of the women had posthysterectomy vault endometriosis, which can pose greater intraoperative difficulties. The follow-up data for these women seem to be very limited, and these data are very important to determine whether such radical surgery is indeed worthwhile. The authors only managed to follow up just less than half of those women enrolled into the study, and it is not clear what proportion of women had follow up over 2 years. This period of time is essential to cover in order to determine the percentage of women who develop a recurrence of symptoms. In addition, fertility rates of appropriately aged women would be another area to assess in order to help justify this type of surgery and to determine symptom severity. j Reference 1 Slack A, Child T, Lindsey I, et al. Urological and colorectal complications following surgery for rectovaginal endometriosis.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.