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This presentation of one of the larger series of patients with cornual ectopic pregnancy managed by laparoscopic surgery reveals that experience at ultrasonography and laparoscopic technique can lead to earlier diagnosis and few cases requiring laparotomy or further treatment. In addition laparoscopic surgery for cornual ectopic is safe and lends itself to conservative approach (cornuostomy) in selected cases.

We set out to evaluate the effect of a programme introduced in January 2003 to make operative laparoscopy the standard surgical treatment for women requiring surgery for ectopic pregnancy. This was a retrospective and prospective clinical data analysis performed at The Whipps Cross University Hospital in London, with a comparison of data taken before and after the introduction of the programme. A total of 116 women who had surgical management for ectopic pregnancy from January 2000 to December 2002 and 313 women who had surgery for ectopic pregnancy between January 2003 and December 2006 took part in the study. A programme was started in January 2003 to make operative laparoscopy the surgical management of choice. The main outcome measure was the proportion of women requiring surgery who had operative laparoscopy in the two study periods. The chi(2)-test was used to determine if there was any statistically significant difference between proportions. A difference was deemed statistically significant if p < 0.05. The results showed that there was a progressive rise in the proportion of ectopic pregnancies managed by operative laparoscopy following the change in January 2003. A total of 34% of women were managed laparoscopically between 2000 and 2002, increasing to 90% between 2003 and 2006. This difference was statistically significant (p < 0.001). In 2006, some 96% of women requiring surgery were managed by laparoscopic surgery. The findings of this study indicate that it is possible to implement changes which increase and sustain a high rate of laparoscopic surgery for women with ectopic pregnancy requiring surgery in a district general hospital setting.

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Persistent ectopic pregnancy (PEP) following ipsilateral "salpingectomy" is a rare occurrence. This report describes this uncommon condition in a 26-year-old woman who presented with a sudden onset of right fossa iliac pain following an earlier salpingectomy. At laparoscopy, a persistent ipsilateral EP in the right fallopian tube stump was found. At the initial laparoscopy, an endoloop was used for salpingectomy, and a tubal stump of about 4 cm was left. This poses the questions: Are salpingectomies performed with endoloops true salpingectomies or partial salpingectomies? Do women managed with endoloops need to have human chorionic gonadotropin (hCG) follow-up, as do those with salpingostomy?

A 28-year old woman with one previous pregnancy termination presented with delayed menstrual periods for about 7 weeks, left-sided lower abdominal pain, mild vaginal bleeding and vomiting. A transvaginal scan revealed an intrauterine pregnancy of 6 weeks' gestation with fetal heart activity and a suspected cervical ectopic pregnancy. She requested termination of the pregnancy. Suction evacuation of the cervical ectopic pregnancy followed by cervical dilatation and suction evacuation of the intrauterine pregnancy was performed with ultrasound scan guidance. Cervical haemostatic sutures were inserted prior to suction evacuation and estimated blood loss was 200 ml. Separate tissue specimens from the two pregnancy sites confirmed pregnancy tissue on histology.

In October 2003, The National Institute for Clinical Excellence recommended screening tests for Down's syndrome (DS) to come into effect from April 2007. These tests were recommended based on studies performed in research centres. Some of the recommended tests have a fetal nuchal translucency scan component. In this retrospective study at the Basildon and Thurrock University Hospital we have evaluated nuchal translucency (NT) scans performed between July 1998 and January 2004 on 18,965 fetuses with a view to comparing our findings with research centres. In spite of our high standards, our detection rate for DS was 72.0% (95% CI 56.0-83.8%) for a 5% false positive rate. This was much lower than the 85% reported from the seminal paper in 1994. We believe that the advice given to women should be based on data from working programmes and not research units.